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1.
William Mosher Rosemary B. Hughes Tina Bloom Leah Horton Ramin Mojtabai Jeanne L. Alhusen 《Contraception》2018,97(6):552-558
Objective
The objective was to determine population-based estimates of use of contraception among women 15–44?years of age in the United States by disability status.Study design
We examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011–2015 National Survey of Family Growth.Results
After examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12–2.12) and physical disabilities (aOR=1.59, CI=1.08–2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40–0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36–2.66).Conclusions
Self-reported cognitive disabilities (“serious difficulty concentrating, remembering or making decisions”), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use.Implications
The patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals. 相似文献2.
Objective
We sought to determine the prevalence of postpartum contraceptive use among women with postpartum depressive symptoms (PDS) and examine the association between PDS and contraceptive method.Study design
We evaluated data from 16,357 postpartum women participating in the 2009–2011 Pregnancy Risk Assessment Monitoring System. PDS was defined as an additive score of ≥10 for three questions on depression, hopelessness, and feeling physically slowed. Contraceptive use was categorized as permanent, long-acting reversible contraception (LARC), user-dependent hormonal, and user-dependent non-hormonal. Logistic regression models compared postpartum contraceptive use and method by PDS status.Results
In total, 12.3% of women with a recent live birth reported PDS. Large percentages of women with (69.4%) and without (76.1%) PDS, used user-dependent or no contraceptive method. There were no associations between PDS and use of any postpartum contraception (adjusted Prevalence Ratio (aPR) = 1.00, 95% CI 0.98–1.03) or permanent contraception (aPR=1.05, 95% CI 0.88–1.27). LARC use was elevated, but not significantly, among women with PDS compared to those without (aPR=1.16, 95% CI: 1.00–1.34).Conclusions
Large percentages of women with and without PDS used user-dependent or no contraception. Since depression may be associated with misuse of user-dependent methods, counseling women about how to use methods more effectively, as well as the effectiveness of non-user dependent methods, may be beneficial.Implications
A large percentage of women with PDS are either not using contraception or using less effective user-dependent methods. Since depression may be associated with misuse of user-dependent contraceptive methods, counseling women about how to use methods more effectively, as well as non-user dependent options, such as LARC, may be beneficial. 相似文献3.
Sharon L. Achilles Felix G. Mhlanga Petina Musara Samuel M. Poloyac Zvavahera M. Chirenje Sharon L. Hillier 《Contraception》2018,97(4):346-353
Objective
Researchers traditionally rely on participant self-report for contraceptive use. We hypothesized that self-reported contraceptive use by clinical research participants may disagree with objectively measured hormonal status.Study design
We enrolled women in Harare, Zimbabwe, aged 18–34, who by self-report had not used hormonal or intrauterine contraception for >30 days, or depot medroxyprogesterone acetate for >10 months, into a study designed to assess biologic changes with contraceptive initiation and use. Blood samples obtained at enrollment and each follow-up visit (N=1630 from 447 participants) were evaluated by mass spectrometry for exogenous hormones. We individually interviewed a subset of participants (n=20) with discrepant self-reported and measured serum hormones to better understand nondisclosure of contraceptive use.Results
Discrepant with self-reported nonuse of hormonal contraception, synthetic progestogens were detectable in 120/447 (27%, 95% confidence interval 23%–31%) enrolled women. Measured exogenous hormones consistent with use of contraceptive pills (n=102), injectables (n=20) and implants (n=3) were detected at enrollment, with 7 women likely using >1 contraceptive. In-depth interviews revealed that participants understood the requirement to be hormone free at enrollment (100%). Most (85%) cited partner noncooperation with condoms/withdrawal and/or pregnancy concerns as major reasons for nondisclosed contraceptive use. All interviewed women (100%) cited access to health care as a primary motivation for study participation. Of participants who accurately reported nonuse of hormonal contraception at enrollment, 41/327 (12.5%) had objective evidence of nonstudy progestin use at follow-up that disagreed with self-reported nonuse.Conclusions
Women joining contraceptive research studies may misrepresent their use of nonstudy contraceptive hormones at baseline and follow-up. Objective measures of hormone use are needed to ensure that study population exposures are accurately categorized.Implications statement
Among Zimbabwean women participating in a contraceptive research study, 27% had objective evidence of use of nonstudy contraceptives at enrollment that disagreed with self-report. Studies that rely on self-report to identify contraceptive hormone exposure could suffer from significant misclassification. 相似文献4.
