1
|
Mathur S, Kirk K, Dadi C, Dougherty L. Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger. BMC Womens Health 2024; 24:278. [PMID: 38715013 PMCID: PMC11075281 DOI: 10.1186/s12905-024-03115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).
Collapse
Affiliation(s)
- Sanyukta Mathur
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA.
| | - Karen Kirk
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
| | - Leanne Dougherty
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
| |
Collapse
|
2
|
Chukwudeh SO, Oduaran A. "My Mother Persuaded Me to Have More Children", Understanding the Influence of Social Network on Fertility Behavior in Sub-Saharan Africa. Int J Environ Res Public Health 2024; 21:396. [PMID: 38673309 PMCID: PMC11050537 DOI: 10.3390/ijerph21040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Introduction: Despite the adoption of an antenatal demographic transition model in sub-Saharan Africa, population growth continues to soar in the region. The reasons for population growth are nebulous and should be approached from different perspectives. Inadequate attention has been paid to how social pressures shape reproductive behavior. Thus, this study examines the association between social networks and fertility behavior in sub-Saharan Africa. Methods: This study used a cross-sectional design that employed a qualitative method to conduct 28 in-depth interviews among married women. Data was collected in 2023. Thematic analyses were utilized to interpret the results. Results: Parental pressure, the desire for more children, the desire for male children, values placed on children, norms, and pronatalist culture were associated with high fertility in sub-Saharan Africa. Conclusions: Thus, there is a need for more awareness of family planning and contraceptive use in order to reduce fertility in sub-Saharan Africa.
Collapse
Affiliation(s)
- Stephen Okechukwu Chukwudeh
- Department of Criminology and Security Studies, Faculty of Social Sciences, Federal University, Oye-Ekiti 371104, Nigeria
- Community-Based Educational Research (COMBER) Entity, North-West University, Potchefstroom 2531, South Africa;
| | - Akpovire Oduaran
- Community-Based Educational Research (COMBER) Entity, North-West University, Potchefstroom 2531, South Africa;
| |
Collapse
|
3
|
Abstract
The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.
Collapse
Affiliation(s)
- Tom Emery
- Department of Public Administration, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Judith C. Koops
- Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW, University of Groningen, Groningen, Netherlands
| |
Collapse
|
4
|
Moulton JE, Corona MIV, Vaughan C, Bohren MA. Women's perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis. PLoS One 2021; 16:e0261551. [PMID: 34932570 PMCID: PMC8691598 DOI: 10.1371/journal.pone.0261551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reproductive coercion and abuse is a major public health issue, with significant effects on the health and well-being of women. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person's reproductive choices. The aim of this qualitative evidence synthesis is to explore women's experiences of reproductive coercion and abuse globally, to broaden understanding of the different ways reproductive coercion and abuse is perpetrated, perceived and experienced across settings and socio-cultural contexts. METHOD We searched Medline, CINAHL and Embase for eligible studies from inception to 25th February 2021. Primary studies with a qualitative study design that focused on the experiences and perceptions of women who have encountered reproductive coercion and abuse were eligible for inclusion. Titles and abstracts, and full texts were screened by independent reviewers. We extracted data from included studies using a form designed for this synthesis and assessed methodological limitations using CASP. We used Thomas and Harden's thematic analysis approach to analyse and synthesise the evidence, and the GRADE-CERQual approach to assess confidence in review findings. RESULTS We included 33 studies from twelve countries in South Asia, the Asia Pacific, North America, South America, Africa and Europe. Most studies used in-depth interviews and focus group discussions to discuss women's experiences of reproductive coercion and abuse. Reproductive coercion and abuse manifested in a range of behaviours including control of pregnancy outcome, pregnancy pressure or contraceptive sabotage. There were a range of reasons cited for reproductive coercion and abuse, including control of women, rigid gender roles, social inequalities and family pressure. Women's different responses to reproductive coercion and abuse included using covert contraception and feelings of distress, anger and trauma. Across contexts, perpetration and experiences of reproductive coercion and abuse were influenced by different factors including son preferences and social exclusion. CONCLUSIONS We reflect on the importance of socio-cultural factors in understanding the phenomenon of reproductive coercion and abuse and how it affects women, as well as how the mechanisms of power and control at both individual and societal levels work to perpetuate the incidence of reproductive coercion and abuse against women.
Collapse
Affiliation(s)
- Jessica E. Moulton
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Martha Isela Vazquez Corona
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Cathy Vaughan
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
5
|
Tamirat KS, Tesema GA, Tessema ZT. Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: A pooled analysis of nine East African countries. PLoS One 2021; 16:e0253736. [PMID: 34191843 PMCID: PMC8244896 DOI: 10.1371/journal.pone.0253736] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia. Method This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia. Result According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women’s residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia. Conclusion This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.
Collapse
Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Chitneni P, Bwana MB, Muyindike W, Owembabazi M, Kalyebara PK, Byamukama A, Mbalibulha Y, Smith PM, Hsu KK, Haberer JE, Kaida A, Matthews LT. STI prevalence among men living with HIV engaged in safer conception care in rural, southwestern Uganda. PLoS One 2021; 16:e0246629. [PMID: 33657120 PMCID: PMC7928454 DOI: 10.1371/journal.pone.0246629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
HIV care provides an opportunity to integrate comprehensive sexual and reproductive healthcare, including sexually transmitted infection (STI) management. We describe STI prevalence and correlates among men living with HIV (MLWH) accessing safer conception care to conceive a child with an HIV-uninfected partner while minimizing HIV transmission risks. This study reflects an ongoing safer conception program embedded within a regional referral hospital HIV clinic in southwestern Uganda. We enrolled MLWH, planning for pregnancy with an HIV-uninfected partner and accessing safer conception care. Participants completed interviewer-administered questionnaires detailing socio-demographics, gender dynamics, and sexual history. Participants also completed STI laboratory screening for syphilis (immunochromatographic testing confirmed by rapid plasma reagin), and chlamydia, gonorrhea, trichomoniasis, and HIV-RNA via GeneXpert nucleic acid amplification testing. Bivariable associations of STI covariates were assessed using Fisher's exact test. Among the 50 men who completed STI screening, median age was 33 (IQR 31-37) years, 13/50 (26%) had ≥2 sexual partners in the prior three months, and 46/50 (92%) had HIV-RNA <400 copies/mL. Overall, 11/50 (22%) had STIs: 16% active syphilis, 6% chlamydia. All participants initiated STI treatment. STI prevalence was associated with the use of threats/intimidation to coerce partners into sex (27% vs 3%; p = 0.03), although absolute numbers were small. We describe a 22% curable STI prevalence among a priority population at higher risk for transmission to partners and neonates. STI screening and treatment as a part of comprehensive sexual and reproductive healthcare should be integrated into HIV care to maximize the health of men, women, and children.
Collapse
Affiliation(s)
- Pooja Chitneni
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases and General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Global Health Collaborative, Mbarara, Uganda
- * E-mail:
| | - Mwebesa Bosco Bwana
- Global Health Collaborative, Mbarara, Uganda
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara, Uganda
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Paul Kato Kalyebara
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adolf Byamukama
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
- Epicentre, Médecins Sans Frontières (MSF), Mbarara, Uganda
| | - Yona Mbalibulha
- Mbarara Regional Referral Hospital and Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia M. Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine K. Hsu
- Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA, United States of America
- Section of Pediatric Infectious Disease, Boston University Medical Center, Boston, MA, United States of America
| | - Jessica E. Haberer
- Global Health Collaborative, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Angela Kaida
- Global Health Collaborative, Mbarara, Uganda
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lynn T. Matthews
- Global Health Collaborative, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States of America
| |
Collapse
|
7
|
Quashie NT, Arpino B, Antczak R, Mair CA. Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries. J Gerontol B Psychol Sci Soc Sci 2021; 76:348-359. [PMID: 31768550 DOI: 10.1093/geronb/gbz153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes. METHODS Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648). RESULTS Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures. DISCUSSION We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.
