Pregnancy coercion, intimate partner violence and unintended pregnancy

Background

Reproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services.

Study Design

A cross-sectional survey was administered to females ages 16-29 years seeking care in five family planning clinics in Northern California (N=1278).

Results

Fifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36-2.46, and AOR 1.58, 95% CI 1.14-2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence.

Conclusions

Pregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.     

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

Background

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

Study Design

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16–29 years (N=906) completed audio computer-assisted surveys prior to a clinic visit and 12–24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

Results

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio=1.63; 95% confidence interval=1.01–2.63).

Conclusions

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.     

Practice of and attitudes towards family planning among South Asian American immigrants

Background

Previous studies performed outside of the US that examined contraceptive knowledge and beliefs in South Asian women identified significant barriers. Our study aimed to further understand these practices in this population residing in the US.

Methods

This cross-sectional study surveyed women of all ethnicities receiving health care from either of two ambulatory practices in New Jersey from October 2011 to November 2012. Using chi-squared testing, the frequencies of contraceptive outcomes between South Asians and non-South Asians were compared.

Study Design

There were 42 South Asian respondents and 143 non-South Asian respondents. Our results show that South Asians are statistically significantly less likely to routinely use contraception and that gaps in contraceptive knowledge appear to stem from multiple barriers, including family opposition and pressure from spouse or in-laws to have children, cultural prohibitions, fear of side effects and misinformation, lack of education/knowledge about contraceptives and difficulty in accessing contraception. These gaps in contraceptive knowledge were also found to be multigenerational, despite higher levels of education generally seen in the South Asian population.

Conclusions

Clinicians caring for South Asian women should acknowledge both the barriers and the lack of contraceptive knowledge in this population and provide culturally competent family planning information to them during all women's health encounters.     

护理专业女生避孕和意外妊娠认知状况

目的 了解护理专业女生避孕知识及对意外妊娠的认知情况,为制定有针对性的避孕教育策略提供依据.方法 采用自编问卷,对蚌埠医学院326名护理专业女生进行问卷调查,内容包括个人信息、对妊娠的认识、避孕知识及紧急事后避孕、对意外妊娠的担心和处理意愿等.结果 在326名女生中,分别有91.72％,76.07％,76.38％对妊娠的主要表现、早期预警及早期诊断有较好的认知.但对避孕相关知识(月经周期中最易受孕的时间、偶尔性交能否怀孕、避孕方法)及实际运用认知并不高.被调查对象中只有23.00％会计算安全期,13.50％意愿采纳避孕药避孕.一旦遭遇意外妊娠,83.74％担心的问题是流产(流产的危险48.77％、流产并发症34.97％),其中一半以上选择终止意外妊娠的方法是流产(人工流产31.90％,药物流产23.62％),意外妊娠后主要求助于家人(41.72％)和同学(26.07％),71.47％认为意外妊娠对心理有伤害,而对意外妊娠造成的远期影响如妇科炎症、不孕症认识不足.结论 护理专业的女生避孕知识有待提高,意外妊娠相关认知需全面加强.     

Counseling tools alone do not improve method continuation: further evidence from the decision-making tool for family planning clients and providers in Nicaragua

Background

The decision-making tool (DMT) was developed by the World Health Organization's Department of Reproductive Health and Research and the Johns Hopkins University Center for Communication Program's staff to promote clients' informed choice and participation in family planning service delivery, to enable providers to apply evidence-based best practices during client-provider interaction and to provide the technical information necessary for optimal delivery of contraceptive methods. This tool has been tested in several countries and been shown to improve the quality of counseling for family planning clients.

Study Design

We conducted intercept and follow-up home interviews with new family planning acceptors in three health departments in Nicaragua to assess the impact of the DMT on method continuation and counseling experiences. The study was a quasi-experimental design with 65 experimental and control clinic sites.

Results

Analyses of overall and method-specific contraceptive use rates revealed no differences between experimental and control clinic clients. However, clients in the experimental group reported better counseling experiences than their counterparts in the control group.

Conclusion

The authors conclude that sufficient evidence exists that counseling alone — with or without specialized job aids — does not influence contraceptive use rates. A new strategy is needed to help women maintain use of family planning methods.     

Feasibility study of family planning services screening as clinical decision support at an urban Federally Qualified Health Center network

Objective

The objective was to assess the feasibility of an intervention introducing family planning services screening clinical decision support to improve provision of contraception and/or preconception services for women of reproductive age in our primary care Federally Qualified Health Center (FQHC) network.

