Women's Reproductive Decision-making Research Articles

Socio-sexual norms and young people's sexual health in urban Bangladesh, India, Nepal and Pakistan: A qualitative scoping review.

In South Asia, young people face myriad challenges and opportunities regarding their sexual lives relating to varied experiences of norms and restrictions; gender norms and socio-sexual taboos limit communication around sexual health which in turn can affect sexual health outcomes. In this article we focus on norms affecting young people's sexual health experiences in urban settings in Bangladesh, India, Nepal, and Pakistan. We conducted a scoping review of peer reviewed empirical studies based on qualitative data pertaining to young people's experiences of sexuality and sexual health in Bangladesh, India, Nepal, and Pakistan. We searched four electronic databases for articles published (2010-2022), using terms relating to sexual health, young people, and South Asia. Sixteen articles met the inclusion criteria with sample size ranging from 9 to 180. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for the design and analysis of this study. We synthesised the included articles using thematic analysis. The studies covered topics such as sexual health services and contraceptive use; sexuality education and communication; and gender and sexual violence. Recurring findings included: parental and societal expectations around premarital 'sexual purity' through abstinence; limited communication around sexuality between young people and parents/adults; gender norms limiting young women's sexual and reproductive decision making; and an absence of research on experiences of sexual and gender minorities. We identified common themes as well as prominent gaps which must be addressed if we are to capture diverse experiences and build a better evidence base to improve sexual health services for young people in the region. The body of research fails to include experiences of young people with diverse gender, sexual orientation, and sex characteristics.

Multiple Sclerosis and Family Planning: A Survey Study of the Patient Experience.

Multiple sclerosis (MS) commonly affects women in their childbearing years, necessitating discussion between patients and their MS treatment team around the issues of family planning, pregnancy, and postpartum experiences. This study assessed the impact of a diagnosis of MS on women's reproductive decision-making and on their perception of counseling received surrounding pregnancy. It also sought to evaluate trends in pregnancy and postpartum experiences and determine whether experiences differed by race, ethnicity, and zip code. Women with an MS diagnosis seen at the University of Virginia MS Clinic or at Virginia Commonwealth University (VCU) MS Clinic were invited to participate in a survey study. MS disease and pregnancy history, and, when appropriate, reasons for pregnancy avoidance were collected. Respondents who had >1 pregnancy following MS diagnosis were asked to evaluate the counseling they received from medical professionals and to share their pregnancy experiences including complications during pregnancy, delivery outcomes, and postpartum experience including breastfeeding. Of the 280 respondents, 76.6% were currently receiving MS specialty care. Most of them (79.3%) had not been pregnant following MS diagnosis. Of them, 20.1% indicated that this decision was driven by MS-related concerns: MS worsening with pregnancy (47%); ability to care for child secondary to MS (35%); passing MS onto child (19%); stopping disease-modifying therapies to attempt pregnancy (14%); lack of knowledge about options for pregnancy and MS (9%). Women with a more recent estimated decade of pregnancy were more likely to report neurologist counseling regarding MS and pregnancy (pregnancy before 2000: 40%, 2000-2010: 64.7%, 2010- present: 83.3%; χ2 0.020). Breastfeeding initiation was reported in 71.4% of postdiagnosis pregnancies (median duration 6 months, interquartile range 1.75-11). Over the past few decades, women with MS have received a wide range of evolving guidance surrounding family planning, pregnancy, and postpartum care. Survey data suggest improvements in MS/pregnancy counseling and medical management in recent years, which may be driven by an increase in research in the field. There remains an important need and opportunity to improve counseling of women with MS who are considering pregnancy.