Collapse
Affiliation(s)
| | - Bruno Arpino
- Department of Statistics, Computer Science, Applications, University of Florence, Italy
| | - Radoslaw Antczak
- Institute of Statistics and Demography, SGH Warsaw School of Economics, Poland
| | | |
Collapse
|
8
|
Abstract
There is evidence in humans for genetic influences on the probability (Pboy) that a birth yields a boy instead of a girl [1-6], suggesting a potential variation of Pboy among families. To quantify this variation, we analyze the survey data from over 300,000 UK Biobank participants primarily born between 1940 and 1970 [7]. Surprisingly, the proportion of male children in a family, or sex ratio (SR), has a significantly smaller among-family variation than expected under a uniform Pboy. We propose that this phenomenon results from reproductive behaviors reflecting a preference for having children of both sexes, much like the coupon collector's problem in probability theory where collecting a complete set of distinct coupons is considered a win. We find that the observed deficit in SR variation is explainable by 3.3% of "coupon-collecting" families. Consistently, significantly more families than expected have all children of the same sex except for the child born last. This trend is more pronounced in the late than the early half of the families in the data, suggesting an increasing popularity of this behavior. Analysis of a Dutch genealogical dataset spanning the past 4 centuries reveals higher-than-expected SR variations over much of the history; only after 1940 did the SR variation drop below the expectation. We conclude that a significant fraction of couples now exhibit the coupon collection behavior in reproduction such that SR is more homogeneous among families than expected by chance.
Collapse
Affiliation(s)
- Erping Long
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Jianzhi Zhang
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
| |
Collapse
|
9
|
Stack SW, Jagsi R, Biermann JS, Lundberg GP, Law KL, Milne CK, Williams SG, Burton TC, Larison CL, Best JA. Childbearing Decisions in Residency: A Multicenter Survey of Female Residents. Acad Med 2020; 95:1550-1557. [PMID: 32568852 DOI: 10.1097/acm.0000000000003549] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To characterize how female residents make decisions about childbearing, factors associated with the decision to delay childbearing, and satisfaction with these decisions. METHOD In 2017, the authors sent a voluntary, anonymous survey to 1,537 female residents enrolled across 78 graduate medical education programs, consisting of 25 unique specialties, at 6 U.S. academic medical centers. Survey items included personal, partner, and institutional characteristics, whether the respondent was delaying childbearing during residency, and the respondent's satisfaction with this decision. RESULTS The survey response rate was 52% (n = 804). Among the 447 (56%) respondents who were married or partnered, 274 (61%) were delaying childbearing. Residents delaying childbearing were significantly more likely to be younger (P < .001), not currently a parent (P < .001), in a specialty with an uncontrollable lifestyle (P = .001), or in a large program (P = .004). Among self-reported reasons for delaying childbearing, which were not mutually exclusive, the majority cited a busy work schedule (n = 255; 93%) and desire not to extend residency training (n = 145; 53%). Many cited lack of access to childcare (n = 126; 46%), financial concerns (n = 116; 42%), fear of burdening colleagues (n = 96; 35%), and concern for pregnancy complications (n = 74; 27%). Only 38% (n = 103) of respondents delaying childbearing were satisfied with this decision, with satisfaction decreasing with increasing age. CONCLUSIONS Decisions to delay childbearing are more common in certain specialties, and many residents who delay childbearing are not satisfied with that decision. These findings suggest that greater attention is needed overall, and particularly in certain specialties, to promote policies and cultures that both anticipate and normalize parenthood in residency, thus minimizing the conflict between biological and professional choices for female residents.
Collapse
Affiliation(s)
- Shobha W Stack
- S.W. Stack is assistant professor of medicine, associate director, Medicine Student Programs, and director, Medical Student Scholarship, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0001-6586-9266
| | - Reshma Jagsi
- R. Jagsi is professor of radiation oncology, program director, Radiation Oncology Residency Program, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228
| | - J Sybil Biermann
- J.S. Biermann is professor of orthopedic surgery and associate dean of graduate medical education, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gina P Lundberg
- G.P. Lundberg is associate professor of medicine, Division of Cardiology, Emory University School of Medicine, and clinical director, Emory Women's Heart Center, Atlanta, Georgia; ORCID: https://orcid.org/0000-0002-8011-7094
| | - Karen L Law
- K.L. Law is associate professor of medicine, program director, Internal Medicine Residency Program, and associate vice chair of education, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline K Milne
- C.K. Milne is professor of medicine, program director, Internal Medicine Residency Program, and vice chair for education, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-4782-1901
| | - Sigrid G Williams
- S.G. Williams is assistant professor of reproductive medicine, University of California at San Diego, San Diego, California
| | - Tracy C Burton
- T.C. Burton is assistant professor of pediatrics, University of South Florida College of Medicine, Tampa, Florida
| | - Cindy L Larison
- C.L. Larison is research consultant, Department of Health Services, University of Washington School of Public Health, Seattle, Washington; ORCID: https://orcid.org/0000-0002-1412-5993
| | - Jennifer A Best
- J.A. Best is associate professor of medicine, associate program director, Internal Medicine Residency Program, and associate dean of graduate medical education, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
10
|
Abstract
PURPOSE To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training. METHOD The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles. RESULTS Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified. CONCLUSIONS Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.
Collapse
Affiliation(s)
- Anna R Todd
- A.R. Todd is a third-year resident, Department of Surgery, Section of Plastic Surgery, University of Calgary, Calgary, Canada
| | - Thomas R Cawthorn
- T.R. Cawthorn is a fourth-year resident, Department of Surgery, Section of Plastic Surgery, University of Calgary, Calgary, Canada
| | - Claire Temple-Oberle
- C. Temple-Oberle is full professor, Department of Surgery and Department of Oncology, Section of Plastic Surgery, University of Calgary, Calgary, Canada
| |
Collapse
|
11
|
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. Perspect Sex Reprod 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Willan S, Gibbs A, Petersen I, Jewkes R. Exploring young women's reproductive decision-making, agency and social norms in South African informal settlements. PLoS One 2020; 15:e0231181. [PMID: 32348303 PMCID: PMC7190118 DOI: 10.1371/journal.pone.0231181] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
Abstract
This paper explores reproductive decision-making among young women in South Africa's informal settlements and considers whether and how agency and social norm theory inform their decisions. Understanding whether, when and how young women make decisions about conception and motherhood is critical for supporting women to avoid unplanned, early motherhood. Qualitative data were collected from 15 young women in informal settlements in eThekwini, South Africa at three time points over 18 months, using in-depth interviews, participant observation and photovoice, and were analysed inductively. When the young women were teenagers and into their early twenties, and had not yet had a child, most paid little attention to whether or not they conceived. This shifted as they grew older and/or after having a first child, at which point many of the women began to express, and sometimes act upon, a greater desire to control whether and when they conceived and delay further pregnancies. At different times in their lives, both social norms and reproductive agency, specifically 'distributed agency' played significant roles in influencing their reproductive decision-making. Social norms held the most influence when they were teenagers and experiencing normative pressures to have a baby while young. As they grew older and/or had a first child they began to assert some agentic control around their reproduction. We therefore recommend that in order to improve the effectiveness of services and interventions supporting young women to delay unplanned pregnancies, programmers, researchers and policy makers must develop a better understanding of the role of social norms and agency at different stages of women's lives.
Collapse
Affiliation(s)
- Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| |
Collapse
|
13
|
Ralph LJ, Foster DG, Rocca CH. Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women. Perspect Sex Reprod Health 2020; 52:39-48. [PMID: 32189427 PMCID: PMC8126343 DOI: 10.1363/psrh.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 05/17/2023]
Abstract
CONTEXT Measurement of pregnancy intentions typically relies on retrospective reporting, an approach that may misrepresent the extent of unintended pregnancy. However, the degree of possible misreporting is unclear, as little research has compared prospective and retrospective reports of intention for the same pregnancies. METHODS Longitudinal data collected between 2010 and 2015 on 174 pregnancies were used to analyze the magnitude and direction of changes in intendedness (intended, ambivalent or unintended) between prospective and retrospective measurements of intendedness using versions of the London Measure of Unplanned Pregnancy (LMUP). Changes were assessed both continuously and categorically. Differences in the degree of change-by pregnancy outcome and participant characteristics-were examined using mixed-effects linear and logistic regression models. RESULTS Over two and one-half years of follow-up, 143 participants reported 174 pregnancies. Approximately half showed changes in intention between the prospective and retrospective assessments, with 38% of participants reporting increased intendedness and 10% decreased intendedness. Reported intendedness increased more among those who gave birth (mean change in continuous LMUP score, 2.2) than among those who obtained an abortion (0.7), as well as among individuals with a college degree (4.1) than among those with a high school diploma (1.2). Participants who reported recent depression or anxiety symptoms showed more stable intentions (0.02) than those who did not (2.1). CONCLUSIONS Retrospective measurement of pregnancy intentions may underestimate the frequency of unintended pregnancy, with such underestimation being greater among certain subgroups. Estimates based on retrospective reports thus may produce inaccurate impressions of intentionality. Further efforts to refine the measurement of pregnancy preferences are needed.
Collapse
Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Corinne H Rocca
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| |
Collapse
|
14
|
Horner-Johnson W, Dissanayake M, Wu JP, Caughey AB, Darney BG. Pregnancy Intendedness by Maternal Disability Status and Type in the United States. Perspect Sex Reprod Health 2020; 52:31-38. [PMID: 32096336 DOI: 10.1363/psrh.12130] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 05/07/2023]
Abstract
CONTEXT Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities. METHODS Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates. RESULTS A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9). CONCLUSIONS Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.
Collapse
Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Justine P Wu
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Blair G Darney
- Department of Obstetrics and Gynecology-all at the Oregon Health & Science University, Portland
| |
Collapse
|
15
|
Tobey E, Jain A, Mozumdar A. The relationship between attitudes towards pregnancy and contraceptive continuation: Results from a longitudinal study of married women in India. PLoS One 2020; 15:e0229333. [PMID: 32097433 PMCID: PMC7041815 DOI: 10.1371/journal.pone.0229333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/04/2020] [Indexed: 11/26/2022] Open
Abstract
To understand the relationship between pregnancy intentions and contraceptive use, a growing body of research has begun to examine various domains of women's attitudes towards pregnancy, acknowledging that these attitudes may contradict one another, and women may be ambivalent. This study examines pregnancy ambivalence and assesses the relationship between attitudes towards pregnancy and contraceptive continuation after nine months among a sample of women in Odisha and Haryana, India. Data come from a longitudinal study of married women age 15–49 who began using a modern reversible method of contraception at the time of study enrollment. To assess their cognitive attitudes (beliefs/knowledge) towards pregnancy, women were asked “how important is it you to avoid a pregnancy now?” To assess their affective attitudes (feelings/emotions), women were asked about their agreement with the statement: “If I found out I was pregnant in the next several weeks, I would be happy.” A joint, 4-category measure combining these cognitive and affective attitudes towards pregnancy was created to measure concordance and ambivalence in attitudes towards pregnancy. Multivariate random-effects logistic regression models were employed to examine the relationship of these two measures with method-specific contraceptive continuation nine months later. Two models were conducted, one with the two attitude variables included independently and the second with the joint, 4-category measure included. Results showed that affective and cognitive attitudes were both significantly associated with continuation, but that there were no significant differences between those that were ambivalent and those whose attitudes were concordantly anti-pregnancy. This study suggests that attitudes towards pregnancy are multifaceted and both cognitive and affective attitudes towards pregnancy may play an important role in contraceptive use in India.
Collapse
Affiliation(s)
- Elizabeth Tobey
- Population Council, Washington, DC, United States of America
- * E-mail:
| | - Aparna Jain
- Population Council, Washington, DC, United States of America
| | | |
Collapse
|
16
|
Leenhardt R, Rivière P, Papazian P, Nion-Larmurier I, Girard G, Laharie D, Marteau P. Sexual health and fertility for individuals with inflammatory bowel disease. World J Gastroenterol 2019; 25:5423-5433. [PMID: 31576090 PMCID: PMC6767981 DOI: 10.3748/wjg.v25.i36.5423] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.
Collapse
Affiliation(s)
- Romain Leenhardt
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Pauline Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Patrick Papazian
- Hôpital Bichat, Service des maladies infectieuses et tropicales, APHP, Paris 75018, France
| | - Isabelle Nion-Larmurier
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| | - Guillaume Girard
- Service de gynécologie obstétrique, Hôpital Armand Trousseau, Paris 75012, Ile-de-France, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux 33604, Pessac, France
| | - Philippe Marteau
- Sorbonne Université, Hépatologie, Gastroentérologie et Saint Antoine IBD NeTwork, APHP, Hôpital St Antoine, Paris 75012, Ile-de-France, France
| |
Collapse
|
17
|
Tozzo P, Fassina A, Nespeca P, Spigarolo G, Caenazzo L. Understanding social oocyte freezing in Italy: a scoping survey on university female students' awareness and attitudes. Life Sci Soc Policy 2019; 15:3. [PMID: 31049743 PMCID: PMC6498620 DOI: 10.1186/s40504-019-0092-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/04/2019] [Indexed: 05/19/2023]
Abstract
In Western countries, a social trend toward delaying childbearing has been observed in women of reproductive age for the last two decades. This delay is due to different factors related to lifestyle, such as the development of a professional career or the absence of the right partner. As a consequence, women who defer childbearing may find themselves affected by age-related infertility when they decide to conceive. Fertility preservation techniques are, therefore, proposed as a solution for these women. Among all possible solutions, social freezing is an alternative strongly discussed from a scientific, social and ethical point of view.A survey among 930 female students at the University of Padova (Italy) investigated their knowledge and attitudes on social egg freezing and their potential intentions regarding this procedure. To our knowledge, this is the first study to examine the level of awareness of age-related infertility in Italian young women and their attitudes regarding acceptable indications for elective oocyte freezing, their potential personal use, the circumstances in which they would then decide to use cryopreserved eggs, and their attitudes towards cost coverage and oocyte donation.Data collected in this study revealed some important points about young women and their knowledge about social oocyte freezing in Italy as compared to other European countries and the United States.Overall, 34.3% of the students reported having heard about the possibility of oocyte cryopreservation for non-medical reasons and being aware of the meaning of this procedure; only 19.5% were in favour of social egg freezing and 48.4% thought that the cost for this procedure should be borne entirely by the woman herself. Regarding egg donation, the majority of students (64.9%) would not accept donating their eggs to a known woman or couple and 42.5% would instead accept donating to a biobank.Our study shows that young Italian women are significantly less aware of age-related decline in fertility and the possibility of using social egg freezing compared to their similarly situated counterparts in other Western countries.
Collapse
Affiliation(s)
- Pamela Tozzo
- Department of Molecular Medicine, University of Padova, via Falloppio 50, 35121 Padova, Italy
| | - Antonio Fassina
- Department of Molecular Medicine, University of Padova, via Falloppio 50, 35121 Padova, Italy
| | - Patrizia Nespeca
- Department of Molecular Medicine, University of Padova, via Falloppio 50, 35121 Padova, Italy
| | - Gloria Spigarolo
- Department of Molecular Medicine, University of Padova, via Falloppio 50, 35121 Padova, Italy
| | - Luciana Caenazzo
- Department of Molecular Medicine, University of Padova, via Falloppio 50, 35121 Padova, Italy
| |
Collapse
|
18
|
Abstract
A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation-postponement-that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.
