Reproductive Decision-making Process Research Articles

Women’s support-seeking for reproductive decision-making in Australia: rationales and socio-demographic contexts

ABSTRACT While a positive relationship between social support and women’s reproductive decision-making outcomes exists, little is known about the reasons why women engage supporters to assist them when making reproductive decisions. This study explores Australian women’s reasons for engaging supporters for reproductive decision-making and whether women’s socio-demographic characteristics are suggestive of any such reasons. A modified content analysis approach, combining directed and summative analysis methods, was applied to data from two qualitative Australian studies exploring women’s support-seeking for reproductive decision-making. Findings suggest that the most important rationales for engaging supporters were ‘understanding or empathy’, ‘informed or educated’, ‘on the same page’, ‘little interference’, ‘close’ and ‘stake in the decision’. Some socio-demographic characteristics, particularly regional area and partner status, helped to explain some reasons, while other reasons were better explained by the nature of the decision being made. Further research is required to enhance our understanding of reproductive decision-making processes and enable women to access support that facilitates decisions appropriate to their bodies and life circumstances.

“It’ll be All Right, Everybody Has Children”: Regretting Motherhood in Iceland

ABSTRACT Social expectations of women as mothers significantly impact the reproductive decision-making process for those who have the potential for childbirth. This article focuses on women in Iceland who regret motherhood. It aims to understand how regretting motherhood is experienced and the consequences of living with a socially unacceptable emotion. Based on the results of in-depth interviews taken with sixteen heterosexual ciswomen who regret becoming mothers, we employ reflexive thematic analysis to explore the social and personal factors that promote motherhood and how they manage their regret. The results suggest that despite the intention of the participants not to become mothers, pro-natalist ideals, social assumptions, and expectations of women as mothers wield a powerful hold over the ability to reject the role. Many participants grapple with the expectation that all women want to become mothers, familial expectations, and the assumption that mothering is an inherently emotionally fulfilling undertaking. The findings also suggest that the discourse of maternal regret can be understood as a resistance to normative cultural motherhood expectations and intensive motherhood narratives.

Does Fertility Culture Matter in Reproductive Decision Making? A Case Study of a Chinese Multi-child Family

This study delves into individual cases within multi-child families, building upon a literature review of sociocultural factors influencing reproductive decision-making. Although previous research has highlighted the significant influence of societal factors on reproductive choices, there is a knowledge gap regarding specific cases within multi-child families, necessitating a more in-depth investigation. The research question is framed as follows: "How do sociocultural factors interact in the reproductive decision-making of multi-child families, influencing family interactions and dynamics?" Using a case study approach, this paper employs a qualitative methodology by conducting semi-structured interviews to gather data. Grounded theory is applied for in-depth qualitative analysis. Findings reveal the pivotal role of sociocultural factors in internal family dynamics, supporting and extending previous research. Theoretical implications highlight a nuanced understanding of multi-child family dynamics, while practical implications underscore the need for tailored family support programs. This research contributes theoretical insights and practical guidance for addressing the unique needs of multi-child families in reproductive decision-making processes.

Accepting or declining preconception expanded carrier screening: An exploratory study with 407 couples.

Rapidly evolving genomic technologies have made genetic expanded carrier screening (ECS) possible for couples considering a pregnancy. The aim of ECS is to identify couples at risk of having a child affected with a severe disorder and to facilitate their reproductive decision-making process. The ECS test we offer at our center, called BeGECS (Belgian Genetic ECS), consists of 1268 autosomal recessive (AR) and X-linked pathogenic genes, including severe childhood-onset disorders. However, thus far data are scarce regarding the actual uptake of preconception ECS in a clinical setting. Therefore, our aim was to describe the characteristics of 407 couples to whom ECS was offered at the Center for Medical Genetics of the University Hospital Ghent (CMGG). In addition, we aimed to identify their reasons for accepting or declining BeGECS. Between October 2019 and January 2023, 407 preconception couples were offered BeGECS and were asked to fill in a questionnaire after their decision. Of the 407 couples participating in the survey, 270 (66%) decided to take the test and 137 (34%) declined. We observed that age, highest education level as well as indication for consultation were statistically different between the group that accepted to take the test and the group that declined (p = 0.037). In particular, age and education level were substantially higher in the group that accepted the test. Major reasons for taking BeGECS include prevention, wishing to obtain all information possible, helping preparing their future reproductive decision and increasing their sense of control by being informed. However, couples that do not chose to take BeGECS stated that too much information would make them anxious, that the result would not change their decision to have children, that they do not want to spend money on something that will not happen and that they do not worry about their family history. These findings show that the majority of preconception couples that were offered ECS, accepted the test.