计划生育服务机构开展流产后计划生育服务的干预效果研究

目的:探讨计划生育服务机构开展人工流产后计划生育服务(PAFPS)的干预效果。方法:在福建省3家计划生育服务机构选取愿意参加本研究的625例人工流产妇女,随机分为干预组和对照组,分别于术前和术后6个月进行内容相同的"避孕及相关知识"的问卷调查。干预组术后发放专门针对人工流产妇女编印的《避孕及相关知识宣传手册》,同时采取知情选择的原则指导落实一项"高效"(除外安全期、体外排精和紧急避孕药)的避孕措施,免费提供3个月的避孕药具,于术后2周、1个月、3个月进行跟踪随访,填写《干预随访表》;对照组常规处理。随访6个月后,两组妇女均填写统一的"6个月随访表"。结果:①术前两组的基本情况、"避孕及相关知识"分值、术前6个月的避孕措施使用率、"高效"避孕措施使用率、非意愿妊娠率差异均无统计学意义(P均0.05)。②术后6个月干预组避孕措施使用率、避孕知识分值、"高效"避孕措施使用率、坚持使用率和正确使用率均高于对照组(P均0.01);干预组非意愿妊娠率低于对照组(P0.01)。③术前与术后6个月自身比较:知识分值均有提高,但对照组提高幅度低于干预组(P0.01);避孕措施使用率对照组术前(59.3%),干预组术后6个月(90.7%),干预组术前(66.4%),术后(96.3%)两组均有提高,但对照组提高的幅度低于干预组(P0.01);非意愿妊娠率对照组术后6个月和术前差异无统计学意义(P0.05);干预组术后6个月低于术前(P0.01)。结论:在计划生育服务机构开展PAFPS可以充分利用计划生育服务网络优势进行培训、宣传、指导和随访,显著提高人工流产妇女的生殖健康知识水平和避孕效果、降低非意愿妊娠率,干预措施取得了明显的成效,值得推广。     

基层计划生育工作者知情选择服务能力评测分析

目的:了解计划生育技术服务人员避孕节育知情选择服务能力现况。方法:成立专家组制定《避孕节育知情选择模拟接诊评分标准》,通过模拟接诊的方式测评技术人员提供咨询服务的能力,理论试卷测试其专业知识水平。共调查连云港市新浦区计划生育指导站和2乡1镇计划生育服务所30名技术服务人员,根据避孕节育咨询模拟接诊和理论笔试的成绩,对他们的避孕节育知情选择服务能力进行分析。结果:30名技术人员模拟接诊平均成绩67.77分(合格),理论笔试平均成绩76.19分(优良)。结论:大部分服务人员基本胜任避孕节育知情选择工作,专业技术知识掌握相对较好,但普遍缺乏咨询技巧,需要进一步提高咨询服务能力和专业知识,强化服务意识。     

流产后关爱服务对未婚人工流产女性心理和术后即时避孕的影响

目的：分析流产后关爱（PAC）服务对未婚人工流产女性心理和术后即时避孕的影响。方法：采用随机、前瞻、对照、单盲方法,将120例进行初次无痛人工流产的未婚女性随机分为对照组（n=60）和观察组（n=60）,对照组接受常规的流产服务模式,观察组接受PAC服务模式。评估术后即时避孕的使用情况,并用Zung′s焦虑自评量表（SAS）评估2组不同服务模式下行人工流产术前后患者焦虑程度的差异。结果：手术前,对照组SAS评分为（47.8±8.3）分,观察组为（47.6±8.2）分,2组差异无统计学意义（P＞0.05）。手术后1 h,对照组SAS评分为（45.6±6.1）分,观察组为（28.2±4.7）分,2组差异有统计学意义（t=12.901,P=0.000）。对照组流产后立即落实避孕措施的比例为11.67%,观察组为78.33%,2组差异有统计学意义（P＜0.05）。结论：院内流产后服务模式有助于缓解初次人工流产未婚女性的负性心理,同时对有效、即时落实避孕措施,改善女性生殖健康有积极的意义。     

Exploring the gray areas between “stealthing” and reproductive coercion and abuse

