Similarities and differences in contraceptive use reported by women and men in the National Survey of Family Growth

A model for building a national, patient-driven database to track contraceptive use in women with rare diseases

Data on the safety and effectiveness of contraception among women with rare diseases are critical and sorely lacking. To fill this gap, we propose a national, patient-driven database that tracks contraceptive safety and effectiveness among women with rare diseases. We built a pilot database focusing on women with cystic fibrosis in 3 phases: (1) database design input from patients and experts, (2) merging of contraceptive survey data with relevant clinical outcomes from the Cystic Fibrosis Foundation Patient Registry (CFFPR), and (3) forming a data guide to facilitate accessible output data. We successfully linked 62 contraceptive survey variables with 362 relevant clinical outcome variables for 150 patients. This pilot represents a breakthrough in linking contraceptive data to disease-specific outcomes and informs how to build a national, patient-driven contraceptive database for women with rare diseases.

Are Infertile Men Less Healthy Than Fertile Men? An Analysis of the National Survey for Family Growth

OBJECTIVE

To characterize the general health status of infertile men in the United States using a nationally representative sample of men.

METHODS

Using the National Survey for Family Growth from 2011 to 2017, infertile subgroups were created using a range of inclusion criteria. Univariate and multivariate analyses were conducted comparing these men to fertile men.

RESULTS

Using population estimates, 6.5 million men with reduced fertility potential were compared to 26 million fertile men. After controlling for demographic and healthcare utilization factors, these groups did not have significantly different rates of key medical co-morbidities, including cancer, obesity, and overall disability. Looking at the subset of men who had received a specific infertility diagnosis, estimated as a population of nearly 600,000 men, this pattern held, in that there were no significant differences in the rates of medical co-morbidities. Notably, the rate of male infertility evaluation among potentially infertile men was only 50%. These findings also persisted after a propensity-matched analysis.

CONCLUSION

In this cohort, there was no significant relationship between infertility and specific medical co-morbidities. We must consider the influence of sample selection as we continue to investigate the relationship between medical co-morbidities and reduced fertility potential. Given the persistent low rates of infertility evaluation, even among men who seek medical advice to conceive, we must continue to search for ways to characterize the infertile male population while simultaneously working to improve access.

Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019

OBJECTIVE

This study examines changes over time in the prevalence of select sexual behaviors and contraceptive use measures in a national sample of U.S. adolescents.

STUDY DESIGN

We used data on adolescents aged 15-19 from the 2006-2010 (n=4,662), 2011-2015 (n=4,134), and 2015-2019 (n=3,182) National Surveys of Family Growth. We used logistic regression to identify changes between periods in sexual behaviors and contraceptive use by gender, and for some measures by age. We estimated probabilities of age at first penile-vaginal intercourse with Kaplan-Meier failure analysis.

RESULTS

Over half of adolescents have engaged in at least one of the sexual behaviors measured. Males reported declines in sexual behaviors with a partner of a different sex. Adolescent males reported delays in the timing of first penile-vaginal intercourse. Adolescent females reported increases from 2006-2010 to 2015-2019 in use at last intercourse of any contraceptive method (86%, 95%CI 83-89; 91%, 95%CI 88-94), multiple methods (26%, 95%CI 22-31; 36%, 95%CI 30-43), and IUDs or implants (3%, 95%CI 1-4; 15%, 95%CI 11-20). Adolescent males reported increases in partners' use of IUDs or implants use from <1% to 5% and recent declines in condom use at last intercourse (78%, 95%CI 75-82, 2011-2015; 72%, 95%CI 67-77, 2015-2019). Condom consistency declined over time. Males were more likely than females to report condom use at last intercourse and consistent condom use in the last 12 months.

CONCLUSIONS

These findings identify declines in male adolescent sexual experience, increased contraceptive use overall, and declines in consistent condom use from 2006 to 2019.

IMPLICATIONS

This analysis contributes a timely update on adolescent sexual behavior trends and contraceptive use, showing that adolescent behaviors are complex and evolving. Sexual health information and services must be available so that young people have the resources to make healthy and responsible choices for themselves and their partners.

Standardizing Measurement of Contraceptive Use Among Unmarried Women

Historically, the family planning practices and needs of married women have been monitored and reported uniformly. However, the same uniformity does not hold for unmarried women. Because key data and information platforms employ different measurement approaches-namely, different definitions of sexual recency-reports of contraceptive prevalence and unmet need among unmarried women are inconsistent. We examine how the measurement approaches employed by 3 large organizations yield such divergent estimates. We find that contraceptive prevalence and unmet need estimates among married women do not vary much by sexual recency. For unmarried women, contraceptive prevalence is systematically lower and unmet need is systematically higher as the sexual recency window widens. In the short term, we recommend using the 1-month cutoff as analyses reveal it yields the most precise estimates for better recognizing the needs of this important demographic group.

Do young men's reports of hormonal and long-acting contraceptive method use match their female partner's reports?