Understanding Multifaceted Determinants of Contraceptive Utilization among Adolescent Females: Insights from Wakiso District, Uganda

Despite global efforts to enhance contraceptive utilization, adolescent females in Uganda face persistent challenges accessing and utilizing modern contraceptive methods, resulting in high fertility rates and maternal mortality. This cross-sectional study investigated the intricate factors influencing contraceptive usage among adolescent females attending Kasangati Health Center IV in Wakiso District, Uganda. Employing questionnaire-based surveys, the study targeted adolescent females attending the health center, utilizing simple random sampling to select 220 participants, as determined by Fisher's formula. Data analysis was conducted using Microsoft Excel and SPSS version 20, presenting comprehensive findings through tables, pie charts, bar graphs, and narratives. The study uncovered a concerning contraceptive prevalence rate (CPR) of 19% among adolescent females, despite existing awareness of family planning methods. Key determinants of contraceptive usage included limited knowledge about contraception, constrained access to services, entrenched societal norms, and gender dynamics. The findings highlight the urgent need to address these multifaceted barriers to enhance contraceptive utilization and mitigate unmet needs among adolescent females. The study's recommendations encompass targeted educational campaigns, improved accessibility of family planning services, and fostering the engagement of both genders in reproductive health decision-making processes. Ethical considerations were meticulously observed, with informed consent obtained from participants and ethical approval secured from relevant authorities. This study contributes seminal insights into the complex landscape of contraceptive utilization among adolescent females in Uganda, offering critical guidance for policy formulation and programmatic interventions aimed at improving reproductive health outcomes and curtailing maternal mortality rates. Keywords: Contraceptive utilization, Adolescent females, Reproductive health, Family planning, Wakiso District and Uganda

Reproductive Decision Making of Spanish Women Living With HIV: A Constructivist Grounded Theory Study.

The process of reproductive decision making among women living with HIV is intricate and multifaceted, influenced by health considerations, societal factors, and personal values. In this study, we employed Charmaz's Constructivist Grounded Theory to understand how Spanish women living with HIV make decisions regarding reproduction. We conducted 26 face-to-face interviews until data saturation was achieved. Findings suggested that social constructs such as femininity and motherhood play a significant role in the reproductive decision-making process for women living with HIV. The women's beliefs about HIV, doubts, marginalizing situations, and health barriers create challenges to making reproductive decisions. These findings provide valuable implications for designing care plans that meet the unique sexual and reproductive health needs of women with HIV. An integrated and comprehensive multidisciplinary counseling approach is necessary to improve the quality of care.

Queer Reproductive Decision-Making in Saskatoon

This article is a plain writing summary of a master’s thesis researched and written in the Department of Archaeology and Anthropology at the University of Saskatchewan between 2020-2023. This thesis examined how eighteen queer people living in Saskatoon, Saskatchewan made their reproductive decisions during the COVID-19 pandemic by asking what meanings do queer people in Saskatoon find in their reproductive decision-making processes, and how do those meanings influence those processes during the COVID-19 pandemic? Three themes emerged from these interviews. The first was how queer family structures are formed, including an analysis of the nuclear family and the ways that approach does or does not work for queer families and the gendered problems queer people face when contemplating pregnancy. The second centres on safety, with people born and raised in Saskatchewan prioritizing social safety and people born in different, sometimes less queer-supporting countries prioritizing physical safety when making reproductive decisions. The third is the relationship between COVID-19 and place, dissecting how the COVID-19 pandemic has changed the meanings of place through social distancing and isolation, and how the space between places (i.e., travel and remote connection software like Zoom) has changed meaning during this pandemic. This research has implications for informing institutional responses to Canada’s declining population levels and to better support queer people in making their reproductive decisions.

‘It wasn’t what I was suited for’: regretful mothers negotiating their reproductive decision and mother role

This study contributes to our understanding of why women without a longing to have children and who, in theory, have the possibility of refraining from parenthood still become mothers. The...

