Reproductive Goals Research Articles

Intermittent Needs for Family Planning among Women with an Internal Migrant Husband in Bangladesh: A Qualitative Study

Bangladesh is one of the major labour-exporting countries in the world, with large-scale labour migration flows occurring both internationally and domestically. Spousal separation due to migration has the potential to disrupt women’s ability to use contraception in line with their reproductive goals. This qualitative study complements the 2014 Bangladesh Demographic and Health Survey (BDHS) data; we conducted in-depth interviews with a sub-sample of 23 BDHS respondents whose husbands stayed elsewhere but returned at least once a year to Barisal Division, Bangladesh. The study explores how husbands’ migration patterns influence couples’ fertility intentions, contraceptive decision-making and behaviour, and unintended pregnancies. Results showed that contraceptive use was high among the study participants, with nearly all couples using some method to avoid pregnancy – usually pills and condoms. However, the use was episodic and inconsistent, reducing effectiveness. Experiences of side effects were commonplace, which contributed to this pattern of inconsistent use: women used pills only during the duration of their husband’s visits. Half of the informants experienced unintended pregnancies either due to the inconsistent use of pills or other method failures. The study findings indicate that women with migrant husbands need family planning education related to their particular circumstances and access to a wider range of family planning choices. Quality counselling should respect women’s experiences with side effects and include thorough discussion of viable alternatives.

Engaging Stakeholders in the Development of a Reproductive Goals Decision AID for Women with Cystic Fibrosis.

Objective: More people with cystic fibrosis (pwCF) are reaching adulthood and considering their reproductive futures. Unfortunately, many pwCF report gaps in their reproductive healthcare. We describe measures of stakeholder engagement in developing a reproductive goals decision aid for women with CF called MyVoice:CF. Methods: Stakeholders reviewed the content, design, and usability of the tool, which was informed by prior research related to CF family planning experiences and preferences as well as a conceptual understanding of reproductive decision making. We evaluated stakeholder engagement via process measures and outcomes of stakeholder involvement. We collected data via recorded stakeholder recommendations and surveys. Results: Fourteen stakeholders participated and the majority described their role on the project as “collaborator”, “advisor”, or “expert.” Most felt their expectations for the project were met or exceeded, that they had contributed significantly, and that they received sufficient and frequent information about the process. All stakeholders provided recommen­dations and clarified aims for a CF-specific family planning tool, including its content and focus on facilitating shared decision making. Discussion: Utilizing meaningful stakeholder contributions, we developed MyVoice:CF, a novel web-based decision aid to help women with CF engage in shared decision-making regarding their reproductive goals. Practical Value: Our findings from working with stakeholders for MyVoice:CF indicate that disease-specific reproductive health resources can and should be designed with input from individuals in the relevant communities.

Impact of the COVID-19 Pandemic on Patient Fertility Care.

The effects of the COVID-19 pandemic on the healthcare system have been widespread, with many institutions in the United States pausing elective procedures to redirect resources to critical care. Fertility care and assisted reproductive procedures were classified as elective procedures and similarly paused. We conducted qualitative interviews with patients and/or their partners (n = 25 female patients; n = 3 male partners) receiving care at a fertility clinic in the Midwest to understand patient appraisal of COVID-19 risk on the resumption of care following a month-long closure of an infertility clinic, and patient agreement with the clinic closure. Interview transcripts were thematically analyzed from a grounded theory approach. Study participants reported an increased sense of urgency due to the delay in fertility procedures. This urgency often superseded concerns of potential COVID-19 infection, motivating patients to continue fertility treatment during a pandemic. In hindsight, some participants did not agree with the clinic's closure and treatment cessation, feeling that these steps negatively interrupted time-sensitive reproductive goals. Patient responses highlight the need for additional resources to support decision-making during times of crisis. Triaging patients based on time-sensitivity of treatment instead of a total shutdown respects patient autonomy for continuing treatment amidst uncertain COVID-19-impact.

