1
|
Jones SC, Boniface ER, Boehnlein C, Jones Packham A, Baldwin MK. Menstrual Health Literacy among Adolescents and Young Adults Who Menstruate: Impact of Christian Family Background and United States Region. J Pediatr Adolesc Gynecol 2023; 36:518-524. [PMID: 37482080 DOI: 10.1016/j.jpag.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
STUDY OBJECTIVE To compare menstrual health literacy among adolescents and young adults on the basis of family religious background and United States region METHODS: We conducted a cross-sectional online survey of post-menarcheal US adolescents and young adults aged 14-24 years who identified their family religious background, including Christian or non-religious, with recruitment via the social media platform TikTok. We asked participants several questions to assess their health literacy regarding common myths about the use of gonadal steroid hormones for menstrual suppression. RESULTS From 3250 online survey respondents, 2997 met the criteria for analysis, with 1989 identifying their family as Christian (66.4%) and 1008 identifying their family as non-religious (33.6%), with equal representation by US region. Health literacy was lower among those with a Christian family background, with concerns that menstrual suppression is unhealthy (16.4% vs 10.5% with non-religious background, P < .01), is unsafe (31.4% vs 24.2%, P < .01), and could lead to infertility (32.6% vs 20.0%, P < .01). Similarly, adolescents and young adults from the US South were worried that menstrual suppression is unhealthy (31.5%; P < .01) and would lead to infertility (33.8%; P < .01). CONCLUSION Health literacy is lower among adolescents and young adults with a Christian family background and those who live in the South. These results demonstrate a need for an evidence-based national curriculum that addresses the safe and effective use of hormonal medications for menstrual suppression.
Collapse
|
2
|
Nappi RE, Tiranini L, Bosoni D, Cucinella L, Piccinino M, Cumetti A, Perone V, Benedetto C. Women's attitudes about combined hormonal contraception (CHC) - induced menstrual bleeding changes - influence of personality traits in an Italian clinical sample. Gynecol Endocrinol 2023; 39:2189971. [PMID: 36918022 DOI: 10.1080/09513590.2023.2189971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES We investigated the attitudes to change the frequency of menstrual bleeding by using combined hormonal contraception (CHC). Personality characteristics were also explored. METHODS We conducted a cross-sectional study in two university hospitals in northern Italy. Current, past and never CHC users (n = 545; age 18-44 years) completed a self-administered semi-structured questionnaire and the Ten-Item Personality Inventory (TIPI). RESULTS Forty-five percent of responders (n = 301) would prefer to change their bleeding frequency by using CHC. A flexible regimen was the preferred choice (n = 80; 33%) followed by extended regimens to bleed every 3 months (n = 54; 22%) or to never bleed (n = 43; 18%). The main positive reasons were to avoid dysmenorrhea (43%) and have more freedom in sexual (36%) and active (35%) life, whereas the main reason for a negative attitude was 'menstrual rhythm is natural' (59%). Age had a significant influence on women's willingness to change menstrual frequency by using CHC [>39 years (57%), 30-39 years (31%) and <30 years (46%)] (χ2: 9.1; p = 0.01). Never users significantly reported a more negative attitude (71%) in comparison with past (51%) and current users (49%) (χ2: 18.7; p = 0.001). Personality traits played a role, with higher scores of openness (p = 0.005) and extraversion (p = 0.001) in women with a positive attitude. CONCLUSIONS Almost half of our study sample reported a preference for changing their menstrual pattern by using CHC. Flexibility was the preferred choice across age and use of CHC. Personality characteristics (openness and extroversion) might influence attitudes toward CHC-induced menstrual bleeding changes.
