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Newton-Levinson A, Blake SC, Swartzendruber A, Kramer MR, Sales JM. "So that I can trust them with my body:" How people with low incomes who may become pregnant define and prioritize quality reproductive health care. Contraception 2024; 138:110517. [PMID: 38885892 PMCID: PMC11365768 DOI: 10.1016/j.contraception.2024.110517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES As part of a larger mixed-methods study to better define equity in access to sexual and reproductive health (SRH) care in Georgia, this analysis sought to understand: (1) how individuals define quality care for their SRH services; and (2) how quality of care is salient in their SRH care-seeking. STUDY DESIGN From January 2019 to February 2020, we conducted life history interviews with individuals with the capacity to become pregnant in suburban areas in Georgia. We analyzed interviews using thematic analysis. RESULTS SRH care quality was shaped by experiences with health center environment, with providers, and with staff. Study participants emphasized elements associated with trusted SRH care such as showing compassion, respecting and non-judging, taking time, providing information, and assuring agency. Participants also voiced a desire for holistic care that addressed the lived experiences of the individual. Participants took quality of care into account when care-seeking but sometimes had to weigh out preferences for quality with issues of affordability. CONCLUSIONS Access to quality person-centered care is an essential component of realized access to SRH services. Measures of equitable access and quality should account for experiences of quality care that include both provider and staff interactions as well as the larger healthcare environment and ability to use quality care despite financial constraints. IMPLICATIONS Quality family planning care should involve both clinicians and staff to incorporate showing compassion, providing respectful and non-judgmental care, taking time with patients, providing information, assuring agency in decision-making, as well as addressing the lived experiences of individuals.
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Affiliation(s)
- Anna Newton-Levinson
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Sarah C Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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2
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Johnsen S. Patient-Centered Care in Action: How Clinicians Respond to Patient Dissatisfaction with Contraceptive Side Effects. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241262029. [PMID: 39104143 DOI: 10.1177/00221465241262029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.
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Affiliation(s)
- Sara Johnsen
- University of California, Los Angeles, Los Angeles, CA, USA
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3
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Dehlendorf C, Perry JC, Borrero S, Callegari L, Fuentes L, Perritt J. Meeting people's pregnancy prevention needs: Let's not force people to state an "Intention". Contraception 2024; 135:110400. [PMID: 38369272 DOI: 10.1016/j.contraception.2024.110400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Pregnancy intention screening does not identify need for pregnancy prevention and ignores the nuances of lived experiences while reinforcing white middle-class normative expectations. Asking about desire for contraception is a patient-centered approach to meeting people's needs.
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Affiliation(s)
- Christine Dehlendorf
- Person-Centered Reproductive Health Program, UCSF Departments of Family and Community Medicine, San Francisco, CA, United States.
| | | | - Sonya Borrero
- Center for Innovative Research on Gender Health Equity (CONVERGE), Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa Callegari
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Liza Fuentes
- Health Equity Accelerator, Boston Medical Center, Boston, MA, USA
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4
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Zapata LB, Kortsmit K, Curtis KM, Romero L, Hurst S, Lathrop E, Acosta Perez E, Sánchez Cesáreo M, Whiteman MK. Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z-CAN) in Puerto Rico, 2016-2020. Stud Fam Plann 2024; 55:105-125. [PMID: 38659169 PMCID: PMC11299421 DOI: 10.1111/sifp.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The Zika Contraception Access Network (Z-CAN) provided access to high-quality client-centered contraceptive services across Puerto Rico during the 2016-2017 Zika virus outbreak. We sent online surveys during May 2017-August 2020 to a subset of Z-CAN patients at 6, 24, and 36 months after program enrollment (response rates: 55-60 percent). We described contraceptive method continuation, method satisfaction, and method switching, and we identified characteristics associated with discontinuation using multivariable logistic regression. Across all contraceptive methods, continuation was 82.5 percent, 64.2 percent, and 49.9 percent at 6, 24, and 36 months, respectively. Among continuing users, method satisfaction was approximately ≥90 percent. Characteristics associated with decreased likelihood of discontinuation included: using an intrauterine device or implant compared with a nonlong-acting reversible contraceptive method (shot, pills, ring, patch, or condoms alone); wanting to prevent pregnancy at follow-up; and receiving as their baseline method the same method primarily used before Z-CAN. Other associated characteristics included: receiving the method they were most interested in postcounseling (6 and 24 months) and being very satisfied with Z-CAN services at the initial visit (6 months). Among those wanting to prevent pregnancy at follow-up, about half reported switching to another method. Ongoing access to contraceptive services is essential for promoting reproductive autonomy, including supporting patients with continued use, method switching, or discontinuation.
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Grants
- CC999999 Intramural CDC HHS
- The CDC Foundation secured large-scale donations, offers of contraceptive products, support tools, and services from Bayer, Allergan, Medicines360, Americares and Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mylan, the Pfizer Foundation, Teva Pharmaceuticals, Church & Dwight Co., Inc., RB, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), Upstream USA, and Market Vision, Culture Inspired Marketing.
- Funding for the Z-CAN program via the CDC Foundation was made possible by the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the William and Flora Hewlett Foundation, the Pfizer Foundation, and the American College of Obstetricians and Gynecologists.
- This data collection was funded by the Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Edna Acosta Perez
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Marizaida Sánchez Cesáreo
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
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5
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Guy GP, Adams EK, Redd SK, Dunlop AL. Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes. Womens Health Issues 2024; 34:125-134. [PMID: 38103999 DOI: 10.1016/j.whi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes. MATERIALS AND METHODS We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008-2009) and two post-periods (2012-2013; 2017-2019). We identified those likely eligible for P4HB in Georgia (n = 1,967) and 10 comparison states (n = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling. RESULTS P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (p < .01) and an 11.4 pp decrease in the later post-period (p < .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (p < .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (p < .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (-3.9 pp; p < .05) but not for mothers of other races/ethnicities. DISCUSSION Medicaid family planning waivers are an important structural policy intervention that can improve reproductive health care, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.