‘I still desire to have a child’: a qualitative analysis of intersectional HIV- and childlessness-related stigma in rural southwestern Uganda

This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer conception strategies. This secondary analysis explored how challenges conceiving informed pregnancy plans and HIV prevention behaviours. The following themes were developed (1) partnership conflicts arise from HIV- and infertility-related forms of stigma, contributing to gender-based violence, partnership dissolution and the pursuit of new partners; (2) cultural and gender norms pressure men and women to conceive and maintain partnerships, which is complicated by the stigma directed towards serodifferent couples; (3) frustration with low partner participation in safer conception strategies led to the decreased use of these methods of HIV prevention; (4) health care provider support promotes continued hope of conception and helps overcome stigma. In HIV-affected partnerships, these intersecting forms of stigma may impact HIV prevention. Seeking to fulfil their reproductive needs, partners may increase HIV transmission opportunities as they engage in condomless sex with additional partners and decrease adherence to prevention strategies. Future research programmes should consider the integration of fertility counselling with reproductive and sexual health care.

Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol

BackgroundPostpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth.MethodsThis is a mixed method cohort study on PPFP and is nested within an ongoing “Women and Infants Integrated Interventions for Growth Study” (WINGS). Married women aged 18–30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices.DiscussionThe findings from the study will provide useful insights into couples’ contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women.Trial registrationTrial registration number: CTRI/2020/03/023954.

Sexual and Relationship Benefits of a Safer Conception Intervention Among Men with HIV Who Seek to Have Children with Serodifferent Partners in Uganda.

Many men with HIV (MWH) in Uganda desire children, yet seldom receive reproductive counseling related to HIV care. Because men are under engaged in safer conception programming, they miss opportunities to reap the benefits of these programs. The objective of this sub-analysis was to explore the relationship and intimacy benefits of integrating safer conception counseling and strategies into HIV care, an emergent theme from exit interviews with men who participated in a pilot safer conception program and their partners. Twenty interviews were conducted with MWH who desired a child in the next year with an HIV-uninfected/status unknown female partner, and separate interviews were conducted with female partners (n = 20); of the 40 interviews, 28 were completed by both members of a couple. Interviews explored experiences participating in The Healthy Families program, which offered MWH safer conception counseling and access to specific strategies. Data were analyzed using thematic analysis. Three major subthemes or "pathways" to the relationship and intimacy benefits associated with participation in the program emerged: (1) improved dyadic communication; (2) joint decision-making and power equity in the context of reproduction; and (3) increased sexual and relational intimacy, driven by reduced fear of HIV transmission and relationship dissolution. These data suggest that the intervention not only helped couples realize their reproductive goals; it also improved relationship dynamics and facilitated intimacy, strengthening partnerships and reducing fears of separation. Directly addressing these benefits with MWH and their partners may increase engagement with HIV prevention strategies for conception.

Abstract 9551: Presence of Disabilities is Associated With Reproductive Health Counseling, Concerns, and Experiences and Marital History Among Women With Congenital Heart Defects, 2016-2019

Most females with congenital heart defects (CHD) will reach reproductive age. Our objective was to examine whether presence of disabilities is associated with reproductive health counseling, concerns, and experiences among women with CHD. Methods: We used 2016-2019 population-based data from the Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) among women ages 19 to 38 years with CHD born in Arkansas, Arizona, and Atlanta, Georgia. We examined contraceptive and pregnancy counseling, pregnancy concerns and experiences, and marital history by disability status. Disability was based on six validated questions on vision, hearing, mobility, cognition, self-care, and independent living. Multivariable Poisson regression was used to examine adjusted prevalence ratios (aPR) between reporting ≥ 1 disability and each outcome, adjusted for CHD severity, age, race/ethnicity, place of birth, and insurance type. Results: Of 783 survey respondents with complete data (88% of all respondents), 41.9% were 25-30 years of age, 66.8% were non-Hispanic White, and 41.5% reported ≥1 disability. Women with CHD and disabilities were more likely than women without disabilities to receive clinician counseling on safe contraceptive methods (aPR=1.3) and on avoiding pregnancy because of their CHD (aPR=2.3). They were also more likely to report concern about their ability to have children (aPR=1.2) and having delayed or avoided pregnancy because of their CHD (aPR=2.2). They were less likely to have ever been pregnant (aPR=0.8) or married (aPR=0.7). Associations held across specific disability types and after excluding 71 women with known chromosomal anomalies. Conclusions: Among women with CHD, those with disabilities may be more likely to receive clinician advice to avoid pregnancy and less likely to ever have been pregnant. Evidence-based information may improve services and help women with CHD and disabilities meet their reproductive health goals.