Rising Up, Pushing Forward: Standing Our Ground in the Face of Injustice

At the one-year mark since the overturning of Roe v. Wade, there is an urgent, vital need for feminist scholarship that addresses the ways structural stigma and oppressive policy affect diverse groups of women and people assigned female at birth (AFAB). Accordingly, in this introduction to the special issue of Psychology of Women Quarterly, we provide a historical overview and timeline of reproductive rights and (in)justice in the United States in order to illustrate how we have arrived at this perilous moment in history. Reproductive (in)justice exacerbates inequities regarding who has been encouraged to reproduce, who has been denied reproductive autonomy, and who has been required to reproduce and refused the right to parent their children in safe environments. Accordingly, we aver the importance of centering an intersectional and reproductive justice framework in understanding how coalescing forms of oppression (e.g., racism, capitalism, sexism, ableism) circumscribe reproductive autonomy. We begin the special issue with articles that examine how social policy and structural oppression have violated women's and people AFAB reproductive healthcare, followed by articles that examine how such policy and oppression affect women's reproductive decision-making. We conclude this special issue with an article that centers reproductive justice advocacy in the ongoing fight for reproductive rights and bodily autonomy.

Exploring Black Women's Pathways to Motherhood Within a Reproductive Justice Framework.

Amidst the increasing push to address racial disparities in maternal health equity, fewer studies have considered Black women's perspectives on their needs, concerns, and priorities regarding family planning care. Such evidence might help address the lack of support and information that many Black women report in patient-provider encounters, and broaden empirical knowledge on the contextual factors that influence Black women's reproductive decisions. In the present qualitative study, we explored Black women's pathways to motherhood within a reproductive justice framework. We drew on individual, semi-structured interview data from 31 Black mothers (25-50years, Mage = 35years) across the United States. Using consensual qualitative research methods, we elaborated on three themes: (1) intentional family planning, (2) unintended pregnancy, and (3) othermothering. The findings challenge deficit-based stereotypes of Black mothers' reproductive choices and illuminate how health practitioners can facilitate humanizing conversations that prioritize Black women's family planning goals and decision-making.

“Thinking with my dad brain, not my man brain”: Understanding Men's and Women's sterilization risk narratives

The interpretation of risk influences women's reproductive decisions. Research has yet to show how men understand and interpret risk, particularly in their decision to use contraception. Contraceptive sterilization provides a case through which we compare risk narratives between men and women, as it is the only analogous birth control for both men and women. A study of risk narratives held by sterilized adults and their partners reveals how risk narratives are gendered and how they contribute to contraceptive use. Using 75 in-depth interviews with sterilized heterosexual men (n = 25), women (n = 25), and unsterilized partners (n = 17 women, n = 8 men), the present study finds that men and women report similar risk narratives grounded in (1) birth control risks to health and life plans and (2) risks to maternal health from past pregnancies and age. As expected, women's risk narratives appear to stem from their embodied experiences and their interactions with medical authorities. Rather than addressing their own embodied experiences or experiences with medicine, men's beliefs mirror women's, and are centered on the dangers of hormonal birth control and pregnancy to women. This study is novel in showing the couple dyad as a site of men's beliefs about risk, as how heterosexual couples form ideas about health and life plan risk through a mutually shared gendered lens.

Prenatal Genetic Screening, Epistemic Justice, and Reproductive Autonomy

AbstractNoninvasive prenatal testing (NIPT) promises to enhance women's reproductive autonomy by providing genetic information about the fetus, especially in the detection of genetic impairments like Down syndrome (DS). In practice, however, NIPT provides opportunities for intensified manipulation and control over women's reproductive decisions. Applying Miranda Fricker's concept ofepistemic injusticeto prenatal screening, this article analyzes how medical professionals impair reproductive decision-making by perpetuating testimonial injustice. They do so by discrediting positive parental testimony about what it is like to raise a child with DS. We argue that this testimonial injustice constitutes a twofold harm: (1) people with DS and their family members who claim that parenting a child with DS may be a rewarding and joyous experience are harmed when they are systematically silenced, disbelieved, and/or denied epistemic credibility by medical professionals, and (2) pregnant women are harmed since they might make poorly informed choices without access to all relevant information. The broader implication of the analysis is that epistemic justice is a precondition of reproductive autonomy. We conclude by calling for federal oversight of the acquisition and dissemination of information that prospective parents receive following a positive diagnosis of DS to ensure that it is comprehensive and up to date.

