Reproductive Intentions Research Articles

Australian women's views concerning non-medical egg freezing and factors motivating freezing decisions.

We aimed to determine women's views about egg freezing for non-medical reasons and the factors motivating freezing decisions. In this study, 514 women aged 18-44 years completed an online cross-sectional survey exploring fertility knowledge, reproductive intentions and views concerning non-medical egg freezing. Data were analysed descriptively. Additionally, 14 variables noted as potential motivators in prior literature were entered into a multinomial regression to explore factors that would motivate women to consider freezing their eggs for non-medical reasons. Views concerning non-medical egg freezing were generally positive, with 61.3% of participants reporting that they would consider egg freezing ('Yes' or 'Maybe'). Factors motivating decisions to freeze varied among women who responded 'Yes', 'Maybe' and 'I don't know' to whether they would consider freezing. The availability of Medicare subsidization and the procedure not affecting future fertility were significant predictors for all three groups of women. Acceptability of egg freezing for non-medical reasons was moderate to high. However, there is a need for targeted fertility information to educate women about fertility and optimal times to conceive and freeze their eggs. Future research about views concerning non-medical egg freezing among diverse populations and examining the health economics of this procedure would be beneficial.

Research on the influence of house price to income ratio on female fertility intention and countermeasures – Research proof based on stata

Low fertility rates are accelerating the aging of populations around the world. Developed countries experienced demographic shifts in the 20th century. Many developed countries are aging because of improved medical care, longer life expectancy and declining fertility rates. In the past decade or so, China has not escaped the impact of an aging population. The increase of the elderly population has brought great challenges to the social security system, so the aging problem in China deserves our attention. As we all know, the factors that affect people’s fertility willingness are various, such as economic constraints, social and cultural influences, and traditional family concepts. In China, high housing prices, an important part of economic factors, are increasingly becoming an important constraint for urban population fertility decisions. Based on the data analysis of stata, this paper studies the impact of housing price on women’s reproductive intention from 2015 to 2022. Through data analysis, it is concluded that housing price has a negative impact on women’s reproductive intention in inverse proportion.

Модели будущей жизни в биографическом проекте старшеклассников

The processes of individualization, destandardization of the life trajectory, the weakening of cultural continuity in modern society force the individual to rethink and correct his own life trajectory at different stages of personal history. Modern sociology pays special attention to perceptions of the future as a social fact that influences social outcomes for individuals. The article examines the image of the future in the context of an individua’s biographical project through the example of the plans for life of high school students in St. Petersburg. Special emphasis is placed on the relationship between the desired image of the future, life ideals, plans and strategies, which gives the key to understanding modern socio-cultural transformations at the level of individual persons. Quantitative and qualitative methods of study made it possible to find and describe types of ideas about the future and the factors that determine them. Three models of gender-marked ideas of high school students about their future family life and professional trajectory were identified based on the analysis of intersections of gender representations and reproductive intentions. Traditional, neo-traditional, and emancipatory meanings are analyzed in the context of biographical project. It is shown that religiosity (the importance of God) is connected neither with the solution of existential issues by teenagers nor with their subjective well-being, i.e., realizes neither the worldview function nor the compensatory one. The connection of religiosity with the reproduction of traditional values allows us to consider it as an axiological component of biographical project. The results indicate that family and childbearing generally remain significant for high school students although the alternative intention toward a non-family future is also clearly seen in biographical project.

Study of the Impact of Housing Affordability on the Fertility Rate in Bulgaria (2014–2021): A Regional Aspect

Abstract The present study is devoted to the influence of housing affordability on the fertility rate in Bulgaria. Both data published by NSI and data obtained by individual request were used. Housing affordability is a factor and is represented as the ratio of the average price of a 70 m2 apartment and the average gross salary of an employed person, as well as the ratio of the average housing price and the average income per person in a household. Fertility has the role of an outcome variable and is represented by the gross fertility rate, average age of the mother at the birth of the first child and at the birth of a child, number of live births by age of the mother and total fertility rate. Such lag values of the factor variable were used due to the long period from the moment of availability of housing to its acquisition, completion, furnishing and commissioning, and the long biological period from the decision to implement reproductive intentions to the birth of a child. The Pearson correlation coefficient was used to assess the direction and strength of the relationship. A strong negative relationship is found between housing affordability and fertility rate, except for the relationship with the total fertility rate, which is weakly positive. The change in the lag has a minimal effect on the value of the correlation coefficients. Therefore, a conclusion can be made that children are mostly born where housing affordability is low and parents are forced to raise them in unsuitable housing conditions.