Supplementation of ram's semen extender with Mito-TEMPO II: Quality evaluation and flow cytometry study of post-thawed spermatozoa.

Cryopreservation is an effective method to spread qualified ram spermatozoa for reproductive goals in different farms, but cryopreservation's shocks reduce sperm quality. This study investigated the efficacy of the new mitochondria-targeted antioxidant Mito-TEMPO on post-thawed quality of spermatozoa in sheep. Collected samples were divided into five groups and after dilution, received different doses of Mito-TEMPO (0, 0.5, 5, 50 and 500µM), and frozen. Thawed sperm motility parameters, malondialdehyde content, membrane functionality, abnormal morphology, mitochondria activity, acrosome integrity, DNA fragmentation, ROS concentration, viability and apoptotic-like changes, were evaluated. According to the results, Mito-TEMPO (5 and 50μM) improved (p≤0.05) motility parameters, average path velocity, membrane functionality, mitochondria activity and viability compared with the other groups. Moreover, apoptotic-like changes, lipid peroxidation and ROS concentration were lower (p≤0.05) in groups received 5 and 50μM Mito-TEMPO. Mito-TEMPO showed no effect (p>0.05) on sperm acrosome integrity, morphology and DNA fragmentation. In conclusion, Mito-TEMPO as a targeted antioxidant could be an efficient cryo-additive to enhance quality parameters of post-thawed ram semen.

100: Engaging stakeholders in the development of a reproductive goals decision aid for women with cystic fibrosis

100: Engaging stakeholders in the development of a reproductive goals decision aid for women with cystic fibrosis

Redefining Primum Non Nocere to Include Reproductive Autonomy: A New Paradigm in Subspecialty Medicine.

People with chronic medical illnesses are at particularly high risk for adverse pregnancy outcomes, yet current clinical approaches largely fail to identify and support their individualized reproductive and pregnancy goals. Instead, the predominant approach to pregnancy in subspecialty medicine is disease centered rather than patient centered. To better meet the individual needs and preferences of people with childbearing potential who have chronic medical conditions, we advocate in this article for a paradigm shift in subspecialty care that honors individuals' reproductive autonomy and human right of reproduction.

The association between depression and contraceptive behaviors in a diverse sample of new prescription contraception users

ObjectiveAmong women initiating new prescription contraception, we investigated the relationship between recent depression and a range of contraceptive behaviors. Study DesignWe used medical and pharmacy records of 52,325 women ages 19 to 29 who initiated prescription contraception (pills, patches or rings, injectables, and long-acting reversible contraceptives) in 2014−2016 at a large integrated healthcare system in Northern California. Women had continuous enrollment for a year before and after initiating, and no records of prescription contraceptive use in the year before initiating. Depression in the year prior to initiation was dichotomized into (1) no depression indicator (reference group) or (2) depression diagnosis or redeemed antidepressant. Multinomial logistic regression models examined the associations between depression and method type initiated, and contraceptive patterns, timing of discontinuation, inconsistent use, and switching methods over a year after initiating, adjusting for sociodemographics and testing for interactions between depression and having a recent birth or abortion. ResultsWomen with recent depression were more likely to initiate methods other than the pill, and the association was stronger for patches or rings vs pills among those with a recent birth compared to those without. Among women initiating all methods and the pill, those with depression were more likely to discontinue their method, use it inconsistently, and switch from it than use it continuously for a year. ConclusionWomen with recent depression were less likely to initiate the pill; and when the pill was initiated, those with depression were more likely to discontinue use, use it inconsistently, and switch from it. ImplicationsWomen with recent depression indicators should be followed closely to ensure they have the support they need to meet their reproductive goals. Those who wish to avoid pregnancy may benefit from methods that do not require daily use.

