Contraceptive Decision Research Articles

Women decision-making on modern contraceptive use and its associated factors among married women in Girawa District, Eastern Ethiopia: a community-based cross-sectional study, 2024.

Women's decision-making power on contraceptive use is crucial for increasing modern contraceptive uptake. However, evidence in Ethiopia regarding this topic is limited and inconclusive. To assess the prevalence and factors associated with women's decision-making power on modern contraceptive use in Girawa district, Eastern Ethiopia, January1-30, 2024. A community-based cross-sectional study was conducted among 510 married contraceptive users in Girawa district selected through multistage sampling. Descriptive statistics and logistic regression analyses were employed. The questionnaire was developed reviewing different literature, and pretested before actual data collection. Trained data collectors were collected the data. Face-to-face interview was conducted to collect data from study participants. Data cleaned and entered to Epidata, transferred to SPSS version 20 for analysis. Descriptive statistics were computed for all variables and the results were presented using frequency, tables and percentages. Using binary logistic regression, bivariate analysis was conducted to recruit variables for multivariable analysis at p-value of less than 0.25. Then multivariable analysis was conducted to control confounding variables. The strength of associations of variables was reported using odds ratio, with its 95% confidence interval, and p-value less than 0.05 used to declare significant association of explanatory with outcome variable. The prevalence of women's decision-making power on modern contraceptive use was 78% (95%CI: 74.4, 81.6). Factors significantly associated with increased decision-making power included: women's education (primary: AOR = 10.51[5.37, 20.56]; secondary and above: AOR = 2.58[1.35, 4.93]), husband's education (primary: AOR = 2.53[1.33, 4.81]; secondary and above: AOR = 2.25[1.08, 4.68]), government employment (AOR = 5.29[1.44, 19.57]), ANC visits (1-3: AOR = 2.16[1.18, 3.95]; ≥4: AOR = 1.86[1.85, 4.05]), positive attitude (AOR = 2.83[1.28, 6.25]), and good knowledge about modern contraceptives (AOR = 3.67[1.78, 7.56]). Three in four married women in Girawa district have decision-making power on modern contraceptive use. Education, employment, Antenatal care (ANC) utilization, positive attitudes, and good knowledge about contraceptives were associated with increased decision-making power. Interventions targeting these factors could further empower women in contraceptive decision-making.

Family planning and contraception in people with multiple sclerosis: perspectives for obstetricians, gynaecologists, and other health care professionals involved in reproductive planning.

Multiple sclerosis (MS) is often diagnosed in people of reproductive age. However, family planning counselling is not always integrated within MS care. Decisions on family planning can be further complicated by potential side effects associated with several disease-modifying therapies. While neurologists may lack training in contraceptive use and family planning counselling, obstetricians and gynaecologists (OB-GYNs) and other health care professionals involved in reproductive life planning (RHCPs) may lack detailed knowledge and experience around the use of contemporary MS treatments. Through a modified Delphi consensus programme, a multidisciplinary steering committee of 13 international experts developed practical clinical recommendations on contraceptive use and family planning for people with MS (PwMS). This article offers insights to help OB-GYNs and RHCPs implement these recommendations, focusing on contraceptive decision-making and MS medications. The perspectives discussed emphasise providing education on MS to OB-GYNs and other RHCPs, enabling informed counselling for PwMS and their partners regarding contraception and family planning. Close collaboration among the multidisciplinary team, including neurologists, is crucial in providing reproductive care for PwMS. The detailed perspectives provided aim to enable OB-GYNs and other RHCPs to provide informed counselling for PwMS and their partners regarding contraception and family planning.

Predictors of Contraceptive Use Associated with Foreign-Born Women in the US During the Preconception Period of Their First Pregnancy.

Contraceptive use is the most effective means of preventing unintended pregnancies among sexually active individuals. Foreign-born women are less likely to use contraception when compared to US-born women. However, there are limited studies focused on understanding factors that influence contraceptive use among foreign-born women in the US. This study aimed to explore the factors associated with contraceptive use in the early reproductive lives of foreign-born women in the US. This study utilized the 2017-2019 National Survey on Family Growth to conduct a cross-sectional secondary data analysis. Analyses were restricted to observations from 708 women who identified as foreign-born, were aged 15-49 years, and provided information about their first pregnancies. Chi-square tests and multivariable logistic regression were used to assess the factors influencing contraceptive use. 70.9% of the participants had used a form of contraception in the period leading to their first pregnancy. Multivariable regression analysis identified significant predictors of contraceptive use: educational level, age, religion, income levels, health insurance, and race/ethnicity.Those with a religious affiliation and were 25 years and above had greater odds of contraceptive use while non-Hispanic blacks and non-Hispanic other/multiple race participants had lower odds of contraceptive use. Based on the predictors identified, public health interventions should be tailored to address specific socio-demographic factors that influence contraceptive decisionmaking among foreign-born women in the US. Additionally, understanding the disparities in contraceptive use across racial/ethnic backgrounds underscores the need for culturally sensitive approaches that acknowledge and respect diverse beliefs surrounding contraception.

Family Planning Counseling and Practices in Kidney Transplant Recipients.

Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited. This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14-45 years. A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified. Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients' reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.

Patient and OBGYN Perspectives on Considering Long-Acting Reversible Contraception for Postpartum Patients Who Desire Permanent Contraception

Objective(s)We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference. Study DesignWe interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n=67) from four U.S. institutions to explore patient and OBGYN perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software. ResultsOur analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body. Conclusion(s)These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.

Qualitative Exploration of Contraceptive Knowledge in Men and Women.

The level of knowledge about contraceptives overall is low in the United States. This qualitative study adds to the literature that explores gendered differences in contraceptive knowledge. Specifically, we examined knowledge regarding different contraceptive methods, directions on use, mechanism of action, efficacy, and adverse effects. We also looked at men's perspectives on their partner's knowledge. Participants were interviewed at a Planned Parenthood Association of Utah clinic. They were asked about contraception knowledge, attitudes, and male involvement in contraceptive decision making. In this secondary analysis, we reanalyzed codes that were previously identified under primary analysis for specific content about contraceptive knowledge and differences by sex. We found an overall low level of knowledge about contraceptives, particularly in men as compared with women. Men often overestimate their female partners' knowledge. Men were more likely to understand how to use methods that require their direct participation. Although women's contraceptive knowledge was better than that of the male participants, it was still poor overall. A low level of knowledge about contraceptives is associated with increased rates of unintended pregnancy. This study demonstrates a need for improved education about contraception. Given the impact of male opinion in contraceptive use, efforts to increase their knowledge could be important interventions to increase contraceptive uptake.

Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions

PurposeAnti-seizure medications (ASM) can lower the efficacy of hormonal birth control (BC), while estrogen-containing BC can increase ASM metabolism, altering seizure frequency. Despite these adverse interactions, many youth with epilepsy demonstrate inadequate knowledge about this topic. Thus, there is a need to develop tools that empower youth with epilepsy to make more informed contraceptive decisions. This study assesses the use of a video-based educational tool to raise awareness of BC and ASM interactions in this population. MethodsWe created a video that gives an overview of possible interactions between certain BC methods and ASMs, mainly increased risk of pregnancy and change in seizure frequency. The video was shown to female patients aged 12 and older with epilepsy in a child neurology clinic and followed by a discussion with their treating neurologist. Fifteen patients completed two surveys that collected demographics, ASM regimen, BC history, and assessed exposure to and understanding of the subject matter before and after viewing the educational tool using 11-point Likert scales. We received seven responses from provider opinion surveys that were administered after the visit to assess the practicality of the video tool in teaching patients about their medication interactions. Data was analyzed with descriptive statistics and one-tailed paired t-tests (α = 0.05). ResultsPatients ranged from ages 16 to 24, with 46.7 % being in the 16 to 18 year-old range, 26.7 % in the 19 to 21 year-old range, and 26.7 % in the 22 to 24 year-old range. The median age was 19. 33 % of the patients reported having used BC, with 27 % reporting current interest in using BC. 33 % of patients were taking ASM that could reduce BC efficacy, and 27 % were on ASM with efficacy that can be reduced by BC. While 80 % of patients endorsed having previously discussed BC and ASM interactions with a doctor, patients rated their knowledge of the subject pre-video as moderately low with high interest in learning more about the topic. Patients’ understanding of how BC and ASM interactions can increase risk of pregnancy showed a significant increase post-video. Patients also indicated a high likelihood that they would think of the video when choosing a BC method and that they are more likely to start a discussion with their doctor about BC and ASM interactions because of the video. Treating neurologists showed high agreement that the video is useful in teaching their patients about BC and ASM interactions. ConclusionYouth with epilepsy deserve engaging resources that empower them to make informed decisions about BC. Despite most of our patients having had prior education about BC and ASM interactions, our results support the need for educational tools beyond patient-provider discussion and the efficacy of video as a tool to enhance understanding of this topic. The tool also showed potential to influence future patient decision making regarding BC and to empower patients to take an active role in discussing BC with their doctor. Our findings support a role for educational videos as an effective way to teach youth with epilepsy about reproductive health concerns and to promote active participation in decision making.