ABSTRACT

The aim of this qualitative study was to understand and differentiate between women’s experiences of “stealthing” (non-consensual condom removal) and reproductive coercion and abuse (RCA) which is defined as any deliberate attempt to control a woman’s reproductive choices or interfere with her reproductive autonomy. These two experiences are often conflated within the literature, yet little is known about whether this understanding reflects women’s lived reality. We recruited female participants from a large Australian metropolitan hospital who self-identified as having experienced a partner interfering with contraception or trying to force them to get pregnant or end a pregnancy against their wishes. Fourteen women (predominantly white, educated and employed) participated in an in-depth interview. Interviews were transcribed verbatim and a process of thematic narrative analysis was undertaken, focusing on the meanings women assigned to their experiences and the differences and similarities across the stories. Analysis revealed that stories about stealthing were characterized by disrespect and selfishness, whereas RCA stories highlighted control with intent. The concepts of intent and control can therefore be understood as central to defining RCA and differentiating it from stealthing. It seems likely that stealthing is primarily a form of sexual violence, as it lacks the specific reproductive intent that characterizes RCA. These findings have important implications for how RCA and stealthing are addressed and measured in research and responded to in practice.     

北京市未婚人工流产女青年避孕知识、态度、行为的调查研究

目的：研究未婚人工流产（人流）女青年的避孕知识,态度、行为以及影响避孕行为的因素。方法：以Lawrence的PROCEDE-pROCEED健康促进计划模式为基础的调查问卷,对306例自愿要求人工流产,年龄在18－24岁的未婚女青年进行断面的调查。结果：近12个月以来,仅有13％和女青地持每次性行为都使用避孕方法,偶尔使用和从未使用者的比例分别为26％和275,在224例曾经用过避孕方法的女青年中,最常用的方法分别是避孕套（495）、体外排精（285）、安全期（165）,在从未使用任何避孕方法的女青年中,735认为没想到会怀孕是最主要的不避孕的原因。logistic 逐步回归分析显示,女青年对避孕知识的了解,对意外妊娠风险的认识,男友对避孕方法使用的态度。与男友讨论避孕方法,对占孕服务可及性的感受是影响女 年既往避孕行为的主要因素,结论亟需对未婚青年开展有关避孕知识的性教育,提高对意外妊娠风险和人工并发症的认识促进男性积极参与避孕,加强性伴侣之间有关避孕方法的交流。     

人工流产后避孕指导服务效果的研究

目的：评价人工流产后避孕指导服务对降低再次人工流产和妇科疾病的作用。方法：选择2011年1月—2013年1月因意外妊娠而自愿接受人工流产并患有妇科炎症的900例妇女作为研究对象,观察组患者接受流产后避孕指导服务,对照组未接受流产后避孕指导服务。术后电话随访1年,调查2组避孕措施选择的不同,比较重复人工流产率及对妇科疾病的影响。结果：观察组和对照组人工流产术后选择的避孕措施排在前2位的均是宫内节育器和男用避孕套。观察组选择用男用避孕套率低于对照组,差异有统计学意义（χ2=28.145,P＜0.01）,而对于口服避孕药和体外排精,对照组的选择率大于观察组（P＜0.05）。观察组发生重复流产者81例（19.29%）,而对照组发生重复流产者149例（30.63%）,差异有统计学意义（χ2=15.22,P＜0.01）。观察组与对照组重复流产的原因如下,宫内节育器失败、避孕药失败、男用避孕套失败、安全期避孕、体外排精、未避孕。通过多因素Logistic回归分析结果得出,安全期避孕、未避孕、体外排精是重复流产者避孕失败的独立危险因素。结论：人工流产后避孕指导服务可使流产后妇女选择有效的避孕方法,降低妇科疾病的风险,减少再次非意愿妊娠和重复性人工流产。     

Family planning funding cuts and teen childbearing

Publicly funded family planning clinics provide low-cost and free contraception to nearly 1.5 million teens each year. In recent years, several states have considered legislation to defund family planning services, although little is known about how these cuts affect teen pregnancy. This paper fills this knowledge gap by exploiting a policy change in Texas that reduced funding for family planning services by 67% and resulted in over 80 clinic closures. I estimate the effects of the funding cuts on teen health outcomes using a difference-in-differences approach that compares the changes in teen birth rates in Texas counties that lost family planning funding to changes in counties outside of Texas with publicly funded clinics. I find that reducing funding for family planning services in Texas increased teen birth rates by approximately 3.4% over four years with effects concentrated 2–3 years after the initial cuts.     