Dunstan Achwoka Jillian Pintye Christine J. McGrath John Kinuthia Jennifer A. Unger Norah Obudho Agnes Langat Grace John-Stewart Alison L. Drake 《Contraception》2018,97(3):227-235
Objective
The objective was to characterize uptake and correlates of effective contraceptive use postpartum.Study design
We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP).Results
We included 955 (94%) of 1012 women 8–10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9 months postpartum, 62% of all women used contraception and 59% used effective contraception [injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs] and tubal ligations]. Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%) and condoms alone (2%). The majority (n=733, 77%) had a need for FP, and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC [prevalence ratio (PR) for PNC alone: 1.35, 95% confidence interval (CI): 1.16–1.58; PR for PNC and antenatal care (ANC): 1.42, 95% CI: 1.21–1.67; p=.001 for both].Conclusions
Two thirds of postpartum women with a need for FP used effective contraception at 9 months postpartum, and use was associated with discussing FP during PNC.Implications
Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use. 相似文献5.
Aimee Benson Lisa Calhoun Meghan Corroon Abdou Gueye David Guilkey Essete Kebede Peter Lance Rick O&#x;Hara Ilene S. Speizer John Stewart Jennifer Winston 《Contraception》2018,97(5):439-444
Objectives
This paper presents the impact of key components of the Senegal Urban Reproductive Health Initiative, including radio, television, community-based activities, Muslim religious-leader engagement and service quality improvement on modern contraceptive use by all women and the sub-sample of poor women.Study design
This study uses baseline (2011) and endline (2015) longitudinal data from a representative sample of urban women first surveyed in 2011 to examine the impact of the Initiative's demand- and supply-side activities on modern contraceptive use.Results
By endline, there was increased exposure to radio and television programming, religious leaders speaking favorably about contraception, and community-based initiatives. In the same period, modern contraceptive use increased from 16.9% to 22.1% with a slightly larger increase among the poor (16.6% to 24.1%). Multivariate analyses demonstrate that women exposed to community-based activities were more likely to use modern contraception by endline (marginal effect (ME): 5.12; 95% confidence interval (CI): 2.50–7.74) than those not exposed. Further, women living within 1 km of a facility with family planning guidelines were more likely to use (ME: 3.54; 95% CI: 1.88–5.20) than women without a nearby facility with guidelines. Among poor women, community-based activities, radio exposure (ME: 4.21; 95% CI: 0.49–7.93), and living close to program facilities (ME: 4.32; 95% CI: 0.04–8.59) impacted use.Conclusions
Community-based activities are important for reaching urban women, including poor women, to achieve increased contraceptive use. Radio programming is also an important tool for increasing demand, particularly among poor women. Impacts of other program activities on contraceptive use were modest.Implications
This study demonstrates that community-based activities led to increased modern contraceptive use among all women and poor women in urban Senegal. These findings can inform future programs in urban Senegal and elsewhere in francophone Africa. 相似文献6.
7.
Rachel K. Jones 《Contraception》2018,97(4):309-312
Objectives
The objective was to determine whether types of contraceptive methods used by abortion patients in the month they became pregnant changed between 2000 and 2014.Study design
We used secondary data from the 2000 (n=10,015) and 2014 (8177) Abortion Patient Surveys. Patients were asked which contraceptive methods they had last used and when they had stopped or if they were still using them. The main outcome variable was type of contraceptive method used in the month the pregnancy began. We used bivariate logistic regressions to assess changes in the demographic and contraceptive use profiles of abortion patients.Results
In both years, slightly more than half of patients reported that they had used a contraceptive method in the month they became pregnant, though the decline from 54% in 2000 to 51% in 2014 was statistically significant (p=.011). The methods most commonly reported to have been used in the month the pregnancy began were condoms (28% and 24% in 2000 and 2014, p<.001) followed by the pill (14% and 13%, p=.12). There was a statistically significant increase in the proportion of abortion patients who reported using long-acting reversible methods in the month they got pregnant (0.1% in 2000 vs. 1% in 2014, p<.001), and the estimated number of abortions attributed to these users was greater in 2014 than in 2000 (9500 vs. 1800).Conclusions
Contraceptive use patterns of abortion patients were similar in both time periods, and changes in method use mirrored changes in contraceptive use among the larger population of women.Implications
Postabortion contraception counseling has the potential to help nonusers find methods that meet their preferences and to help women better use their current methods. 相似文献8.