Collapse
Affiliation(s)
- Sarah R Hayford
- Department of Sociology, Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210-1404, USA.
| | - Victor Agadjanian
- Department of Sociology, University of California-Los Angeles, Los Angeles, CA, 90095-1551, USA
| |
Collapse
|
19
|
Abstract
Disparities in the intention to parent have been found for lesbian and gay individuals compared with heterosexual individuals, but little is known about what social contexts predict these differences. Qualities of family relationships, friendships, and romantic relationships may all play a role, but these have not been studied as a function of sexual orientation. Using a large national sample of adults in the United States, this study explored intentions for parenthood, ideal family size, and predictors of parenting intentions as a function of gender and sexual orientation. Results showed that fewer lesbian and gay than heterosexual individuals intended to become parents. In addition, among those who intended parenthood, lesbian and gay individuals reported smaller intended family sizes than did their heterosexual peers. Sociocontextual and demographic variables predicted parenting intentions similarly among all participants, regardless of sexual orientation. However, dissimilarities in the levels of these predictors explained some of the disparity in parenting intentions between lesbian/gay and heterosexual participants. Much remains to be learned about the role of sexual orientation in family formation processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
20
|
Gómez AM, Arteaga S, Villaseñor E, Arcara J, Freihart B. The Misclassification of Ambivalence in Pregnancy Intentions: A Mixed-Methods Analysis. Perspect Sex Reprod Health 2019; 51:7-15. [PMID: 30762937 PMCID: PMC6476569 DOI: 10.1363/psrh.12088] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 05/23/2023]
Abstract
CONTEXT Researchers have developed various measures of pregnancy ambivalence in an effort to capture the nuance overlooked by conventional, binary measures of pregnancy intention. However, the conceptualization and operationalization of the concept of ambivalence vary widely and may miss the complexity inherent in pregnancy intentions, particularly for young people, among whom unintended pregnancy rates are highest. METHODS To investigate the utility and accuracy of current measures of pregnancy ambivalence, a mixed-methods study was conducted with 50 young women and their male partners in northern California in 2015-2016. Survey data were used to descriptively analyze six existing pregnancy ambivalence measures; in-depth interviews addressing pregnancy desires and plans were deductively coded and thematically analyzed to understand why some participants appeared to be ambivalent from the survey data when their interview responses suggested otherwise. RESULTS Eighty participants would be considered ambivalent by at least one measure. After assessment of the interview data, however, these measures were deemed to have misclassified almost all (78) participants. Qualitative analysis revealed several themes regarding misclassification: conflation of current pregnancy desires with expected postconception emotional responses; acceptability of an undesired pregnancy; tempering of survey responses to account for partners' desires; perceived lack of control regarding pregnancy; and, among participants with medical conditions perceived to impact fertility, subjugation of pregnancy desires in the interest of self-protection. CONCLUSIONS Current approaches to measuring pregnancy ambivalence may fail to capture the intricacies of pregnancy intentions and may be ineffective if they do not account for young people's experiences, especially when used to inform clinical practice, programs and policy.
Collapse
Affiliation(s)
- Anu Manchikanti Gómez
- Assistant Professor and Director, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Stephanie Arteaga
- Research Associate, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Elodia Villaseñor
- Project Director, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Jennet Arcara
- Research Associate, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Bridget Freihart
- Graduate Student Researcher, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| |
Collapse
|
21
|
Dean M, Rauscher EA. Men's and Women's Approaches to Disclosure About BRCA-Related Cancer Risks and Family Planning Decision-Making. Qual Health Res 2018; 28:2155-2168. [PMID: 30051759 DOI: 10.1177/1049732318788377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about how men and women who test positive for a BRCA gene mutation or have a strong family history of carrying a BRCA mutation manage disclosures about their BRCA-related cancer risks and family planning decision-making. By conducting interviews with 25 men and 20 women, this study investigated men's and women's approaches to disclosing their BRCA-related cancer risks and family planning decision-making. Guided by the Disclosure Decision-Making Model (DD-MM), this study demonstrates that men and women assess both information and the recipients of disclosures when making disclosure decisions. Theoretical implications for the DD-MM are discussed along with practical implications for hereditary cancer risk and family planning.
Collapse
|
22
|
Simopoulou M, Sfakianoudis K, Bakas P, Giannelou P, Papapetrou C, Kalampokas T, Rapani A, Chatzaki E, Lambropoulou M, Lourida C, Deligeoroglou E, Pantos K, Koutsilieris M. Postponing Pregnancy Through Oocyte Cryopreservation for Social Reasons: Considerations Regarding Clinical Practice and the Socio-Psychological and Bioethical Issues Involved. Medicina (Kaunas) 2018; 54:E76. [PMID: 30366459 PMCID: PMC6262467 DOI: 10.3390/medicina54050076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 11/21/2022]
Abstract
Oocyte freezing for 'social reasons' refers to women of reproductive age who are aiming to prolong, protect and secure their fertility. The term emerged to describe application of the highly promising technique, namely vitrification on oocytes retrieved through controlled ovarian stimulation (COS) from women intending to preserve their fertility for social reasons. These women opt to cryopreserve their oocytes at a point in their life when they need to postpone childbearing on the grounds of so called 'social' reasons. These reasons may include a highly driven career, absence of an adequate partner, financial instability, or personal reasons that make them feel unprepared for motherhood. This is a sensitive and multifaceted issue that entails medical, bioethical and socio-psychological components. The latest trend and the apparent increase noted on oocyte freezing for 'social reasons' has prompted our team of fertility specialists, embryologists, obstetricians, gynecologists and psychologists to proceed with a thorough, critical and all-inclusive comprehensive analysis. The wide range of findings of this analysis involve concerns of embryology and epigenetics that shape decisions made in the IVF laboratory, issues regarding obstetric and perinatal concerns on the pregnancy concluding from these oocytes and the respective delivery management and neonatal data, to the social and bioethical impact of this trend's application. This literature review refers to matters rising from the moment the 'idea' of this option is 'birthed' in a woman's thoughts, to proceeding and executing it clinically, up until the point of the pediatric follow up of the children born. We aim to shed light to the controversial issue of oocyte freezing, while objectively exhibit all aspects regarding this complex matter, as well as to respectfully approach how could the prospect of our future expectations be shaped from the impact of its application.
Collapse
Affiliation(s)
- Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | | | - Panagiotis Bakas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Polina Giannelou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
- Centre for Human Reproduction, Genesis Athens Clinic, 14⁻16, Papanikoli, 15232 Athens, Greece.
| | - Christina Papapetrou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Theodoros Kalampokas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Ekaterini Chatzaki
- Laboratory of Histology-Embryology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Chrysoula Lourida
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Efthymios Deligeoroglou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, 14⁻16, Papanikoli, 15232 Athens, Greece.
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| |
Collapse
|
23
|
Abstract
There has been evidence demonstrating that China has had a persistently low and below-replacement level fertility since early 1990s, causing concerns of a rapidly aging population and sustainability of the Chinese economy. To avoid adverse effects of excessively low fertility, the Chinese government has recently changed its family planning policy from "one-child policy" to "two-child policy." Nonetheless, the effectiveness of the newly initiated two-child policy is questionable if women's average desired number of children or desired fertility for their lifetime is below the threshold fertility allowed by the two-child policy. Therefore, this study argues that it would be interesting and pertinent to know women's fertility desires under the circumstances of no policy restrictions and understand major factors that may affect their desired fertility. Based on a multi-stage stratified cluster sampling survey with 2,516 women respondents in rural Shaanxi, this study tries to estimate desired fertility of rural women and evaluate the impact of important socioeconomic factors on their desired fertility. The results of this study reveal that the average lifetime desired fertility for rural women of childbearing age in Shaanxi is about 1.71, below the total fertility rate at the replacement level. The findings of this study suggest that women's marriage age, the pecuniary costs of having children, women's income forgone for having children, and social security benefits available for rural residents at retirement age, are significantly and negatively related to desired fertility. However, rural women's cultural views towards fertility are significantly but positively related to their desired fertility. This study further confirms that China has entered an era of low fertility, and thus, any policy restrictions on fertility may no longer be necessary. Instead, government programs which support childbearing and childrearing are needed to prevent excessive low fertility and rapid aging of the population.