THE UNINTENDED CONSEQUENCE OF MEDICAL TRAINING: DELAYED CHILDBEARING. A SURVEY OF REPRODUCTIVE GOALS AND FERTILITY KNOWLEDGE IN MEDICAL RESIDENTS

To assess reproductive goals and baseline fertility knowledge in residents and fellows across various specialties in a university teaching hospital. Residents and fellows at the McGaw Medical Center program of Northwestern University were invited to attend informational seminars hosted by the REI division. Postgraduate trainees have insurance coverage for infertility and oocyte vitrification. Participants were asked to complete a 38-question REDCap survey to assess their reproductive goals and baseline fertility knowledge prior to the sessions. Answers from the survey were compiled and descriptive statistics were analyzed. 112 residents and fellows attended the seminars and 59 of these attendees completed the survey (54 females and 5 males). with only 3.4% aged 35 or older. The largest percentage of participants were in their third post-graduate year (27.1%) and were training in surgical specialties (35.6%). One third of the participants were single, a third were married, and the remainder were partnered. No participants had children, although 2 experienced infertility and had pursued treatment. Over 80% planned to have children and nearly 90% of those individuals hoped to have their first child by age 35. More than 70% of participants reported that they delayed childbearing due to their career. Other reasons identified for delaying pregnancy included plans for ongoing training (50.8%), as well as concerns about time (49.2%), cost (49.2%), childcare (40.7%), and parental leave (27.1%). Nearly half of participants delayed starting a family due to their partner or lack of partner. Over 70% of participants were not aware of fertility benefits and reported desire to pursue fertility treatment or oocyte cryopreservation if covered by insurance. Barriers to pursuit included cost (74.6%), lack of knowledge regarding the procedure (59.3%), initiation (55.9%), and time commitment (54.2%). Ten percent of participants reported that female fertility does not decline until age 40. One third believed that success with one IVF cycle is 80% in women under 35. Nearly 10% of participants underreported miscarriage rates for all age groups. Sixty-five percent of respondents overestimated the upper age limit for IVF success with autologous oocytes, estimating 50.5 years and 14.3% of participants believed that women over age 60 could conceive with their own eggs. Over 80% recognized that males continuously produce sperm but greater than 30% were not aware that sperm concentration decreases with age and 11% were not aware that sperm quality similarly declines. Most medical residents and fellows delay childbearing due to training. Knowledge gaps are highly prevalent in this educated population who desire children but are delaying childbearing. Education focused on the impact of age on fertility and options such as oocyte or embryo cryopreservation should be taught in medical school or during residency training.

Hubungan Usia, Tingkat Pengetahuan, dan Riwayat Penggunaan Alat Kontrasepsi dengan Pemilihan Alat Kontrasepsi pada Penderita HIV/AIDS

Introduction: In couples, one of whom is diagnosed with HIV, generally the partner is emphasized not to have unprotected sex. This includes the selection of contraceptive methods for women with HIV/AIDS to achieve their reproductive goals. Objective: to analyze the relationship between age, education level, and history of contraceptive use with the choice of contraceptive method in women with HIV/AIDS. Methods: This study uses a descriptive correlative design using Fisher test analysis with a total sample of 20 people who meet the criteria. Results: the relationship between age and current contraceptive use with a p value of 0.241, a history of contraceptive use and current contraceptive use with a p value of 1.00, and the level of knowledge with current contraceptive use with a p value of 0.122. Conclusion: there is no relationship between age, history of contraceptive use, level of knowledge, and current use of contraceptives with p value > 0.005.