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Affiliation(s)
- Gery P Guy
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - E Kathleen Adams
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sara K Redd
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Anne L Dunlop
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Holt K, Challa S, Alitubeera P, Atuyambe L, Dehlendorf C, Galavotti C, Idiodi I, Jegede A, Omoluabi E, Waiswa P, Upadhyay U. Conceptualizing Contraceptive Agency: A Critical Step to Enable Human Rights-Based Family Planning Programs and Measurement. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300299. [PMID: 38346841 PMCID: PMC10906552 DOI: 10.9745/ghsp-d-23-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/23/2024] [Indexed: 03/01/2024]
Abstract
We propose a detailed framework for contraceptive agency to serve as a rights-based guide for centering individuals’ ability to make and act on their own contraceptive choices, regardless of what those choices are, in program design and evaluation.
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Affiliation(s)
- Kelsey Holt
- University of California, San Francisco, San Francisco, CA, USA.
| | - Sneha Challa
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Atuyambe
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | - Ushma Upadhyay
- University of California, San Francisco, San Francisco, CA, USA
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7
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Bhan N, McDougal L. Centring agency and norms to meet the health needs of pregnant adolescents. Lancet 2023; 402:1505-1507. [PMID: 37837992 DOI: 10.1016/s0140-6736(23)02226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Nandita Bhan
- Jindal School of Public Health and Human Development, OP Jindal Global University, Sonipat 131001, India.
| | - Lotus McDougal
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
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8
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Ermias Y, Averbach SH, Dey AK, Gebrehanna E, Holt K. The association between quality of contraceptive counseling and selection of contraceptive method post-counseling among women in Ethiopia. Contraception 2023; 124:110060. [PMID: 37178813 DOI: 10.1016/j.contraception.2023.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To better understand the relationship between high-quality contraceptive counseling and met family planning needs, we examined the association between quality of counseling and selection of a method postvisit among women requesting contraception in Ethiopia. STUDY DESIGN We used post-counseling survey data from women receiving care in public health centers and nongovernmental clinics in three regions in Ethiopia. Among women whose reason for visit was requesting a contraceptive method, we examined the association between scores on the validated quality of contraceptive counseling (QCC) scale and subscales and selection of a method post-counseling (primary analysis) and type of method selected (secondary analysis). We conducted mixed-effects multivariable logistic regression for the primary analysis and multinomial regression for the secondary analysis. RESULTS There was a nonsignificant increase in odds of selecting contraception with increasing total QCC scale scores (adjusted odds ratio [aOR] 2.35, 0.43-12.95). However, among women experiencing no disrespect and abuse, there was increasing odds of selecting contraception (aOR 3.46, 95% CI 1.09-10.99) and likelihood of selecting injectable contraception (adjusted relative risk ratio 4.27, 95% CI 1.34-13.60) compared to women experiencing disrespect and abuse. Additionally, 168 (32.1%) of women felt pressured by their provider to use a certain method of which>50% selected long-acting reversible contraception. CONCLUSIONS Increasing QCC is associated with selecting contraception among women requesting contraception. Additionally, probing for negative experiences can reveal feelings of disrespect and abuse that could lead women to avoid selecting contraception or feeling pressured to use methods heavily promoted by providers. IMPLICATIONS Our study assesses contraceptive counseling quality using a validated tool with items on provider pressure and other forms of disrespect and abuse; findings highlight the importance of respectful treatment in meeting women's needs and the potential influence of disrespect on decision to select contraception and type of method selected.
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Affiliation(s)
- Yokabed Ermias
- School of Medicine, University of California, La Jolla, San Diego, CA, United States.
| | - Sarah H Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, San Diego, CA, United States.
| | - Arnab K Dey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, San Diego, CA, United States.
| | - Ewenat Gebrehanna
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Kelsey Holt
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States.
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9
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Bossick AS, Painter I, Williams EC, Katon JG. Development of a Composite Risk Index of Reproductive Autonomy Using State Laws: Association With Maternal and Neonatal Outcomes. Womens Health Issues 2023:S1049-3867(23)00075-0. [PMID: 37120364 DOI: 10.1016/j.whi.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE We developed a composite index to quantify state legislation related to reproductive autonomy and examined its association with maternal and neonatal outcomes. We hypothesized that greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. DESIGN A Delphi panel was used to inform development of the index. Restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data were used to conduct a cross-sectional study among all live births in the 50 U.S. states to people aged 15 to 44 between January 1, 2016, and December 31, 2018, to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. We used linear regression with state scores and quartiles, adjusted for state-level proportions of White, Black, and Hispanic live births; percent living in rural areas; percent of population foreign born; Health Resources and Services Administration spending on maternal and child health; and the Opportunity Index, a composite measure of indicators of the economy, education, and community. RESULTS From 2016 to 2018, there were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM. The Delphi panel resulted in a summed state measure of 106 laws in 8 categories that could affect reproductive autonomy. In adjusted analyses, states in the most enabling (most reproductive autonomy) quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile (least reproductive autonomy). CONCLUSIONS A composite policy index of reproductive autonomy was found to be associated with higher rates of SMM but lower rates of PRM and PTB. Further research is needed to understand how reproductive autonomy in the cumulative index may influence these and other maternal and birth outcomes.
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Affiliation(s)
- Andrew S Bossick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Henry Ford Health, Detroit, Michigan.
| | - Ian Painter
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Washington State Department of Health, Olympia, Washington
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Jodie G Katon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
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10
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Swan LET, Senderowicz LG, Lefmann T, Ely GE. Health care provider bias in the Appalachian region: The frequency and impact of contraceptive coercion. Health Serv Res 2023. [DOI: http:/doi.org/10.1111/1475-6773.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Laura E. T. Swan
- Department of Population Health Sciences University of Wisconsin‐Madison Madison Wisconsin USA
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
| | - Leigh G. Senderowicz
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Gender and Women's Studies University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Obstetrics and Gynecology University of Wisconsin‐Madison Madison Wisconsin USA
| | - Tess Lefmann
- Department of Social Work University of Mississippi Oxford Mississippi USA
| | - Gretchen E. Ely
- College of Social Work University of Tennessee Knoxville Tennessee USA
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11
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Holt K, Galavotti C, Omoluabi E, Challa S, Waiswa P, Liu J. Preference-Aligned Fertility Management as a Person-Centered Alternative to Contraceptive Use-Focused Measures. Stud Fam Plann 2023; 54:301-308. [PMID: 36723038 DOI: 10.1111/sifp.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Equating contraceptive use with programmatic success is fundamentally flawed in failing to account for whether individuals desire contraceptive use; this is problematic because nonuse can reflect empowered decision-making and use may reflect an individual's inability to refuse or discontinue a method. A rights-based approach demands respect for individuals' freedom to weigh options and choose how their desire for pregnancy prevention can be accommodated by available methods and within the context of their own personal, social, and material constraints. We offer an alternative construct, preference-aligned fertility management (PFM), that provides a more holistic indicator of whether one's contraceptive needs are met. PFM is more person-centered and informative for programming than status quo measures of unmet need, demand satisfied, and contraceptive use which define a positive outcome in relation to pregnancy risk rather than one's stated preferences. The PFM approach goes beyond other recent proposals for modifying the concept of unmet need by refraining from judgment of legitimate reasons for nonuse of contraception and offers a straightforward way to capture whether people act in line with their preferences. We conclude with discussion of how we plan to measure PFM in the Innovations for Choice and Autonomy (ICAN) study in Nigeria and Uganda.
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Affiliation(s)
- Kelsey Holt
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA
| | - Christine Galavotti
- Department of Family Planning, Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | | | - Sneha Challa
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Jenny Liu
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA
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12
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Burke KL, Potter JE. Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator. Stud Fam Plann 2023; 54:281-300. [PMID: 36705876 DOI: 10.1111/sifp.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Joseph E Potter
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
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13
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Averbach S, Johns NE, Ghule M, Dixit A, Begum S, Battala M, Saggurti N, Silverman J, Raj A. Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India. Contraception 2023; 118:109907. [PMID: 36328094 PMCID: PMC10695301 DOI: 10.1016/j.contraception.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The CHARM2 (Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) intervention engages health care providers to deliver gender-equity and family planning sessions to couples using a person-centered shared decision-making approach for contraception counseling. We previously showed that the intervention improved contraceptive use at 9-month follow-up. We sought to assess whether the intervention was further associated with the quality of care reported by participants and whether the quality of care reported mediated the effect of the intervention on contraceptive use. STUDY DESIGN This is a planned secondary analysis of the effect of the CHARM2 intervention on 1201 married couples in rural Maharashtra, India in a cluster randomized controlled trial completed between 2018 and 2020. We assessed the effect of CHARM2 on perceived quality of care as measured by the Interpersonal Quality of Family Planning (IQFP) scale using a difference-in-differences linear regression approach including a mixed-effects model with nested random effects to account for clustering. We assessed whether the association between CHARM2 and modern contraceptive use was mediated by quality of family planning care. RESULTS Intervention participants had higher mean IQFP scores than control participants at 9-month follow-up (intervention 3.2, SD 0.6 vs. control 2.3 mean, SD 0.9, p < 0.001). The quality of care reported mediated the effect of the intervention on contraceptive use (indirect effect coefficient 0.29, 95% CI 0.07-0.50). CONCLUSION Family planning interventions such as CHARM2, which utilize person-centered shared decision-making contraceptive counseling approaches improve women's perceived quality of care. Effects on quality of care mediate observed effects of the intervention on contraceptive use. IMPLICATIONS Contraceptive interventions should focus on improving person-centered outcomes, such as quality of care, rather than contraceptive use targets. By focusing on improving person-centered care, interventions will improve contraceptive use among those who desire a method while meeting the holistic reproductive health needs of clients and couples.
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Affiliation(s)
- Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States.
| | - Nicole E Johns
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Mohan Ghule
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anvita Dixit
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Jay Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, CA, United States; Department of Education Studies, Division of Social Sciences, University of California San Diego School of Medicine, La Jolla, CA, United States
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Schmidt CN, Wingo EE, Newmann SJ, Borne DE, Shapiro BJ, Seidman DL. Patient and provider perspectives on barriers and facilitators to reproductive healthcare access for women experiencing homelessness with substance use disorders in San Francisco. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231152374. [PMID: 36939096 PMCID: PMC9947686 DOI: 10.1177/17455057231152374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals. OBJECTIVE This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them. DESIGN This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers. METHODS We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed. RESULTS Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9/28) reported desiring pregnancy in the next year; over half (16/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14/28). Twenty-six healthcare providers participated in interviews (n = 15) and focus groups (n = 2). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect. CONCLUSION Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.
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Affiliation(s)
- Christina N Schmidt
- School of Medicine, University of
California San Francisco, San Francisco, CA, USA
| | - Erin E Wingo
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
| | - Sara J Newmann
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
| | - Deborah E Borne
- San Francisco Department of Public
Health, San Francisco, CA, USA
| | - Brad J Shapiro
- Department of Psychiatry, University of
California San Francisco, San Francisco, CA, USA
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
- Dominika L Seidman, Department of
Obstetrics, Gynecology & Reproductive Services, University of California San
Francisco and San Francisco General Hospital, 1001 Potrero Avenue Ward 6D, San
Francisco, CA 94110, USA.
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15
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Bullington BW, Tumlinson K, Karp C, Senderowicz L, Zimmerman L, Akilimali PZ, Zakirai MS, OlaOlorun FM, Kibira SP, Makumbi FE, Shiferaw S. Do users of long-acting reversible contraceptives receive the same counseling content as other modern method users? A cross-sectional, multi-country analysis of women's experiences with the Method Information Index in six sub-Saharan African countries. Contracept X 2022; 4:100088. [PMID: 36419776 PMCID: PMC9676194 DOI: 10.1016/j.conx.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective There has been a growing focus on informed choice in contraceptive research. Because removal of long-acting reversible contraception (LARC), including implants and IUDs, requires a trained provider, ensuring informed choice in the adoption of these methods is imperative. We sought to understand whether information received during contraceptive counseling differed among women using LARC and those using other modern methods of contraception. Study Design We used cross-sectional data from Burkina Faso, Côte d'Ivoire, the Democratic Republic of Congo (DRC), Kenya, Nigeria, and Uganda collected in 2019-2020 by the Performance Monitoring for Action project. We included 7969 reproductive-aged women who reported use of modern contraception. Our outcome of interest, information received during contraceptive counseling, was measured using a binary indicator of whether respondents answered "yes" to all 4 questions that make up the Method Information Index Plus (MII+). We used modified Poisson models to estimate the prevalence ratio between method type (LARC vs. other modern methods) and the MII+, controlling for individual- and facility-level covariates. Results Reported receipt of the full MII+ during contraceptive counseling ranged from 21% in the DRC to 51% in Kenya. In all countries, a higher proportion of LARC users received the MII+ compared to other modern method users. A greater proportion of LARC users answered "yes" to all questions that make up the MII+ at the time of counseling compared to other modern method users in DRC, Kenya, Nigeria, and Uganda. There was no significant difference in the prevalence of reporting the full MII+ between users of LARC and other modern methods in Burkina Faso (Adjusted prevalence ratio (aPR): 1.16; 95% confidence interval (CI): 0.91, 1.48) and Côte d'Ivoire (aPR: 1.13; 95% CI: 0.87, 1.45). Conclusion Information received during contraceptive counseling was limited for all modern contraceptive users. LARC users had significantly higher prevalence of receiving the MII+ compared to other modern method users in the DRC, Kenya, and Uganda. Family planning programs should ensure that all women receive complete, unbiased contraceptive counseling. Implications Across 6 sub-Saharan African countries, a substantial proportion reproductive-aged women using contraception did not report receiving comprehensive counseling when they received their method. Women using long-acting reversible contraception received more information compared to women using other modern methods in the DRC, Kenya, Nigeria, and Uganda after controlling for individual- and facility-level factors.
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Affiliation(s)
- Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapell Hill, Chapel Hill United States of America,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill United States of America,Corresponding author.
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill United States of America,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapell Hill, Chapel Hill United States
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore United States
| | - Leigh Senderowicz
- Departments of Gender and Women's Studies and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison United States
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore United States
| | - Pierre Z. Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Simon P.S. Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kimpala, Uganda
| | - Frederick Edward Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kimpala, Uganda
| | - Solomon Shiferaw
- Department of Reproductive and Health Services Management, Addis Ababa University, Ethiopia
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16
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Mihretie GS, Abebe SM, Abebaw Y, Gedefa L, Gure T, Alemayehu BA, Amenu D, Tadesse D, Fanta GA, Abubeker FA, Yemane A, G/Michael AD, Teklu AM, Damtew MH, Girma B. Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia. BMJ Open 2022; 12:e059372. [PMID: 35918115 PMCID: PMC9351308 DOI: 10.1136/bmjopen-2021-059372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users. DESIGN A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women. SETTING The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study. PARTICIPANTS The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period. INTERVENTIONS A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation. RESULT From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation. CONCLUSION The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
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Affiliation(s)
- Getasew Sisay Mihretie
- Department of Obstetrics and Gynecology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- University of Gondar, Gondar, Ethiopia
- University of Gondar, Gondar, Ethiopia
- Human Nutrition, Institute of Public Halth, Gondar, Ethiopia
| | - Yeshiwas Abebaw
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- Obstetrics and Gynecology, School of Medicine, Gondar, Ethiopia
| | - Leta Gedefa
- Haramaya University, Dire Dawa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Haromaya, Ethiopia
| | - Tadesse Gure
- Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, Harar, Ethiopia
- Obstetrics and Gynaecology, Haramaya University College of Health and Medical Sciences, Haramaya, Oromia, Ethiopia
| | - Birtukan Asmare Alemayehu
- Department of Obstetrics and Gynecology, Menelik II Referral Hospital, Ethiopia, Addis Ababa, Ethiopia
| | | | - Daniel Tadesse
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research and project unit, Addis Ababa, Ethiopia
| | - Girma Abraham Fanta
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Addis Ababa, Ethiopia
| | - Ferid Abbas Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Medical College, Addis Ababa, Ethiopia
| | - Awol Yemane
- Mekelle University, Mekelle, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Mekella, Ethiopia
| | - Amanuel Desta G/Michael
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
- College of Health Science, Mekelle, Ethiopia
| | - Alula M Teklu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research, MERQ PLC LLC, Baltimore, Maryland, USA
- Research Unit, Addis Ababa, Ethiopia
| | - Mengistu Hailemariam Damtew
- University of Michigan Center for International Reproductive Health Training Ethiopia, Addis Ababa, Oromia, Ethiopia
- CIRHT, Addis Ababa, Ethiopia
| | - Bisrat Girma
- Jimma University, Jimma, Ethiopia
- College of health and Medical Sciences, Jimma, Ethiopia
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17
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Lindberg LD, Mueller J, Haas M, Jones RK. Telehealth for Contraceptive Care During the COVID-19 Pandemic: Results of a 2021 National Survey. Am J Public Health 2022; 112:S545-S554. [PMID: 35767798 PMCID: PMC10490317 DOI: 10.2105/ajph.2022.306886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate trends in the use and quality of telehealth for contraceptive care during the COVID-19 pandemic in the United States. Methods. The 2021 Guttmacher Survey of Reproductive Health Experiences is a national online survey of 6211 people assigned female at birth, aged 18 to 49 years, and that ever had penile‒vaginal sex. We used weighted bivariable and multivariable logistic regressions to analyze the use of telehealth for contraceptive care and the quality of this care. Results. Of the respondents, 34% received a contraceptive service in the 6 months before the survey; of this group, 17% utilized telehealth. Respondents who were uninsured at some point in the 6 months before the survey had greater odds of using telehealth for this care. Respondents had lower odds of rating the person-centeredness of their care as "excellent" if they received services via telehealth compared with in person (25% vs 39%). Conclusions. Telehealth has helped bridge gaps in contraceptive care deepened by COVID-19. More work is needed to improve the quality of care and reduce access barriers to ensure telehealth can meet its full potential as part of a spectrum of care options. (Am J Public Health. 2022;112(S5):S545-S554. https://doi.org/10.2105/AJPH.2022.306886).