Objective
The objective was to determine if young women initiating long-acting reversible contraceptives (LARCs) who report new sexual partner(s) would be less likely to report use of a condom than women using short-acting reversible contraceptive (SARC) methods.Study design
We enrolled a prospective cohort of 13–24-year-old women attending an adolescent-specific contraception clinic. Participants completed questionnaires at the contraceptive initiation visit and 6 months later. At follow-up, we asked if they had sexual intercourse with a new partner, if they had used condoms, if their condom use patterns had changed and why. We analyzed factors associated with condom use.Results
We enrolled 1048 women; 771 (73.6%) initiated LARC and 384 (36.6%) initiated SARC. At 6 months, 508 participants (48.5%) completed the follow-up survey: 380 LARC initiators and 128 SARC initiators. Approximately 23% of LARC initiators and 27% of SARC initiators reported a new partner. SARC initiators who had a new partner were more likely to report condom use at least one time than LARC initiators reporting a new partner [82.4% vs. 59.6%; odds ratio (OR): 3.17, 95% confidence interval (CI): 1.19–8.43]. Such condom use was 42% higher among LARC initiators who reported a new sexual partner than those without and 38% higher for SARC initiators. In multivariable logistic regression, new sexual partner [adjusted OR (aOR) 3.29, 95% CI 2.10–5.16], SARC initiation (aOR 2.08, 95% CI 1.35–3.22) and age <20 (aOR 1.68, 95% CI 1.14–2.49) were independent predictors of condom use.Conclusion
While young women are less likely to report condom use in the 6 months after initiating a LARC than after initiating a short-acting method, both groups increase their condom use similarly if they report a new sexual partner.Implications
The differential in condom use between LARC initiators and SARC initiators is likely related to their perceived need for pregnancy prevention, as both groups increase their condom use similarly if they had new sexual partners. 相似文献9.
Objective
The objective was to examine levels of, correlates of and changes in the use of individual and grouped methods of contraception among US females aged 15–44 from 2008 to 2014.Study design
Using three rounds of the National Survey of Family Growth, we analyzed samples of 12,279 (2008), 5601 (2012) and 5699 (2014) females. We conducted simple and multivariable logistic regression analyses to identify associations between demographic characteristics and contraceptive use, as well as between characteristics and changes in use patterns.Results
In terms of overall trends in contraceptive use between 2008 and 2014, there was no significant change in the proportion of women who used a method among either all women (60%) or those at risk of unintended pregnancy (90%). Significant changes in use occurred among six methods. The largest increase in use was among users of long-acting reversible contraceptive (LARC) methods, including the intrauterine device and implant — from 6% to 14% — across almost all population groups of female contraceptive users, while the largest decrease occurred among users of sterilization — from 37% to 28% — with lower-income women driving the decline in female sterilization and higher-income women driving the decline in a partner's sterilization as a primary method. Moderate increases were seen in the use of withdrawal and natural family planning.Conclusion
Most shifts in recent contraceptive use have occurred among the most effective methods — sterilization and LARCs. Differences in method-specific user characteristics underscore the importance of ensuring full access to the broad range of methods available.Implications
The lack of change in the overall use of contraceptives among women at risk for unintended pregnancy may have implications for the extent to which further declines in national rates of unintended pregnancy can be expected. 相似文献10.
