The social construction of 'reproductive vulnerability' in family planning clinics

AIM: The aim of this paper is to report a study exploring the discursive construction of contraceptive use within nurse consultations with women in family planning clinics. BACKGROUND: This paper takes as its starting point the lack of a contraceptive 'strand' to the literature on the discursive construction of the female body generally, and the female reproductive system specifically, within health care practice. The literature in this field concentrates on pregnancy, menstruation and menopause, and the manner in which contraceptive use is discursively constructed is under-explored. Furthermore, the literature on nurse-women consultations in family planning clinics is also limited, with the current literature concentrating on assessing clinical skills rather than discourse. METHODS: Using a grounded theory methodology to explore how nurses educate women about contraception in family planning clinic, 49 consultations were audio-taped in two large family planning clinics in the United Kingdom (UK). FINDINGS: Open coding and subsequent axial coding resulted in the emergence of three elements of contraceptive education. One concerned reproductive anatomy, another reproductive physiology and a third education about contraceptive functioning. These three axial codes were formed into a core category: 'body education/reproductive vulnerability'. Within the consultation, nurses linked the 'vulnerable' reproductive system with the requirement for contraceptive 'protection'. This approach seems linked to ensuring women's future contraceptive use. CONCLUSION: The discourse employed by nurses differs from the body discourse aimed at menopause and menstruation. These areas of women's health were constructed as disintegrating, malfunctioning and failing, whereas reproductive vulnerability suggests a fully functioning, active system, in need of restraint. However, this discourse still constructs the female body as fundamentally weak and unstable, requiring contraception to protect it and prevent transgression.     

The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory study

Aims. This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education. Background. Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one‐to‐one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations. Design. A qualitative study using a grounded theory approach was used. Results. Three linked ‘core categories’ emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: ‘reproductive education’. This core category is closely linked to ‘surveillance’ where women are taught to monitor their reproductive health and to ‘contraceptive regimen’ where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of ‘contraceptive education’. Conclusions. Nursing practice in this important area of women’s health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one‐to‐one consultations with women – providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection. Relevance to clinical practice. Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side‐effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.     

Productive power and the 'practices of the self' in contraceptive counselling

This paper explores an under-researched issue within the reproductive health of women - the discursive construction of self-examination instruction in sexual health clinics. The study utilises Foucault's work on 'productive power', the 'practices of the self' and discourse to map out how nurses instruct contraceptive-using women in self-care practices. Forty-nine consultations in sexual health clinics were tape recorded and analysed. The data reveal how nurses utilise the discourse of risk as a technique to reinforce and develop self-care practices - a concept congruent with the Greco-Roman concept of the cura sui, the philosophical notion that one must make oneself into the object of care. Nurses build upon the notion of risk by educating women about their reproductive anatomy and physiology utilising medical texts as tools. This provides a contemporary example of the mia chora: identified by Foucault as the incitement for the individual to develop a usable knowledge of the body. Lastly, nurses instruct women in the development of a self-care regimen - the epimeleia, the development of habitual body techniques. It is proposed that this process is congruent with the Aristotelian notion of habitus, the development of body knowledge, body techniques and self-care practices necessary to pursue health.     

Emergency contraception given via a patient group direction

The aim of this audit was to evaluate the effectiveness of a patient group direction (PGD) for nurses issuing the emergency contraceptive Levonelle-2 within a sexual health clinic. The PGD was designed to increase the accessibility of emergency contraception for women, not only minimising the time they needed to spend in the clinic, but also reducing the time at which the emergency contraception was taken after unprotected intercourse, which is an important factor in efficacy rates.     

Contraception: what has changed over the past decade?

The past decade has seen major advances in contraceptive technology. These have resulted in the launch of several new highly effective methods of contraception and also significant improvements in existing methods. The main purpose of this article is to review how the contraceptive field has changed over the past 10 years, explain the new methods that have become available, e.g. hormone-releasing intrauterine systems, hormone implants and female condoms, re-examine existing methods, and mention new research and how this has affected clinical practice over the past decade. When discussing contraception, clients should be given up-to-date and accurate information on currently available methods: their efficacy, advantages, disadvantages and how the method works. As with any other specialty in medicine, nurses offering contraceptive advice should ensure they regularly update their knowledge and are aware of new developments and research in order to facilitate their clients in making an informed choice. New research and developments affect the choices and potentially the health of a large part of the population.     