Adaptation of the G-NORM (Gender norms scale) in Uganda: An examination of how gender norms are associated with reproductive health decision-making.

Restrictive gender norms exacerbate health inequalities all over the world. More specifically, they prevent women from seeking preventive health services, constrain women's economic empowerment, and are associated with reproductive health decision making. Gender norms, a subset of social norms, are dynamic and change over time. However, we lack data on how they are changing and how these changes affect health outcomes because current measures do not adequately capture the complex concept of gender norms. We originally developed and validated a gender norms scale, the G-NORM, in India. In this study, using cross-sectional data, we adapted the G-NORM from Southeast Asia (India and Nepal) to sub-Saharan Africa (Uganda) in four steps: 1. Formulation of new scale items (via qualitative analysis) 2. Cognitive Interviewing 3. Questionnaire Administration (n = 2422 women of reproductive age) and 4. Psychometric analysis (Confirmatory Factor Analysis). Like the original scale, descriptive norms and injunctive norms comprised two unique sub scales with high Cronbach's alphas (.80 & .92). Average scores differed depending on the type of norm suggesting that some gender norms are changing faster than others. Specifically, more equitable injunctive norms were associated with lower odds of partner-dominated contraceptive decision making but descriptive norms were not. Gender norms serve as a multi-faceted determinant of health and wellbeing and require measurement tools which account for their conceptual complexity. Validating the G-NORM in Uganda expands measurement options for researchers in the sub-Saharan African region working to change norms to reduce health inequalities or to understand the gender normative context before beginning a study.

The impact of the Roe v. Wade overturn on birth control prescriptions and sterilisation procedures in rural NC

Background/Introduction On June 24, 2022, the Supreme Court overturned the 1973 verdict in the Roe v. Wade legal suit that had established the constitutional right to medical abortion [1]. With the right to abortion now being left to the states, many restrictions regarding abortion procedures are being established [2]. We aim to evaluate whether this has led to an increase in the number of birth control prescriptions and sterilisation procedures at Cape Fear Valley Medical Centre in rural North Carolina. Methods SlicerDicer program within EPIC medical records database was used to retrieve the records of all women that had an obstetrics and gynaecology appointment with Cape Fear Valley Health System between 11/01/21-12/31/2022 for contraception. The data was sorted into race/ethnicity, age, and types of birth control. Principal outcomes measured the trends in birth control prescription or sterilisation procedure appointments before and after the overturn of Roe v. Wade. Results Contraceptive pill prescriptions decreased from 51.70% to 32.40%. IUD insertions decreased from 39.40% to 11.30%. Injectable birth control remained consistent, at approximately 16%. Nexplanon implantations dropped from 20.60% to 9.70%. Lastly, sterilisation procedures increased from 6.7% to 10.7%. Conclusion Majority of birth control prescriptions decreased following the overturn of Roe v. Wade, except for sterilisation, which increased by 4.0%. This may indicate that women are now looking for more permanent birth control options after the overturn of Roe v. Wade. Future research should investigate whether similar trends of increasing prevalence of sterilisation procedures is seen throughout the United States.

Contraception Choice for Female Endurance Athletes: What’s Sport Got to Do With It? A Cross-Sectional Survey

BackgroundWhile there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport.ObjectivesStudy objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes.MethodsThis was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively.ResultsA total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport.ConclusionsThis exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.

Mother-Daughter Dyads’ Perceptions of Contraception

In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception. Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semi-structured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach. There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted. These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.

Exploring adolescent-facing US clinicians' perceptions of their contraceptive counseling and use of shared decision-making: A qualitative study.

Adolescent contraceptive decision-making is influenced by a number of patient and clinician-driven factors. Although the AAP continues to endorse an efficacy-based model of contraceptive counseling, many professional organizations are shifting to a shared decision-making model as the optimal approach for providing unbiased and patient-driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self-reported contraceptive counseling practices among US-based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person-centered contraceptive care. We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose. We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using "ask then explain" or "explain then ask" approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision-making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework. Clinicians in this study frequently engaged in non-patient-centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high-quality contraceptive counseling using shared decision-making.

Power to choose? Examining the link between contraceptive use decision and domestic violence

Contraception is a crucial tool that empowers women to control their bodily autonomy. Concurrently, domestic violence remains a pressing public health issue, depleting women’s autonomy. We establish a causal link between a woman’s contraceptive use decision and the occurrence of intimate partner violence. We use an instrumental variable approach to estimate our causal effects by utilizing nationally representative data for India. Using exogenous variation in the neighbourhood average of women’s exposure to family planning messages via radio, we find that if a woman independently makes the decision to use contraceptives, she is at a significantly higher risk of physical, sexual and emotional domestic violence. We estimate the bounds of our effects by assuming the IV to be plausibly exogenous, where we relax the exogeneity condition. Our findings underscore the importance of reproductive health in initiatives that reduce domestic violence and targeted policies that provide support to younger and employed women and those from backward caste and rural areas.

What are the associated factors of low husbands/partners independent decision-maker in women’s contraceptive use decision-making process in Ethiopia? Multilevel analysis

BackgroundMany married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands’ or partners’ decision-making power on contraceptive use in Ethiopia.ObjectiveThis study aimed to assess the determinants of low involvement of husbands/partners in women’s contraceptive use decision-making processes in Ethiopia.MethodsThis study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands’/partners’ independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as “Yes” or “No”. A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance.ResultsHusbands’/partners’ independent decision-making in women’s contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31–59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3–5.4) and over 59 years (AOR = 2.3; CI 1.2–4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9–4.3), secondary education (AOR = 3.9; CI 2.7–4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2–5.4), History of pregnancy termination (AOR = 3.3; CI 2.6–4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7–4.7) and Urban residency (AOR = 3.5; CI 1.6–4.2).ConclusionsIn Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency.

(255) “WHAT PUSHED IT FOR ME WAS THE OVERTURNING OF ROE V. WADE”: ASSESSING THE PATIENT-REPORTED INFLUENCE OF SOCIOPOLITICAL ISSUES ON POST-DOBBS VASECTOMY DECISIONS

Abstract Introduction Following the June 2022 US Supreme Court decision on Dobbs v Jackson Women’s Health Organization overturning the federal constitutional right to abortion recognized since Roe, high levels of vasectomy interest and confusion regarding male reproductive healthcare options have persisted despite no direct impact to male contraception. To the best of our knowledge, the patient-reported influence of sociopolitical issues on male patients’ vasectomy decisions has not been studied. Objective Our objective was to characterize the impact of sociopolitical issues, including the Dobbs reversal of the right to abortion recognized since 1973, on male patients’ vasectomy decisions and timing. Methods Patients of a men's reproductive health outpatient clinic within a large academic healthcare system in Southwestern Pennslyvania who had initiated a vasectomy consult from July 2022 – February 2024 were eligible to participate in a survey questionnaire. Patients were called retrospectively or approach prospectively in-person. Demographics, factors influencing vasectomy, and general economic and political interest data were collected via modified Likert and short free-text answers. Chi-square, logistic regression, Mann–Whitney U, and Kruskal-Wallis tests were performed as indicated. Results 311 patients completed the survey. Mean age of patients was 37 years of age (range: 21, 61); 11.7% (n = 30) were under 30 at time of appointment. Median number of biological children was two (IQR: 1, 3); 19.6% (n = 50) had no biological children. Patients spent on average 2.9 years (range: 0, 33) considering a vasectomy prior to deciding. Regarding factors influencing vasectomy, 31.3% (n = 80) of participants indicated sociopolitical issues as very influential in deciding to undergo a vasectomy, with 17 participants writing in the “reversal of Roe v Wade” or “abortion legislature” in response to a free-text question asking what prompted their vasectomy decision. Men with no children were seven times more likely than men with to cite sociopolitical issues as influencing their vasectomy (sociopolitical: OR = 7.3, p &amp;lt; 0.001). When asked how Roe would influence access to male reproductive healthcare options in their home state, 21.9% (n = 56) answered Roe would limit or prevent access to the listed options (ie, hormone replacement therapy, IVF, vasectomy, or sperm cryopreservation). Conclusions While recent sociopolitical and legislative issues may not directly impact male patients’ reproductive healthcare, our results demonstrate the influence broader events have on male patients’ contraceptive decisions and reproductive healthcare understanding. Furthermore, clinicians may need to proactively address uncertainty and confusion around the impact of reproductive healthcare legislature on male patients’ reproductive healthcare options. Disclosure No.

Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives

PurposeWe sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process. Basic ProceduresIn 2022–2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making. Main FindingsMost patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions. Principal ConclusionsPatient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives.