Psychological and reproductive decision-making experiences of young women after breast cancer diagnosis: a qualitative study

BackgroundBreast cancer has the highest incidence rate among malignant tumors in China, with a trend of affecting younger women. The treatment has short- and long-term adverse effects such as damage to the ovaries, which may result in infertility. Such consequences then increase patients’ concerns over future reproduction. At present, nor do medical staffs continuously assess their overall well-being, or ensure that they have the knowledge necessary to manage their reproductive concerns. This qualitative study aimed to explore psychological and reproductive decision-making experiences of young women who had experienced childbirth after their diagnosis.MethodsThe phenomenological research, as a kind of qualitative study, was conducted on 12 young women who experienced childbirth after breast cancer diagnosis. Data collection was from September 2021 to January 2022 and content analysis method was used to analyze the data.ResultsFive main themes were identified: (1) desire for childbearing from individual, familial, and social aspects after the diagnosis of breast cancer; (2) emotional experiences through pregnancy till raising children; (3) support needs from professionals, family, and peer; (4) self and doctors’ influencing factors on reproductive decision-making; and (5) satisfaction with the outcome of reproductive decision-making.ConclusionsThe desire for childbearing of young women should be considered during the reproductive decision-making process. A multidisciplinary team is suggested to be set up to provide professional support. During the reproductive process, professional and peer support should be strengthened to improve decision-making abilities, alleviate negative emotional experience, and smoothen the process of reproductive experience for young patients.

The Effectiveness of an Online Decision Aid on Reproductive Options for Couples at Risk of Transmitting a Genetic Disease to their Offspring: Protocol for a Randomized Controlled Trial

Introduction: Couples at high risk of transmitting a genetic disease to their offspring have several reproductive options. As decision making is often experienced as difficult, there is a need for a decision aid (DA), to assist couples in their reproductive decision-making process and to reduce decisional conflict and increase (joint) informed decision-making. This article describes the design of a nationwide randomized controlled trial to assess the efficacy of the online DA.Methods: The development of the DA was based on the International Patient Decision Aid Standards (IPDAS) guidelines. A nationwide multi-centre Randomized Controlled Trial (RCT) will be conducted in the eight genetic centres in the Netherlands to assess the effects of the DA, compared to a website with standardized information based on information provided during standard care. The required sample size is 128 couples. Participants are randomly assigned to either the intervention or control group and are asked to complete four questionnaires within six months to study the effects of the information. The questionnaires will assess decisional conflict, knowledge, attitude, deliberation, and the decision-making process between partners.Discussion: Findings of this study can help to improve the counselling of couples at risk of transmitting a genetic disease to their offspring. Additionally, it provides insight into the joint informed decision-making process of couples. This could help professionals to better support both partners during consultations.Trial registration number: N9415.

Women's experience of the decision-making process for home-based postnatal midwifery care when discharged early from hospital: A Swedish interview study.

INTRODUCTIONWomen and their families are often excluded from reproductive decision-making processes in postnatal care, and do not know which choices they have. Shared decision-making is a critical but challenging component of maternity care quality. The aim was to explore women’s experience of the decision-making process about early return from hospital with home-based postnatal midwifery care.METHODSThis is a descriptive qualitative study. In total, 24 women participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis according to Braun and Clarke.RESULTSThe main theme explored was ‘The supremacy of giving new mothers autonomy to decide on the postnatal care model they would prefer’. Important aspects of the women’s decision-making process were the time-point for receiving information about the home-based midwifery model of care, to receive sufficient time for consideration about the model, to have a rationale for choosing home-based care, and to comprehend the concept.CONCLUSIONSWomen must be given sufficient time for consideration and necessary information about postnatal care models, which is essential for making an informed decision. Parents’ readiness for discharge must be identified by midwives who need to facilitate shared decision-making by introducing early postnatal care model choices, describe these options, and support women to explore their preferences. Midwives must ensure parents’ participation in decision-making for the time of discharge from hospital.

The effects of an online decision aid to support the reproductive decision-making process of genetically at risk couples-A pilot study.

Couples at risk of transmitting a genetic disease to their offspring may experience doubts about their reproductive options. This study examines the effects of an online decision aid (DA) on the (joint) reproductive decision-making process of couples (not pregnant at time of inclusion) at risk of transmitting a genetic disease to their offspring. The primary outcome is decisional conflict, and secondary outcomes are knowledge, realistic expectations, deliberation, joint informed decision-making, and decisional self-efficacy. These outcomes were measured with a pretest-posttest design: before use (T0), after use (T1), and 2 weeks after use (T2) of the decision aid (DA). Usability of the DA was assessed at T1. Paired sample t-tests were used to compute differences between baseline and subsequent measurements. The comparisons of T0-T1 and T0-T2 indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict scores. Furthermore, use of the DA led to increased knowledge, improved realistic expectations, and increased levels of deliberation, with higher increase in participants with low baseline scores. Decision self-efficacy only improved for participants with lower baseline scores. Participants indicated that the information in the DA was comprehensible and clearly organized. These first results indicate that this online DA is an appropriate tool to support couples at risk of transmitting a genetic disease and a desire to have (a) child(ren) in their reproductive decision-making process.

Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid

BackgroundResearch has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD.MethodsThe International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility.ResultsIssues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received.ConclusionsThe novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

BackgroundWomen living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries.MethodsA systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis.ResultsTwenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage.ConclusionWLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

Hereditary diseases and child wish: exploring motives, considerations, and the (joint) decision-making process of genetically at-risk couples

Couples who are at risk of transmitting a genetic disease to their offspring may face difficult challenges regarding reproductive decision-making. Deciding if, and how, to purse their child wish can be a demanding process. This study aims to describe the reproductive joint decision-making process of genetically at-risk couples. A qualitative study was conducted with 16 couples (N=31) at risk of transmitting a genetic disease to their offspring and who received genetic counseling. Most couples were not aware of all available reproductive options in the Netherlands. A variety of motives was reported with almost all couples expressing a preference towards a reproductive option in which the child is genetically related to both parents. Only a few couples considered other options such as the use of donor gametes, adoption, and foster parenting. All couples indicated that they had multiple conversations to reach a mutually supported reproductive decision. Several carriers reported feelings of guilt and in some couples, the woman appeared to have a greater impact in the decision-making process as she should carry a pregnancy and should undergo medical treatments. This study provides insight in the extensive decision-making process of genetically at-risk couples and the role of both partners in this process. These findings can guide the development of genetic counseling (e.g., increase awareness of available reproductive options) and decision support for these couples.

Fertility Intentions Within a 3-Year Time Frame: a Comparison Between Migrant and Native Italian Women

The body of literature on the fertility of migrants in Europe has grown significantly in recent decades. The focus has mostly been on analysing their actual behaviours, and reflection on other crucial aspects extensively analysed in studies on natives has been lacking. In particular, differences between migrants’ reproductive decision-making process and that of natives are currently understudied in the European context. We will focus on the association between demographic and socio-economic characteristics and fertility intentions, comparing native Italian and migrant women in Italy. We apply logistic regression models to analyse factors associated with strong intentions to have a child (or positive fertility intention) and strong intentions not to have a child (or negative fertility intention) in the short term. We use data from the Social Condition and Integration of Foreign Citizens survey on households with at least one foreign member and from the Italian Gender and Generation Survey, both carried out at the national level by the National Institute of Statistics (ISTAT). Net of controlled covariates, migrant women have both higher positive and lower negative fertility intentions within a 3-year time frame than native women do. However, the patterns of fertility intentions are different for natives and migrants as a function of age, educational level, marital status, parity, homeownership and, notably, labour market status. Focusing only on migrant women, we observe that fertility intentions vary by age at arrival and time since migration and that there are significant differences by country and geographical area of birth.

“Just because I don't bleed, doesn't mean I don't go through it”: Expanding knowledge on trans and non-binary menstruators

Objectives Critical menstruation studies is a field in its nascence, marginalized within the broader area of reproductive health research. Menstruation-related research is virtually absent from trans studies, itself a marginalized field of inquiry. This article focuses on the experiences of trans and non-binary menstruators, to contribute to this burgeoning area of study. Methods This article involves secondary data analysis of a qualitative dissertation research study on trans people’s reproductive lives, health, and decision-making processes. Of the fourteen participants in the broader study, eleven discussed their perceptions of and experiences with menstruation and menstrual health. Those experiences where subjected to thematic narrative analysis, with a focus on themes that were substantively significant. Results Participants describe experiences with amenorrhea associated with the use of testosterone, menstrual resumption following the cessation of testosterone and for other reasons, menstruation-related dysphoria management strategies beyond medical interventions, as well as barriers to menstruation-related health care. One participant describes bloodless periods as a trans woman, a phenomenon altogether absent from the clinical and experiential literature in this field. The article explores how cisnormativity, repronormativity and transnormativity informed the participants experiences of menstruation and reproductive health care. Conclusions Contributing novel stories to the literature, this article illustrates how clinically focused research fails to attend to the experiential components of menstruation for trans and non-binary people. Expanded knowledge is beneficial to the development of gender-inclusive menstruation research, clinical interventions, healthcare environments, and activist efforts.