Girly mags and girly jobs: Pornography and gendered inequality in forensic practice

This article presents findings from a discourse analytic study into the constructive nature and textual variations of language in a high‐security hospital. It explores how mental health nurses, and men convicted of sexual offences who also have a diagnosis of personality disorder, talked about pornography and sexual crime in the context of forensic provision. Access to sexually‐explicit media, in relation to treatment environments for people convicted of sexual offences, has become a cause for professional and political concern in the UK. Data collection and analysis, undertaken concurrently, were informed by a discursive design. Semistructured interviews, as co‐constructed accounts with nursing staff and detained patients, were audio‐taped and transcribed. Data were coded to identify the discursive repertoires, or collective talk, of respondents. In contrast to empirical inquiry into pornography and sexual violence, methodology shifted attention from measurement to meaning, and situated research in a clinical domain. The findings focus on performative language use, where talk about pornography textured the treatment environment, contributed to an overtly masculine discourse, framed the ward as male space, and promoted gendered inequality. The discussion questions the legitimacy of the therapeutic enterprise.     

A causal model of contraceptive intention and its gender comparison among Taiwanese sexually inexperienced adolescents

Aims and objectives. To test latent constructs of social influences, contraceptive attitude and self‐efficacy for contraception as a causal model of contraceptive intention among adolescents and to search for possible gender differences in the causal model of contraceptive intention. Background. A greater understanding of the causal model of contraceptive intention among sexually inexperienced adolescents will help nurses design contraceptive programmes to improve adolescent contraceptive use when they have sex. Design. This was a cross‐sectional study; 770 boys and 685 girls that self‐reported not being sexually experienced were selected for this study. Methods. An anonymous questionnaire was used to collect data. By structural equation modelling using the eqs 6.1 software, a hypothesized structural model of contraceptive intention was tested. Findings. For both genders, social influences affected contraceptive intention indirectly through the contraceptive attitude and self‐efficacy for contraception. Contraceptive attitude and self‐efficacy for contraception affected contraceptive intention directly. Contraceptive attitude also affected contraceptive intention indirectly through the mediation of self‐efficacy for contraception. There were gender differences in the variances of contraceptive intention explained by contraceptive attitude, self‐efficacy for contraception and social influences. Nevertheless, the data explain only a low proportion of the variability in contraceptive intention. More causal constructs influencing contraceptive intention should be explored in future. Conclusions. Personal factors and social influences operate interdependently to influence contraceptive intention among sexually inexperienced adolescents. Gender is a moderator that can modify the influential level of social influences, contraceptive attitude and self‐efficacy for contraception on contraceptive intention. Relevance to clinical practice. Nurses should operate personal factors and social influences interdependently when they are designing intervention programmes for sexually inexperienced adolescents. To make intervention more effective, nurses also need to provide gender‐specific intervention programmes for sexually inexperienced adolescents.     

围绝经期妇女避孕方法的研究进展

本文综述了围绝经期妇女避孕方法 的研究进展,围绝经期妇女可采用多种避孕方法 ,包括口服避孕药、输卵管结扎、宫内节育器,屏障避孕、避孕针和皮下埋植.最近一些新的避孕方法 高效、副作用小,如每月注射的长效避孕针、阴道环和透皮贴剂等.围绝经期采用不同的方法 避孕各有利弊,根据个体需要选择恰当的避孕措施.     

Working women and contraception: History, health, and choices.

Contraception is not a new concept. Historically, various contraceptive methods and practices have been used throughout the world. Contraception is often a topic of great interest to working women because family planning helps them balance work and home more effectively. Occupational health nurses can play a vital role in supporting these women by providing education regarding health, contraception, and contraceptive choices.     

The birth control pill revisited.

The evolution of oral contraceptives is summarized in this chapter. The social context into which the birth control pill was introduced, early and recent formulations of the pill, side effects, and the identification of serious complications of taking the pill are presented. The role of the nurse as a health educator of women and the responsibility of nurses to assist patients to make informed decisions about their reproductive function are emphasized. The outlook for future research and development of alternative forms of contraception is discussed.     

Hormonal contraception update

Unintended pregnancy continues to be a serious public health issue in the United States. Of the 3 million unplanned pregnancies per year, 60% occur in women using some form of contraception. Educating and helping women choose a contraceptive agent that best suits their needs will improve compliance and contraceptive efficacy. A multitude of new contraceptive agents are now available. We review new hormonal contraceptive options and discuss newer oral agents, extended-cycle contraception, and innovative delivery methods.     