Nerys Benfield Felicia Hawkins Laurie Ray Andrea McGowan Ketty Floyd Dawn Africa Myrta Barreto Erika Levi 《Contraception》2018,97(5):411-414
Objectives
Nurses play an integral role in intrapartum and postpartum patient education. This exploratory study aims to assess the attitudes, knowledge, and practices of labor and delivery and postpartum nurses regarding contraception and evaluate for changes in these measures 1 year after an institutional initiative allowing routine availability of immediate postpartum long-acting reversible contraception (LARC).Study design
In 2014, Montefiore Medical Center began to routinely offer comprehensive immediate postpartum contraception. The initiative included education and feedback sessions for labor and delivery and postpartum nurses on contraception, including immediate postpartum initiation of LARC. Nurses completed anonymous surveys at the beginning of the initiative (n=59) and at 1 year (n=56). We compared baseline and 1 year survey results of contraceptive knowledge, attitudes and practices using χ2 test, Fisher's Exact Test, or t test as appropriate.Results
Nurses who stated they counseled patients on contraception “always” or “most of the time” increased from 27/59 (46%) to 40/56 (71%) (p=.005). The number of nurses who would recommend the intrauterine device and implant for postpartum contraception increased from 1/59 (2%) to 18/56 (32%) (p<.0001). Attitudes towards injectable contraception and breastfeeding remained negative; 27/59 nurses (46%) at baseline and 34/56 (61%) at 1 year agreed with the statement “DMPA [depot medroxyprogesterone acetate] has a negative effect on breastfeeding.”Conclusions
Experience working in a location with routine access to immediate postpartum contraception is associated with increased awareness among nurses of postpartum contraceptive options, especially LARC, and increased contraceptive counseling. Concerns about the impact of hormonal contraception on breastfeeding, specifically DMPA, are persistent and prevalent.Implications
Labor and delivery and postpartum nurses' knowledge regarding immediate postpartum contraception, particularly LARC methods, may change with exposure to routine access to these methods. This exposure may also impact nurses' practices of providing patient counseling on what methods are appropriate for postpartum women. 相似文献11.
Willi Horner-Johnson Esther L. Moe Ryan C. Stoner Krystal A. Klein Alison B. Edelman Karen B. Eden Elena M. Andresen Aaron B. Caughey Jeanne-Marie Guise 《Disability and health journal》2019,12(2):139-154
Background
Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population.Objective
To systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use.Methods
We searched MEDLINE, PsychINFO, the Cochrane Library, CINAHL, and ERIC databases from inception through December 2017. Two reviewers independently reviewed studies for eligibility, abstracted study data, and assessed risk of bias following PRISMA guidance.Results
We reviewed 11,659 citations to identify 62 publications of 54 unique studies (total n of women with disabilities?=?21,246). No standard definition of disability existed across studies. The majority of studies focused on women with intellectual disabilities (ID). Women with ID and those who were deaf or hard-of-hearing had lower knowledge of contraceptive methods than women without disabilities. Estimates of contraceptive use varied widely, with some evidence that women with disabilities may use a narrower range of methods. Five of six studies evaluating educational interventions to increase contraceptive knowledge or use reported post-intervention improvements.Conclusions
Women with disabilities may use a more narrow mix of contraceptive methods and are often less knowledgeable about contraceptives than women without disabilities. Interventions to improve knowledge show some promise. A lack of data exists on contraceptive preferences among women with disabilities. 相似文献12.
Objective
Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates.Study design
Data are based on interviews with a national sample of 11,300 women in the 2011–2015 National Survey of Family Growth. We analyzed women ages 20–44 at risk of unintended pregnancy. The primary dependent variable was BMI category. Covariates analyzed included age, parity, race/ethnicity, marital status, self-reported health and education. Data were analyzed via cross-tabulation and logistic regression. We determined unadjusted and adjusted odds ratios for three categories of contraceptive method: female sterilization, intrauterine device (IUD) and hormonal contraception.Results
Obese women have higher odds of female sterilization (BMI 30.0–34.9 kg/m2: adjusted odds ratio (aOR) = 1.96, 95% confidence interval (CI) 1.45–2.66; BMI 35.0 kg/m2 and higher: aOR=1.56, 95% CI 1.13–2.14) compared to women with normal BMI. Odds of IUD use are significantly higher among women with BMI >35 kg/m2 (aOR=1.64, 95% CI 1.20–2.25). Odds of hormonal contraceptive use are correspondingly reduced (aOR=0.78, 95% CI 0.62–0.98) for women in the highest BMI category.Conclusions
Contraceptive use varies by BMI category even after adjusting for usual correlates of use. Differences in contraceptive use by BMI category have implications for contraceptive counseling and provision.Implications
Findings that obese women are more likely to rely on female sterilization raise questions about how weight concerns and obesity affect contraceptive decision making. Future research could explore associations between obesity and contraceptive use in adolescent women. 相似文献13.