Collapse
Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Manuela Piccinino
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Andrea Cumetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Valeria Perone
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Obstetrics and Gynecology I, Ospedale S. Anna, University of Turin, Turin, Italy
| |
Collapse
|
3
|
Din HN, Singh-Carlson S, Corliss HL, Hartman SJ, Strong D, Madanat H, Su HI. Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer. JAMA Netw Open 2023; 6:e2337245. [PMID: 37819662 PMCID: PMC10568355 DOI: 10.1001/jamanetworkopen.2023.37245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Fertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population's fertility perceptions and their alignment with objective infertility risk are scant. Objective To assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception. Design, Setting, and Participants This retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022. Exposures Participants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review. Main Outcomes and Measures Participants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk. Results This study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation. Conclusions and Relevance In this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.
Collapse
Affiliation(s)
- Hena Naz Din
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- School of Public Health, San Diego State University, San Diego, California
| | | | - Heather L. Corliss
- School of Public Health, San Diego State University, San Diego, California
- Center for Research on Sexuality and Sexual Health, San Diego State University, San Diego, California
- Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - Sheri J. Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- Moores Cancer Center, University of California San Diego, La Jolla
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
- Moores Cancer Center, University of California San Diego, La Jolla
| | - Hala Madanat
- School of Public Health, San Diego State University, San Diego, California
- Division of Research and Innovation, San Diego State University, San Diego, California
- Institute for Behavioral and Community Health, San Diego State University, San Diego, California
| | - H. Irene Su
- Moores Cancer Center, University of California San Diego, La Jolla
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, La Jolla
| |
Collapse
|
4
|
Supporting young women with menstrual pain – Experiences of midwives working at youth clinics. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100795. [DOI: 10.1016/j.srhc.2022.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
|
5
|
Reyes-Martí L, Rubio-Rico L, Ortega-Sanz L, Raigal-Aran L, de la Flor-López M, Roca-Biosca A, Valls-Fonayet F, Moharra-Francés M, Escuriet-Peiro R, de Molina-Fernández MI. Contraceptive counselling experiences in Spain in the process of creating a web-based contraceptive decision support tool: a qualitative study. Reprod Health 2021; 18:237. [PMID: 34838040 PMCID: PMC8626746 DOI: 10.1186/s12978-021-01254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. Methods/design Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects’ experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. Results In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. Conclusions Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment. In Spain, individuals can use a variety of contraceptive methods. Professionals involved in contraceptive counselling should help users to choose and properly use the method that best suits their preferences, personal situation and health status. However, there is a high number of unplanned pregnancies and the population feels dissatisfied with the counselling received. In the context of creating a website dealing with contraceptive methods, we wished to find out how counselling was taking place, giving voice those directly concerned. A qualitative study was proposed to explore the experiences and needs of users and professionals during counselling. Ten focus groups were conducted involving 64 users and 19 professionals from Tarragona (Spain). The results were ordered based on the Quality on Contraceptive Counseling (QCC) framework, created by experts, which determines what the relationship between user and professional should be like during the counselling process. Our analysis highlighted users’ little knowledge and false beliefs concerning contraception who, moreover, complained of receiving little information during counselling. They expressed their discontent with methods being imposed on them by the professional without exploring their preferences or needs. Meanwhile, the professionals argued that they often prescribe the method with which they are most familiar due to the lack of time during consultations at their office and/or because they are unfamiliar with other methods. These results, among others, offer the possibility of improving contraceptive counselling in Spain, if solutions to the difficulties and/or barriers detected are posed and implemented.
Collapse
Affiliation(s)
- Laura Reyes-Martí
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Lourdes Rubio-Rico
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain.