Using progestins in clinical practice

Progestational agents have many important functions, including regulation of the menstrual cycle, treatment of dysfunctional uterine bleeding, prevention of endometrial cancer and hyperplastic precursor lesions, and contraception. Because of the reported side effects of synthetic analogs called "progestins," there has been interest in replicating the natural hormone for clinical use. Natural progesterone is obtained primarily from plant sources and is currently available in injectable, intravaginal and oral formulations. An oral micronized progesterone preparation has improved bioavailability and fewer reported side effects compared with synthetic progestins. Adolescents and perimenopausal women may require progestational agents for the treatment of dysfunctional uterine bleeding resulting from anovulatory cycles. These agents may also be used in women at risk for endometrial hyperplasia because of chronic unopposed estrogen stimulation. Progestin-only contraceptives can be used in women with contraindications to estrogen; however, efficacy requires rigorous compliance. New progestins for use in combination oral contraceptive pills were specifically developed to reduce androgenic symptoms. It is unclear whether these progestins increase the risk of venous thromboembolic disease. Progestin-only emergency contraception offers a regimen that is more effective than combination oral contraceptive pills, with fewer reported side effects.     

Sexual health and women with bipolar disorder

AIM: The aim of this paper is to illustrate the importance of sexual health promotion strategies for women with bipolar disorder in order to stimulate interest and debate in this area of care. BACKGROUND: Sexual health promotion is an important aspect of holistic nursing care. However, the literature indicates that nurses are reluctant to discuss sexual health and sexual behaviour with their clients. People with bipolar disorder warrant special consideration with regards to sexual health because the nature of the manic, or hypomanic, mood state is associated in some cases with sexually risky behaviour. For women with bipolar disorder, the associated risks include the threat of unplanned pregnancy or sexually transmitted diseases. To ignore sexual health and sexual behaviour in mental health care increases the vulnerability of women who may already be at risk of sexual exploitation. CASE EXAMPLE: A brief case example is included to demonstrate how the sexual health of a young woman with bipolar disorder was promoted. The sexual health promotion that was incorporated into her care enabled her to make a choice about appropriate contraception, and also provided her with the opportunity to explore acceptable boundaries in different types of interpersonal relationships. As a result of the episodic nature of Bipolar disorder, it is impossible to state whether the positive outcomes from this strategy will be enduring or not. CONCLUSION: Consideration of sexual health is an essential element of the care of women with Bipolar disorder. To ignore it is to neglect an important sphere of human behaviour that can be affected by the condition.     

Contraception by age group

From menarche to menopause, women choose different methods of contraception for many different reasons. Some of the reasons include: convenience, expense, availability, benefits, sexual intentions, attitudes and the maturity of the contraceptive user. Contraceptive choices such as condoms, IUDs, natural family planning, spermicides and others are explored in relationship to a women's age and choice. The age groups are divided as follows: menarche to 18, 18 to 35 and 35 years to menopause. Hormonal methods, particularly the combined oral contraceptive pill, are a viable choice for young women from menarche age to 35 as is the choice of condoms. Both require, however, an understanding of effective use. In the 35 to menopause age group, there is a discussion of cycle irregularity and its affect on contraceptive choice and the uncertainty surrounding fertility. It is of importance to note that as fertility decreases so does the safety of nearly any method of contraception. Side effects of each choice, both good and bad, on the user's health are discussed.     

Pills, panics, precautions

This article discusses on the increasing role of nurses in contraceptive services and their need for updated information to respond to product changes and media scares. The role of nurses in providing contraception services will grow more heavily especially given delivery of medicines through group protocols and the prospect of an expansion in nurse prescribing. Moreover, nurses are confronted with the issues of limited contraceptive choices, media scares especially on pill risks, the need to make emergency contraception accessible and the declining teenage contraception. They have to be well trained and must keep abreast of research in order to convey all of the risks of contraceptives without alarming people. Some nurses have been working to good protocols, on trust, for issuing emergency contraception to women over age 16, and some under that age. In dealing with young people who are alienated and intimidated by mainstream family planning services, health boards have considered services especially designed for young people.     

Oral contraceptives: the risks in perspective

In 1968 three large prospective cohort studies were begun for the purpose of studying the long-term effects of oral contraceptive use. In all three studies, the major serious side effect of oral contraceptive use was an increased risk of circulatory mortality; this risk, however, was concentrated in older women who smoked and all women over the age of 45. The concept of risk is poorly understood by many consumers and providers of health care. This article explains the concept of risk and how it is determined, and reviews the most recent findings of the cohort studies relative to pill-related mortality. Comprehension of the concept of risk relative to pill-related mortality and its implications for nursing practice will assist nurses in providing their clients with the knowledge base necessary for an informed choice regarding contraceptive method.     

Impact of psychotropic medication on sexuality: literature review

Psychotropic medication continues to be a central element in the care and treatment of people experiencing mental health problems. Nurses have a key role to play in patient education and in monitoring the benefits and side effects of prescribed drugs. However, evidence suggests that nurses tend to ignore or minimize side effects that impact on sexuality and sexual function. The focus of this article is on exploring the literature on psychotropic medication and sexual dysfunction.