Collapse
Affiliation(s)
- Jieqiong Wei
- College of Economics and Management, Northwest A&F University, Shaanxi, China
| | - Jianhong Xue
- College of Economics and Management, Northwest A&F University, Shaanxi, China
- * E-mail:
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
24
|
Ghiossi CE, Goldberg JD, Haque IS, Lazarin GA, Wong KK. Clinical Utility of Expanded Carrier Screening: Reproductive Behaviors of At-Risk Couples. J Genet Couns 2018; 27:616-625. [PMID: 28956228 PMCID: PMC5943379 DOI: 10.1007/s10897-017-0160-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
Expanded carrier screening (ECS) analyzes dozens or hundreds of recessive genes to determine reproductive risk. Data on the clinical utility of screening conditions beyond professional guidelines are scarce. Individuals underwent ECS for up to 110 genes. Five-hundred thirty-seven at-risk couples (ARC), those in which both partners carry the same recessive disease, were invited to participate in a retrospective IRB-approved survey of their reproductive decision making after receiving ECS results. Sixty-four eligible ARC completed the survey. Of 45 respondents screened preconceptionally, 62% (n = 28) planned IVF with PGD or prenatal diagnosis (PNDx) in future pregnancies. Twenty-nine percent (n = 13) were not planning to alter reproductive decisions. The remaining 9% (n = 4) of responses were unclear. Of 19 pregnant respondents, 42% (n = 8) elected PNDx, 11% (n = 2) planned amniocentesis but miscarried, and 47% (n = 9) considered the condition insufficiently severe to warrant invasive testing. Of the 8 pregnancies that underwent PNDx, 5 were unaffected and 3 were affected. Two of 3 affected pregnancies were terminated. Disease severity was found to have significant association (p = 0.000145) with changes in decision making, whereas guideline status of diseases, controlled for severity, was not (p = 0.284). Most ARC altered reproductive planning, demonstrating the clinical utility of ECS. Severity of conditions factored into decision making.
Collapse
Affiliation(s)
- Caroline E Ghiossi
- California State University Stanislaus, 1 University Cir, Turlock, CA, 95382, USA.
| | | | - Imran S Haque
- Counsyl, 180 Kimball Way, South San Francisco, 94080, CA, USA
| | | | - Kenny K Wong
- Counsyl, 180 Kimball Way, South San Francisco, 94080, CA, USA
| |
Collapse
|
25
|
Genowska A, Szafraniec K, Polak M, Szpak A, Walecka I, Owoc J. Study on changing patterns of reproductive behaviours due to maternal features and place of residence in Poland during 1995-2014. Ann Agric Environ Med 2018; 25:137-144. [PMID: 29575861 DOI: 10.26444/aaem/75544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland. MATERIAL AND METHODS Information about live births in Poland in the years 1995-2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used. RESULTS In 1995-2014, a shift in the age of highest fertility from 20-24 years to 25-29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15-29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30-49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5-29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005-2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped. CONCLUSIONS The postponement of births and reduction of fertility in women aged 15-29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas. ABBREVIATIONS APC - annual percentage change; AAPC - average annual percentage change; CSO - Central Statistical Office; TFR - total fertility rate.
Collapse
Affiliation(s)
| | - Krystyna Szafraniec
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Szpak
- Department of Epidemiology, Demography and Biostatistics, Institute of Rural Health, Lublin, Poland
| | - Irena Walecka
- Clinic of Dermatology, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw , Poland
| | - Jakub Owoc
- College of Public Health, Zielona Góra, Poland
| |
Collapse
|
26
|
Rosenfeld EA, Miller E, Zhao X, Sileanu FE, Mor MK, Borrero S. Male partner reproductive coercion among women veterans. Am J Obstet Gynecol 2018; 218:239.e1-239.e8. [PMID: 29056537 DOI: 10.1016/j.ajog.2017.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Male partner reproductive coercion is defined as male partners' attempts to promote pregnancy through interference with women's contraceptive behaviors and reproductive decision-making. Male partners may try to promote pregnancy through birth control sabotage such as taking away or destroying their partners' contraceptives, refusing to wear condoms, and/or verbally pressuring their partners to abstain from contraceptive use. Reproductive coercion is associated with an elevated risk for unintended pregnancy. Women who experience intimate partner violence, who are in racial/ethnic minorities, and who are of lower socioeconomic status are more likely to experience reproductive coercion. Women veterans who use Veterans Affairs for health care may be particularly vulnerable to reproductive coercion because they are disproportionally from racial/ethnic minority groups and experience high rates of intimate partner violence. OBJECTIVES We sought to examine the prevalence, correlates, and impact of reproductive coercion among women veterans who are served by the Veterans Affairs healthcare system. STUDY DESIGN We analyzed data from a national telephone survey of women veterans aged 18-44 years, with no history of sterilization or hysterectomy, who had received care within the Veterans Affairs system in the previous 12 months. Participants who had sex with men in the last year were asked if they experienced male partner reproductive coercion. Adjusted logistic regression was used to examine the relationship between participant characteristics and male partner reproductive coercion and the relationship between reproductive coercion and the outcomes of contraceptive method used at last sex and pregnancy and unintended pregnancy in the last year. RESULTS Among the 1241 women veterans in our study cohort, 11% reported experiencing male partner reproductive coercion in the past year. Black women, younger women, and single women were more likely to report reproductive coercion than their white, older, and married counterparts. Women who experienced military sexual trauma were also more likely to report reproductive coercion compared with women who did not report military sexual trauma. In adjusted analyses, compared with women who did not experience reproductive coercion, those who did were less likely at last sex to have used any method of contraception (76% vs 80%; adjusted odds ratio, 0.61; 95% confidence interval, 0.38-0.96), prescription contraception (43% vs 55%; adjusted odds ratio, 0.62; 95% confidence interval, 0.43-0.91), and their ideal method of contraception (35% vs 45%; adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.93). Those who reported coercion were more likely to have had a pregnancy in the last year (14% vs 10%; adjusted odds ratio, 2.07; 95% confidence interval, 1.17-3.64); there were no significant differences in unintended pregnancy by coercion status (6% vs 4%; adjusted odds ratio, 1.63; 95% confidence interval, 0.71-3.76). CONCLUSION Eleven percent of women veterans in our sample experienced male partner reproductive coercion, which may impact their use of contraception and ability to prevent pregnancy.
Collapse
Affiliation(s)
- Elian A Rosenfeld
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System.
| | - Elizabeth Miller
- Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System; Center for Research on Health Care, University of Pittsburgh School of Medicine
| |
Collapse
|
27
|
Higgins JA. Pregnancy Ambivalence and Long-Acting Reversible Contraceptive (LARC) Use Among Young Adult Women: A Qualitative Study. Perspect Sex Reprod Health 2017; 49:149-156. [PMID: 28419700 PMCID: PMC5597464 DOI: 10.1363/psrh.12025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 05/16/2023]
Abstract
CONTEXT Many young adults are unclear about how much they want to have, or prevent having, a baby. However, pregnancy ambivalence is an underexamined factor in the uptake of long-acting reversible contraceptive (LARC) methods-IUDs and implants-the most effective methods available. METHODS In 2014, investigators conducted six focus groups and 12 interviews with 50 women aged 18-29 in Dane County, Wisconsin; participants were either university students or community residents receiving public assistance. A modified grounded theory approach was used to analyze the data. RESULTS Four themes emerged. First, participants described a pregnancy desire spectrum: Those strongly motivated to avoid pregnancy were most receptive to LARC methods, while those with less clear or mixed desires worried that these methods would prevent "accidental" pregnancies that might not be unwelcome. Second, women within a few years of wanting children perceived LARC methods as too "permanent," despite awareness of their reversibility. Third, age and life stage were important factors: Younger women and those attending school or beginning careers were more likely than others to consider these methods because they had clearer motivations to avoid pregnancy. Finally, relationship stage influenced receptiveness to LARC methods: Women in newer relationships were more receptive than were those in longer term relationships who imagined having a baby with their partner someday. CONCLUSION Effectiveness is not the only factor in women's selection and use of contraceptive methods. Individual preferences will lead some women to choose non-LARC methods even when fully informed of their options.