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Affiliation(s)
- Laura D Lindberg
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Jennifer Mueller
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Madeleine Haas
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Rachel K Jones
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
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18
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Seidman D, Logan R, Weber S, Gandhi A, Blackstock O. Reimagining Preexposure Prophylaxis Provision for Women in the United States. Clin Infect Dis 2022; 74:2243-2248. [PMID: 35482659 PMCID: PMC9890470 DOI: 10.1093/cid/ciab959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
Structural determinants of health drive inequities in the acquisition of human immunodeficiency virus (HIV) and the use of preexposure prophylaxis (PrEP) for HIV prevention among cisgender women in the United States. However, current PrEP clinical guidance and implementation paradigms largely focus on individual behaviors and characteristics, resulting in missed opportunities to improve PrEP access, and the implicit transferring of prevention work from health systems to individuals. In this viewpoint article, we outline ways to apply a structural lens to clinical guidance and PrEP implementation for women and propose areas for future work.
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Affiliation(s)
- Dominika Seidman
- Correspondence: Dominika Seidman, 1001 Potrero Ave, Ward 6D, San Francisco, CA 94110, USA ()
| | - Rachel Logan
- Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Anisha Gandhi
- Racial Equity and Social Justice Initiatives, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
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19
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Kramer RD, Higgins JA, Everett B, Turok DK, Sanders JN. A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time. Am J Obstet Gynecol 2022; 226:396.e1-396.e11. [PMID: 34656551 PMCID: PMC8916969 DOI: 10.1016/j.ajog.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contraceptives are used to prevent unwanted pregnancies and treat certain gynecologic conditions, but many women report non-use or inconsistent use because of method dissatisfaction. The sexual acceptability of contraception-how birth control methods affect users' sexual well-being-is likely an important component of contraceptive satisfaction but has yet to be systematically examined. OBJECTIVE This study aimed to assess contraceptive satisfaction among new-start contraceptive users and examine whether sexual acceptability measures predict contraceptive satisfaction at 3 months while controlling for more commonly measured contraceptive side effects. STUDY DESIGN This analysis used data derived from the baseline, 1-month, and 3-month surveys of the HER Salt Lake Contraceptive Initiative, a prospective cohort study of new contraceptive clients. From March 2016 to March 2017, enrolled participants received their desired contraceptive method at no cost and could switch or discontinue at any time (up to 3 years). This analysis included individuals who continued their new contraceptive method for at least 1 month and completed all relevant survey measures. We used ordered logistic regression modeling to predict contraceptive satisfaction at 3 months. Primary predictor variables included changes in sexual functioning (6-item Female Sexual Function Index), sexual satisfaction (New Sexual Satisfaction Scale), and perceived impact of the contraceptive method on sex life at 1 month. Covariates included vaginal bleeding changes, physical side effects, and mood-related side effects. RESULTS Our analytical sample included 1879 individuals. At 3 months, 52.1% of participants were "completely satisfied" with their contraceptive method, 30.7% were "somewhat satisfied," 4.2% were "neither satisfied nor dissatisfied," 6.9% were "somewhat dissatisfied," and 6.2% were "completely dissatisfied." Compared with patients who said their contraceptive method made their sex life "a lot" worse at 1 month, patients whose method improved their sex life "a lot" had a 7.7 times increased odds of greater satisfaction at 3 months (95% confidence interval, 4.02-14.60; P<.0001) and patients whose method improved their sex life a "little" had a 5.88 times increased odds of greater satisfaction (confidence interval, 3.12-11.11; P<.001). To a much lesser degree, experiencing less or no bleeding was significantly associated with increased satisfaction, whereas worsening of physical side effects was linked to decreased satisfaction. The only other factors significantly associated with satisfaction were changes in bleeding and physical side effects. CONCLUSION Our findings suggest that patients' sexual experiences of their contraceptive methods are important correlates of satisfaction. Clinicians may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.
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Affiliation(s)
- Renee D Kramer
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI.
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI; Departments of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI
| | - Bethany Everett
- Department of Sociology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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20
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Manzer JL, Bell AV. "Did I Choose a Birth Control Method Yet?": Health Care and Women's Contraceptive Decision-Making. QUALITATIVE HEALTH RESEARCH 2022; 32:80-94. [PMID: 33870772 DOI: 10.1177/10497323211004081] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the United States, unintended pregnancy is medicalized, having been labeled a health problem and "treated" with contraception. Scholars find women's access to contraception is simultaneously facilitated and constrained by health care system actors and its structure. Yet, beyond naming these barriers, less research centers women's experiences making contraceptive decisions as they encounter such barriers. Through in-depth, semi-structured interviews with 86 diverse, self-identified women, this study explores how the medicalization of unintended pregnancy has influenced women's contraceptive access and decision-making. We highlight the breadth of such influence across multiple contraceptive types and health care contexts; namely, we find the two most salient forces shaping women's contraceptive decisions to be their insurance coverage and providers' contraceptive counseling. Within these two categories, we offer crucial nuance to demonstrate how these oft-cited barriers implicitly and explicitly influence women's decisions. Paradoxically, it is the health care system, itself, that both offers yet constrains women's contraceptive decisions.
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Affiliation(s)
| | - Ann V Bell
- University of Delaware, Newark, Delaware, USA
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21
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Harrington EK, Casmir E, Kithao P, Kinuthia J, John-Stewart G, Drake AL, Unger JA, Ngure K. "Spoiled" girls: Understanding social influences on adolescent contraceptive decision-making in Kenya. PLoS One 2021; 16:e0255954. [PMID: 34383836 PMCID: PMC8360567 DOI: 10.1371/journal.pone.0255954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents. METHODS Using community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15-19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making. RESULTS Participants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk. CONCLUSIONS Contraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents' seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related contraceptive concerns, and promoting innovative contraceptive access points rather than increasing contraceptive prevalence.