Objective

To assess whether young men's reports of hormonal and long-acting contraceptive methods match their female partner's reports.

Study design

We analyzed a sample of 1096 heterosexual couples (aged 18–26) from the National Longitudinal Study of Adolescent to Adult Health Romantic Pair subsample. We compared male and female partner reports of hormonal/long-acting method use using class of method (hormonal/long-acting) rather than type (e.g., intrauterine device). Regression analyses linked men's reports of individual and relationship characteristics with alignment of reporting.

Results

Sixteen percent of young men reported hormonal/long-acting method use at last sex differently than their female partner, that is, had a mismatched report. Men who had fewer lifetime sexual partners, had greater relationship satisfaction, believed their partner was monogamous and had a matched report of condom use at last sex were more likely to match their partner's report of hormonal/long-acting contraceptive use. Men living with children (from either partner) were less likely to have a matched report. Hispanic men were more likely to have a matched report than black men.

Conclusions

Men are an increasingly important part of pregnancy prevention efforts. Pregnancy prevention and healthy relationship programs that incorporate communication skills may also indirectly improve young men's knowledge of their partner's contraceptive use and engagement in contraceptive decision making.

Implications

Analyses showed that nearly two thirds of the 16% of young men that did not accurately report their partner's hormonal/long-acting method use at last sex underreport method use. Men at increased risk of misreporting may benefit the most from targeted pregnancy prevention programs.

Reporting sterilization as a current contraceptive method among sterilized women: lessons learned from a population with high sterilization rates, Rajasthan, India

Objective

Measuring current use of contraception relies on self-reported responses from survey respondents. Reporting validity may be affected by women's interpretation of the question and may vary by background characteristics of women. The study aims to understand levels and patterns of underreporting of female sterilization in a population with high sterilization rates.

Study design

Data came from the Performance Monitoring and Accountability 2020 survey conducted in Rajasthan, India, in early 2017. In addition to a conventional question to ascertain current contraceptive use, the survey included a probing question; women who did not report sterilization as a current method were asked if they were ever sterilized. Women were defined as sterilization users based on either question. Among sterilized women, we estimated the percent who reported sterilization as a current method. Multivariable logistic regression analysis was conducted to assess differential reporting across background characteristics.

Results

Among women who were ever sterilized, 78% reported currently using any contraceptive method(s), and 77% reported sterilization as the current method. Women in the lowest household wealth quintile or in general caste were less likely to report sterilization as a current method. Time since sterilization was not associated with correct reporting of sterilization.

Conclusion

This study demonstrates, in a population with high sterilization, that sterilization as a current contraceptive method would be substantially underestimated using conventional survey questions. It highlights the importance of context-specific questionnaire adaptation to measure and monitor contraceptive use and provides implications in measuring current use of contraception in populations with high rates of sterilization.

Implications

The paper examined reporting of sterilization as a current method among sterilized women. Only 77% of sterilized women reported sterilization as a current contraceptive method. In a population with high sterilization, inclusion of a probe question in surveys is recommended to understand reporting quality and accurately measure contraceptive prevalence rates.

Perceptıon scale of barrıers to contraceptıve use: a methodologıcal study

BACKGROUND

The objective of this study was to design and develop the Perception Scale of Barriers to Contraceptive Use (PSBCU) as a measurement tool for the qualitative assessment of the barriers and obstacles women perceived with regard to contraceptive use or low rates of contraceptive use in women using family planning services.

METHOD

The data for this methodological study were collected using the face-to-face interview technique from 320 married women between the ages of 15-49 who were attending clinics at the Hafsa Sultan Hospital, CBU. The data collection tools used in the study, which was carried out from May to September 2014, were the "Introductory Information Form" and the "Perception Scale of Barriers to Contraceptive Use". Language validity and construct validity (explanatory factor analysis) were applied in order to test the validity of the Perception Scale of Barriers to Contraceptive Use.

RESULTS

Kaiser Meier Olkin (KMO) analysis was performed to determine the availability of the scale for the size of participants. The sample adequacy calculated as the KMO value was 0.916 and the Bartlett's Test of Sphericity (X² = 6721.793 p < 0.000) sample size analysis value was found to be sufficient for factor analysis. The total Cronbach's Alpha coefficient of 34 items which included three factors explaining 54.95% of the variance after Varimax rotation was calculated to be 0.95. The largest factor was the "cognitive domain" explaining 18.89% of the variance, followed by the "emotional domain" explaining 18.05% of the variance, and finally the "social domain" explaining 18.01% of the variance. Item-total score correlation coefficients of scale items were found to be between 0.54 and 0.83.

CONCLUSIONS

The study demonstrateded that the "Perception Scale of Barriers to Contraceptive Use" was valid and reliable. We believe that the scale is suitable for use by women in a family planning education and training programs in order to evaluate their situation. It should also be assessed for validity and reliability for different groups (adolescents, men, etc.).