Reproductive Decision-making Process Research Articles

Pregnancy after Solid Organ Transplantation.

To explore the reproductive decision-making process with women who were organ transplant recipients (renal, lung, & heart transplants). Grounded theory guided data collection and analyses. Mixed methods with audiotaped telephone interviews and a written survey measuring social support were used. As social support is critical for women who are organ transplant recipients considering pregnancy, a search for disconfirming evidence for social support via a survey and interviews was included. Verbatim responses were analyzed through the constant comparative method using open, axial, and selective coding. Trustworthiness was established through prolonged engagement, member checking, and thick descriptions. Participants included 10 women who were solid organ recipients (2 lung, 1 heart, and 7 renal transplant recipients). The core theme was Wanting a child. Other themes included Getting information, Advocating, Dealing with problems, Preparing, Talking, Supporting, Coping, and Advising others. There was no evidence of a lack of social support as evaluated via the survey or interviews. This study provides new knowledge on clinical decision-making about pregnancy for women who are solid organ recipients and for healthcare professionals. Nurses can use these data to help guide women on how to obtain the most accurate information to make a personal decision about pregnancy and to develop support from their healthcare team and family.

Predictors of male condom utilization in Plateau State, Nigeria.

Nigerian men play major roles in the reproductive decision-making process, including issues concerning fertility. Despite efforts made by the government to reduce the incidence of HIV by using condom as a means of dual protection, the utilization of male condom is still relatively low in Nigeria. This study aimed to assess the condom utilization and predictors of condom use among male respondents in Plateau State. An analysis of secondary data of the 2013 Nigeria Demographic Health Survey dataset was done. Data were collected through a cross-sectional study using multistage cluster sampling technique from 393 consenting males aged 15-49 years in Plateau State using a semistructured, closed-ended questionnaire. Survey data quality was ascertained using field check tables during data entry. The dataset was analyzed using SPSS version 21.0 software (SPSS, IBM Corp, Armonk, NY, USA). Condom utilization prevalence rate was calculated for the 393 males, while predictors were determined by logistic regression. P ≤ 0.05 was considered statistically significant. Mean age of the respondents was 31.05 ± 9.395 years. Most (90.3%) of the respondents were aware of at least one of the various family planning methods. The prevalence of condom use among them was 15.5% with the 20-29 years' age group having the highest proportion (28.8%). Significant associations were found between condom use and age, level of wealth, level of education, marital status, knowledge of contraception, occupation, and religion. Predictors of condom use include level of wealth (middle class), not being married, and primary level education. The prevalence of male condom use is low in Plateau State. The predictors of condom use are level of wealth, being unmarried, and primary level of education. Having only a primary level of education and been in the middle class reduces the likelihood of using condoms while being unmarried increases it.

Fertility Desires among Women Living with HIV.

ObjectiveRates of pregnancy among women living with HIV (WLHIV) have increased with the availability of effective HIV treatment. Planning for pregnancy and childbirth is an increasingly important element of HIV care. Though rates of unintended pregnancies are high among women in general, among couples affected by HIV, significant planning and reproductive decisions must be considered to prevent negative health consequences for WLHIV and their neonates. To gain insight into this reproductive decision-making process among WLHIV, this study explored women’s knowledge, attitudes and practices regarding fertility planning, reproductive desires, and safer conception practices. It was hypothesized that pregnancy desires would be influenced by partners, families, the potential risk of HIV transmission to infants, and physicians’ recommendations.MethodsWLHIV of childbearing age were recruited from urban South Florida, and completed an assessment of demographics (N = 49), fertility desires and a conjoint survey of factors associated with reproductive decision-making.ResultsUsing conjoint analysis, we found that different decision paths exist for different types of women: Younger women and those with less education desired children if their partners wanted children; reproductive desires among those with less education, and with less HIV pregnancy-related knowledge, displayed a trend toward additional emphasis on their family’s desires. Conversely, older women and those with more education appeared to place more importance on physician endorsement in their plans for childbearing.ConclusionsResults of this study highlight the importance of ongoing preconception counselling for all women of reproductive age during routine HIV care. Counselling should be tailored to patient characteristics, and physicians should consider inclusion of families and/or partners in the process.