Context
In low- and middle-income countries, anemia is a major public health issue in women of reproductive age for a series of factors including iron deficiency.Objective
To estimate prevalence of anemia and to assess the association of low level of hemoglobin versus duration of use of oral contraceptives (OC).Methods
Demographic and Health Surveys of 12 countries, conducted between 2005 and 2012, were analyzed. The status of anemia was separately evaluated for nonpregnant women using OC for at least 6 months, 1 year and 2 years, and for women using no method of contraception and/or using nonhormonal contraception.Results
The total study population comprised 201,720 women, with 40% diagnosed with anemia; around 1 out of 25 women was using oral contraception.The current and continuous use of oral contraception was of benefit against anemia, with the risk for anemia decreasing from odds ratio (OR) 0.68 [95% confidence interval (CI) 0.64–0.73] for use of at least 6 months to OR 0.56 (95% CI 0.52–0.61) for use of at least 1 year and to OR 0.50 (95% CI 0.46–0.54) for use of at least 2 years.Conclusions
Findings reinforce evidence of the noncontraceptive benefit of long-term use of OC and provide valuable information for policy makers, family planning staff and clinicians working in low- and middle-income countries in efforts to control anemia. 相似文献14.
15.
Jenna S. Hynes Jessica M. Sales Anandi N. Sheth Eva Lathrop Lisa B. Haddad 《Contraception》2018,97(3):277-284
Objective
High rates of sexually transmitted infections (STIs) and unintended pregnancy suggest a role for multipurpose prevention technologies (MPTs) designed to combine contraception and infection prophylaxis into one unified method. This study aims to determine factors associated with interest in MPTs among US women.Study Design
We administered a national cross-sectional survey via MTurk. Eligibility criteria included female gender, age 18–29 years, residence in the USA, and sexual activity with a male partner in the past three months. In total, 835 surveys were suitable for analysis. Bivariable and multivariable logistic regressions were performed to determine factors associated with interest in MPTs.Results
Eighty-three percent of women were interested in MPTs. Factors associated with interest included oral sex in the past three months (aOR 1.87, 95% CI 1.07, 3.53), recent use of oral contraceptive pills (OCPs; aOR 1.78, 95% CI 1.08, 2.93), HIV test within one year (aOR 2.10, 95% CI 1.29, 3.40), and increased STI worry score (aOR 1.98, 95% CI 1.36, 2.86). No use of contraception in the past three months was associated with decreased interest in MPTs (aOR 0.31, 95% CI 0.17, 0.58). HIV risk factors including race were not associated with MPT interest.Conclusion
Our data show that young, sexually active, US women are interested in MPTs. Women who used contraception, specifically OCPs, or evidenced concern for infection were most likely to be interested in such a product. Women reporting unsafe sexual habits were less likely to be interested, highlighting the importance of HIV/STI prevention education.Implications
Women in the USA are interested in multipurpose prevention technologies, particularly those women who currently use contraception or are concerned about their risk of infection. Our results emphasize the importance of moving forward with MPT development as well as continued HIV/STI prevention education. 相似文献16.
17.
Emily Dorman Brian Perry Chelsea B. Polis Lisa Campo-Engelstein Dominick Shattuck Aaron Hamlin Abigail Aiken James Trussell David Sokal 《Contraception》2018,97(1):62-69
Objective
We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the United States, South Africa, and Nigeria.Study design
We used an established methodology for calculating the number of couple-years of protection provided by a given contraceptive method mix. We compared a “current scenario” (reflecting current use of existing methods in each country) against “future scenarios,” (reflecting whether a male oral pill or a reversible vas occlusion was introduced) in order to estimate the impact on unintended pregnancies averted. Where possible, we based our assumptions on acceptability data from studies on uptake of novel male contraceptive methods.Results
Assuming that only 10% of interested men would take up a novel male method and that users would comprise both switchers (from existing methods) and brand-new users of contraception, the model estimated that introducing the male pill or reversible vas occlusion would decrease unintended pregnancies by 3.5% to 5.2% in the United States, by 3.2% to 5% in South Africa, and by 30.4% to 38% in Nigeria. Alternative model scenarios are presented assuming uptake as high as 15% and as low as 5% in each location. Model results were sensitive to assumptions regarding novel method uptake and proportion of switchers vs. new users.Conclusion
Even under conservative assumptions, the introduction of a male pill or temporary vas occlusion could meaningfully contribute to averting unintended pregnancies in a variety of contexts, especially in settings where current use of contraception is low.Implications
Novel male contraceptives could play a meaningful role in averting unintended pregnancies in a variety of contexts. The potential impact is especially great in settings where current use of contraception is low and if novel methods can attract new contraceptive users. 相似文献18.