Abortion policies at the bedside: incorporating an ethical framework in the analysis and development of abortion legislation

About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the...

Reproductive strategies of Russian women: results of the pilot survey

The sphere of reproduction as an integral part of the health of population today is medicalized at all stages of the formation of reproductive decisions — from conception to childbirth. The choice of reproductive strategies is influenced by two polar trends: the increasing importance of innovative methods of assisted reproductive technologies (ART) and medically-associated reproduction (MAR), on the one hand, and the growing popularity of traditional methods of pregnancy and childbirth management based on folk healing, yoga, oriental medicine and health improving practices, homeopathy, popular psychology and so on., on the other. Thus, two sides of procreative behavior manifest themselves: both the patterns reflecting a biomedical approach based on scientific innovations and the social behavioral models related to public perceptions of health, well-being and gender roles in the society. The article presents the results of a pilot survey of women of reproductive age (n=54) conducted in April 2022 via an electronic questionnaire. The study focused on two topics: ART (awareness and attitude to various ART programs) and pregnancy and childbirth (perception of different forms of preparation for childbirth, the preferred form of childbirth, attitude to medical interventions in the birth process). Data analysis showed that women's reproductive intentions remain medicalized and take into account the possibilities of ART. Also, the results of the survey confirm the growing demand for humanization of maternity care, which is reflected in the desire of women to carefully approach organization of their own childbirth and team of assistants, to attend courses for expectant parents, be more informed and comprehensively prepared.

Mediation of the association between stigma and HIV status and fertility intention by fertility desire among heterosexual couples living with HIV in Kunming, China.

This study aimed to assess the influences of stigma and HIV status on reproductive intention among heterosexual couples living with HIV in China. A cross-sectional study was conducted in Kunming, China among 315 HIV-positive individuals and their spouses (n = 315 couples). An interview questionnaire was used to collect data on intention, desire, HIV Stigma Scale items, and HIV status. Dyadic fertility intention was examined using the actor-partner interdependence mediation model, based on the Traits-Desires-Intentions-Behavior framework. The husbands' or wives' internalized stigma had significant negative effects on their own fertility desire (β = -0.149, p<0.05 and β = -0.238, p<0.01, respectively). HIV-positive status of the husbands was weakly linked to their own fertility intention (β = -0.181, p<0.05). Husbands' perceived provider stigma was associated with their own and their wives' fertility intention via the mediating effect of their fertility desire (β = -0.374, p<0.001 and β = -0.203, p<0.01, respectively). The cumulative influence of their reproductive desire mediated the husband's perceived provider stigma and the wife's internalized stigma on their fertility intention. Stigma and HIV status were associated with fertility intention among couples living with HIV, mediated by fertility desire. The high intra-couple correlation suggested that counseling should be conducted when both spouses are present together with extensive discussions on concerns regarding HIV-related stigma, potential discrepancies between each partner's fertility desire and intention, and the influence of one partner on the other.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