Professionals’ Views on Offering Pre-Natal Testing for Adult Onset Cancer Susceptibility. Reconciling Personal and Professional Ethical Conflicts, Coping Strategies and Need for Policy Transparency

This paper explores views of healthcare professionals (HCPs) in genetics and foetal medicine settings on offering pre-natal diagnosis (PND) for adult onset cancer susceptibility (AOCS) genes. Study participants came from different disciplinary backgrounds and all had considered implications of offering PND for AOCS, directly or indirectly, from professional and personal perspectives. Foetal medicine and genetics teams are accustomed to offering PND with the possibility of terminating an affected foetus on the basis of preventing severe physical or mental handicap to the child [1, 2]. In this qualitative study, participants were invited to semi-structured interviews. Using a narrative approach, participants had space to follow their thought processes. Narratives were thematically analysed. Whilst participants predominantly agreed that PND for AOCS does not fulfil Ground E for termination, they acknowledged difficulties in defining ‘severe’ taking into account patients’ experiences and perspectives in the reproductive decision-making process. Findings indicated that many participants felt uneasy about the prospect of offering PND for a condition which does not, in their view, conform to the types of conditions typically seen and accepted in this context. Inconsistencies emerged around what participants think ‘is’ offered and what reproductive choices ‘should’ be offered to patients in this context. We discuss coping strategies used by HCPs to reconcile personal and professional ethical challenges. Offering Pre- implantation Genetic Testing (PGT) for AOCS is conflated with offering PND by some participants and we discuss possible reasons for this. We also explore potential impacts of PND for AOCS on mainstreaming cancer genetics. Our research demonstrates healthcare professionals’ resilience in aiming to deliver compassionate care despite their personal and professional ethical conflicts. We argue that making policy about PND transparent and accessible will support professionals who feel conflicted about offering PND in new contexts such as AOCS genes.

Counselling for prenatal anomaly screening—A plea for integration of existential life questions

The availability in many countries of new prenatal anomaly screening methods, such as the non-invasive prenatal test (NIPT), and the potential broadening of testing for genetic conditions, creates an ongoing debate about the accompanying existential dilemmas at both societal level and for individual new parents. In many countries, the main goal of counselling for prenatal anomaly screening is to facilitate the reproductive decision-making process of future parents. Therefore, counsellors share information to enable a woman and her partner to think about the pros and cons of participating in screening, try to clarify possible moral dilemmas, and dwell on existential life questions. In line with the CanMEDS framework, healthcare professionals must combine the role of communicator (providing health education) with that of professional (by recognising and responding to existential life questions while facilitating decision-making). This is not easy but it is essential for providing balanced counselling. At present, counselling tends to be sufficient regarding health education, whereas guidance in decision-making, including attention for existential life questions and philosophy of life, offers room for improvement. In this paper, we suggest slowing down and turning the traditional prenatal counselling encounter upside down by starting as a counselling professional instead of a healthcare information sharing communicator and thus making the story of the woman and her partner, within their societal context, the starting point and the basis of the counselling encounter.

Reproductive Rights and Reproductive Choice of Yoruba Women in Southwestern Nigeria

While some social and health comes have improved significantly for women, significant gaps remain in the achievement of reproductive health rights and women’s choice. Women are still constrained by social, legal, religious and cultural impediments and family power dynamics from acting on their desires. The objective of this paper therefore is to examine the reproductive rights and choice of women entrepreneurs in South Western Nigeria Ibadan. The study adopts Rational Choice Theory and Gender role theory as theoretical guide. Quantitative and qualitative methods of data generation were employed. One Hundred and Twenty questionnaires were distributed to women with ten years marital experiences. The distribution of hundred and twenty questionnaires to women respondents was obtained through snowball method. Only In-depth interview conducted among 24women through purposive sampling techniques was employed to generate qualitative data. Quantitative information was analysed through simple percentage and frequency distribution. Findings from the study revealed that women’s reproductive decision-making processes are greatly influenced by their partners ranging from their age at first marriage, their access to family planning and abortion., which also given by the women as challenges on their reproductive rights in Sango, Ibadan.