Maria Pyra Jairam R. Lingappa Renee Heffron David W. Erikson Steven W. Blue Rena C. Patel Kavita Nanda Helen Rees Nelly R. Mugo Nicole L. Davis Athena P. Kourtis Jared M. Baeten 《Contraception》2018,97(4):357-362
Objectives
Studies that rely on self-report to investigate the relationship between hormonal contraceptive use and HIV acquisition and transmission, as well as other health outcomes, could have compromised results due to misreporting. We determined the frequency of misreported hormonal contraceptive use among African women with and at risk for HIV.Study design
We tested 1102 archived serum samples from 664 African women who had participated in prospective HIV prevention studies. Using a novel high-performance liquid chromatography–mass spectrometry assay, we quantified exogenous hormones for injectables (medroxyprogesterone acetate or norethisterone), oral contraceptives (OC) (levonorgestrel or ethinyl estradiol) and implants (levonorgestrel or etonogestrel) and compared them to self-reported use.Results
Among women reporting hormonal contraceptive use, 258/358 (72%) of samples were fully concordant with self-report, as were 642/744 (86%) of samples from women reporting no hormonal contraceptive use. However, 42/253 (17%) of samples from women reporting injectable use, 41/66 (62%) of samples from self-reported OC users and 3/39 (8%) of samples from self-reported implant users had no quantifiable hormones. Among self-reported nonusers, 102/744 (14%) had ≥1 hormone present. Concordance between self-reported method and exogenous hormones did not differ by HIV status.Conclusion
Among African women with and at risk for HIV, testing of exogenous hormones revealed agreement with self-reported contraceptive use for most women. However, unexpected exogenous hormones were identified among self-reported hormonal contraceptive users and nonusers, and an important fraction of women reporting hormonal contraceptive use had no hormones detected; absence of oral contraceptive hormones could be due, at least in part, to samples taken during the hormone-free interval. Misreporting of hormonal contraceptive use could lead to biased results in observational studies of the relationship between contraceptive use and health outcomes.Implications
Research studies investigating associations between hormonal contraceptive use and HIV should consider validating self-reported use by objective measures; because both overreporting and underreporting of use occur, potential misclassification based on self-report could lead to biased results in directions that cannot be easily predicted. 相似文献19.
Kristyn Brandi Elisabeth Woodhams Katharine O. White Pooja K. Mehta 《Contraception》2018,97(4):329-334
Objective
To explore patient experiences of contraceptive coercion by healthcare providers at time of abortion.Study Design
We conducted a qualitative study of English-speaking women seeking abortion services at a hospital-based clinic. We used the Integrated Behavioral Model and the Reproductive Autonomy Scale to inform our semi-structured interview guide; the Scale provides a framework of reproductive coercion as a lack of autonomy or power to decide about and control decisions relating to reproduction. We enrolled participants until thematic saturation was achieved. Two coders used modified grounded theory to analyze transcribed interviews with Nvivo 11.0 (Κ=0.81).Results
The 31 women we interviewed from June 2016 to March 2017 were all in the first trimester, and predominantly young (mean age 27±5 years), non-Hispanic Black (52%) and Medicaid-insured (68%). Some participants (42%) reported feeling “pressured” into choosing some form of contraception. A subset of participants (26%) voiced that providers seemed to prefer LARC methods or were “pushing” a specific method. Several participants perceived pressure to choose any method due to providers' preference to prevent repeat abortions. Conversely, participants who were offered a range of methods through the use of decision aids and who were given time to deliberate demonstrated more reproductive autonomy.Conclusions
Almost half of participants perceived a form of coercion around their contraceptive counseling. Coercion manifested in perceived provider preference for specific methods or immediate initiation of a method. Participant narratives involving decision aids to offer a range of methods and time for deliberation demonstrated greater reproductive autonomy and less coercion. Abortion stigma may mediate potentially coercive interactions between patients and providers.Implications
This qualitative study explored contraceptive coercion at the time of abortion. Findings highlighted provider pressure to initiate contraception, LARC preference, and abortion stigma. Offering many methods and opportunity for deliberation supported autonomy and satisfaction. Findings inform ongoing efforts to improve contraceptive counseling and promote reproductive autonomy, while addressing unintended pregnancies. 相似文献20.
Anuli N. Nwaohiri Jennifer H. Tang Frank Stanczyk Lameck Chinula Stacey Hurst Nicole L. Davis Gerald Tegha Lisa Haddad Athena P. Kourtis 《Contraception》2018,97(4):354-356