Family size desires and intentions in the lowest fertility region in Vietnam

Background: Vietnam's total fertility rate has been relatively stable around the replacement level since 2005. Meanwhile, fertility in the Southeast of Vietnam has always been far below the replacement level. As reproductive desires and intentions are important determinants of fertility, the article estimates family size desires and intentions in the Southeast and analyse related sociodemographic factors, contributing insights to the low fertility in this region. Methods: Based on data from a survey of people aged 18-45 in the Southeast in 2020, bivariate analysis and multinomial logistic regressions were applied to examine family size desires and intentions in this region. Results: Most respondents want two (57.3%) or more (33.1%) children, and only 8.4% of them want to have fewer than two children. There are wide gaps within reproductive desires and intentions and the actual fertility. The mean intended family size is nearly 2.1, lower than the mean desired family size but much higher than the total fertility rate in 2020. Young people and unmarried females are more likely to have desires and intentions of fewer than two children. The most frequent reason for no intention of attaining desired family sizes is the fear of not having enough financial resources to raise their children as their expectations. Discussion and Conclusion: The low fertility in the Southeast of Vietnam is not due to a substantial decline in the value of children, but mainly because socioeconomic conditions are not favourable for having two or more children. In the current context in the Southeast, when most people of reproductive age still want and intend to have at least two children, support policies to reduce difficulties and obstacles to having would be much more effective in increasing the fertility rate than later when the desire of fewer than two children become more popular.

Implementing a school-based HIV prevention program during public health emergencies: lessons learned in The Bahamas

BackgroundNatural disasters and public health crises can disrupt communities’ capacities to implement important public health programs. A nationwide implementation of an evidence-based HIV prevention program, Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT), in The Bahamas was disrupted by Hurricane Dorian and the COVID-19 pandemic, especially in its more remote, Family Islands. We explored the teacher- and school-level factors that affected implementation of the program in these islands during those disruptions.MethodsData were collected from 47 Grade 6 teachers and 984 students in 34 government elementary schools during the 2020–2021 school year. Teachers completed a pre-implementation questionnaire to record their characteristics and perceptions that might affect their implementation fidelity and an annual program training workshop. School coordinators and high-performing teachers acting as mentors received additional training to provide teachers with monitoring, feedback, and additional support. Teachers submitted data on their completion of the 9 sessions and 35 core activities of FOYC + CImPACT. The fidelity outcomes were the number of sessions and core activities taught by teachers.ResultsOn average, teachers taught 60% of sessions and 53% of core activities. Teachers with “very good” school coordinators (34% of teachers) taught more activities than those with “satisfactory” (43%) or no (34%) school coordinator (27.5 vs. 16.8 vs. 14.8, F = 12.86, P < 0.001). Teachers who had attended online training or both online and in-person training taught more sessions (6.1 vs. 6.2 vs. 3.6, F = 4.76, P < 0.01) and more core activities (21.1 vs. 20.8 vs. 12.6, F = 3.35, P < 0.05) than those who received no training. Teachers’ implementation was associated with improved student outcomes (preventive reproductive health skills, self-efficacy, and intention).ConclusionsThe Hurricane Dorian and the COVID-19 pandemic greatly disrupted education in The Bahamas Family Islands and affected implementation of FOYC + CImPACT. However, we identified several strategies that supported teachers’ implementation following these events. Teacher training and implementation monitoring increased implementation fidelity despite external challenges, and students achieved the desired learning outcomes. These strategies can better support teachers’ implementation of school-based interventions during future crises.

Reproductive Intentions Affected by Perceptions of Climate Change and Attitudes toward Death.

Adverse climate change poses a threat to the health of pregnant women and unborn children and has a negative impact on the quality of life. Additionally, individuals with a high awareness of the consequences of climate change may be accompanied by a fear of the inevitable end, such as a fear of death. This, in turn, may discourage planning for offspring. Thus, both the perception of climate change and fear of death can have implications for reproductive intentions. Only a few studies to date indicate that concerns about climate change, especially when combined with attitudes towards death, may influence the formation of attitudes and reproductive plans. Thus, current research is aimed at looking at reproductive intentions from the perspective of both climate change concerns and the fear of death. This study was conducted from December 2020 to February 2021. A total of 177 childless males and females (58.8%) took part in the study. The Death Anxiety and Fascination Scale (DAFS) and Climate Change Perception Questionnaire (CCPQ) were completed online. Overall, 63.8% of respondents displayed a positive reproductive intention. Multivariable logistic regression analysis found that, in addition to the young age of respondents, the likelihood of positive reproductive intentions increases with death anxiety and decreases with death fascination and with climate health concerns. The results indicate that both climate change concerns and the fear of death are relevant to reproductive plans—positive reproductive intentions increase with death anxiety and decrease with death fascination and with climate health concerns. The results fill the gap in the existing research on predictors of reproductive intentions and can be used for further scientific exploration and practical activities addressing the issues of the determinants of decisions about having children. The individual consequences of climate change are clearly taken into account in the context of offspring planning and, therefore, should be considered in the design of social and environmental actions.