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Affiliation(s)
- Elizabeth K. Harrington
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Edinah Casmir
- Kenya Medical Research Institute, Center for Clinical Research, Thika, Kenya
| | - Peninah Kithao
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jennifer A. Unger
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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22
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Eeckhaut MCW, Rendall MS, Zvavitch P. Women's Use of Long-Acting Reversible Contraception for Birth Timing and Birth Stopping. Demography 2021; 58:1327-1346. [PMID: 34251428 PMCID: PMC9341462 DOI: 10.1215/00703370-9386084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of long-acting reversible contraceptive (LARC) methods-intrauterine devices (IUDs) and implants-has recently expanded rapidly in the United States, and these methods together approach the contraceptive pill in current prevalence. Research on LARCs has analyzed their use to reduce unintended pregnancies but not their use to enable intended pregnancies. Knowledge of both is necessary to understand LARCs' potential impacts on the reproductive life courses of U.S. women. We combine data from two nationally representative surveys to estimate women's likelihood and timing of subsequent reproductive events, including births resulting from an intended pregnancy up to nine years after discontinuing LARC use. We estimate that 62% of women will give birth, and 45% will give birth from an intended pregnancy. Additionally, 18% will have a new LARC inserted, and 13% will transition to sterilization. Most of these reproductive events occur within two years after discontinuing LARC use. Births from an intended pregnancy are especially common when no intervening switch to another contraceptive method occurs. We infer that women's motives for using LARC are varied but include the desire to postpone a birth, to postpone a decision about whether to have a(nother) birth, and to transition definitively to the completion of childbearing.
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Affiliation(s)
- Mieke C W Eeckhaut
- Department of Sociology and Criminal Justice, University of Delaware, Newark, DE, USA
| | - Michael S Rendall
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Polina Zvavitch
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
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23
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Bhan N, Raj A. From choice to agency in family planning services. Lancet 2021; 398:99-101. [PMID: 33971154 DOI: 10.1016/s0140-6736(21)00990-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Nandita Bhan
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA; Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, CA, USA
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24
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Robbins CL, Zapata LB, D'Angelo D, Brewer LI, Pazol K. Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy. J Womens Health (Larchmt) 2021; 30:1440-1447. [PMID: 34190626 PMCID: PMC10102922 DOI: 10.1089/jwh.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used 2018 Pregnancy Risk Assessment Monitoring System data from 31 jurisdictions in the United States (n = 32,777) to estimate prevalence of inadequate prenatal care (PNC), inappropriate gestational weight gain, depression during pregnancy, intimate partner violence (IPV) during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking by categories of pregnancy intention: unwanted, ambivalent (i.e., unsure), mistimed (i.e., wanted later), or wanted (i.e., wanted then/sooner). Regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) of associations between pregnancy intention and maternal behaviors or experiences. Results: Approximately 16% of women reported pregnancy ambivalence. Women with pregnancy ambivalence (versus wanted pregnancies) had higher prevalence of all adverse maternal behaviors and experiences. Separate models found women with unwanted pregnancy (vs. ambivalent) had higher prevalence for depression during pregnancy (aPR: 1.40, 95% CI: 1.21-1.63), IPV (aPR: 1.75, 95% CI: 1.11-2.77), no breastfeeding (aPR: 1.22, 95% CI: 1.04-1.44), no postpartum visit (aPR: 1.28, 95% CI: 1.06-1.55), and postpartum depressive symptoms (aPR: 1.19, 95% CI: 1.00-1.42); Women with mistimed pregnancy (vs. ambivalent) had lower prevalence for inadequate PNC (aPR: 0.89, 95% CI: 0.81-0.98), third trimester smoking (aPR: 0.68, 95% CI: 0.57-0.80), no breastfeeding (aPR: 0.85, 95% CI: 0.74-0.98), and postpartum smoking (aPR: 0.83, 95% CI: 0.73-0.95). Discussion: The results emphasize the importance of recommended screening and care during the preconception, prenatal, and postpartum periods.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, USA
| | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lara I Brewer
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Pazol
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Manzer JL, Bell AV. "We're a Little Biased": Medicine and the Management of Bias through the Case of Contraception. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:120-135. [PMID: 33843323 DOI: 10.1177/00221465211003232] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a wealth of literature demonstrating the presence of bias throughout the American health care system. Despite acknowledging such presence, however, little is known about how bias functions within medical encounters, particularly how providers grapple with bias in their patient counseling and decision-making. We explore such processes through the case of contraceptive counseling, a highly raced, classed, and gendered context. In-depth interviews with 51 health care providers reveal that providers use four primary strategies to navigate and minimize bias in their care-using scientific rationale, employing "safe" biases, standardizing counseling, and implementing patient-centered care. Paradoxically, using these strategies can exacerbate rather than resolve bias. Understanding these bias management strategies reveals provider-held biases, how they manifest within appointments, and the potential consequences for patients' health autonomy. Such knowledge informs interventions that promote contraceptive use among women in the United States, addresses bias in health care broadly, and thus ultimately helps combat health disparities.
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Alspaugh A, Reibel MD, Im EO, Barroso J. "Since I'm a little bit more mature": contraception and the arc of time for women in midlife. Womens Midlife Health 2021; 7:3. [PMID: 33836828 PMCID: PMC8033736 DOI: 10.1186/s40695-021-00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Contraceptive methods have rapidly evolved over the past several decades, but little research has explored how women interact with contraception over time. Exploring contraceptive beliefs, perceptions, and attitudes of women in midlife can reveal much about how lived experience affects contraceptive decisions and reproductive health choices. Methods Individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Data were coded using qualitative descriptive methods. Results Three major themes were identified: 1) journey toward empowerment; 2) finding the right fit: evolution over time; and 3) anticipating a transition. Past experiences with or fear of side effects and hormones were common reasons to change or avoid certain contraceptive methods. Most participants were happy with their contraceptive method; however, those who were unhappy were more likely to vocalize fatigue at continuing to need contraception as menopause approached. Conclusion Approaching contraceptive counseling from a place that considers the journey with contraception over a reproductive life span will help identify how beliefs, perceptions, and attitudes of women affect their contraceptive practices and choices.
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Affiliation(s)
- Amy Alspaugh
- UCSF: University of California San Francisco, San Francisco, USA.