34例系统性红斑狼疮患者行中期引产术临床分析

目的：分析系统性红斑狼疮（SLE）患者于妊娠中期终止妊娠的原因及引产方式的选择,探讨SLE患者的生育管理和中期引产相关问题。方法：回顾性分析1994年1月—2012年4月收治的34例SLE患者于妊娠中期行中期引产的相关数据。引产原因分为可避免和不可避免2类,可避免中期引产指社会因素和SLE治疗中意外妊娠;不可避免中期引产包括胎儿因素、妊娠期SLE初发和疾病稳定期计划内妊娠后妊娠期SLE复发。结果：可避免中期引产者共15例（占44.1%）,不可避免中期引产者共19例（占55.9%）。引产方式中：12～16周行大钳刮术者3例,行米非司酮加米索前列醇药物引产者2例,17～28周行依沙吖啶羊膜腔内引产者25例,行剖宫取胎术者4例。除1 例钳刮时大出血外,无手术并发症。2组相比妊娠周及引产方式差异无统计学意义,但妊娠期疾病活动者在不可避免组（16/19）显著高于可避免组（6/15）,差异有统计学意义（P＜0.05）。结论：SLE妇女缺乏生育管理,应加强该人群的妊娠前和避孕咨询,以减少可避免的引产手术。此类患者的中期引产系高危手术,术前应全面评估,选择适合的手术方法以确保母亲的安全。     

Planned,unplanned and in-between: the meaning and context of pregnancy planning for young people

Objective

To understand how young people conceptualize planned, unplanned and “in-between” pregnancies.

Self pregnancy testing in an urban family planning clinic: promising results for a new approach to contraceptive follow-up

BACKGROUND: Immediate initiation of depo-medroxyprogesterone acetate (DMPA) increases continuation and decreases pregnancies compared to conventional (next menstrual period) initiation. A drawback is the need to return in 4 weeks for a repeat pregnancy test to identify any pregnancy that was too early to diagnose on the day of injection. If women can perform home pregnancy tests (HPTs) to detect human chorionic gonadotropin (hCG) in urine, the need for this follow-up visit may be eliminated. This study assesses whether women can perform their own HPT. STUDY DESIGN: This is a single-visit observational trial of an HPT kit. Subjects recruited from a waiting room in an urban family planning clinic received an HPT kit with standard instructions to use immediately. Subjects and a research assistant each interpreted the test. Their results were then compared to a standard cassette type test for detection of hCG performed by clinic staff. kappa was calculated to assess the level of agreement. RESULTS: Three hundred ten subjects enrolled. They were young (mean age, 25.2 years), mostly Hispanic (91%) women. A change in the font and explicitness of the instructions decreased the incidence of invalid tests from 12.7% to 4.8%. The subject and research assistant's interpretation of the test had a high level of agreement, kappa=0.95 [95% confidence interval (CI), 0.92-0.99]. There was also a high level of agreement between the subjects' results and the standard test, kappa=0.88 (95% CI, 0.82-0.95). CONCLUSIONS: Women presenting for pregnancy testing at an urban clinic are able to perform HPTs with a high level of accuracy. The appearance of the instructions influenced the incidence of false-negative and invalid tests. Home pregnancy tests may be useful in follow-up protocols when immediate initiation of DMPA is employed.     

上海市徐汇区2002～2011年计划生育手术状况分析

目的:了解上海市徐汇区2002～2011年计划生育手术现状,为计划生育技术服务机构实施避孕节育优质服务提供建议.方法:根据2002～2011年全区12所开展计划生育技术服务的医疗机构的“上海市计划生育手术质量情况报表”进行历年趋势分析.结果:10年间,年计划生育手术从2002年的45 353例下降到2011年的38 800例;负压吸引手术占计划生育手术总数比例从35.22％逐年上升至43.76％;药物流产术从23.21％逐年下降到13.07％;放置宫内节育器从13.98％逐年下降到10.22％;取出节育器手术从24.79％逐年上升至29.54％;年人工流产手术从27 530例下降到23 084例,本市户籍妇女人工流产手术所占构成比逐年下降,未婚妇女下降更为明显,而同期非本市户籍妇女人工流产手术所占构成比逐年上升.结论:除负压吸引术外,宫内节育器取出术已成为计划生育工作中重要手术之一.避孕节育生殖健康教育的重点还应包括未婚未育和流动人口.