Collapse
Affiliation(s)
- Jenny A Higgins
- associate professor of gender and women's studies, University of Wisconsin-Madison
| |
Collapse
|
28
|
Riskind RG, Tornello SL. Sexual orientation and future parenthood in a 2011-2013 nationally representative United States sample. J Fam Psychol 2017; 31:792-798. [PMID: 28368202 DOI: 10.1037/fam0000316] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Previous researchers have found evidence for differences in parenting goals between lesbian and gay people and their heterosexual peers. However, no previous research has quantified the parenting goals of bisexual people or evaluated parenting goals as a function of sexual partner gender. In addition, political and social climates for sexual minority people had improved rapidly since the last representative data on lesbian and gay peoples' plans for parenthood were collected. We analyzed data from 3,941 childless lesbian, gay, bisexual, and heterosexual participants from the 2011-2013 National Survey of Family Growth (NSFG; United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2014), a nationally representative sample of United States residents aged 15 to 44 years. We found that statistically significant, within-gender sexual orientation differences in parenting plans persist, despite social and legal changes. Consistent with hypotheses, bisexual men's parenting desires and intentions were similar to those of their heterosexual male peers and different from those of their gay male peers, while bisexual women's reports were more mixed. Also consistent with hypotheses, the gender of the most recent sexual partner was a strong predictor of parenting goals. We discuss implications for mental and reproductive health-care providers, attorneys, social workers, and others who interact with sexual minority adults. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Samantha L Tornello
- Department of Psychology and Women, Gender, and Sexuality Studies, Pennsylvania State University-Altoona
| |
Collapse
|
29
|
Sutton JA, Walsh-Buhi ER. Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction. J Am Coll Health 2017; 65:339-347. [PMID: 28362154 DOI: 10.1080/07448481.2017.1312414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women. PARTICIPANTS A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015. METHODS Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC). RESULTS While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information. CONCLUSIONS This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.
Collapse
Affiliation(s)
- Jazmyne A Sutton
- a Annenberg School for Communication , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Eric R Walsh-Buhi
- b Graduate School of Public Health , San Diego State University , San Diego , California , USA
| |
Collapse
|
30
|
Abstract
This paper examines the decline in non-numeric responses to questions about fertility preferences among women in the developing world. These types of response-such as 'don't know' or 'it's up to God'-have often been interpreted through the lens of fertility transition theory as an indication that reproduction has not yet entered women's 'calculus of conscious choice'. However, this has yet to be investigated cross-nationally and over time. Using 19 years of data from 32 countries, we find that non-numeric fertility preferences decline most substantially in the early stages of a country's fertility transition. Using country-specific and multilevel models, we explore the individual- and contextual-level characteristics associated with women's likelihood of providing a non-numeric response to questions about their fertility preferences. Non-numeric fertility preferences are influenced by a host of social factors, with educational attainment and knowledge of contraception being the most robust and consistent predictors.
Collapse
|
31
|
Mertes H. The role of anticipated decision regret and the patient's best interest in sterilisation and medically assisted reproduction. J Med Ethics 2017; 43:314-318. [PMID: 28442552 DOI: 10.1136/medethics-2016-103551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 06/07/2023]
Abstract
There is a clear discrepancy in the way those who request medical assistance in pursuit of their reproductive choices are treated. On the one hand, women who request a sterilisation are urged to consider possible future regrets and are sometimes refused treatment in anticipation of such regrets. This is despite the fact that for all age ranges, the majority of women undergoing a sterilisation do not regret the decision. Moreover, women who are voluntarily childless are likely to have a happier and more gratifying life than parents. On the other hand, women who request fertility treatment are not urged to second guess their desire for parenthood. Although the fact that the probability of regret is expected to be higher in the former case than in the latter justifies this difference in treatment to a certain extent, the gap between the two different approaches is wider than it ought to be if we also take future well-being into consideration, instead of focussing exclusively on anticipated decision regret.
Collapse
|
32
|
Abstract
Sterilisation requests made by young, child-free adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper, I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes towards sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people's sterilisation requests differently in virtue of their gender.
Collapse
|
33
|
van Roode T, Sharples K, Dickson N, Paul C. Life-Course Relationship between Socioeconomic Circumstances and Timing of First Birth in a Birth Cohort. PLoS One 2017; 12:e0170170. [PMID: 28085935 PMCID: PMC5234805 DOI: 10.1371/journal.pone.0170170] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study examines the influence of socioeconomic circumstances in childhood (childhood SES) and adulthood (adult SES) on timing of first birth by age 37. METHODS A longitudinal study of a 1972-1973 New Zealand birth cohort collected information on socioeconomic characteristics from age 3-32 and reproductive histories at 21, 26, 32 and 38; information on first birth was available from 978 of the original 1037. Relative Risks (RR) and 95% Confidence Intervals (CI) were calculated using Poisson regression to examine first live birth prior to age 21, from 21-25, from 26-31, and from 32-37, by socioeconomic characteristics at different ages. RESULTS Overall, 68.5% of men had fathered a child and 75.9% of women had given birth, by age 37; with overall differences in parenthood to age 31 for men, and 37 for women evident by childhood SES. While parenthood by age 20 was strongly associated with lower childhood SES for both sexes, first entry into motherhood from 32-37 was more likely with higher adult SES at age 32 (RR = 1.8, 95% CI 1.1-3.0 for medium and RR = 1.9, 95% CI 1.1-3.3 for high compared with low). Education also differientated age at parenthood, with those with higher education more likely to defer fatherhood past age 31, and motherhood past age 25 followed by a period of increased likelihood of motherhood for women with higher levels of education from age 32-37 (RR = 1.4, 95% CI 0.87-2.2 and RR = 1.7, 95% CI 1.1-2.6 for medium and high respectively compared with low). CONCLUSIONS SES varies across the lifecourse, and SES at the time has the strongest association with first births at that time. Low childhood SES drives adolescent parenthood, with resulting cumulative differences in parenthood past age 30. Those with more education and higher adult SES are deferring parenthood but attempt to catch up in the mid to late thirties.
Collapse
Affiliation(s)
- Thea van Roode
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Katrina Sharples
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Nigel Dickson
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| | - Charlotte Paul
- Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand
| |
Collapse
|
34
|
Mattix Kramer HJ, Tolkoff-Rubin NE, Williams WW, Cosimi AB, Pascual MA. Reproductive and Contraceptive Characteristics of Premenopausal Kidney Transplant Recipients. Prog Transplant 2016; 13:193-6. [PMID: 14558633 DOI: 10.1177/152692480301300305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To obtain information on menstrual patterns before and after transplantation, desire for future pregnancy, and use of contraception among premenopausal kidney transplant recipients. Study Design This observational study collected information using self-administered anonymous questionnaires during a routine outpatient clinic visit. Results Of the 107 women who completed the questionnaire, 41 identified themselves as being premenopausal. Among the 41 premenopausal women, approximately half of the women reported their current menstrual patterns as normal and 26% were not using any form of contraception. Overall, 10 women (24%) reported a desire to become pregnant and 4 women (10%) had a successful pregnancy after transplantation. Most of the women who desired a future pregnancy (8/10) were receiving an immunosuppressive regimen that included mycophenolate mofetil. Conclusion Kidney transplantation in the current era is associated with a return of normal menstrual function in the majority of female transplant recipients. A substantial fraction of women desire pregnancy after transplantation and many are using an immunosuppressive drug with limited safety data on use during pregnancy. More caution should be used with the use of newer immunosuppressive agents in sexually active premenopausal transplant recipients until more safety data are available.
Collapse
Affiliation(s)
- Holly J Mattix Kramer
- Loyola University Medical Center, Maywood, III, Massachusetts General Hospital, Boston, Mass, USA
| | | | | | | | | |
Collapse
|
35
|
Kromer J, Hummel T, Pietrowski D, Giani AS, Sauter J, Ehninger G, Schmidt AH, Croy I. Influence of HLA on human partnership and sexual satisfaction. Sci Rep 2016; 6:32550. [PMID: 27578547 PMCID: PMC5006172 DOI: 10.1038/srep32550] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
The major histocompatibility complex (MHC, called HLA in humans) is an important genetic component of the immune system. Fish, birds and mammals prefer mates with different genetic MHC code compared to their own, which they determine using olfactory cues. This preference increases the chances of high MHC variety in the offspring, leading to enhanced resilience against a variety of pathogens. Humans are also able to discriminate HLA related olfactory stimuli, however, it is debated whether this mechanism is of behavioural relevance. We show on a large sample (N = 508), with high-resolution typing of HLA class I/II, that HLA dissimilarity correlates with partnership, sexuality and enhances the desire to procreate. We conclude that HLA mediates mate behaviour in humans.