| | - Laura Ortega-Sanz
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Laia Raigal-Aran
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Miriam de la Flor-López
- Medicine Department, Universitat Rovira i Virgili, C/Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain
| | - Alba Roca-Biosca
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Francesc Valls-Fonayet
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Montse Moharra-Francés
- Agency for Health Quality and Assessment of Catalonia (AQuAS) of the Catalan Ministry of Health, Carrer de Roc Boronat, 81, 08005, Barcelona, Spain
| | - Ramon Escuriet-Peiro
- Catalan Health Service of the Catalan Ministry of Health, Travessera de Les Corts, 131-159 - Edifici Olímpia. Població, 08028, Barcelona, Spain
| | | |
Collapse
|
6
|
Haddad LB, Townsend JW, Sitruk-Ware R. Contraceptive Technologies: Looking Ahead to New Approaches to Increase Options for Family Planning. Clin Obstet Gynecol 2021; 64:435-448. [PMID: 34323226 PMCID: PMC8328155 DOI: 10.1097/grf.0000000000000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With persistently high global rates of unintended pregnancy and contraceptive nonuse, nonadherence and discontinuation, new contraceptive methods must address the needs of women and men who seek alternatives to their current options. Methods under development aim to reduce potential side effects, improve access and ease of use, ensure safety, increase secondary benefits associated with method use and expand options for both women and men. Developmental approaches employed to enhance current methods utilize new delivery systems and novel active pharmaceutical ingredients. This will improve overall user satisfaction with the methods used while expanding the number of options available to provide choice and value user autonomy in the highly diverse contraceptive markets around the world.
Collapse
|
7
|
Le Guen M, Schantz C, Régnier-Loilier A, de La Rochebrochard E. Reasons for rejecting hormonal contraception in Western countries: A systematic review. Soc Sci Med 2021; 284:114247. [PMID: 34339927 DOI: 10.1016/j.socscimed.2021.114247] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading "hormonophobia", i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.
Collapse
Affiliation(s)
- Mireille Le Guen
- Centre for Demographic Research, Université catholique de Louvain, Place Montesquieu 1, L2.08.03, B-1348, Louvain-la-Neuve, Belgium; Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Clémence Schantz
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) and Université de Paris, Inserm ERL 1244, 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Arnaud Régnier-Loilier
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Elise de La Rochebrochard
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Univ. Paris-Saclay, UVSQ, Inserm, CESP, F-94807, Villejuif, France.
| |
Collapse
|
8
|
Hemmerling A, Christopher E, Young Holt B. Towards a roadmap to advance non-hormonal contraceptive multipurpose prevention technologies: strategic insights from key stakeholders†. Biol Reprod 2020; 103:289-298. [PMID: 32639007 PMCID: PMC7401408 DOI: 10.1093/biolre/ioaa092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022] Open
Abstract
The development of non-hormonal contraceptives is critical to increase options for women. In combination with prevention against sexually transmitted infections, they can become an important component of multipurpose prevention technologies (MPTs) which address multiple reproductive health needs with a single product. Resulting from multiple rounds of expert consultations, this framework aims to guide the development of non-hormonal contraceptive MPTs. Key informant interviews with experts in family planning and HIV and STI prevention and MPT product developers and funders from around the globe were conducted, reviewed, and coded. Identified key themes were discussed by experts at the November 2019 Eunice Kennedy Shriver National Institute of Child Health and Human Development Contraceptive Development Meeting in Houston, Texas. Seven action strategies were identified to address key research gaps and priorities for advancing the field. They highlight the importance of identifying target populations, a systematic approach to collaborative research, and leveraging knowledge from other fields, including regulatory and patenting, manufacturing, and commercialization expertise. Employing expanded target product profiles and setting go/no-go decisions for non-hormonal MPTs will help to prioritize the most promising candidates in the drug development pipeline. Further, they call for optimizing investments and engagement of stakeholders from public and private sectors. These action strategies aim to facilitate collaboration and innovation amongst multidisciplinary MPT stakeholders. Paramount to success will be enhancing strategic alliances and reconciling the essential social–behavioral context and market forces that drive product use with the complexities of research and development, regulatory approval, and commercialization.
Collapse
Affiliation(s)
- Anke Hemmerling
- The Initiative for Multipurpose Prevention Technologies, A Project of CAMI Health, Public Health Institute, Sacramento, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Emily Christopher
- The Initiative for Multipurpose Prevention Technologies, A Project of CAMI Health, Public Health Institute, Sacramento, CA, USA
| | - Bethany Young Holt
- The Initiative for Multipurpose Prevention Technologies, A Project of CAMI Health, Public Health Institute, Sacramento, CA, USA
| |
Collapse
|
9
|
Judge-Golden CP, Wolgemuth TE, Zhao X, Mor MK, Borrero S. Agreement between Self-Reported "Ideal" and Currently Used Contraceptive Methods among Women Veterans Using the Veterans Affairs Healthcare System. Womens Health Issues 2020; 30:283-291. [PMID: 32321666 DOI: 10.1016/j.whi.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women veterans who use the Veterans Affairs Healthcare System theoretically have access to the full range of contraceptive methods. This study explores match between currently used and self-reported "ideal" methods as a potential marker of contraceptive access and preference matching. METHODS This mixed methods study uses data from a nationally representative survey of reproductive-aged women veterans who use the Veterans Affairs Healthcare System for primary care, including 979 participants at risk of unintended pregnancy. Women reported all contraceptive methods used in the past month and were asked, "If you could choose any method of contraception or birth control to prevent pregnancy, what would be your ideal choice?" and selected a single "ideal" method. If applicable, participants were additionally asked, "Why aren't you currently using this method of contraception?" We used adjusted logistic regression to identify patient-, provider-, and system-level factors associated with ideal-current method match. We qualitatively analyzed open-ended responses about reasons for ideal method nonuse. RESULTS Overall, 58% were currently using their ideal method; match was greatest among women selecting an IUD as ideal (73%). Non-White race/ethnicity (adjusted odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and mental illness (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.92) were negatively associated with ideal-current match in adjusted analyses; the presence of a gynecologist at the primary care site was associated with an increased odds of match (adjusted odds ratio, 1.35; 95% confidence interval, 1.03-1.75). Modifiable barriers to ideal method use were cited by 23% of women, including access issues, cost concerns, and provider-level barriers; 79% of responses included nonmodifiable reasons for mismatch including relationship factors and pregnancy plans incongruent with ideal method use, suggesting limitations of our measure based on differential interpretation of the word "ideal." CONCLUSIONS Many women veterans are not currently using the contraceptive method they consider ideal. Results emphasize the complexity of contraceptive method selection and of measuring contraceptive preference matching.
Collapse
Affiliation(s)
| | | | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
A Biopsychosocial Model for the Counseling of Hormonal Contraceptives: A Review of the Psychological, Relational, Sexual, and Cultural Elements Involved in the Choice of Contraceptive Method. Sex Med Rev 2019; 7:587-596. [DOI: 10.1016/j.sxmr.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/22/2022]
|
11
|
Alspaugh A, Barroso J, Reibel M, Phillips S. Women's Contraceptive Perceptions, Beliefs, and Attitudes: An Integrative Review of Qualitative Research. J Midwifery Womens Health 2019; 65:64-84. [PMID: 31135081 DOI: 10.1111/jmwh.12992] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Unintended pregnancy rates will remain high until researchers explore the lived experience of women's relationships with contraception. This integrative review examines the extant qualitative literature on women's contraception to illuminate common themes in women's perspectives through the lens of the feminist poststructuralist framework. METHODS A literature review of PubMed and CINAHL databases was completed for English-language studies conducted in the United States from January 2008 through September 2018 that qualitatively examined women's perceptions, beliefs, and attitudes regarding contraception. Reports, dissertations, mixed-methods research, and literature reviews were excluded. The sample, methods, and findings of 19 studies were reviewed. Themes were identified using the 5 major tenets of the feminist poststructuralist framework: discourse, power, language, subjectivity, and agency. RESULTS Themes of power imbalance between partners and health care providers; societal and communal discourses on femininity and motherhood; distrust of hormonal contraception; the ability to enhance personal agency through contraceptive decision making; and a need for open, patient-focused communication arose from the 19 studies included in the review. DISCUSSION Using a feminist poststructuralist framework to examine women's contraceptive perceptions illuminates and magnifies the many ways in which contraceptive beliefs and use are dependent on gender roles and power dynamics. Gaps in knowledge specific to older women and exploration of women's subjectivity should be addressed. Clinicians should evaluate the power structures inherent to their practice while providing woman-focused, evidence-based contraceptive education.
Collapse
Affiliation(s)
- Amy Alspaugh
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Barroso
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Melody Reibel
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
12
|
The relationship between the use of combined hormonal contraception with a predominance of gestagens and the selected types of female body in young women from the region of Lower Silesia. ANTHROPOLOGICAL REVIEW 2018. [DOI: 10.2478/anre-2018-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Oral contraceptive agents are currently the most popular and one of the most effective methods for preventing pregnancy. The data shows that over 300 million women in the world use contraceptive drugs containing synthetic hormones to avoid an unwanted pregnancy. Their effects may affect other systems, leading to the occurrence of various problems associated with the use of the drug. The aim of the study is to estimate the frequency of prevalence of subjective effects associated with the use of combined hormonal contraception with a predominance of gestagens by young women Surveys were conducted among female students of Wrocław universities from December 2010 to January 2011. They covered 257 women aged statistically 23.58 (SD=2.95). They were divided into three age classes: 19-22, 23-24, 25- 28. The individual age of menarche and the hormonal type of body were determined. Only persons with a gestagenic or estrogenic type of body were qualified for the study. Results: 64.6% of all respondents declared the use of hormonal contraception. Combined agents with a predominance of gestagens constituted 87% in this group. Their use brings both positive (90%) and negative (65%) aspects. The most common positive effects include high contraceptive effectiveness, regulation of menstruation and minimisation of skin problems. The most frequent negative effects include: weight gain, spotting, breast swelling and decreased libido. Surprisingly, the study did not show any correlation between the hormonal type and the occurrence of side effects. There was no significant statistical relationship between the type of hormonal contraception used and the hormonal type.
Collapse
|
13
|
Polis CB, Hussain R, Berry A. There might be blood: a scoping review on women's responses to contraceptive-induced menstrual bleeding changes. Reprod Health 2018; 15:114. [PMID: 29940996 PMCID: PMC6020216 DOI: 10.1186/s12978-018-0561-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/15/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. METHODS We conducted a systematic scoping review of data on women's responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. RESULTS We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women's responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women's responses to menstrual suppression; and other emergent themes. Women's preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of "dirty" or "blocked" blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. CONCLUSIONS Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women's lives. Women's responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely - and potentially substantial - impacts on contraceptive discontinuation and unmet need for modern contraception.
Collapse
Affiliation(s)
- Chelsea B. Polis
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Rubina Hussain
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Amanda Berry
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
| | - Katrina Kimport
- 2 University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
15
|
Nelson AL. Levonorgestrel-releasing intrauterine system (LNG-IUS 12) for prevention of pregnancy for up to five years. Expert Rev Clin Pharmacol 2017; 10:833-842. [DOI: 10.1080/17512433.2017.1341308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anita L Nelson
- Obstetrics & Gynecology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| |
Collapse
|
16
|
Dole DM, Martin J. What Nurses Need to Know About Immediate Postpartum Initiation of Long-Acting Reversible Contraception. Nurs Womens Health 2017; 21:186-195. [PMID: 28599740 DOI: 10.1016/j.nwh.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/07/2017] [Indexed: 06/07/2023]
Abstract
Initiation of long-acting reversible contraception (LARC) in the immediate postpartum period is becoming more common, resulting in increased requests for early removal, primarily because of unpredictable bleeding patterns. Competing interests of healthful spacing of pregnancies, impact on breastfeeding, risks associated with pregnancy versus contraceptive method, potential adverse effects of LARC, and timing of informed consent make immediate postpartum initiation of LARC an important issue. Nearly 40% of women do not attend a postpartum visit at all, resulting in decreased initiation of contraception and increased risk of unplanned pregnancy. Nurses caring for women during the peripartum period can help women make informed decisions and can provide anticipatory guidance regarding this method of contraception. Evidence-based postpartum education and support can result in women's increased continuation of and satisfaction with LARC.
Collapse
|