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Kusunoki Y, Barber JS. The Dynamics of Intimate Relationships and Contraceptive Use During Early Emerging Adulthood. Demography 2020; 57:2003-2034. [PMID: 32901407 PMCID: PMC8112453 DOI: 10.1007/s13524-020-00916-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigate the immediate social context of contraceptive behaviors: specifically, the intimate relationship. We use the Relationship Dynamics and Social Life (RDSL) study (2008-2012), based on a random sample of 1,003 women ages 18-19 residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18-22. We test three sets of hypotheses about change over time within a relationship, using relationship-level within-between models, which compare a couple's contraceptive behaviors across different times in the relationship. First, we find that a couple is less likely to use contraception when the relationship is more intimate and/or committed and that a couple becomes less likely to use contraception over time, regardless of intimacy and commitment. Second, we find that a couple using contraception becomes increasingly likely to choose hormonal over coital methods, but this change occurs as a relationship endures and is unrelated to intimacy and/or commitment. Third, we find that a condom-using couple's consistency does not decline when there is conflict; rather, consistency of condom use declines over time regardless of the relationship's characteristics. We also demonstrate that conflict and power imbalance increase reliance on hormonal methods among those using contraception; conflict decreases consistency among withdrawal (but not condom) users; and nonmonogamy increases reliance on condoms and decreases withdrawal consistency. The strong and consistent link between duration and contraceptive behaviors-regardless of intimacy, commitment, conflict, or power imbalance-suggests that the continual vigilance required for long-term contraceptive use is difficult during early emerging adulthood.
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Affiliation(s)
- Yasamin Kusunoki
- School of Nursing, Department of Systems, Populations and Leadership, and Population Studies Center and Survey Research Center at the Institute for Social Research, University of Michigan, 400 North Ingalls Street, Room 4156, Ann Arbor, MI, 48109-4582, USA.
| | - Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, 47405-7103, USA
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Program Fidelity and Patient Satisfaction among Women Served by the Zika Contraception Access Network Program in Puerto Rico. Womens Health Issues 2020; 30:268-276. [PMID: 32376188 DOI: 10.1016/j.whi.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective. METHODS An online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception. RESULTS Of 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received. CONCLUSIONS A contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.
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Carpenter E, Everett BG, Greene MZ, Haider S, Hendrick CE, Higgins JA. Pregnancy (im)possibilities: identifying factors that influence sexual minority women's pregnancy desires. SOCIAL WORK IN HEALTH CARE 2020; 59:180-198. [PMID: 32208846 PMCID: PMC7784242 DOI: 10.1080/00981389.2020.1737304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Sexual minority women (SMW) face both increased risk for unintended pregnancy and barriers to achieving wanted pregnancy, but little research investigates SMW's pregnancy desires. To fill this gap, we conducted five focus groups and 11 in-depth interviews with 20-30-year-old SMW in three US cities. Findings highlight that the heteronormative pregnancy planning paradigm lacks salience for SMW. While some SMW clearly wish to avoid pregnancy, many others are unsure, and factors influencing this uncertainty include relationship context, anticipating logistical barriers, and discord between queer identity and pregnancy.
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Affiliation(s)
- Emma Carpenter
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - C. Emily Hendrick
- School of Community Health Sciences, University of Nevad-Reno, Reno, NV, USA
| | - Jenny A. Higgins
- Departments of Gender and Women’s Studies and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
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30
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Birth Control Connect: A randomized trial of an online group to disseminate contraceptive information. Contraception 2020; 101:376-383. [PMID: 32032641 DOI: 10.1016/j.contraception.2020.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to test whether participation in an online group including IUD users influenced IUD-related knowledge, attitudes, and behavior among IUD non-users, as a proof-of-concept evaluation of information dissemination for less commonly used or novel contraceptives. STUDY DESIGN We conducted a blinded, randomized controlled trial on the effect of online communication with IUD users within an online program called Birth Control Connect. Participants were women age 18-45 living in the United States who had never used an IUD. We invited participants randomized to the intervention to join two-week, nine-member discussion groups including four satisfied IUD users and five IUD non-users; we invited control participants to groups including nine IUD non-users. We performed chi-squared tests on IUD knowledge, information-seeking, informational support and use in immediate post-surveys, and t-tests comparing change in IUD attitudes and frequency of logins to discussion groups. RESULTS We invited 488 IUD non-users and enrolled them into 70 groups between October 2015 and April 2016. We found increased positive attitudes towards the IUD in the intervention arm (0.65-point increase between pre- and post-surveys, versus 0.05 mean change for control arm, p = 0.03 for hormonal IUD, with a trend in the same direction for the non-hormonal IUD). Informational support also increased, with 70.3% of intervention arm participants self-reporting that they gained a better idea of what the IUD would be like, compared to 51.3% in control arm (p < 0.01). Of intervention participants, 63.3% versus 51.3% of control participants reported gaining new information from their group (p = 0.03). There were no differences in correct responses to knowledge items or information-seeking between groups. CONCLUSIONS Online exposure to IUD users increased positive attitudes toward the IUD and informational support for decision-making about the IUD among non-users. IMPLICATIONS STATEMENT Online spaces provide a promising environment for the exchange of accurate, useful contraceptive information based on real user experiences. Interventions aiming to harness social communication through structured online conversations (e.g., on existing social media platforms) about user experiences with lesser-known contraceptive methods such as the IUD may be worthwhile.