Family-building and parenting considerations for people with cystic fibrosis.

As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family‐building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.

“I talked to a couple of friends that had it”: Informal feminized health networks and contraceptive method choices

Scholars recognize that social networks can influence a number of health behaviors, including women's contraceptive method choices. However, the gendered dynamics underlying the process of using non-medical information sources to make decisions about contraception has received less attention. Using 30 semi-structured interviews with women enrolled in a contraceptive initiative in the western United States, we explore how women use gendered understandings of medicine and feminized social networks to make decisions about contraceptives. Frequently categorizing their experiences in medical settings as unsatisfactory, women often turn to social support networks of other women—what we call “informal feminized health networks”—to gather information about the effects of contraceptives on women's bodies and to make decisions about which contraceptives are best. While informal feminized health networks are useful, women utilize them in light of unsatisfactory experiences in clinical settings. Working to uproot the paternalistic legacy of institutionalized medicine and improving provider-patient communication will enhance contraceptive access and help women reach their reproductive goals.

Provider Perspectives on Navigating Relationship Challenges in Assisting HIV-Affected Couples to Meet Their Reproductive Goals: Lessons Learned from a Safer Conception Counseling Intervention in Uganda

In Uganda, 60% of HIV-affected couples are serodiscordant, many of whom want children. There is a need to assess their reproductive intentions and provide appropriate services that limit transmission risks while meeting reproductive goals. Our Choice intervention engaged male and female HIV-infected clients and their partners in safer conception counseling (SCC) or family planning based on their childbearing decision. We report findings of provider experiences and recommendations for engaging couples in SCC. The intervention was implemented in four clinics offering either SCC1, an intensive training and supervision arm, or SCC2, utilizing the Ministry of Health's standard approach. Qualitative interviews were conducted at 12 (N = 23) and 24months (N = 25) after initiation of the intervention. Many partners attended at least some SCC sessions, although engaging male partners was more challenging. Providers reported partner involvement improved understanding and facilitated successful implementation of SCM, whereas confusion and challenges were common when the client participated alone. Providers shared successful strategies for engaging male partners.

The road from ICPD to SDGs: Health returns of reducing the unmet need for family planning in India

ObjectiveThis study attempts to estimate the impact of reducing the unmet need for family planning on the key maternal and child health indicators in India from 1993 to 2016, and projecting this for the period from 2016 to 2030. Data and methodsThe data have been compiled from various sources such as the United Nations’ World Population prospects, national family health surveys and the sample registration system. The family planning and demographic projection modules of ‘Spectrum’, a modular computer simulation program, were used to estimate the impact of family planning programmes on reproductive, maternal and child health outcomes in India from 1993 to 2030. ResultsReduction of the unmet need for family planning averted approximately 56 million unintended pregnancies, 7 million unsafe abortions and 167,000 maternal deaths between 1993 and 2016. It is expected that an additional 41 million unintended pregnancies, 5 million unsafe abortions and 124,000 maternal deaths can be avoided by reducing the unmet need for family planning to 5% by 2030. Similarly, the declining unmet need for family planning between 1993 and 2016 led to a reduction in the pregnancy rate, abortion rate, and risk-adjusted infant and under-five mortality rates by 27 per 1000 married women, 1.8 per million married women, 10 per 1000 live births and 15 per 1000 live births, respectively. It is expected that approximately 24 pregnancies per 1000 married women, 1.6 abortions per million married women, 10 risk adjusted infant deaths per 1000 live births, and 14 under-five deaths per 1000 live births can be avoided by reducing the unmet need for family planning to 5% by 2030. ConclusionsThe findings of this study advocate that family planning is one of the best return on-investment strategies for India to achieve several targets under the reproductive, maternal and child health-related sustainable development goals.