Erratum to “Whether to have a second child or not? An integrative approach to women's reproductive decision-making in current China” [Evolution and Human Behavior 40 (2019) 194–203

Erratum to “Whether to have a second child or not? An integrative approach to women's reproductive decision-making in current China” [Evolution and Human Behavior 40 (2019) 194–203

Are ‘low socioeconomic status’ and ‘religiousness’ barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research

Objective'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions. DesignSemi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. FindingsWe found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established. ConclusionWe have shown that the dominant theory that ‘low socioeconomic status’ and ‘religiousness’ are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception. Implications for practiceThis study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals’ health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

Whether to have a second child or not? An integrative approach to women's reproductive decision-making in current China

Abstract The transition to low fertility worldwide has led to introduction of diverse frameworks across disciplines to understand its causes and consequences. Previous attempts to compare the relative importance of the key factors influencing women's fertility decision-making largely focused on a single rather than multiple steps of decision-making—an important problem if different factors are associated with different steps. Furthermore, insufficient attention has been paid explicitly to husband's and already-born children's influences, two potentially important factors. Here we introduce a framework covering three steps of reproductive decision-making—ideal family size, fertility desire and fertility intention—and test it using multi-level survey data collected from Chinese one-child mothers. Mother's attitudes towards having two children were paramount factors underlying her ideal family size, and husband's and the firstborn child's attitudes were critical to her desire to have a second child, which in turn played a decisive role in her intention to have a second child. Although husband's attitude was related to all steps, most factors were only relevant to one step; e.g., perceived child mortality and value for old-age security predicted ideal family size, admiration—a prerequisite for social learning—for two-child families predicted fertility desire, and physical/economic constraints primarily predicted fertility intention. Our study emphasizes multiple decision-makers in family reproduction; indicates the relative importance of fertility-influencing factors could vary with steps of decision-making; and has important implications for population policy in low-fertility societies.

The anatomy of uncertainty: A critical interpretative phenomenological analysis of childless academic women's reproductive decision-making

The anatomy of uncertainty: A critical interpretative phenomenological analysis of childless academic women's reproductive decision-making

Intersecting ethics of responsibility: Childless academic women and their ambivalence in reproductive decision-making

Neoliberalism has transformed both higher education and society generally; professors are to be self-sufficient, putting the university before everything else, while citizens must care for themselves, so the state does not have to. This creates a tension for academic women, who are least likely among highly educated professional women to have children – a tension between the essentialist imperative that all women embrace motherhood, and the academic imperative that faculty give the university their undivided attention. Drawing from interviews with Canadian academic women about their reproductive decision-making, this article uses Thematic Analysis to develop the concept of “responsible ambivalence” as a framework for understanding their childlessness. It shows how conflicting ethics of responsibility – to the self and to others – intersect and coexist within their accounts and inform the women's reproductive decision-making. In rejecting the ideology of maternal femininity, this article shows how the women's childlessness is consistent with the responsibilizing imperatives of neoliberal academic culture.

Women's reproductive decision making and abortion experiences in Cape Town, South Africa: A qualitative study

ABSTRACTUnintended pregnancy is a significant public health issue in South Africa. Despite free services including contraception, women face structural and institutional barriers to accessing care. This qualitative study comprised interviews with 16 women aged 18 to 40 years and receiving post-abortion services at a public clinic in Cape Town. Data analysis revealed three main themes: personal journeys in seeking abortion, contraceptive experiences, and contrasting feelings of empowerment (in reproductive decision making) and disempowerment (in the health care system). Women perceived themselves as solely responsible for their reproductive health, but found it difficult to obtain adequate information or services.

The Shifting Landscape of Prenatal Testing: Between Reproductive Autonomy and Public Health.

