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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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2
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SmithBattle L, Flick LH. Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens. J Obstet Gynecol Neonatal Nurs 2024; 53:345-354. [PMID: 38575116 DOI: 10.1016/j.jogn.2024.02.009] [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: 12/06/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.
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Morison T. Patient-provider power relations in counselling on long-acting reversible contraception: a discursive study of provider perspectives. CULTURE, HEALTH & SEXUALITY 2023; 25:537-553. [PMID: 35510833 DOI: 10.1080/13691058.2022.2067593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Contraceptive providers play an essential role in shaping contraceptive decision-making and care, with the potential to constrain patients' agency. This is a particular concern given the rising hegemony of Long-Acting Reversible Contraception (LARC) and growing evidence of negative patient experiences of LARC promotion and provision. Despite this evidence, little research has considered health providers' perspectives. Drawing on interviews with 22 contraceptive health providers in Aotearoa New Zealand, this paper explored their professional identity construction, focusing on meaning-making in instances of conflict between providers' and patients' priorities and agendas. Guided by feminist poststructuralist theory, the discursive analysis highlights common rhetorical strategies used by participants to (1) justify the use of coercive practices to encourage LARC uptake, and (2) in turn, negotiate positive identities. Findings show how participants grapple with the reproductive politics structuring contraceptive care, including established understandings of the purpose of (long-acting) contraception and contraceptive providers' roles vis-à-vis provision and promotion. The findings point to limitations on contraceptive agency, despite the unanimous endorsement of rights-based voluntary care. Extending the critical literature on LARC and contributing to the under-researched area of contraceptive coercion and agency, the findings of this study have important implications for the delivery of contraceptive care.
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Affiliation(s)
- Tracy Morison
- School of Psychology, Massey University, Palmerston North, New Zealand
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
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4
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Zinke-Allmang A, Bhatia A, Gorur K, Hassan R, Shipow A, Ogolla C, Keizer K, Cislaghi B. The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study. Reprod Health 2023; 20:41. [PMID: 36894997 PMCID: PMC9997433 DOI: 10.1186/s12978-023-01581-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.
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Affiliation(s)
- Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Amy Shipow
- Busara Center for Behavioral Economics, Nairobi, Kenya
| | | | - Kees Keizer
- University of Groningen, Groningen, Netherlands
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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5
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Aziz T, Gobioff S, Flink-Bochacki R. Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss. PATIENT EDUCATION AND COUNSELING 2022; 105:3071-3077. [PMID: 35738964 DOI: 10.1016/j.pec.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss. METHODS We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression. RESULTS We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005). CONCLUSIONS Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping. PRACTICE IMPLICATIONS Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.
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Affiliation(s)
- Tania Aziz
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Samantha Gobioff
- Albany Medical College, 47 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Rachel Flink-Bochacki
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
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6
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The limitations of patient-centered care: The case of early long-acting reversible contraception (LARC) removal. Soc Sci Med 2021; 292:114632. [PMID: 34891032 DOI: 10.1016/j.socscimed.2021.114632] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/30/2022]
Abstract
Patient-centered care (PCC) is frequently recommended to improve healthcare outcomes in the United States. Despite its purported benefits, little research explores how and to what extent providers implement this model in their care. We examine such processes through the case of contraception, specifically, "early" removals of long-acting reversible contraception (LARC). In-depth interviews with 51 healthcare providers reveal that while providers describe embracing patient-centeredness when considering patients' early LARC removal requests, their implementation ironically sidelines patient preferences and needs. Rather than be responsive to patients' requests, all providers in the study resist early LARC removal by: withholding information about self-removal of intrauterine devices (IUDs); negotiating with patients to keep their device longer; setting subjective timelines to prolong LARC use; and/or engaging in delay tactics to wear down patients' resolve for removal. Furthermore, beyond simply resisting LARC removal requests using these strategies, providers purposively employ tenets of PCC to sway patients away from removal. In other words, providers utilize PCC as a means to undermine it. Understanding how providers implement patient-centered care reveals the challenges to doing so, even in cases like early LARC removal where providers indicate patient-centeredness is a priority. It also elucidates the need for enhanced training, specificity, and institutionalization around patient-centered models of care; informs interventions that promote LARC use among patients; as well as offers opportunities for improving patient-provider exchanges generally.
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Kissling A. "Thinking with my dad brain, not my man brain": Understanding Men's and Women's sterilization risk narratives. Soc Sci Med 2021; 292:114579. [PMID: 34891034 DOI: 10.1016/j.socscimed.2021.114579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
The interpretation of risk influences women's reproductive decisions. Research has yet to show how men understand and interpret risk, particularly in their decision to use contraception. Contraceptive sterilization provides a case through which we compare risk narratives between men and women, as it is the only analogous birth control for both men and women. A study of risk narratives held by sterilized adults and their partners reveals how risk narratives are gendered and how they contribute to contraceptive use. Using 75 in-depth interviews with sterilized heterosexual men (n = 25), women (n = 25), and unsterilized partners (n = 17 women, n = 8 men), the present study finds that men and women report similar risk narratives grounded in (1) birth control risks to health and life plans and (2) risks to maternal health from past pregnancies and age. As expected, women's risk narratives appear to stem from their embodied experiences and their interactions with medical authorities. Rather than addressing their own embodied experiences or experiences with medicine, men's beliefs mirror women's, and are centered on the dangers of hormonal birth control and pregnancy to women. This study is novel in showing the couple dyad as a site of men's beliefs about risk, as how heterosexual couples form ideas about health and life plan risk through a mutually shared gendered lens.
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Affiliation(s)
- Alexandra Kissling
- University of Maryland- College Park Maryland Population Research Center 2105 Morrill Hall, Bldg. 040 7313 Preinkert Dr. College Park, MD, 20742-6304, USA.
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8
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Gomez AM, Arteaga S, Freihart B. Structural Inequity and Pregnancy Desires in Emerging Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2447-2458. [PMID: 33511506 PMCID: PMC8316486 DOI: 10.1007/s10508-020-01854-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 06/12/2023]
Abstract
Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18-24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the "Things Will Be Different Later" theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the "I Don't Have Everything I Need" theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the "I'll Never Have Everything I Need" theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA
| | - Bridget Freihart
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, 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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10
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Abstract
Teen mothers are stigmatized for violating age norms for parenting and for being members of devalued racial or socioeconomic groups. Stereotypes of young mothers perpetuate stigma by teen pregnancy prevention campaigns, television shows, sex education programs, professionals, and the general public. How teen mothers became a stigmatized group; updates on research about their experience of stigma; and resources for reducing stigma are presented. Because stigma is pervasive and has damaging effects, nurses are urged to reduce stigma and discrimination by assuring that health settings are safe and welcoming, and that pregnant and parenting teens are treated with respect and dignity. Doing so is consistent with our professional commitment to promote social justice and mitigate the social inequities that contribute to health disparities for all parents, irrespective of age, gender, ethnicity, immigration status, or income.
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11
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Morison T, Eagar D. Women's perspectives on long-acting reversible contraception: a critical scoping review of qualitative research. Women Health 2021; 61:527-541. [PMID: 34006210 DOI: 10.1080/03630242.2021.1927284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Long-acting Reversible Contraception (LARC) has significant promise both from a public health outlook and a social justice perspective. However, if women's empowerment is to be supported, then perspectives and experiences of LARC must be considered. This scoping review assesses research about contraceptive users' perspectives and experiences of contraceptive decision-making and practices. A content analysis was conducted to identify research trends in qualitative studies of contraceptive-user perspectives (n = 54), located by means of a systematic search. Interpreting findings through a reproductive justice lens, three main limitations in the scholarship were identified, viz., (1) an instrumentalist, individual-level focus; (2) a lack of consideration for diverse perspectives; and (3) an uncritical focus on young women. While the small body of qualitative research on LARC offers some valuable insights, when viewed from a sexual and reproductive justice perspective, it is not sufficiently user-centered or grounded within the reproductive politics surrounding contraceptive care and provision. Research is needed that draws on appropriate social theory; widens its focus beyond dominant groups; and is cognizant of the multi-level power relations surrounding LARC. Such work provides a nuanced picture of the complex social and contextual factors at play and inform person-centered approaches in sexual and reproductive health policy and programming.
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Affiliation(s)
- Tracy Morison
- School of Psychology, Massey University, Palmerston North, New Zealand & Critical Studies in Sexualities and Reproduction, Rhodes University, Grahamstown, South Africa
| | - Daygan Eagar
- School of Health Sciences, Massey University, Palmerston North, New Zealand
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12
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Cannon R, White K, Seifert B, Woodhams E, Brandi K, Yinusa-Nyahkoon L. Exploring the physician's role in contraceptive counseling at the time of abortion in the US. Contraception 2021; 103:316-321. [PMID: 33545128 DOI: 10.1016/j.contraception.2021.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We explored how physicians conceptualize their role in contraceptive counseling at the time of abortion, including identifying clinician attitudes that may lead to patients' perceptions of contraceptive coercion. STUDY DESIGN We conducted individual semi-structured interviews using questions based on components of the Theory of Planned Behavior. We recruited physician abortion providers using purposeful sampling to attain diversity in practice setting and geographic practice region. We analyzed transcribed interviews using initial and values coding methods. RESULTS We interviewed 39 participants across the United States, who primarily self-reported as White female obstetrician gynecologists (OB/GYNs) aged 25 to 44. Over half of participants practiced in an academic setting. Participants perceived providing patient education and taking a patient-centered approach as part of their role in contraceptive counseling. Participants also believed it was their responsibility to prevent unintended pregnancies and subsequent abortions among their patients. External motivations behind this belief included wanting patients to avoid the challenges of obtaining another abortion, particularly in states with multiple abortion restrictions. Internal motivations included valuing professional goal attainment, discomfort with abortion, and abortion stigma. When physicians counseled about contraception, many expressed preferences toward methods of long-acting reversible contraception (LARC) and an emphasis on contraception provision for adolescents and women with prior abortions. CONCLUSIONS Physicians providing abortions strive to use a patient-centered approach to contraceptive counseling. However, many continue to be motivated by the goal of avoiding a subsequent abortion which patients may perceive as coercion towards contraceptive uptake. IMPLICATIONS Considering contraceptive counseling as a means to prevent subsequent abortion may lead to coercive practices, especially with specific patient populations. Moral codes and abortion stigma influence physicians' counseling practices and physicians must examine their personal values and motivations behind recommending contraception after an abortion.
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Affiliation(s)
- Rachel Cannon
- Department of Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
| | - Katharine White
- Department of Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States
| | - Britta Seifert
- Boston University School of Public Health, Boston, MA, United States
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States
| | - Kristyn Brandi
- Department of Obstetrics and Gynecology and Women's Health Rutgers, The State University of New Jersey, Newark, NJ, United States
| | - Leanne Yinusa-Nyahkoon
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, United States
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13
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Wright KQ. Contraceptive selection and practice: Associations with self-identified race and socioeconomic disadvantage. Soc Sci Med 2020; 266:113366. [PMID: 33068869 PMCID: PMC7669550 DOI: 10.1016/j.socscimed.2020.113366] [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] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 01/27/2023]
Abstract
Many researchers and policymakers have linked contraceptive programs to improvements in women's and children's socioeconomic outcomes. However, these studies have overlooked how socioeconomic status may be an initial driver of contraceptive choice and behavior. Here, I examine the relationship between a comprehensive measure of socioeconomic disadvantage, self-identified race, and contraceptive method selection at enrollment in a unique longitudinal study of contraceptive clients who received a new type of method at no cost. I then examine whether socioeconomic disadvantage has an association with contraceptive switching or discontinuation. I demonstrate that socioeconomic disadvantage decreases the chance of selecting any IUD, while Black racial membership increases the chance of selecting the 3-month injectable and Multiracial membership increases the chance of selecting the Vaginal Ring. I then demonstrate that socioeconomic disadvantage and self-identified race have intersectional and variable associations with switching, and, to a lesser extent, discontinuing methods. These findings offer an important insight for implementation in contraceptive programs: eliminating financial barriers to access contraceptive services does not eliminate the socioeconomic contexts that influence method selection and use that occur as part of everyday lived experiences. Taken cumulatively, these results suggest that contraceptive services should be offered to women in ways that ensure access to reproductive justice without obscuring the need for social changes in the institutions that create disadvantage and shape contraceptive use itself.
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Affiliation(s)
- Kelsey Q Wright
- University of Wisconsin, Sewell Social Sciences, 1180 Observatory Drive Madison, Madison 4471, WI, 53706, USA.
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Arteaga S, Downey MM, Freihart B, Gomez AM. "We Kind of Met In-Between": A Qualitative Analysis of Young Couples' Relationship Dynamics and Negotiations About Pregnancy Intentions. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:87-95. [PMID: 32372517 PMCID: PMC8699581 DOI: 10.1363/psrh.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CONTEXT The literature on reproductive decision making often focuses on women and neglects the role of men and the importance of relationship context. Research with couples is vital to understanding joint decision making regarding having children at various stages of a couple's relationship and an individual's life course. METHODS In-depth, individual interviews were conducted with a socioeconomically, racially and ethnically diverse sample of 50 young heterosexual women and their male partners in northern California in 2015-2016. A dyadic, thematic analytic approach was used to examine whether and how prospective pregnancy intentions and current pregnancy desires are negotiated at the couple level, and how relationship dynamics influence any negotiation and decision-making processes. RESULTS Twenty-three couples described engaging in joint pregnancy decision making, which required purposeful communication and, for some, compromise and acceptance. For nearly all of these couples, these processes led to aligned prospective pregnancy intentions, even when current pregnancy desires differed. The remaining 27 couples described individual pregnancy decision-making processes; many respondents reported intentions that aligned with their partner's by happenstance, despite some respondents having avoided communicating their desires to their partner. Some of these couples faced relationship difficulties, including poor communication, leading some participants to misinterpret or be unaware of their partner's pregnancy intentions and desires. CONCLUSIONS The relationship context is important in the formulation of prospective pregnancy intentions among young people. Counseling protocols, interventions and policies that attend to the complex factors that influence young couples' pregnancy decision making are needed to better help couples attain their reproductive goals.
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Affiliation(s)
- Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Margaret Mary Downey
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Bridget Freihart
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
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15
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Robinson JH. What the pregnancy test is testing. THE BRITISH JOURNAL OF SOCIOLOGY 2020; 71:460-473. [PMID: 32323866 DOI: 10.1111/1468-4446.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 01/27/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Is the test result positive or negative? Tests that occur in labs and doctors' offices pose specific questions to try to obtain specific information. But what happens in the social world when these tests never see the inside of a lab or doctor's office, and instead they are used in a house, in a Walmart bathroom, or in a dormitory bathroom stall? Putting the diagnosis aside, what does the presence of these tests do to social life? This paper examines one such test, the home pregnancy test, and specifically, its use in contemporary intimate life of people who do not want to be pregnant. Pregnancy tests test for pregnancy. But what else is the pregnancy test putting to the test? To investigate this, I spent 8 years studying American pregnancy tests using a qualitative mixed methods approach. This paper draws on some of my research materials, specifically, 85 life history interviews. Each participant was asked to recall, in full, all of their experiences with home pregnancy tests throughout their lives, resulting in well over 300 narratives of home pregnancy test usage which I qualitatively analyzed. I find that more than just a test for a pregnancy, the use of the home pregnancy test is a test of roles, relationships, and responsibilities in social life. These findings suggest implications for social life as more biomedical tests move out of the purview of the medical establishment.
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Affiliation(s)
- Joan H Robinson
- Department of Interdisciplinary Arts and Sciences, The City College, CUNY, New York, NY, USA
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16
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Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103702. [PMID: 32456323 PMCID: PMC7277238 DOI: 10.3390/ijerph17103702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
Preconception care (PCC) is acknowledged as a vital preventive health measure aiming to promote health today and for subsequent generations. We aimed to describe the content and context of PCC delivery in a very remote Australian Aboriginal Community Controlled Health Service setting. A retrospective audit was undertaken to identify what PCC was delivered between 2011 and 2018 to 127 Aboriginal women who had at least one pregnancy during this period. Of 177 confirmed pregnancies, 121 had received PCC prior to the pregnancy. Sexually transmissible infection screening (71%) was the most common care delivered, followed by folic acid prescription (57%) and smoking cessation support (43%). Younger women received PCC less often, particularly screening for modifiable pregnancy risk factors. Rates of prediabetes/diabetes, albuminuria, overweight/obesity and smoking were high amongst those screened (48-60%). PCC was usually patient-initiated and increased significantly over the audit period. Presentation for antenatal care in the first trimester of pregnancy was high at 73%. Opportunities to increase PCC delivery include integration with routine health checks, pregnancy tests and chronic disease programs. PCC programs codesigned with young people are also recommended. All primary care providers should be supported and assisted to provide opportunistic PCC and health promotion.
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Kimport K. Pregnant Women's Reasons for and Experiences of Visiting Antiabortion Pregnancy Resource Centers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:49-56. [PMID: 32103617 DOI: 10.1363/psrh.12131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/19/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT The primary mission of pregnancy resource centers is to dissuade women from choosing abortion. Reproductive health and rights advocates have asserted that these centers interfere in abortion decision making. However, the reasons pregnant women go to such centers and what they experience while there have not been examined. METHODS Between June 2015 and June 2017, in-depth, semistructured phone interviews were conducted with 21 pregnant women who had presented at prenatal care clinics in southern Louisiana and Baltimore, Maryland, and who had visited a pregnancy resource center. Topics covered in the interviews included reasons for visiting a center and the experience of the visit. Transcripts were analyzed first thematically and then using grounded theory. RESULTS Most of the women were low income and had not been considering abortion when they visited a pregnancy resource center. Respondents reported that they had gone to these centers for pregnancy-related services, material goods and social support. They chose these centers because the resources were free, and they were largely satisfied with their experiences. Nonetheless, their receipt of services and goods was limited and often contingent on participation in the centers' activities. CONCLUSIONS Pregnancy resource centers play a role in meeting the acute material and social needs of low-income pregnant women. However, the constraints on the resources the centers offer mean that this support cannot be part of a reliable system of care. Advocates and policymakers should take a nuanced approach to regulating these centers and consider the reasons women visit them, especially low-income women.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Srinivasulu S, Falletta KA, Bermudez D, Almonte Y, Baum R, Coriano M, Grosso A, Iglehart K, Mota C, Rodriguez L, Taveras J, Tobier N, Garbers SV. Primary care providers' responses to pregnancy intention screening challenges: community-based participatory research at an urban community health centre. Fam Pract 2019; 36:797-803. [PMID: 31185086 DOI: 10.1093/fampra/cmz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Incorporating pregnancy intention screening into primary care to address unmet preconception and contraception needs may improve delivery of family planning services. A notable research gap exists regarding providers' experiences conducting this screening in primary care. OBJECTIVE To explore primary care providers' perceived challenges in conducting pregnancy intention screening with women of reproductive age and to identify strategies to discuss this in primary care settings. METHODS This qualitative study emerged from a 2017 community-based participatory research project. We conducted semi-structured, in-depth interviews with 10 primary care providers who care for women of reproductive age at an urban federally qualified health centre. Analysis consisted of interview debriefing, transcript coding and content analysis with the Community Advisory Board. RESULTS Across departments, respondents acknowledged difficulties conducting pregnancy intention screening and identified strategies for working with patients' individual readiness to discuss pregnancy intention. Strategies included: linking patients' health concerns with sexual and reproductive health, applying a shared decision-making model to all patient-provider interactions, practicing goal setting and motivational interviewing, fostering non-judgmental relationships and introducing pregnancy intention in one visit but following up at later times when more relevant for patients. CONCLUSIONS Opportunities exist for health centres to address pregnancy intention screening challenges, such as implementing routine screening and waiting room tools to foster provider and patient agency and sharing best practices with providers across departments by facilitating comprehensive training and periodic check-ins. Exploring providers' experiences may assist health centres in improving pregnancy intention screening in the primary care setting.
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Affiliation(s)
- Silpa Srinivasulu
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, NY
| | - Katherine A Falletta
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, NY
| | | | - Yolyn Almonte
- William F. Ryan Community Health Center, New York City, NY, USA
| | | | | | | | | | - Cathy Mota
- William F. Ryan Community Health Center, New York City, NY, USA
| | - Laura Rodriguez
- William F. Ryan Community Health Center, New York City, NY, USA
| | - Jecenia Taveras
- William F. Ryan Community Health Center, New York City, NY, USA
| | | | - Samantha V Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, NY
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"If You Don't Ask, I'm Not Going to Tell You": Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care. Womens Health Issues 2019; 30:25-34. [PMID: 31562052 DOI: 10.1016/j.whi.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings. METHODS This community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context. RESULTS Participants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI. CONCLUSIONS Future work should examine the experience and effectiveness of implementing these community-based participatory research-derived recommendations in primary care.
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Griffiths E, Atkinson D, Friello D, Marley JV. Pregnancy intentions in a group of remote-dwelling Australian Aboriginal women: a qualitative exploration of formation, expression and implications for clinical practice. BMC Public Health 2019; 19:568. [PMID: 31088427 PMCID: PMC6518809 DOI: 10.1186/s12889-019-6925-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements. METHODS Semi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18-49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation. RESULTS Most (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community. CONCLUSION Consultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.
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Affiliation(s)
- Emma Griffiths
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia. .,Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia.
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia
| | - Domenica Friello
- Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, 6725, Australia.,Kimberley Aboriginal Medical Services, Broome, WA, 6725, Australia
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Kimport K. More Than a Physical Burden: Women's Mental and Emotional Work in Preventing Pregnancy. JOURNAL OF SEX RESEARCH 2018; 55:1096-1105. [PMID: 28418714 PMCID: PMC6115298 DOI: 10.1080/00224499.2017.1311834] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In the United States, responsibility for preventing pregnancy in heterosexual relationships disproportionately falls on women. While the biotechnological landscape of available methods may explain the assignment of the physical burden for contraception to women, this does not mean the concomitant time, attention, and stress that preventing pregnancy requires must also be primarily assumed by women. Building on work identifying health care providers as contributors to the construction of normative ideas about reproduction, this study analyzed 52 contraceptive counseling visits with women who reported they did not want future children for the construction of responsibility for the mental and emotional aspects of contraception. Offering a case of how gender inequality is (re)produced through clinical encounters, findings demonstrate that clinicians discursively constructed these responsibilities as women's and point to structural aspects of the visit itself that reify this unequal burden as normal. Results are consistent with research identifying the broader feminization of family health work in heterosexual relationships. To the extent that the distribution of the mental and emotional responsibilities of preventing pregnancy is both a product of and contributor to gender inequality, this analysis yields insight into the production-and possible deconstruction-of (reproductive) health care as a gendered social structure.
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Affiliation(s)
- Katrina Kimport
- a Advancing New Standards in Reproductive Health , University of California , San Francisco
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Stevens LM. “We have to be mythbusters”: Clinician attitudes about the legitimacy of patient concerns and dissatisfaction with contraception. Soc Sci Med 2018; 212:145-152. [DOI: 10.1016/j.socscimed.2018.07.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Arteaga S, Caton L, Gomez AM. Planned, unplanned and in-between: the meaning and context of pregnancy planning for young people. Contraception 2018; 99:16-21. [PMID: 30120926 DOI: 10.1016/j.contraception.2018.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand how young people conceptualize planned, unplanned and "in-between" pregnancies. METHODS We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned. RESULTS Conceptualizations of pregnancy planning were influenced by personal experiences and life circumstances, including previous unplanned pregnancies. While many participants held up planned pregnancies as an ideal, the majority of participants (n=71) also felt that a status in between planned and unplanned pregnancy existed. Many described this in-between stage occurring when someone is "not not trying" or would find an unplanned pregnancy acceptable. Notably, a few participants mentioned that pregnancy planning was not possible because either it was uncommon among their peers or they felt a general lack of control over pregnancy. CONCLUSION Our analysis suggests that binary operationalization of pregnancies as "planned" and "unplanned" neglects the complexity of young people's lived experiences and perspectives. Contraceptive counseling approaches that allow patients the flexibility to express their considerations and feelings toward a potential future pregnancy could improve the quality of family planning visits and patient-provider interactions. IMPLICATIONS The traditional binary conceptualization of pregnancies as planned and unplanned may not holistically capture the diverse perspectives of young people. Increased understanding of the complexities in young people's conceptualizion of pregnancy planning can inform family planning care that is inclusive, relevant and supportive of a variety of perspectives.
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Affiliation(s)
- Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Lauren Caton
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
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Kazmerski TM, Gmelin T, Slocum B, Borrero S, Miller E. Attitudes and Decision Making Related to Pregnancy Among Young Women with Cystic Fibrosis. Matern Child Health J 2018; 21:818-824. [PMID: 27531009 DOI: 10.1007/s10995-016-2181-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction The number of female patients with CF able to consider pregnancy has increased with improved therapies. This study explored attitudes and decision making regarding pregnancy among young women with CF. Methods Twenty-two women with CF ages 18-30 years completed semi-structured, in-person interviews exploring experiences with preconception counseling and reproductive care in the CF setting. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Results Participants indicated CF is a major factor in pregnancy decision making. Although women acknowledged that CF influences attitudes toward pregnancy, many expressed confusion about how CF can affect fertility/pregnancy. Many perceived disapproval from CF providers regarding pregnancy and were dissatisfied with reproductive care in the CF setting. Discussion Young female patients with CF reported poor understanding of the effect of CF on fertility and pregnancy and limited preconception counseling in CF care. Improvements in female sexual and reproductive health care in CF are warranted.
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Affiliation(s)
- Traci M Kazmerski
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA.
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
| | - Breonna Slocum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh and VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
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Kimport K. Talking about male body-based contraceptives: The counseling visit and the feminization of contraception. Soc Sci Med 2018; 201:44-50. [PMID: 29433012 DOI: 10.1016/j.socscimed.2018.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
In developed countries, women bear the primary, and sometimes exclusive, responsibility for preventing pregnancy in heterosexual sexual relations. This unequal burden is not an intrinsic fact; it is the consequence of broad social narratives and interpersonal negotiations. The contraceptive counseling visit is increasingly recognized as a site of the discursive production of normative ideas about reproduction, suggesting that clinicians themselves may contribute to the assignment of responsibility for contraceptive labor to women (i.e. the feminization of contraception). Scholars have not yet considered how providers talk to patients about methods that are male body-based (i.e. condoms, withdrawal, and vasectomy) and, as such, may disrupt the feminization of responsibility for contraception. Using transcripts of 101 contraceptive counseling visits recorded between 2009 and 2012 in the San Francisco Bay Area, I investigate how clinicians discuss male body-based methods with female patients. Drawing on a constructivist approach, I find that clinicians generally devalued male body-based methods in their counseling. They did so by, first, failing to discuss them as options for long-term contraception. Second, when they did discuss them, clinicians tended to emphasize aspects of the methods that were presumed "negative" (e.g. the lower efficacy of withdrawal and condoms) but not features that patients might view positively (e.g. the high efficacy of vasectomy or the lack of side effects with condoms and withdrawal). In aggregate, these discursive practices marginalize male body-based methods as contraceptive choices. As a practical effect, this may encourage women to choose a method that does not best meet their preferences. At a structural level, by devaluing methods that could undercut the unequal division of fertility work, these discursive patterns contribute to the feminization of responsibility for contraception and the retrenchment of the unequal gendered division of fertility work.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
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Littlejohn KE, Kimport K. Contesting and Differentially Constructing Uncertainty: Negotiations of Contraceptive Use in the Clinical Encounter. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:442-454. [PMID: 29172767 PMCID: PMC6101241 DOI: 10.1177/0022146517736822] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Most women of reproductive age have access to highly effective contraception, and all available methods are associated with side effects. Whether a woman will experience side effects is uncertain, however, which can pose challenges for clinicians who discuss the methods with patients. In this study, we analyze 102 contraceptive counseling visits to understand how clinicians discursively construct knowledge in the context of uncertainty. We find that while some present the uncertainty of side effects in a straightforward, patient-accessible way, others negotiate their predictions by (1) differentially constructing uncertainty, suggesting that positive side effects are likely and negative side effects are unlikely, and (2) contesting uncertainty, presenting the risk of serious side effects as controllable. In the end, these strategies deemphasize consideration of negative side effects in women's contraceptive decision making. Our results demonstrate the importance of elucidating the translation, instantiation, and construction of medical uncertainty both in theory and in practice.
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Affiliation(s)
| | - Katrina Kimport
- 2 University of California, San Francisco, San Francisco, CA, USA
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Gomez AM, Wapman M. Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care. Contraception 2017; 96:221-226. [DOI: 10.1016/j.contraception.2017.07.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
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More Than a Destination: Contraceptive Decision Making as a Journey. Womens Health Issues 2017; 27:539-545. [DOI: 10.1016/j.whi.2017.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/07/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
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Gomez AM, Mann ES, Torres V. ‘It would have control over me instead of me having control’: intrauterine devices and the meaning of reproductive freedom. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1343935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Emily S. Mann
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vanessa Torres
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
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Callegari LS, Aiken ARA, Dehlendorf C, Cason P, Borrero S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol 2017; 216:129-134. [PMID: 27776920 DOI: 10.1016/j.ajog.2016.10.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
Abstract
Engaging women in discussions about reproductive goals in health care settings is increasingly recognized as an important public health strategy to reduce unintended pregnancy and improve pregnancy outcomes. "Reproductive life planning" has gained visibility as a framework for these discussions, endorsed by public health and professional organizations and integrated into practice guidelines. However, women's health advocates and researchers have voiced the concern that aspects of the reproductive life planning framework may have the unintended consequence of alienating rather than empowering some women. This concern is based on evidence indicating that women may not hold clear intentions regarding pregnancy timing and may have complex feelings about achieving or avoiding pregnancy, which in turn may make defining a reproductive life plan challenging or less meaningful. We examine potential pitfalls of reproductive life planning counseling and, based on available evidence, offer suggestions for a patient-centered approach to counseling, including building open and trusting relationships with patients, asking open-ended questions, and prioritizing information delivery based on patient preferences. Research is needed to ensure that efforts to engage women in conversations about their reproductive goals are effective in both achieving public health objectives and empowering individual women to achieve the reproductive lives they desire.
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Affiliation(s)
- Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA; Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA.
| | - Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX
| | - Christine Dehlendorf
- Departments of Family and Community Medicine, Obstetrics, Gynecology, and Reproductive Sciences, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Patty Cason
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Sonya Borrero
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity, Research, and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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Stevens LM. Environmental Contaminants and Reproductive Bodies: Provider Perspectives on Risk, Gender, and Responsibility. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:471-485. [PMID: 27803265 DOI: 10.1177/0022146516671569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increasingly, leading health organizations recommend that women who are pregnant or considering pregnancy avoid certain toxic chemicals found in our products, homes, and communities in order to protect fetuses from developmental and future harm. In the contemporary United States, women's maternal bodies have been treated as sites of exceptional risk and individual responsibility. Many studies have examined this phenomenon through the lens of lifestyle behaviors like smoking, drinking, and exercise. However, we know little about how environmental hazards fit into the dominant framework of gendered, individual responsibility for risk regulation. I draw on in-depth interviews with 19 reproductive healthcare providers in the United States to explore how they think about their patients' exposure to environmental contaminants and sometimes subvert this gendered, individualized responsibility and adopt more collective frames for understanding risk.
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Mumford SL, Sapra KJ, King RB, Louis JF, Buck Louis GM. Pregnancy intentions-a complex construct and call for new measures. Fertil Steril 2016; 106:1453-1462. [PMID: 27490044 PMCID: PMC5159192 DOI: 10.1016/j.fertnstert.2016.07.1067] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of unintended pregnancies under relaxed assumptions regarding birth control use compared with a traditional constructed measure. DESIGN Cross-sectional survey. SETTING Not applicable. PATIENT(S) Nationally representative sample of U.S. women aged 15-44 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Prevalence of intended and unintended pregnancies as estimated by [1] a traditional constructed measure from the National Survey of Family Growth (NSFG), and [2] a constructed measure relaxing assumptions regarding birth control use, reasons for nonuse, and pregnancy timing. RESULT(S) The prevalence of unintended pregnancies was 6% higher using the traditional constructed measure as compared with the approach with relaxed assumptions (NSFG: 44%, 95% confidence interval [CI] 41, 46; new construct 38%, 95% CI, 36, 41). Using the NSFG approach, only 92% of women who stopped birth control to become pregnant and 0 women who were not using contraceptives at the time of the pregnancy and reported that they did not mind getting pregnant were classified as having intended pregnancies, compared with 100% using the new construct. CONCLUSION(S) Current measures of pregnancy intention may overestimate rates of unintended pregnancy, with over 340,000 pregnancies in the United States misclassified as unintended using the current approach, corresponding to an estimated savings of $678 million in public health-care expenditures. Current constructs make assumptions that may not reflect contemporary reproductive practices, so improved measures are needed.
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Affiliation(s)
- Sunni L Mumford
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland.
| | - Katherine J Sapra
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | - Rosalind B King
- Population Dynamics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | | | - Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
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Patient-Centered Contraceptive Counseling: Evidence to Inform Practice. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0139-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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