Partner Communication and Decision-Making Regarding Sexual Issues among Students in a South African University

Young people are faced with high levels of HIV/AIDS and unwanted pregnancy in South Africa. Thus it is important to understand partner communication and shared reproductive decision-making process with regard to these sexual risks. The study draws on in-depth interviews conducted with 20 Black students aged 18 to 24 years at the Walter Sisulu University. The study found that many young people engaged in risky sexual behaviors. Differing cultural norms that set different standards for men and women discouraged partner communication and shared decision-making and seemed to significantly promote risky sex. The study suggests that men often dominated the decision-making process. In addition, partner coercion was prevalent, and it negatively affected the health choices of young people. Young people were afraid to freely discuss sexual issues and preferred actions to avoid antagonizing partners who might suspect infidelity, lack of commitment and HIV infection. Moreover, the cues used to communication their sexual desires and concerns would at times be misunderstood. Given the negative repercussions of sexual risks; it is important that in addition to creating greater awareness of the risks and adopting prevention strategies; health promotion interventions that go beyond risk awareness and incorporate the cultural, social and economic contexts in which partner communication and shared decision making should be encouraged.

“Out of All of this Mess, I Got a Blessing”: Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N=42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Would It Be Better for Her Not to Be Born?: Down Syndrome, Prenatal Testing, and Reproductive Decision-Making

The article examines the reproductive decision-making processes of women who had prenatal testing and learned that their fetus had Down syndrome. Interviews with women who experienced this decisional process have revealed features that are recurrent in these women’s experiences; in fact, in many cases, the decision-making is substantively identical, regardless of the ultimate decision the woman makes. All the women found the decision-making difficult and painful; all identified the fetus as their child and identified themselves as mothers. There was no clear “right” answer for any of the women, so they often struggled with narratives and experiences that were paradoxical. The insights that these interviews provided will enable more nuanced and informed analyses and arguments from feminist disability studies scholars.

Reproductive decision-making among individuals at risk for familial amyotrophic lateral sclerosis

This qualitative study explored the reproductive decision-making process in individuals at 50% risk for familial amyotrophic lateral sclerosis (FALS) from families with a known genetic mutation. We spoke with 10 individuals utilizing a semi-structured interview. Participants had a first-degree relative with FALS, made reproductive decisions in the past 30 years and did not know their genetic status during decision-making. We delineated themes emerging in individuals who chose to have children, those who chose not to have children, and themes describing the process in general. Results showed that those who chose to have children believed that regardless of disease, life is productive. They compared ALS relatively favorably to other diseases, always planned on having children, and hoped for a cure. Individuals who chose not to have children had extensive experience with ALS and caretaking, saw ALS as an inevitable tragedy, and avoided serious relationships. In consultation with partners, individuals considered other reproductive options. Conversations varied in length, and often strengthened relationships. Children experiencing death of a parent was a primary concern. In conclusion, the reproductive decision-making process is complex. Results can guide future research and provide direction for healthcare professionals when discussing the family planning process and prior to predictive genetic testing.

Decision-making on preimplantation genetic diagnosis and prenatal diagnosis: a challenge for couples with hereditary breast and ovarian cancer

How do couples with a BRCA1/2 mutation decide on preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND) for hereditary breast and ovarian cancer syndrome (HBOC)? BRCA couples primarily classify PGD and/or PND as reproductive options based on the perceived severity of HBOC and moral considerations, and consequently weigh the few important advantages of PGD against numerous smaller disadvantages. Awareness of PGD is generally low among persons at high risk for hereditary cancers. Most persons with HBOC are in favour of offering PGD for BRCA1/2 mutations, although only a minority would consider this option for themselves. Studies exploring the motivations for using or refraining from PGD among well-informed BRCA carriers of reproductive age are lacking. We studied the reproductive decision-making process by interviewing a group of well-informed, reproductive aged couples carrying a BRCA1/2 mutation, regarding their decisional motives and considerations. This exploratory, qualitative study investigated the motives and considerations taken into account by couples with a BRCA1/2 mutation and who have received extensive counselling on PGD and PND and have made a well-informed decision regarding this option. Eighteen couples took part in focus group and dyadic interviews between January and September 2012. Semi-structured focus groups were conducted containing two to four couples, assembled based on the reproductive method the couple had chosen: PGD (n = 6 couples) or conception without testing (n = 8 couples). Couples who had chosen PND for BRCA (n = 4) were interviewed dyadically. Two of the women, of whom one had chosen PND and the other had chosen no testing, had a history of breast cancer. None of the couples who opted for PGD or conception without testing found the use of PND, with possible pregnancy termination, acceptable. PND users chose this method because of decisive, mainly practical reasons (natural conception, high chance of favourable outcome). Motives and considerations regarding PGD largely overlapped between PGD users, PND users and non-users, all mentioning some significant advantages (e.g. protecting the child and family from the mutation) and many smaller disadvantages (e.g. the necessity of in vitro fertilization (IVF), low chance of pregnancy by IVF/PGD). For female carriers, the safety of hormonal stimulation and the time required for PGD before undergoing preventive surgeries were important factors in the decision. Non-users expressed doubts about the moral justness of their decision afterwards and emphasized the impact the decision still had on their lives. The interviewed couples were at different stages in their chosen trajectory, up to 3 years after completion. This may have led to recall bias of original motives and considerations. Couples who did not actively seek information about PGD were excluded. Therefore the results may not be readily generalizable to all BRCA couples. The perceived severity of HBOC and, for female carriers, the safety of hormonal stimulation and the time frames for PGD planning before preventive surgeries are essential items BRCA couples consider in reproductive decision-making. The emotional impact of this decision should not be underestimated; especially non-users may experience feelings of doubt or guilt up to several years afterwards. PGD counselling with tailored information addressing these items and decisional support in order to guarantee well-informed decision-making is needed. This study was funded by the Dutch breast cancer foundation Stichting Pink Ribbon, grant number 2010.PS11.C74. None of the authors have competing interests to declare. Not applicable.

REPRODUCTIVE PREFERENCES AND CONTRACEPTIVE USE: A COMPARISON OF MONOGAMOUS AND POLYGAMOUS COUPLES IN NORTHERN MALAWI

There is now widespread agreement on the importance of men's role in reproductive decision-making. Several studies have argued that fertility preferences and their translation into behaviour differ between polygamous and monogamous unions. Studies investigating the dominance of men's preferences over women's preferences, in cases of couple disagreement, found mixed evidence of the effect of polygamy. However, an often cited limitation of these studies has been the inability to link husband's intention with each of his wives in a polygamous union. By adding fertility-intention questions to an on-going Demographic Surveillance Site in Karonga District in northern Malawi the fertility preferences and contraceptive use of husbands and wives were investigated. An analysis of the relationship between the level of agreement and disagreement between husbands' and wives' fertility preferences was then performed to gain insight into the reproductive decision-making process of polygamous couples.

Men

Family planning services have typically been directed at the female client. In addition, most family planning services and programs are female client-centered, with female-specific health care services such as family planning counseling, female sexual/reproductive medical care, genetic counseling, pregnancy tests, contraception administration, and prenatal care rendered primarily to the female client. The presence of men in most family planning clinics is negligible. Men are key persons in the reproductive decision-making process. In some cultures, the male significantly influences the choice of birth control methods, birth number, birth sequencing, and timing, along with an opinion regarding the birthing method. Comprehensive family planning services should include men and women as equal partners and clients in the family planning process and delivery of family planning services. This would require the development and funding of family planning services directed at male clients. A basis to assist with the development of these types of services is Title X Family Planning programs and funding streams. The integration of men into family planning services should include male sexual/reproductive health services, development of male-focused reproductive life plans, discussion of intimate partner violence, basic primary care services to include immunizations, sexually transmitted disease testing and treatment, along with primary care services to promote healthy lifestyle choices. In addition, family planning services that include men should either integrate men into the existing family planning services and have a true family--male and female client together planning program or develop male-centered family planning services. In addition to the aforementioned male services, male-centered family planning services should include demonstration of condom usage; sexually transmitted infection counseling; pregnancy prevention; pregnancy timing methods and female and male birth control options; preconception health counseling; genetic counseling; testicular health and self-examination; infertility counseling and management; discussion of alcohol, tobacco, and other substance use from an overall health and reproductive health perspective; and depression screening. A secondary benefit of male-centered family planning services or the integration of men into existing family planning services is that this may serve as an entry point into the health care system and lead men to a further referral processes to secure primary health care prevention and treatment services. Men are the critical missing client in most family planning services. It is our obligation to provide male-centered family planning services either through an integrated model or male-focused model of health care delivery. Language: en

Reproductive decision‐making: a qualitative study among couples at increased risk of having a child with retinoblastoma

Little is known about the reproductive decision-making process of couples with an increased risk of having a child with retinoblastoma (Rb). A qualitative study was conducted to explore the impact of prospective risk on reproductive decisions, factors influencing these decisions, and the needs of couples with regard to reproductive counselling. Fourteen couples of childbearing age who received genetic counselling between 2002 and 2006 participated in semi-structured interviews in 2008. The risk of having a child with Rb ranged from less than 1% to 50%. In most cases, the diagnosis of Rb influenced subsequent family planning. Prenatal diagnosis was used by two couples, while others refrained from having more children. Reproductive decisions were influenced by the burden of the disease for the patient and family members, the impact of ophthalmological screening under anaesthesia, and couples' perceived risk, which did not always relate to their actual risk. Reproductive choices with regard to the number of children wanted changed over time. Our findings indicate topics to be discussed during genetic counselling of couples at increased risk for a child with Rb. We suggest continued access to genetic counselling also after the initial diagnosis and treatment.

Genetic risk perception and reproductive decision making among people with epilepsy

We investigated estimated offspring risk among people with epilepsy and factors important in the family-planning process. Data were collected for 88 participants using a questionnaire assessing perceived risk of offspring to develop epilepsy, importance of factors in the reproductive decision-making process, decision to have fewer children, and association between risk perception and family planning decisions. Thirty-four percent of participants had fewer children because of their epilepsy. Concerns about the ability to care for a child (p < 0.0001) and passing epilepsy onto a child (p = 0.003) were associated with the decision to have fewer children. The mean estimated risk of offspring to develop epilepsy was 26%, a 4-fold increase over estimated population risks. Genetic counseling may be beneficial for people with epilepsy, given the considerable overestimation of offspring risk.

Couples’ First Child Intentions and Disagreement: An Analysis of the Italian Case

The aim of this article is to examine the determinants of couples’ childbearing intentions, by explicitly taking into account the agreement or disagreement of the two members of the couple. The relevance of the partner’s reproductive intentions has been well recognised in the literature, but few studies have provided in-depth analyses of the fertility plans of both partners. In our study, we used the household-level data from a survey on “Family and Social Subjects”, carried out by the Italian National Statistical Office in 2003, which provides characteristics on both partners. We adopted a couple’s perspective which allows us to give a unitary picture of the concordant or discordant nature of partners’ first child intentions. We found that a lack of agreement in the reproductive decision-making process is likely to occur in the Italian couples where the role of the woman is less traditional. In particular, cohabitant, highly educated and working women are more likely to be in disagreement with their partners in the decisions concerning having a first child. Being religious may be also a source of discordance in the couples’ reproductive plans. Our findings support the utility of taking a couple-based approach in studies on fertility intentions.

Reproductive Decision‐Making Among HIV‐Positive Couples in Taiwan

To explore the gender-based power relationships and social and cultural influences on reproductive decision-making processes among HIV-positive couples in Taiwan. The study sample consisted of 14 HIV-positive couples in southern Taiwan. Data were analyzed using feminist ethnography to explore reproductive decisions made by these couples within the context of Taiwanese society. Self-knowledge of HIV status had a limited influence on decisions about childbearing. More important was the Confucian values of filial piety and familial obligation, a powerful norm that still dictates procreation decisions in Taiwan. The process by which the couples made reproductive decisions consisted of four stages: initial reproductive decisions between partners, their search for information, their encounters with medical systems, and their weighing risks and benefits. Male and female partners expressed different concerns, and gender-based power relationships were exercised during the decision-making process. HIV status was not the sole determinant of reproductive decisions made by HIV-positive couples. Rather, the Confucian value of filial piety drove the couples' reproductive decisions.

Attitudes towards reproductive issues and carrier testing among adult patients and parents of children with cystic fibrosis (CF)

Assessing the reproductive choices of parents of children with cystic fibrosis (CF) is important in getting a greater insight into the possible needs for counselling of carrier couples in the reproductive decision-making process. Also, parents' reproductive attitudes might indicate critical issues for discussion with regard to introducing general population screening programmes. Data were available from two groups of subjects: 287 adult patients with CF (mean age 27.5 years) and 288 parents of a child with CF (mean age of child 7.7 years) who participated in a Dutch national survey. Attitudes towards reproductive issues and carrier screening and parents' reproductive behaviour were analysed in terms of responses to questionnaires. To avoid having another child with CF, most parents decided against further pregnancies or used other reproductive options. Prenatal diagnosis was used by 72% of parents, whereas 76% of parents planning more children intended using this option. Intention to use prenatal diagnosis was associated with the strength of religious conviction, and was not associated with perceived severity of CF, health of the child, or future therapeutic possibilities. Respondents demonstrated difficulties in deciding to abort for CF. A majority of parents and adult patients supported carrier couple identification within CF families. The results suggest that those most closely involved with CF will accept the reproductive choices of carrier couples identified in population screening programmes.

Attitudes towards reproductive issues and carrier testing among adult patients and parents of children with cystic fibrosis (CF).

Assessing the reproductive choices of parents of children with cystic fibrosis (CF) is important in getting a greater insight into the possible needs for counselling of carrier couples in the reproductive decision-making process. Also, parents' reproductive attitudes might indicate critical issues for discussion with regard to introducing general population screening programmes. Data were available from two groups of subjects: 287 adult patients with CF (mean age 27.5 years) and 288 parents of a child with CF (mean age of child 7.7 years) who participated in a Dutch national survey. Attitudes towards reproductive issues and carrier screening and parents' reproductive behaviour were analysed in terms of responses to questionnaires. To avoid having another child with CF, most parents decided against further pregnancies or used other reproductive options. Prenatal diagnosis was used by 72% of parents, whereas 76% of parents planning more children intended using this option. Intention to use prenatal diagnosis was associated with the strength of religious conviction, and was not associated with perceived severity of CF, health of the child, or future therapeutic possibilities. Respondents demonstrated difficulties in deciding to abort for CF. A majority of parents and adult patients supported carrier couple identification within CF families. The results suggest that those most closely involved with CF will accept the reproductive choices of carrier couples identified in population screening programmes.

Analysis of birth intervals in a non-contracepting Indian population: an evolutionary ecological approach.

Reproductive strategies are related to ecological constraints. This paper examines data on early birth spacing in a scheduled caste, Bengali-speaking, non-contracepting population of the Karimganj district of southern Assam, India, taking an evolutionary ecological perspective. It is found that on average birth intervals closed by boy-boy are longer than those closed by girl-girl. Birth spacing tends to be longer among upper-income and Craftsman sub-caste mothers. The presence of a 'grandmother' in the household shortens spacing. These findings are compatible with an evolutionary-based reproductive decision-making process.

Reproductive decision making of aunts and uncles of a child with cystic fibrosis: genetic risk perception and attitudes toward carrier identification and prenatal diagnosis.

This paper evaluates the perceived genetic risk, the perceived burden, the impact on reproductive decision making, and the attitudes of aunts and uncles of a child with cystic fibrosis toward carrier identification, prenatal diagnosis, and pregnancy termination. A mailed questionnaire was sent to the aunts and uncles of 32 CF children (1) who attended the Paediatric Department of the University Hospital and (2) whose parents agreed to give the names and addresses of their sibs. The results for the 109 respondents aged less than 40 years are discussed. About one-fourth of them was aware of the "approximate" level of the risk to be a carrier of the CF gene and/or of the risk of having a CF child themselves. Nevertheless the subjective evaluation of the genetic risk has played a part in the reproductive decision-making process of at least 39% of the respondents. About three-fourths would (probably) make use of heterozygote detection and would (probably) ask for prenatal diagnosis should they become pregnant. It is striking that less than half of the group would interrupt the pregnancy should the fetus be affected. The intention to use prenatal diagnosis was significantly correlated with age and educational level while the acceptance of pregnancy interruption was significantly correlated with perceived burden, respondents' age, and health situation of the proband.

Reproductive Behavior: Central and Eastern European Experience

The authors attempt to clarify the reproductive decision-making process and to assess the factors influencing reproductive behavior in the Socialist countries of Central and Eastern Europe. Particular attention is paid to the effects of government policies. In Part 1 the authors present overviews of demographic trends the role of women the historical development of population policies abortion policies and private behavior and pro-natalist incentives. Part 2 consists of country reports on the Soviet Union Poland Yugoslavia Romania the German Democratic Republic Czechoslovakia Hungary Bulgaria and Albania. Each country report includes information on demographic trends: abortion and population policies; fertility planning including family research womens roles and family size intentions and actualities; fertility regulating behavior including contraceptive practice abortion trends and pro-natalist incentives; and sex and society including marriage sex education and adolescent sexuality. The final part of the book is a bibliography containing over 1000 references.

Reproductive Behavior, Central and Eastern European Experience

The authors attempt to clarify the reproductive decision-making process and to assess the factors influencing reproductive behavior in the Socialist countries of Central and Eastern Europe. Particular attention is paid to the effects of government policies. In Part 1 the authors present overviews of demographic trends the role of women the historical development of population policies abortion policies and private behavior and pro-natalist incentives. Part 2 consists of country reports on the Soviet Union Poland Yugoslavia Romania the German Democratic Republic Czechoslovakia Hungary Bulgaria and Albania. Each country report includes information on demographic trends: abortion and population policies; fertility planning including family research womens roles and family size intentions and actualities; fertility regulating behavior including contraceptive practice abortion trends and pro-natalist incentives; and sex and society including marriage sex education and adolescent sexuality. The final part of the book is a bibliography containing over 1000 references.