Since the 1970s, prenatal testing has been integrated into many health care systems on the basis of two competing and largely irreconcilable rationales. The reproductive autonomy rationale focuses on nondirective counseling and consent as ways to ensure that women's decisions about testing and subsequent care are informed and free of undue pressures. It also represents an easily understandable and ethically convincing basis for widespread access to prenatal testing, since the value of autonomy is well established in Western bioethics and widely recognized by funders of health care. In contrast, the public health rationale approaches prenatal testing as designed to reduce the incidence of certain conditions in the population to reduce the burden of disease. This rationale emphasizes the societal consequences of reproduction and the aggregate impact of women's individual reproductive decisions on the overall health of future populations. In this essay, I argue that, despite what could be seen as a persistent failure to meet the ideals of reproductive autonomy, resisting the public health rationale as a basis for prenatal screening is ethically and pragmatically crucial. I recommend policy mechanisms that can enhance reproductive autonomy at a societal level to support choice at the individual level.

Reasons why women have induced abortions: a synthesis of findings from 14 countries

ObjectiveMany reasons inform women's reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. Study designWe examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women's sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. ResultsIn most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women's sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. ConclusionThis study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women's decisions to have abortions. ImplicationsFuture research should examine in greater depth the personal, social, economic, and health factors that inform a woman's decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women's lives.

Pronatalism, Geneticism, and ART

In this essay, I argue that pronatalism—a social bias in favor of gestational motherhood—and geneticism—a social bias in favor of genetic motherhood—are conceptually and operationally distinct social forces that influence some women's reproductive decision making. Each of these social forces shapes the reproductive landscape, relates differently to women's identities, and causes different social stigmatization and harm. Pronatalism and geneticism warrant feminist concern because they can compromise some women's reproductive autonomy and well-being. I suggest that combating pronatalism and geneticism will require different sets of media, policy, education, and health care practice strategies.

Localizing NIPT: Practices and meanings of non-invasive prenatal testing in China, Italy, Brazil and the UK

Summary This paper is the result of a collaborative work between researchers based in UK, Italy, China and Brazil, and aims at providing a comprehensive review of practices and meanings of Non-Invasive Prenatal Testing (NIPT) in these countries, while also highlighting the ethical implications that NIPT poses. In the first part of this paper we describe how the technology is being integrated into the ‘moral economy’ of prenatal testing in the different countries we analysed. In the second section of the paper, we position NIPT within the trajectory of prenatal diagnosis that displays the role of conflicting values and often incommensurable moral economies in the emergence of new technologies, and in their transformation into routine medical procedures. The two ‘often incommensurable moral economies’ are women's autonomy and individual-centred medicine, as emphasised in gynaecologists and midwives/obstetricians’ public discourse; and considerations about the cost/efficacy of long-term care for people with Down syndrome or other chromosomal-related disabilities as emphasized in public health discourses. We discuss how these two contrasting narratives are also at play in the discourses around NIPT. We then consider some of the ethical issues raised by NIPT, including the argument that NIPT will lead to a harmful bias towards people with Down syndrome and to an increase in termination rates; and the ethical issues raised possible incidental findings resulting from a maternal chromosomal mosaicisms, and other hidden abnormalities in one of the parents, including genetic diseases with late expressions in life. We note how the counselling step following incidental finding will be of the utmost importance and that in many countries, including the ones we analysed, doctors and healthcare professionals are not adequately prepared for it. We conclude that it is important that bioethics scholarship engages proactively with the ethical issues that arise at the nexus of these conflicting values and moral economies, especially as future evolutions of NIPT combined with whole genome sequencing (WGS) will affect women's reproductive decisions, and shape the scope of their reproductive choices, in a way that will lead to a completely new level of ‘supervision’, ‘management’ and ‘scrutiny’ of human foetuses and pregnant women.

Do Babies Matter?: Gender and Family in the Ivory TowerMaryAnn Mason, Nicholas H.Wolfinger, and MarcGoulden. New Brunswick, NJ: Rutgers University Press, 2013.

