Reproductive autonomy and contraceptive use among women in Hanoi, Vietnam

Nghia Nguyen,Jessica Londeree,Linh H Nguyen,Dung H Tran,Maria F. Gallo

doi:10.1016/j.conx.2019.100011

Nghia Nguyen, Jessica Londeree

Open Access

https://doi.org/10.1016/j.conx.2019.100011

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Abstract

ObjectiveReproductive autonomy (i.e., power to control and decide about contraceptive use, pregnancy and childbearing) could determine a woman’s capacity to use contraception. Although the Reproductive Autonomy Scale was developed to quantitatively assess women’s reproductive autonomy, it has not been validated in any population outside the United States. Study designWe conducted a cross-sectional study of reproductive-age, sexually active women in Hanoi, Vietnam, who did not desire pregnancy. We administered a questionnaire containing the Reproductive Autonomy Scale and calculated composite scores of the measure’s three subscales: (1) decision-making power, (2) freedom from coercion and (3) communication ability. To assess internal consistency, we calculated Cronbach’s alpha score for each subscale. We used logistic regression to evaluate differences in subscale scores between women who did and did not engage in unprotected sex in the past month. ResultsAnalysis is based on 500 participants; of these women, 17% (n=85) engaged in unprotected sex in the past month. Subscales had moderate to high internal consistency (Cronbach’s alpha: 0.65–0.87). Mean subscale scores did not vary between women who did and did not engage in recent unprotected sex. Unprotected sex in the past month was not associated with decision-making power (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.49–1.20), freedom from coercion (aOR, 0.94; 95% CI, 0.52–1.67) or communication ability (aOR, 1.69; 95% CI, 0.92–3.09). ConclusionFindings highlight the need to develop and validate a new measure for reproductive autonomy for populations outside the United States or to adapt the existing measure for these contexts.

Highlights

An estimated 44% of pregnancies worldwide were unintended in 2000–2014 [1]
As compared to women who did not engage in unprotected sex in the past month, women who engaged in unprotected sex tended to be unmarried, to be less educated and to report lower household incomes, but these differences were not statistically significant at α=0.05
In this study of reproductive-age, sexually active women not desiring pregnancy in Hanoi, Vietnam, we found that variations in reproductive autonomy, as measured using the Reproductive Autonomy Scale, did not correspond to differences in engagement in sex unprotected by a modern contraceptive method in the past month

Summary

Introduction

An estimated 44% of pregnancies worldwide were unintended in 2000–2014 [1] For women and their families, the consequences of unintended pregnancies are often lasting and severe; unintended pregnancies can lead to poorer health among children, lost educational opportunities and increased levels of pregnancy-related morbidity and mortality [2,3,4]. Studies assessing the individual-level factors affecting contraceptive use are often grounded in the assumption that individuals have control over their contraceptive behavior [5]. As with other sexual risk outcomes, a woman’s capacity to act upon her intention to use contraception may be contingent upon the wishes and actions of her partner or other members of her family or community. Social and cognitive constraints to contraceptive use, reproductive autonomy — defined as power to control and decide about matters concerning contraceptive use, pregnancy and childbearing — could determine a woman’s capacity to use contraception [6]

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Results

Conclusion