Collapse
Affiliation(s)
- J. Kromer
- Smell & Taste Clinic, Department of Otorhinolaryngology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
| | - T. Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
| | - D. Pietrowski
- Smell & Taste Clinic, Department of Otorhinolaryngology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
| | - A. S. Giani
- DKMS German Bone Marrow Donor Center, Kressbach 1, 72072 Tübingen, Germany
| | - J. Sauter
- DKMS German Bone Marrow Donor Center, Kressbach 1, 72072 Tübingen, Germany
| | - G. Ehninger
- Department of Internal Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
| | - A. H. Schmidt
- DKMS German Bone Marrow Donor Center, Kressbach 1, 72072 Tübingen, Germany
| | - I. Croy
- Smell & Taste Clinic, Department of Otorhinolaryngology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany
| |
Collapse
|
36
|
Murray-Johnson L, Witte K, Boulay M, Figueroa ME, Storey D, Tweedie I. Using Health Education Theories to Explain Behavior Change: A Cross-Country Analysis. Int Q Community Health Educ 2016; 25:185-207. [PMID: 17686703 DOI: 10.2190/1500-1461-44gk-m325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.
Collapse
|
37
|
Abstract
The study purpose was to generate a theoretical understanding of women’s experiences and perceptions of intimate partner abuse during the childbearing cycle. Dimensional analysis, a grounded theory method, was used. Twenty-one interviews were conducted with 12 women who were (a) currently in an abusive relationship with an intimate male partner and pregnant or postpartum (n = 5) or who had (b) experienced abuse by an intimate male partner during a past pregnancy or postpartum (n = 7). Disparities between the two concurrent phenomena of abuse and pregnancy led women to feel as though they were living two separate lives. Pregnancy provided the impetus for reinvesting in the partnered relationship and constructing a family. Leaving an abusive relationship was not considered unless the partner ended the relationship first or the woman perceived an increased risk of danger. Postpartum up to 2 years after birth was a critical transitional time for women.
Collapse
|
38
|
Patchen L, Rebok G, Astone NM. Differences in Obesity Rates Among Minority and White Women: The Latent Role of Maternal Stress. J Midwifery Womens Health 2016; 61:489-96. [PMID: 27355406 DOI: 10.1111/jmwh.12461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
White and minority women experience different rates of obesity in the United States. Yet our understanding of the dynamics that give rise to this gap remains limited. This article presents a conceptual framework that considers pathways leading to these different rates. It draws upon the life-course perspective, allostatic load, and the weathering hypothesis to identify pathways linking childbearing, stress, and obesity. This conceptual framework extends prior work by identifying age at first birth as an important parameter that influences these pathways. Empirical evidence to test these pathways is needed.
Collapse
|
39
|
Moreano B. [Why delay pregnancy?]. MMW Fortschr Med 2016; 158:3. [PMID: 27462656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
40
|
Gotlib A. "But You Would Be the Best Mother": Unwomen, Counterstories, and the Motherhood Mandate. J Bioeth Inq 2016; 13:327-347. [PMID: 26797511 DOI: 10.1007/s11673-016-9699-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
This paper addresses and challenges the pronatalist marginalization and oppression of voluntarily childless women in the Global North. These conditions call for philosophical analyses and for sociopolitical responses that would make possible the necessary moral spaces for resistance. Focusing on the relatively privileged subgroups of women who are the targets of pronatalist campaigns, the paper explores the reasons behind their choices, the nature and methods of Western pronatalism, and distinguishes three specific sources of some of the more lasting, and stigmatizing attacks: popular culture, law and policy, and medicine itself. I then argue that because they are construed by motherhood-essentializing, and increasingly popular, pronatalist narratives as, among other things, "failed" or "selfish," voluntarily childless women are subsequently burdened with damaged identities that can leave them personally othered and uniquely liminal in ways that are destructive to moral agency. Finally, I conclude with a challenge to the pronatalist master narratives by suggesting the possibility of counter narratives to the voluntarily childless woman's liminality that might serve as the ground of moral and political solidarity among differently situated women, regardless of their motherhood status.
Collapse
Affiliation(s)
- Anna Gotlib
- Department of Philosophy, Brooklyn College CUNY, Brooklyn, NY, USA.
| |
Collapse
|
41
|
Kim IJ, Kim HA, Suh CH, Park YW, Lee HS, Bang SY, Bae SC, Kang YM, Lee WK, Park H, Lee J. Impact of Childbearing Decisions on Family Size of Korean Women with Systemic Lupus Erythematosus. J Korean Med Sci 2016; 31:729-34. [PMID: 27134494 PMCID: PMC4835598 DOI: 10.3346/jkms.2016.31.5.729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) predominantly affects women in their reproductive years and has a significant impact on childbearing. We investigated the influence of personal decision on family size among Korean women with SLE and factors that affect the decisions. A case-control study comparing childbearing history and decisions of 112 SLE patients and 135 controls was performed. Women with SLE participating in the Network for Lupus Clinical Research in South Korea and matching controls between ages of 18-45, who are/were married or living with a partner were included. Data regarding socio-demographics, reproductive history, and childbearing decisions were collected through a survey using a standardized questionnaire and medical record review. More women with SLE reported at least one pregnancy (85.7% vs. 71.9%, P = 0.009) or at least one live birth (85.7% vs. 71.9%, P = 0.003) compared with controls. Mean number of pregnancies was significantly higher (2.4 ± 1.6 vs. 1.4 ± 1.3, P < 0.001), and mean number of live births was significantly lower in women with SLE (1.2 ± 0.8 vs. 1.6 ± 0.8, P < 0.001). Significantly more women with SLE made the decision not to have children compared with controls (54.5% vs. 40.7%, P = 0.031), and health-related concerns were the major cause of the decision. Other socio-demographic factors did not influence the decision to limit childbearing in SLE women. The disease-related concerns had significant impact on family size and childbearing decisions among Korean women with SLE.
Collapse
Affiliation(s)
- In Je Kim
- Department of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Young Mo Kang
- Department of Rheumatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jisoo Lee
- Department of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Bentley RA, Brock WA, Caiado CCS, O'Brien MJ. Evaluating reproductive decisions as discrete choices under social influence. Philos Trans R Soc Lond B Biol Sci 2016; 371:20150154. [PMID: 27022081 PMCID: PMC4822434 DOI: 10.1098/rstb.2015.0154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 11/12/2022] Open
Abstract
Discrete choice, coupled with social influence, plays a significant role in evolutionary studies of human fertility, as investigators explore how and why reproductive decisions are made. We have previously proposed that the relative magnitude of social influence can be compared against the transparency of pay-off, also known as the transparency of a decision, through a heuristic diagram that maps decision-making along two axes. The horizontal axis represents the degree to which an agent makes a decision individually versus one that is socially influenced, and the vertical axis represents the degree to which there is transparency in the pay-offs and risks associated with the decision the agent makes. Having previously parametrized the functions that underlie the diagram, we detail here how our estimation methods can be applied to real-world datasets concerning sexual health and contraception.
Collapse
Affiliation(s)
- R Alexander Bentley
- Department of Comparative Cultural Studies, University of Houston, Houston, TX 77204, USA
| | - William A Brock
- Department of Economics, University of Missouri, Columbia, MO 65211, USA Department of Economics, University of Wisconsin, Madison, WI 53706, USA
| | - Camila C S Caiado
- Department of Mathematical Sciences, Durham University, Durham DH1 3LE, UK
| | - Michael J O'Brien
- Department of Anthropology, University of Missouri, Columbia, MO 65211, USA
| |
Collapse
|
43
|
Snopkowski K, Towner MC, Shenk MK, Colleran H. Pathways from education to fertility decline: a multi-site comparative study. Philos Trans R Soc Lond B Biol Sci 2016; 371:20150156. [PMID: 27022083 PMCID: PMC4822436 DOI: 10.1098/rstb.2015.0156] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 11/12/2022] Open
Abstract
Women's education has emerged as a central predictor of fertility decline, but the many ways that education affects fertility have not been subject to detailed comparative investigation. Taking an evolutionary biosocial approach, we use structural equation modelling to examine potential pathways between education and fertility including: infant/child mortality, women's participation in the labour market, husband's education, social network influences, and contraceptive use or knowledge across three very different contexts: Matlab, Bangladesh; San Borja, Bolivia; and rural Poland. Using a comparable set of variables, we show that the pathways by which education affects fertility differ in important ways, yet also show key similarities. For example, we find that across all three contexts, education is associated with delayed age at first birth via increasing women's labour-force participation, but this pathway only influences fertility in rural Poland. In Matlab and San Borja, education is associated with lower local childhood mortality, which influences fertility, but this pathway is not important in rural Poland. Similarities across sites suggest that there are common elements in how education drives demographic transitions cross-culturally, but the differences suggest that local socioecologies also play an important role in the relationship between education and fertility decline.
Collapse
Affiliation(s)
- Kristin Snopkowski
- Department of Anthropology, Boise State University, 1910 University Drive, Boise, ID 83725, USA
| | - Mary C Towner
- Department of Integrative Biology, Oklahoma State University, Stillwater, OK 74078, USA
| | - Mary K Shenk
- Department of Anthropology, University of Missouri, Columbia, MO 65211, USA
| | - Heidi Colleran
- Institute for Advanced Study in Toulouse, Toulouse School of Economics, Toulouse 31015, France
| |
Collapse
|
44
|
|
45
|
Abstract
OBJECTIVE To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23 years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. DESIGN A cross-sectional study. SETTING A Center of Reproductive Medicine (RMC) at a Swedish University hospital. PARTICIPANTS 520 women who had undergone at least one IVF cycle at the University Hospital in Linköping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. INTERVENTIONS Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the women's self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. OUTCOME MEASURES The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. RESULTS Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p≤0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). CONCLUSIONS The majority of the women who have been treated with IVF 20-23 years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.
Collapse
Affiliation(s)
- J Vikström
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - A Josefsson
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M Bladh
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - G Sydsjö
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| |
Collapse
|
46
|
Barrett G, Shawe J, Howden B, Patel D, Ojukwu O, Pandya P, Stephenson J. Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services. BMC Pregnancy Childbirth 2015; 15:236. [PMID: 26432278 PMCID: PMC4592566 DOI: 10.1186/s12884-015-0672-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/25/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care. METHODS We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method. RESULTS We identified three groups in relation to pre-pregnancy health and care: 1) The "prepared" group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The "poor knowledge" group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The "absent pre-pregnancy period" group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups. CONCLUSION Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the "prepared" group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the "poor knowledge" group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the "absent pre-pregnancy period" group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.
Collapse
Affiliation(s)
- Geraldine Barrett
- Department of Clinical Sciences, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Jill Shawe
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| | - Beth Howden
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Dilisha Patel
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Obiamaka Ojukwu
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| | - Pranav Pandya
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
| | - Judith Stephenson
- Reproductive Health, Institute for Women's Health, UCL, London, WC1E 6AU, UK.
| |
Collapse
|
47
|
Abstract
The social construction of womanhood in Africa can be said to have two central defining elements: being a wife and being a mother. The interplay between HIV and these elements is not well understood outside of prevention efforts. We conducted a qualitative study of womanhood in Botswana; specifically the sexual and reproductive lives of women living with HIV. Twelve focus-group discussions were held with 61 women, with a median age of 35, taking anti-retroviral therapy. Major themes describing womanhood, before and after HIV diagnosis, were identified using grounded theory strategies. Findings illustrate that womanhood is synonymous with motherhood and that women are expected to have sex in order to please a partner. HIV was said to create a barrier to fulfilling these expectations as it caused anxiety over disclosing one's HIV status and/or infecting the partner. The sense of pride and dignity that traditionally accompanied pregnancy was said to be lost and a common refrain was concern about passing HIV to an unborn child, having pregnancy complications or advancing HIV infection. Fear, shame and stigma play a large role in these negative perceptions. Interventions to address stigma, societal views of women and the integration of holistic family planning into HIV care are needed.
Collapse
Affiliation(s)
- Michelle Marian Schaan
- a School of Nursing and Public Health , University of Kwazulu Natal , Durban , South Africa
| | - Myra Taylor
- a School of Nursing and Public Health , University of Kwazulu Natal , Durban , South Africa
| | | | - Richard Marlink
- c Department of Immunology and Infectious Diseases , Harvard School of Public Health , Boston , USA
| |
Collapse
|
48
|
Dommermuth L, Klobas J, Lappegård T. Realization of fertility intentions by different time frames. Adv Life Course Res 2015; 24:34-46. [PMID: 26047988 DOI: 10.1016/j.alcr.2015.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 01/29/2015] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
This paper focuses on the realization of positive fertility intentions with different time frames. The analyses are based on a unique combination of survey data and information from Norwegian administrative registers on childbearing in the years following the complete selected sample. Guided by the theoretical and empirical framework of the Theory of Planned Behavior (TPB), the results suggest that a fertility intention's time frame is relevant for childbearing behaviour, but the patterns are somewhat different for respondents who were childless at the time of the interview compared to those who already had children. Overall, childless were less likely to realize their fertility intentions than parents. Following the TPB, childless may underestimate the difficulty of acting on their intentions and therefore have more difficulty realizing their intentions, versus parents who take into account their ability to manage another child. The results also show that childless with an immediate fertility intention are more likely to succeed than those with a longer-term intention. Likewise, parents with an immediate fertility intention are more likely to realize their intention during the two first years after the interview, but after four years the childbearing rate was higher among those with longer-term fertility intentions.
Collapse
Affiliation(s)
- Lars Dommermuth
- Research Department, Statistics Norway, PB 8131 Dep., 0033 Oslo, Norway.
| | - Jane Klobas
- Murdoch University, PO Box 1164, Nedlands 6909, Western Australia, Australia.
| | - Trude Lappegård
- Research Department, Statistics Norway, PB 8131 Dep., 0033 Oslo, Norway.
| |
Collapse
|
49
|
Bertamini M, Lyons M. How men and women respond to hypothetical parental discovery: the importance of genetic relatedness. Evol Psychol 2015; 13:424-34. [PMID: 26030669 PMCID: PMC10496477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/26/2015] [Indexed: 06/04/2023] Open
Abstract
Paternal uncertainty has shaped human behavior both in evolutionary and cultural terms. There has been much research investigating parenting as a function of genetic relatedness to the child, with a focus on male behavior, but the nature of these sex differences is hard to evaluate. We devised a hypothetical scenario that was as similar as possible for men and women to test whether, even in such a scenario, sex differences would remain strong. Participants were presented with the discovery that a child that s/he believed to be theirs was not carrying their own genes. Irrespective of sex, participants (n = 1007) were more upset when the baby was not genetically related to them than when the child was genetically related but the sex gamete was not from a chosen donor. Women were more upset than men in both scenarios, but were more likely to want to keep the baby. The results are discussed with reference to evolved and rational mechanisms affecting parenting.
Collapse
Affiliation(s)
- Marco Bertamini
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Minna Lyons
- School of Psychology, University of Liverpool, Liverpool, UK
| |
Collapse
|
50
|
Abstract
Prior research has focused on the relationship between parenthood and psychological well-being, with mixed results. Some studies have also addressed potential gender differences in this relationship, again yielding varied findings. One reason may be methodological choices pursued in these studies, including the lack of focus on combined parental roles (for example, biological parent and stepparent). The authors used data from the National Longitudinal Survey of Youth, 1979 (N = 6,276) and multinomial treatment models to address how combined roles influence depressive symptoms in mothers and fathers. Further, they explored potential gender differences. Their results indicated that having multiple parental roles is negatively associated with psychological well-being for both men and women, whereas childlessness is more negative for women, and specific parental role combinations affect mothers and fathers differently. Within the context of changing family structure in the United States, these results have important implications for social workers and other mental health professionals-particularly with regard to screening for depression among parents, who are less likely to seek mental health counseling than childless adults.
Collapse
|