Do Babies Matter?: Gender and Family in the Ivory Tower Mary Ann Mason, Nicholas H. Wolfinger, and Marc Goulden. New Brunswick, NJ: Rutgers University Press, 2013.While debates over whether women can it all rage through the popular media, Mary Ann Mason, Nicholas H. Wolfinger, and Marc Goulden offer a thorough analysis of this issue in a very specific context: the American university. Do Babies Matter? opens with the important observation that while more women than men gain doctorates today, far fewer women reach the top of the academic ladder, and these women are less likely to be married parents than their male counterparts. Relying on empirical data gathered over a decade, the authors find-albeit unsurprisingly -that babies do indeed matter and suggest policy reforms to increase gender equity in the academic workplace.Conveniently devoting one chapter to each stage in the academic career, Mason, Wolfinger, and Goulden identify factors that influence women's reproductive decisions and their effects on career developments. As graduate students, many women are discouraged from having children by the lack of positive role models, access to quality childcare, and health insurance as well as a fear of being perceived as uncommitted. The logistics of job interviews and campus visits pose extreme challenges for nursing mothers applying for tenure-track positions. If married, women are also less likely to get hired when their husbands are presumed unwilling to relocate (31).While women with young children struggle early in their academic careers, marriage and parenthood are found to be beneficial to both male and female scholars when they are up for tenure, especially when the children are six years or older. Uncritically assuming that marriage makes people happier, healthier, and more productive, the authors argue that married tenuretrack faculty tend to have longer publication lists to support their tenure cases than single colleagues. Later in the career, marriage and children seem to have less of an effect on professional development, even though gender still plays a role. For instance, women tend to be assigned more service work, preventing them from producing the research necessary for promotion. Finally, the authors find no statistically significant difference in retirement age.As the authors explain in the appendix, their findings derive from two primary sources: one is the Survey of Doctorate Recipients, conducted by the National Science Foundation, the other is a set of surveys the authors administered themselves on nine University of California campuses. …

Improving Male Involvement in Family Planning in Rural Southeastern Nigeria [201

INTRODUCTION: In Africa, men exact significant influence over women's reproductive health decisions, hence the need to enhance men's knowledge of family planning. The aim of this study was to ascertain the effect of educating men on female reproductive health and family planning. METHODS: A total of 150 male partners of antenatal attendees from 20 communities in rural southeastern Nigeria responded to an invitation to be part of a 3-day free participatory training session on family planning arranged for antenatal mothers in the month of June, 2012, at a rural health care facility. A pretest and posttest questionnaire was used to access men's knowledge and attitudes toward contraception, spousal communication, and contraceptive use. Fifty couples were followed up for 1 year through phone calls every 3 months. RESULTS: Average age of participants was 30 years for men (range 22–45 years) and 26 years for women (range 18–38 years). Men were older but less educated than their partners (66% of men and 48% of women attended primary education only). Men's knowledge of methods of contraception (ie, implants, male and female sterilization, intrauterine device, injectables) increased from 20% to 90% (P<.05). The proportion of men intending future use of family planning increased from 18% to 60%. All 50 couples that were followed up reported improved spousal communication on family planning. CONCLUSION: Educating rural men on family planning improves their knowledge and may enhance contraceptive uptake by the women.

Identifying factors that influence pregnancy intentions: evidence from South Africa and Malawi

In developing-country settings, pregnancy intentions are often assessed using a series of questions from the Demographic and Health Surveys, yet research conducted in several countries yields conflicting results regarding these questions' ability to predict pregnancy. Conducted in Malawi and South Africa, this study identified individual, partner and societal factors that influence desire for pregnancy, and women's ability to achieve their intentions. Data come from interviews and focus-group discussions conducted prior to the FEM-PrEP HIV-prevention trial with women from communities at high risk of HIV infection. Cultural norms regarding contraceptive use and childbearing influenced both women's desire for pregnancy and ability to achieve those goals. Partner's expectations for pregnancy, financial concerns, family composition and contraceptive experiences were additional influences. Actively planning for pregnancy was not a salient concept to the majority of participants. Results support the call for a multidimensional measure of pregnancy intention that reflects the variety of factors that influence intentions, highlight the fluid nature of many women's reproductive health decision making and challenge the notion that all fertility decisions are the result of conscious action. Additional work on how women's plans for pregnancy are achieved would be programmatically more useful than current measures of intention.

The stigmatisation of abortion: a qualitative analysis of print media in Great Britain in 2010

The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as ‘risky’, and in association with other ‘discredited’ social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse.