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Johansson L, Vesström J, Alehagen S, Kilander H. Women's experiences of dealing with fertility and side effects in contraceptive decision making: a qualitative study based on women's blog posts. Reprod Health 2023; 20:98. [PMID: 37381022 DOI: 10.1186/s12978-023-01642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Worldwide, there is limited knowledge regarding women's views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women's experiences of contraceptive methods based on data gathered from individual blog posts. METHODS Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. RESULTS Two themes were identified. Theme 1, 'Seeking control over reproduction and optimise fertility' including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women's sexuality, A wish to understand the body's normal fertility function and Limited knowledge-sharing information about the menstrual cycle during counselling and Theme 2, 'Making the complex decision on their own' including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. CONCLUSIONS During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.
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Affiliation(s)
- Lydia Johansson
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Julia Vesström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helena Kilander
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, P.O. Box 1026, 551 11, Jönköping, Sweden.
- Department of Women's and Children's Health, Karolinska Institutet, and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
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Nkonde H, Mukanga B, Daka V. Male partner influence on Women's choices and utilisation of family planning services in Mufulira district, Zambia. Heliyon 2023; 9:e14405. [PMID: 36950585 PMCID: PMC10025139 DOI: 10.1016/j.heliyon.2023.e14405] [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: 10/19/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023] Open
Abstract
Background Family planning services are essential in reducing maternal deaths as well as improving the reproductive and sexual health of women. Although family planning services are frequently focused on women, men are often the primary decision-makers. We conducted a study to explore male partner influence on women's choices and utilisation of family planning services in Mufulira district, Zambia. Methods A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.×64 for coding and node generation. Findings The study revealed key themes on male partner influence on contraception use such as fear of infidelity, fear of physical abuse, preference for a large family size , disruption of sexual pleasure, and perceived side effects of contraceptives. These themes highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Participants described how their male partners exhibited prenatal attitudes and control over them thereby limiting their decision-making power on contraception use. Undesirable contraception side effects such as reduced vaginal lubrication contributed to sexual pleasure disruption among men. Concerns that women's use of contraception can lead to infidelity also contributed to male partner disapproval of contraception use. Conclusions Understanding barriers to contraception utilisation presented by male partners is essential in preventing contraception discontinuation and can increase contraception uptake among women. Our findings highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Therefore, male partner education on family planning services is key. Also, men need to be incorporated as key stakeholders when planning and implementing family planning programmes.
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Key Words
- Contraception
- FGD, Focus group discussions
- FP, Family planning
- Family planning
- HIV, human immunodeficiency virus
- IDI, Indepth Interviews
- IUD, Intra uterine devices
- LAM, Lactational Amenorrhea Method
- LMIC, Low middle income countries
- Male partner
- SSA, Subsaharan Africa
- STIs, Sexually transmitted Infections
- TDRC, Tropical Diseases Research Centre
- WHO, World Health Organisation
- Zambia
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Chola M, Hlongwana KW, Ginindza TG. Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2744. [PMID: 36768107 PMCID: PMC9915938 DOI: 10.3390/ijerph20032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Dalessandro C, Thorpe R, Sanders J. "For Me, It's Having Something Meaningful": Women's Emotional Understandings of Sex and the Sexual Acceptability of Contraception. JOURNAL OF SEX RESEARCH 2022; 59:445-456. [PMID: 34357808 PMCID: PMC8818050 DOI: 10.1080/00224499.2021.1958194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While the sexual acceptability of contraception - or, the impact of contraceptive methods on individuals' sexual experiences - is a growing area of research, less frequently do studies engage the importance of individual emotions around sex when it comes to perceptions of sexual acceptability. Building on Higgins and Smith's model of sexual acceptability and drawing upon insights from the sociology of gender, we used qualitative interview data with 30 women in Utah (USA) to explore the importance of emotional understandings of sex for women's assessments of the sexual acceptability of different contraceptives. Here we posit that emotional understandings of sex are not just individualistic - they are also structured by experiences with sexual partners and broader gendered expectations. This work adds insight into the importance of emotions in sexual acceptability and suggests the need for an amendment to Higgins and Smith's model that reflects the synergistic nature of the micro/individual, meso/interactional, and macro factors related to sexual acceptability. We conclude that assessing the sexual acceptability of contraceptives requires a nuanced multi-level interaction framework.
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Affiliation(s)
- Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Rachael Thorpe
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
| | - Jessica Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT USA 84132
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Rothschild CW, Richardson BA, Guthrie BL, Kithao P, Omurwa T, Mukabi J, Callegari LS, Lokken EL, John-Stewart G, Unger JA, Kinuthia J, Drake AL. Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study. BJOG 2021; 129:926-937. [PMID: 34839583 PMCID: PMC9035040 DOI: 10.1111/1471-0528.17032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women. DESIGN A prospective cohort study. SETTING Five counties in Western Kenya. PARTICIPANTS Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS Patient-reported side effect symptoms, method switch, and discontinuation were reported through weekly text message-based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS Prevalence, hazards ratio (HR). RESULTS Among 825 women, 44% were using implants, 43% injectables, 7% intrauterine device, and 6% oral contraceptive pills at enrollment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow-up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95%CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95%CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95%CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95%CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (adjusted hazard ratio [aHR] 2.39, 95%CI 1.20-4.77), weight changes (aHR 2.72, 95%CI 1.47-4.68), and sexual side effects (aHR 2.42, 95%CI 1.40-4.20). CONCLUSIONS Addressing irregular bleeding, weight changes, and sexual side effects through development of new products that minimize these specific side effects and anticipatory counseling may reduce method-related discontinuation.
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Affiliation(s)
| | - Barbra A Richardson
- Departments of Biostatistics and Global Health, University of Washington, Seattle, USA, Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Departments of Global Health and Epidemiology, University of Washington, Seattle, USA
| | | | | | | | - Lisa S Callegari
- Departments of Obstetrics & Gynecology and Health Services, University of Washington, Seattle, USA
| | - Erica L Lokken
- Department of Global Health, University of Washington, Seattle, USA
| | - Grace John-Stewart
- Departments of Global Health, Epidemiology, Medicine, and Pediatrics, University of Washington, Seattle, USA
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
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Zimmerman LA, Sarnak DO, Karp C, Wood SN, Ahmed S, Makumbi F, Kibira SPS. Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study. Reprod Health 2021; 18:239. [PMID: 34838097 PMCID: PMC8627069 DOI: 10.1186/s12978-021-01287-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/06/2021] [Indexed: 03/29/2023] Open
Abstract
Background There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role of specific side-effects on contraceptive use dynamics. This study used population-based, longitudinal data to explore the effect of specific side-effects on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of survey data collection in Uganda: PMA2020’s sixth cross-sectional survey and a follow-up survey conducted 1 year later. The main outcomes of interest were discontinuation and switching among users of hormonal contraceptive methods (implants, injectables and oral pill) and the IUD at baseline (n = 560). Multivariable logistic regressions assessed the association of experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching 1 year later, adjusting for socio-demographic characteristics, type of method, and length of use. We also examined the differential effects of side-effects between discontinuation and switching risks. Results About 23% of hormonal and IUD contraceptive users reported experiencing side-effects at baseline survey. Overall, discontinuation and switching were higher among injectables and pill users, compared to IUD and implants users. Reporting more bleeding or less bleeding increased the odds of discontinuation and switching by 2.74 (95% CI 1.00–7.51) and 1.86 (1.04–3.34), respectively. There was no significant difference in discontinuation and switching by side-effects. Conclusions Greater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. While about a quarter of women reported experiencing side effects, those who experienced bleeding specific side effects were at higher risk of contraceptive discontinuation and switching. Providing greater individualized care that includes information and counseling about common side-effects, how they may impact daily life, and how tolerable these effects may be is necessary. Research has shown that experiencing side-effects is related to stopping use of contraception, even when women wish to avoid pregnancy. Most research, however, does not differentiate between distinct side-effects, such as increased bleeding or changes to sexual experience, and instead combined all into “side-effects or health concerns”. We used data from 560 women in Uganda, who were interviewed twice, 1 year apart, to see if women who reported different side-effects at the first interview were more likely to stop using contraception or switch to a different contraceptive method than women who did not report experiencing side-effects. We found that increased or decreased menstrual bleeding was associated with a higher odds of contraceptive discontinuation and switching, Contraceptive discontinuation or switching was not different by women’s reporting of vaginal dryness/reduced libido or physical discomfort, such as cramping. It is important to understand what side-effects are likely to motivate stopping or switching contraception so that education and counseling can inform women of side-effects they may experience, help them choose the best method based on what side-effects they deem important, and if necessary, aid in switching contraceptive methods.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Dana O Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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