Things to Gain, Things to Lose: Perceived Costs and Benefits of Children and Intention to Remain Childless in Poland

A rapid fertility decline observed in Poland since the 1990s has been accompanied by a marked increase in childlessness. This may seem surprising given the high value placed on parenthood in the country. Some evidence exists on how childlessness in Poland relates to biological and situational constraints, but still relatively little is known about how the decision to never have children is made, especially among men. This article contributes to this literature by analysing how the perceived positive and negative consequences of parenthood affect the reproductive intentions of childless women and men of different socioeconomic characteristics in Poland. Using a subsample of childless respondents extracted from the second wave of the Polish Generation and Gender Survey, we examine the interplay between (a) the intention to remain childless, (b) the perceived costs and benefits of having children, included as a unique set of questions in the Polish Generation and Gender Survey (GGS), and (c) respondents’ socioeconomic characteristics (education, employment, household financial situation, and the size of the place of residence). The results suggest that among women both costs and benefits strongly affect the likelihood of intending to remain childless, whereas among men only the benefits matter. While the effects do not depend on any of the socioeconomic characteristics, the probability of not intending to have a child does vary by some of them. Our results indicate the pattern of fertility polarisation already seen in some low‐fertility countries: for the disadvantaged segment of the population, it is increasingly difficult to become parents.

P-744 Fertility intention for a second or third child among childbearing couple in Shanghai, China

Abstract Study question What is the intention rate and related factors for a second or third child among childbearing couple? Summary answer Among couples with one child, 16.2% are willing to have a second child. Only 9.4% of couples with two children are pursuing third child. What is known already The decline in fertility is becoming an inevitable trend in most countries around the world. In the end of 1970s, the one-child policy was implemented. Since 21st century, China has gradually changed its fertility policy, from a selective two-child policy to a comprehensive two-child policy. Nevertheless, the number of total annual births in China has not shown an obviously increasing trend of growth. On August 20, 2021, the Chinese government amended the law to allow a couple to have three children. However, only a few studies have been conducted to evaluate fertility intention in the couples who already have kids. Study design, size, duration We conducted a cross-sectional survey in Shanghai from July to August in 2021. This study population was based on the female fertility database established between 2013 and 2017, which contains basic sociodemographic information and the reproductive intentions. We conducted this study to evaluate the fertility intention of the second or the third child and its related factors. Participants/materials, setting, methods From July to August in 2021, couples aged between 20 and 45 years old with one or two children was invited to participate in our study to give the information about “second/third births intention” and the factors that may probably related to it. Between the groups with and without second/third child intention, the chi-squared test and binary logistic regression was applied to compare the difference in the basic characteristics and relative factors. Main results and the role of chance Among couples with one child, 130 (16.2%) couples had intention to have a second child. Only 9.4% of couples with two children show the desire to have a third child. The ideal number of children for all our participants was 1.72±0.52. And the ideal number of children among couples with one child is 1.61±0.52. By contrast, the ideal number for couples with two kids was 2.06±0.34. The study showed great differences in Socioeconomic and personal factors between two groups. For second-child intention, the female age over 35 years, first child's age over 7 years, annual payment for the first child ranges from 70,000-100,000 RMB and children’s educational barriers were negatively associated with an intention to have a second child. Job with more free time makes it easier for couples to have a second child. Among couples with two children, parents with family financial constraints and children’s educational barriers are less likely to have a third child. Fertility-encouraged government policy can promote couples to pursue a second or third child. It is necessary to take measures to reduce the burden of raising children and increase free time for couples to relief parent’s pressure of rearing a child. Limitations, reasons for caution As this is a single-center study in Shanghai, the sample size is relatively small. Although our sample size still meets the basic statistical requirements and can detect a moderate effect size as significance, the results may not be applicable to some other regions. Wider implications of the findings The decision of fertility intention is influenced by female age, the first child’s age, family economic conditions, children’s education and national fertility policies. It is necessary to take measures to reduce the burden of raising children and increase free time for couples to relief parent’s pressure of rearing a child. Trial registration number ChiCTR2100045315

P-507 Psychosocial and motivational drivers of the increased IVF engagement of infertile couples following Covid-19

Study questionWhat are the main psychosocial motivational factors behind the increased IVF adoption during the Covid-19 Pandemic?Summary answerDuring the Covid -19 Pandemic more time invested in marital relationships prompted infertile couples to act and engage in IVF treatments.What is known alreadyThe Covid 19 Pandemic has generated a sense of lack of control and fear for the future in many individuals. However, like several life-threatening events, it could also have positive effects, motivating people to take significant actions for their life course. Little has been reported on the consequences that the Pandemic has generated on the infertile couple’s attitude toward reproduction, IVF treatments engagement and childbearing desire. We aimed to address if during the Pandemic, there was an increase of IVF demand and what motivational factors prompted infertile patients to pursue IVF as compared to the pre-pandemic.Study design, size, durationThis is a prospective multicenter observational control-case study assessing the relational, emotional, and environmental motivational factors driving infertile couples to purse their first IVF treatment during the Covid-19 Pandemic in different IVF clinics as Valencia, Madrid, Rome, and Chile. To assess the growth rate in IVF activity at recruiting sites, number of cycles was compared over a 18 months period between the pre-pandemic and pandemic. The survey was run between September 2021 to January 2022.Participants/materials, setting, methodsAn ad hoc survey was developed to explore the main relationship, emotional and socioeconomical factors responsible for the IVF engagement. The electronic survey was delivered to 13585 patients attending the recruiting clinics from December 2018 to March 2020 for Prepandemic and from March 2020 to December 2021 for the Pandemic ones, and they were asked to rate their agreement for each answer on a five-points Likert scale.Main results and the role of chanceFor most clinics, data derived from national patients only showed a significant IVF demand increase (5.5-8.7%) for all indicators (number of started ovarian stimulations, oocyte pickups, and embryo transfers). Of 13685 patients receiving the survey only 1556 (810 prepandemic, 746 pandemic, response rate: 11%) completed it. Demographic and infertility history data (including male/female, infertility length, previous children and miscarriages, ethnicity) were homogeneous between two groups. However, the infertility length and the proportion of donation cycles were slightly lower in the pandemic group (2.3 vs 2.1) years and 24.1% vs 19% for pre-pandemic and pandemic, respectively; p < 0.001). Only 25.34% (95%CI: 22.2-28.6) of Pandemic patients experienced their referral clinic closing, and 19.17% (95% CI: 16.4-22.1) public hospital closing, and 30.56% (95%CI:27.2-34.01) valued the use of telemedicine in the IVF positively. Interestingly, over 90.21% (95%CI:87.8-92.2) of pandemic patients started childbearing desire before the Pandemic, and about 68.63% (95%CI:65.1-71.9) knew already about their infertility. This suggests the Pandemic had represented a strong trigger for infertile patients to reframe their reproductive intention. Among all the motivational factors addressed in the survey, the increased time to invest in marital relationship was the stronger driver for pursuing IVF for Pandemic patients (OR:1.48; 95%CI: 1.16-1.89; p < 0.01).Limitations, reasons for cautionNot all potential drivers for IVF attainment have been included in the survey and unexplored factors might have played a role. Other reasons for caution include the possibility of response bias. However, the prospective design and the large multicentre/international setting of the study helped mitigating the effect of specific/local confounding.Wider implications of the findingsThe knowledge gathered here will be crucial to design more effective strategies to cope with patients’ needs during the pandemic. Furthermore, this study can provide a valuable resource for understanding psychosocial factors responsible of the ongoing decline in the natality rate in many developed countries, such as disincentivizing couples’ relationships.Trial registration numbernot applicable

Understanding Patriarchal Ideology in Decision-Making on Induced Abortion in Jharkhand’s Korwa Tribe

Abortion continues to be seen in many societies as an alternative method of contraception. It is a complex dynamic jumble in the patriarchal social structure where the concept of choice is not entirely in hands of women. Deciding to abort involves the interplay of social, cultural, family, and structural dynamics of traditional society. This article describes the study of one of Jharkhand’s primitive tribal communities in order to understand the dilemma that influences women to submit to abortion. Forty-one in-depth personal interviews were conducted with married women aged 13–49 years who were currently living with their husbands and had at least one living child. The interview guide included open-ended questions supported by prompts and the information collected during the discussions was carefully coded and analyzed by theme. The study assessed male hegemony over women’s sexuality expressed as a preference for the son that often triggered domestic violence. The choice to undergo abortion remained under the influence of asymmetric structure of patriarchal power as well as a number of other, juxtaposing social issues, including land rights and religious factors. The gender balance of power affects not only the determination of reproductive intentions but also the continuation or abandonment of reproductive outcomes. This reflects the need to include gender and cultural sensitivity in policies and programs of fertility control.

The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building.

STUDY QUESTIONWhat are the intentions of men and women of reproductive age in the UK regarding reproduction and family building?SUMMARY ANSWERWe identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions.WHAT IS KNOWN ALREADYSeveral studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires.STUDY DESIGN, SIZE, DURATIONWe conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee.PARTICIPANTS/MATERIALS, SETTING, METHODSSurvey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method.MAIN RESULTS AND THE ROLE OF CHANCEFrom the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making.LIMITATIONS, REASONS FOR CAUTIONDue to the online recruitment method, there may be a bias towards more educated respondents.WIDER IMPLICATIONS OF THE FINDINGSWe developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family.STUDY FUNDING/COMPETING INTEREST(S)There was no external funding for this study. The authors report no competing interests.TRIAL REGISTRATION NUMBERN/A.

Utilisation of immediate postpartum family planning among postpartum women at public hospitals of North Shoa Zone, Ethiopia: a cross-sectional study

ObjectiveThis study aimed to assess the prevalence of immediate postpartum family planning utilisation and the associated factors among postpartum women at public hospitals of North Shoa Zone, Ethiopia.Design and methodsA...

A qualitative analysis of Medicaid beneficiaries perceptions of prenatal and immediate postpartum contraception counseling

Objectives:In the United States, about four out of every ten births are financed by Medicaid, making it a program that is key in addressing racial disparities in maternal health. Many women covered by Medicaid have access to prenatal and immediate postpartum contraception counseling that can aid them in their postpartum contraception decision-making. However, existing inequities within Medicaid and a history of reproductive harms targeting Black women and women with low incomes may contribute to women with Medicaid having different experiences of contraception counseling. This qualitative study explores how Black women and White women insured by Medicaid perceive prenatal and immediate postpartum contraception counseling and identifies additional factors that shape their contraception decision-making.Methods:We conducted semi-structured interviews with 15 Medicaid beneficiaries who delivered at a public teaching hospital in North Carolina. Interviews focused on women’s beliefs about planning for pregnancy, experiences with prenatal and immediate postpartum contraception counseling, and perceived need for postpartum contraception. We used a priori and emergent codes to analyze interviews.Results:Seven Black women and eight White women completed interviews 14–60 days postpartum. All women reported receiving prenatal and immediate postpartum counseling. Several women described receiving prenatal counseling, reflective of patient-centered contraception counseling, that helped in their postpartum contraception decision-making; one woman described receiving immediate postpartum counseling that helped in her decision-making. Some Black women reported receiving unsupportive/coercive contraception counseling. In addition to contraception counseling, past reproductive health experiences and future pregnancy intentions were salient to women’s contraception decision-making.Conclusions:Prenatal and immediate postpartum contraception counseling can help some Medicaid beneficiaries with their postpartum contraception decision, but past reproductive health experiences and future pregnancy intentions are also relevant. Counseling that does not consider these experiences may be harmful, particularly to Black women, further contributing to racial disparities in maternal postpartum health outcomes.