Exploring Attitudes, Beliefs and Behavior Towards Hormonal Birth Control Among Female Patients with Sickle Cell Disease through Semi-Structured Interviews

▪Background: Sickle cell disease (SCD) is an inherited, autosomal recessive disorder and one way to decrease the risk of transmission of the disease is through informed reproductive choices. The U.S. Medial Eligibility Criteria for Contraceptive Use advises that the benefits of using hormonal contraceptives usually outweigh the risks for women with SCD. Recommendations for contraceptive use for individuals with sickle cell disease do not discourage the use of any specific contraceptives and identify sickle cell disease as a condition that exposes the woman to increased risk as a result of unintended pregnancy. Research indicates that women with SCD use hormonal contraceptives at lower rates than women without SCD.Objective: We sought to understand women with SCD knowledge, attitudes, and practices around hormonal contraceptives.Methods: African American females 18 and older with SCD were recruited from a sickle cell clinic in Atlanta, Georgia. We administered semi-structured interviews to examine the intersection of sickle cell and reproductive health. These semi-structured interviews explored participants' knowledge and attitudes towards hormonal contraceptives, as well as their personal experiences using hormonal contraceptives.Results: Seventeen women were interviewed on this topic. All but two of the participants indicated they had previously used hormonal contraceptives, but most of the women were not currently using hormonal birth control. Some of the participants had positive thoughts towards hormonal birth control because it prevents pregnancy.Birth control period. I am all for it. I feel like that is a good prevention of having unplanned pregnancies and whatever.Women cited positive experiences with hormonal birth control because it helped with heavy menstrual bleeding and decreased the number of sickle cell pain crises they experienced.I had depo before. It just made me gain weight and my cycles were off balance but it kind of helped with the Sickle Cell crisis a little bit.I would have pain crisis every time I had a menstrual cycle so my doctor told me to go to a gynecologist to get onto a birth control so that kind of decreased the amount of crisis that I was getting.Some of the participants had negative perceptions of hormonal birth control. Some were wary of it altogether. Most of them cited the side effects associated with hormonal birth control as the main reason they did not use them.I don't think any women should be on them just because of all the stuff in it. Some stuff they do not tell you what is in it and the weight gain and all the side effects I don't like them.That's why I don't like them because of the symptoms that I had. I wason Depo and I bleed for two months straight. And then I tried another one.Some green pill I don't know. I tried the implant. Like I said all the side effectsI didn't like them. I didn't like when I had side effects with it.Participants had specific concerns about the side effects related to menstrual bleeding and the intersection between contraceptive and sickle cell.I know they can just regulate your menstrual cycle. I kind of feel like that's unnatural. I think God put that in place for a reason and it needs to clean your body out. I just kind of think that part of it is unnatural and it shouldn't happen.I actually had to get one of them took out. The Nexplanon it actually caused a blood clot which is dangerous for a Sickle Cell patient.Right now I have an IUD and at first it was giving me back problems but I think it was just associated with Sickle Cell. So I think maybe it can trigger a Sickle Cell crisis sometimes.Conclusion: Our study findings indicate that women with SCD have low utilization of hormonal birth control with concerns for side effects caused by, and a general distrust of, hormonal contraception. However, some women also acknowledge that hormonal contraception can help prevent unplanned pregnancy, which not only may lead to unintended transmission of SCD, but also increased health risks to the woman. Providers caring for women with SCD may be able to better support them by adopting a patient-centered approach to contraceptive counseling. Seeking to clarify women's reproductive goals, contraceptive priorities and concerns, as well as correcting misinformation and reassuring women about hormonal contraceptive safety for women with SCD may be beneficial. DisclosuresNo relevant conflicts of interest to declare.

Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care.

Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.

“I'm not going to be a guinea pig:” Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA

BackgroundRacial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans’ adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans’ experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. Study DesignWorking with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. ResultsJust over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. ConclusionsBlack men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans’ history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. ImplicationsWhile the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.