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31
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Loder CM, Minadeo L, Jimenez L, Luna Z, Ross L, Rosenbloom N, Stalburg CM, Harris LH. Bridging the Expertise of Advocates and Academics to Identify Reproductive Justice Learning Outcomes. TEACHING AND LEARNING IN MEDICINE 2020; 32:11-22. [PMID: 31293184 DOI: 10.1080/10401334.2019.1631168] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Reproductive justice (RJ) is defined by women of color advocates as the right to have children, not have children and parent children while maintaining reproductive autonomy. In the United States, physicians have been complicit in multiple historical reproductive injustices, involving coercive sterilization of thousands of people of color, low income, and disabilities. Currently, reproductive injustices continue to occur; however, physicians have no formal RJ medical education to address injustices. The objective of this study was to engage leading advocates within the movement using a Delphi method to identify critical components for such a curriculum. Approach: In 2016, we invited 65 RJ advocates and leaders to participate in an expert panel to design RJ medical education. A 3-round Delphi survey was distributed electronically to identify content for inclusion in an RJ curriculum. In the next 2 survey rounds, experts offered feedback and revisions and rated agreement with including content recommendations in the final curriculum. We calculated descriptive statistics to analyze quantitative data. A team with educational expertise wrote learning outcomes based on expert content recommendations. Findings: Of the 65 RJ advocates and leaders invited, 41 participated on the expert panel of the Delphi survey. In the first survey, the expert panel recommended 58 RJ content areas through open-ended response. Over the next 2 rounds, there was consensus among the panel to include 52 of 58 of these areas in the curriculum. Recommended content fell into 11 broad domains: access, disparities, and structural competency; advocacy; approaches to reproductive healthcare; contemporary law and policy; cultural safety; historical injustices; lesbian, gay, bisexual, transgender, queer/questioning, and intersex health; oppression, power, and bias training; patient care; reproductive health; and RJ definitions. The 97 learning outcomes created from this process represented both unique and existing educational elements. Insights: A collaborative methodology infused with RJ values can bridge experts in advocacy and academics. New learning outcomes identified through this process can enhance medical education; however, it is just as important to consider education in RJ approaches to care as it is knowledge about that care. We must explore the pedagogic process of RJ medical education while considering that expertise in this area may exist outside of the medical community and thus there is a need to partner with RJ advocates. Finally, we expect to use innovative teaching methods to transform medical education and achieve an RJ focus.
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Affiliation(s)
- Charisse M Loder
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Leah Minadeo
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laura Jimenez
- California Latinas for Reproductive Justice, Los Angeles, California, USA
| | - Zakiya Luna
- Department of Sociology, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Loretta Ross
- Women's Studies, Hampshire College, Amherst, Massachusetts, USA
| | - Nancy Rosenbloom
- Legal Advocacy, National Advocates for Pregnant Women, New York, New York, USA
| | - Caren M Stalburg
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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32
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Kost K, Zolna M. Challenging unintended pregnancy as an indicator of reproductive autonomy: a response. Contraception 2019; 100:5-9. [PMID: 31059700 DOI: 10.1016/j.contraception.2019.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kathryn Kost
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038.
| | - Mia Zolna
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038
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Do Adolescent Women's Contraceptive Preferences Predict Method Use and Satisfaction? A Survey of Northern California Family Planning Clients. J Adolesc Health 2019; 64:640-647. [PMID: 30612809 PMCID: PMC6538030 DOI: 10.1016/j.jadohealth.2018.10.291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Contraceptive satisfaction may influence not only contraceptive use but also long-term engagement in care. We investigated the extent to which adolescent and young women's desired contraceptive features are associated with their current contraceptive method and if the presence of preferred features in their current method is associated with satisfaction. METHODS We performed a secondary analysis of a cross-sectional survey at five Northern California family planning clinics, including women aged 13-24 years. Descriptive statistics and multivariate logistic regression identified associations between desired features and sociodemographic characteristics. Multivariate logistic regression was used to examine associations between desired features and current contraceptive method, as well as the presence of desired features and satisfaction with current method. RESULTS Among 814 participants, the features most frequently rated "very important" included effectiveness (87%, n = 685), safety (85%, n = 664), and side effects (72%, n = 562). Contraceptive feature preferences varied by age, race/ethnicity, intimate partner violence history, and sexually transmitted infection history. Having a preference for a specific contraceptive feature was not associated with using a method with that feature, except for sexually transmitted infection prevention (adjusted odds ratio [aOR]: 1.59, confidence interval [CI; 1.18-2.16]). However, respondents with preferences for effectiveness, partner independence, or privacy who used methods that were congruent with their preferences were more likely to express satisfaction (aOReffectiveness: 1.57, CI [1.03-2.37], aORpartner independent: 1.75 [1.03-2.96], and aORprivacy: 1.81 [1.01-3.23]). CONCLUSION Adolescent and young women have varied contraceptive preferences that are associated with demographics and reproductive health experiences. Adolescent and young women's use of contraceptive methods that matched their preferences may improve satisfaction and engagement in care.
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Hill AL, Zachor H, Jones KA, Talis J, Zelazny S, Miller E. Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial. J Womens Health (Larchmt) 2019; 28:863-873. [PMID: 30969147 DOI: 10.1089/jwh.2018.7318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.
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Affiliation(s)
- Amber L Hill
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hadas Zachor
- 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Kelley A Jones
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janine Talis
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah Zelazny
- 3 Allegheny Health Network Trauma Centers, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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A Qualitative Exploration of Somali Refugee Women's Experiences with Family Planning in the U.S. J Immigr Minor Health 2019; 22:66-73. [PMID: 30941615 DOI: 10.1007/s10903-019-00887-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of our study was to explore the knowledge, attitudes, and experiences of Somali refugee women with family planning in the U.S. We conducted focus groups of Somali refugee women and used grounded theory methodology to identify emergent themes. Fifty-three women, aged 18-49 years, participated. Somali refugee women's cultural and religious beliefs and social identities strongly influence their conceptualization of family planning. Participants agreed that a woman's fertility is ultimately decided by Allah and identified environmental changes after immigration and the desire to optimize maternal health as facilitators to modern contraceptive use. Misconceptions about and fear of side effects of modern contraceptive methods, including a fear of infertility, were identified as barriers to use. To deliver patient-centered family planning counseling to Somali refugee women, it is essential that healthcare providers approach these discussions with cultural humility and consider employing community partners or cultural brokers to help provide family planning education.
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Potter JE, Stevenson AJ, Coleman-Minahan K, Hopkins K, White K, Baum SE, Grossman D. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception 2019; 100:1-4. [PMID: 30851238 DOI: 10.1016/j.contraception.2019.02.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E Potter
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712.
| | - Amanda Jean Stevenson
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Sociology, University of Colorado Boulder, UCB 327 Ketchum 195, Boulder, CO, 80309
| | - Kate Coleman-Minahan
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; University of Colorado College of Nursing, 13120 East 19th Avenue, Aurora, CO, 80045
| | - Kristine Hopkins
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
| | - Kari White
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave South RPHB 320, Birmingham, AL, 35294
| | - Sarah E Baum
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Ibis Reproductive Health, 1330 Broadway Suite 1100, Oakland, CA, 94612
| | - Daniel Grossman
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612
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