Observational study of feasibility and acceptability of the levonorgestrel-releasing intrauterine device as a long-acting reversible contraceptive in a primary care setting in India

ObjectivesThe levonorgestrel-releasing intrauterine device (LNG-IUD) is a well-accepted contraceptive across developed countries, yet there is limited experience in use and acceptance amongst women living in low-resource, developing country settings. We studied the feasibility of providing the LNG-IUD through a primary care service, and its acceptability amongst women living in a low-income, rural-tribal community in India. Study designWe conducted an observational study of feasibility and acceptability at four health facilities (three rural, and one urban) in Rajasthan, India. Women seeking contraception were offered the LNG-IUD in addition to existing contraceptive methods. We followed all those who adopted LNG-IUD from August 2015 to September 2019 (n= 1266) till discontinuation or 12 months, whichever was earlier. The primary outcome was continuation rate and acceptability, and the secondary outcome was change in hemoglobin levels, which we measured before insertion and at 12-month follow-up, using Sahli's method. ResultsMost users lived in villages, were illiterate, belonged to marginalized groups, had 2 or more children, and wished to limit births when they adopted the method. The 12-month continuation rate was 87.6%. Amongst all users, 7.4% of women sought removal for side effects and 2% for change in reproductive intention, while another 2% reported spontaneous expulsion. Most continuing users reported hypomenorrhea (54%) or amenorrhea (42%) by 12 months of use. User satisfaction was high at 91.6%, with 92% of women rating their experience as equaling or exceeding expectations. Moderate and severe anemia reduced, and mean hemoglobin levels increased by 0.7 g/dL (p < 0.01). ConclusionPrimary care clinics can feasibly deliver LNG-IUD, with high acceptability amongst women living in low resource settings. Given the paucity of long-acting reversible contraceptive options and high prevalence of anemia among women in India and similar countries, the method should be piloted through the public health system. ImplicationsLong duration of contraceptive action, ability to reduce menstrual bleeding and reduce anemia, reversibility, and easy removal, combine to make LNG-IUD acceptable to women, especially in regions with high prevalence of anemia. This study demonstrates the feasibility and acceptability of introducing LNG-IUD in a low resource, primary care setting.

Family planning practices among women seeking induced abortion: An institution-based cross-sectional study from Eastern India.

Unmet need for contraceptive use indicates the gap between women's reproductive intentions and their contraceptive behavior. It is a direct contributor to the increased incidence of unwanted pregnancies leading to abortion. Abortions, particularly septic abortions constitute an important cause of maternal morbidity and mortality. This study was conducted to determine the pattern of family planning practices among women seeking an induced abortion. The study also aimed to assess the awareness and attitude towards contraceptive methods along with reasons for the nonuse of contraceptives in this study population. An institution-based cross-sectional study was conducted during October 2020 to October 2021. Data was collected using a preformed validated structured questionnaire. Descriptive statistics was used to describe data. The Chi-square test was used to find the significance of differences between categorical variables. A total of 256 pregnant women seeking induced abortion were recruited. Despite high knowledge (99.2%) and attitude (63.7%), a history of contraceptive use could be elicited in 43.8% of study subjects. The most common contraceptive methods used previously were oral contraceptive pills followed by the barrier method of contraception. A significant association was found between contraceptive use and age of the woman, urban or rural background, and marital status. Unplanned sex or infrequent sex was the most common reason for the nonuse of contraceptives followed by fear of side effects. Enhancement of knowledge of contraceptive users through adequate information by health care providers can be helpful. Consideration of socio-demographic characteristics of women and contraceptive barriers is indispensable in implementing family planning interventions.