“I will find the best method that will work for me”: navigating contraceptive journeys amongst South African adolescent girls and young women

BackgroundGiven that South Africa has one of the highest rates of pregnancy amongst adolescent girls and young women (AGYW) globally, the provision of contraceptives to this group has been a key focus in recent years. Pregnancy prevention involves an on-going continuum of decision-making around contraceptive method choice, uptake, use, experience, continuation, and discontinuation.MethodsThis paper presents analysis of data from a cross-sectional survey with 2376 AGYW, as well as qualitative in-depth interviews (IDIs) with 54 AGYW, inclusive of contraceptive journey narratives. We examine the preferences, valued characteristics, choices, beliefs, understandings and experiences of choosing and using contraceptives amongst AGYW in two South African communities characterised by high rates of pregnancy.ResultsThese findings shed light on the preferences towards, beliefs about, and experiences of choosing, using and discontinuing contraceptive methods amongst this population, with survey data suggesting that the most popular methods were the injection, followed by the implant, and then the oral pill. Findings illustrate the complexity and dynamic nature of contraceptive decision-making and the varied embodied and lived experiences of contraceptive use, and how these are impacted by contraception service provision.ConclusionsOur findings show that contraception experiences of each individual are cumulative, and comprise a continuum of method initiation, use, discontinuation, method switching and on-going circular decision-making influenced by multiple social, structural, contextual and interpersonal factors, combined with shifting preferences, values and needs. To maximise the use of contraceptives amongst South African AGYW, it is necessary to provide responsive contraception service provision to reflect the changing contexts and preferences of users, in order to ensure that pregnancy prevention needs are catered for throughout their reproductive life course.

A Latent Class Analysis of Reproductive Coercion Experiences Based on Victim-Survivors' Acknowledgment and Disclosure Patterns.

Reproductive coercion (RC) is a form of violence involving behavior that interferes with an individual's contraceptive and reproductive decisions. Like other forms of violence perpetrated by intimate partners, victims of RC do not necessarily identify it as such. Similarly, victim-survivors do not readily disclose their experiences or seek support and treatment. This study identifies patterns of acknowledgment and formal and informal disclosure of RC experiences in a community sample of 317 participants. Latent classes are then compared with respect to characteristics of victims/survivors, RC consequences, and associated contexts. Participants completed measures to assess experiences of RC and violence perpetuated by intimate partners as well as social support, posttraumatic stress symptoms, and consequences for psychological and sexual health. Latent class analysis was performed to identify acknowledgment and disclosure patterns. An optimal three-class solution was selected: High unacknowledgment with ambivalence, High disclosure (41%); High acknowledgment, High disclosure (30%); and Hesitant acknowledgment, No disclosure (29%). Classes were identified according to the presence of social support, living with a disability, victimization experiences, and mental and sexual health consequences. Future studies should explore the relationship between RC acknowledgment and disclosure, which can influence victims' search trajectories for support and services.

Common misperceptions and public knowledge about intrauterine devices among US-based online respondents

ObjectivesMisperceptions about intrauterine devices (IUDs) may dissuade potential users and public beliefs are not well understood. We sought to describe public knowledge of mechanism of action, failure rate, and IUD health risks. Secondary objectives included identifying inaccurate information and information sources about IUDs. Study designWe conducted a convenience-based survey of participants living in the United States 18 years and older using Amazon Mechanical Turk and ResearchMatch. We collected information on demographics, reproductive history, and IUD knowledge. We asked about IUD mechanism of action, failure rate, potential health risks, and information sources. We used multivariable logistic regression to test the association between gender and perceived lower (vs. higher) risks of IUDs. ResultsWe included 1597 individuals with 726 (45.5%) self-reported men and 871 (54.5%) self-reported women. For both hormonal and non-hormonal IUDs, participants most often selected implantation prevention as the primary mechanism of action. In our sample, 55.5% of individuals believed the failure rate was greater than five percent. Weight gain, uterine perforation, and expulsion were cited as health risks likely to occur ≥5% of the time by 42.1%, 34.3%, and 38.4% of participants, respectively. Participants identified healthcare providers as their primary source of contraceptive information. Our multivariable logistic regression analysis revealed women had higher odds of perceiving IUDs as higher risk (aOR=1.35, 95% CI 1.09–1.68) compared to men. ConclusionsIndividuals underestimated IUD effectiveness while overestimating perceived health risks. Our results highlight areas to target education about IUDs to support informed contraceptive decision-making. ImplicationsParticipants misunderstood IUD mechanism of action, underestimated efficacy, and overestimated failure rates and health risks. Providers should begin clinical counseling by assessing baseline knowledge, since mechanism of action, side effect profiles, and concepts like female anatomy should not be assumed to be known.

Evaluating the effectiveness of a tailored online educational video on the contraceptive knowledge and decision making of young women from culturally and linguistically diverse backgrounds: findings from the EXTEND-PREFER study

BackgroundYoung Australian women from culturally and linguistically diverse (CALD) backgrounds are vulnerable to unwanted pregnancy. We aimed to assess whether an online educational video, co-designed with young CALD women, can...