Reproductive needs of PLHIV in Jamaica: relationship between fertility desire,motives and depression

ABSTRACT

Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.

Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.

Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04–0.44) as well as motives to conceive (p = .02; CI 0.01–0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48–30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01–1.04).

Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.     

Contraceptive risk-taking in women and men facing legal abortion

Objective: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners. Methods: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners. Results: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception. Conclusion: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.     

Sexual Motivation in Women as a Function of Age

IntroductionWomen's motivations to engage in sex are likely influenced by their past sexual experiences, the type of relationship in which they are involved in, and numerous lifestyle factors such as career and family demands. The influences of these factors undoubtedly change as women age.AimThis study aimed to examine potential differences in sexual motivation between three distinct age groups of premenopausal women.MethodsWomen aged 18–22 years (N = 137), 23–30 years (N = 103), and 31–45 years (N = 87) completed an online survey that assessed the proportion with which they had engaged in sexual intercourse for each of 140 distinct reasons.Main Outcome MeasuresThe YSEX? Questionnaire by Meston and Buss [1] was used to measure sexual motivation. The items of this questionnaire were composed of four primary sexual motivation factors (physical, goal attainment, emotional, insecurity), and 13 subfactors.ResultsWomen aged 31–45 years reported a higher proportion of engaging in sex compared with one or both of the younger age groups of women for nine of the 13 YSEX? subfactors: stress reduction, physical desirability, experience seeking, resources, social status, revenge, expression, self‐esteem boost, and mate guarding. At an item level, the top 25 reasons for having sex were virtually identical across age groups.ConclusionWomen aged 31–45 have more motives for engaging in sex than do women aged 18–30, but the primary reasons for engaging in sex do not differ within this age range. Women aged 18–45 have sex primarily for pleasure, and love and commitment. The implications for diagnosis and treatment of women with sexual dysfunctions were discussed. Meston CM, Hamilton LD, and Harte CB. Sexual motivation in women as a function of age.     

Risk factors for induced abortions in St Petersburg,Estonia and Finland. Results from surveys among women of reproductive age

Objectives?To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates.

Methods?Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia.

Results?The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives.

Conclusion?The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.     

Contraceptive use among migrant women with a history of induced abortion in Finland

Abstract

Background: Women’s contraceptive choices may change after an induced abortion, due to contraceptive counselling or a behavioural change prompted by the experience. The effect may vary between women; sociocultural background, for example, may affect their subsequent reproductive choices.

Objective: We examined whether women’s current contraceptive use was differently associated with a history of induced abortion among immigrant groups in Finland (Russian, Kurdish and Somali) and the general Finnish population.

Methods: We analysed data from two surveys, the Migrant Health and Wellbeing study and the Health 2011 study, linked to the Finnish register of induced abortions. Propensity score weighted logistic regression was used to analyse the data.

Results: The likelihood of using contraceptives after an abortion varied depending on women’s sociocultural background. A history of induced abortion increased contraceptive use among all groups, except Russian women, in whom there was no effect. The effect was particularly strong for Kurdish women.

Conclusion: Sociocultural background was an important determinant of post-abortion contraceptive use. Some immigrants may struggle to navigate the Finnish health care system due to language or literacy issues. Attention should be paid to improving access to family planning among these groups.     

The decision to have an abortion from both partners’ perspectives: a dyadic analysis

Objectives: Male partners are often involved in induced abortion although they have no legal rights. It is, however, unknown how women’s thoughts and feelings regarding the decision for abortion are associated with the decisional experiences of the involved male partners and vice versa.

Methods: Flemish women and their involved male partners (IMP) filled out a questionnaire on abortion motives and feelings of decisiveness in the abortion centre waiting room (N?=?106 couples). Actor Partner Interdependence Models investigated whether the decisiveness of one partner was associated with a subjective feeling of autonomy (high internal, low external abortion motivation) and decisiveness of the other partner, above and beyond the own feeling of autonomy and personal vulnerabilities for being uncertain.

Results: Partner congruence in motivation and decisiveness was substantial (r=?0.23 to 0.42), especially for cohabiting partners. The IMPs were less internally motivated for the abortion than the women but both partners reported more internal than external motives, and they both tended to feel certain. In contrast to the women, a higher subjective feeling of autonomy in the IMPs was not associated with feeling more certain. When accounting for partners’ living situation, levels of uncertainty were not only associated with personal vulnerabilities for being uncertain, but were also related to the degree of uncertainty and subjective level of autonomy of the other partner.

Conclusions: Partners’ thoughts and feelings regarding the decision for abortion partially have an interpersonal basis and mostly run parallel despite an inherent gender difference in level and importance of decision autonomy.     

Induced abortion frequency in Ankara,Turkey, before and after the legal regulation of induced abortion

Objective To determine the effects of the 1983 law that legalized induced abortion on the number and place of abortions, and on the use of family planning (FP) methods before and after abortion, and to determine the demographic characteristics and reproductive health features according to the order of abortion.

Method This study included 2455 married, widowed or divorced women presenting at Mother and Child Health-Family Planning Centres in Ankara. A questionnaire was used for data collection.

Result Nearly three out of 10 (28.7%) of the women had undergone at least one induced abortion. In the age groups 45–54 and 55–64, 49 and 37.3%, respectively, had had one or more terminations of pregnancy (TOPs). The induced abortion rate increased following the enacting of the law. In the 15–24 and in the 55–64 age group, 55.6 and 89%, respectively, of the women had been aborted by a private physician. Before the index pregnancy, 63.1% were not using contraception compared with 37.3% thereafter. The rate of use of FP increased after the law was passed.

Conclusion Although the most common reason for having an abortion was unwanted pregnancy in all age groups and nearly 60.0% of the women aged less than 55 reported that they were not using any FP method at the time of the TOP, the proportion of women having undergone at least one of these procedures increased after the law was passed, indicating that abortion is used as a FP method.     

Relationship Between Abortion at First Pregnancy and Live Births by Young Adulthood: A Population-Based Study Among Mexican Women

Study ObjectiveTo identify factors associated with having an abortion (spontaneous or induced) at the time of first pregnancy, and to test the association between abortion in the first pregnancy and the number of live births among young women 20-24 years of age.DesignCross-sectional study.SettingWe used a nationally representative survey of Mexican women 20-24 years of age with data at time of survey and retrospective measures of exposures in adolescence. We include 1913 women who reported ever having a pregnancy.Main OutcomesOur outcomes were history of abortion (spontaneous or induced) and number of live births by 20-24 years of age. We used multivariable logistic regression models to estimate the association between sociodemographic factors at the time of pregnancy and abortion history, and between abortion history and number of live births.ResultsAmong women 20-24 years of age who ever had a pregnancy, 15.5% reported an abortion in the first pregnancy, and 84.4% never had an abortion. Among women who had an abortion in the first pregnancy, 62.3% did not report any live birth by age 20-24 years. Young women living with their parents (adjusted odds ratio [AOR] = 1.87; confidence interval [CI] = 1.16-3.02) or with a partner with a higher educational level (AOR = 4.64; CI = 1.05-20.44) had greater odds of having an abortion in the first pregnancy. Compared with women who never had an abortion, women who reported an abortion in the first pregnancy had lower odds (AOR = 0.02; CI = 0.01-0.03) of having 1 or more children by the age of 20-24 years.ConclusionYoung women who reported abortion in the first pregnancy had fewer live births at ages 20-24 years compared to women with no history of abortion.     

Birth experiences of urban women of advanced age having their second child after introduction of the universal two-child policy in China: A qualitative study

Objectiveto investigate the birth experiences of women of advanced age having a second child in urban China after introduction of the universal two-child policy in 2016.Designdata were collected using semi-structured in-depth interviews, and were processed and analysed using a qualitative phenomenological method.Settingobstetric department of a class 1, level 3 hospital in Henan Province, China.Participantspurposive sampling was undertaken, and 11 hospitalized women from urban backgrounds were selected as the participants. They were all aged >35 years and were having their second child. The interviews were conducted 2–4 days post partum.Findingsthe findings were divided into four themes: motives for the birth of a second child; anticipations for the child's gender; difficulty in conceiving; and conflicts after birth. The main reason for having a second child was no longer in accordance with the traditional Chinese mindset to ‘raise sons to secure a happy life when one gets old’; instead, it was to secure family balance and harmony to respond to the new policy. Educated women from urban backgrounds were able to accept the gender of the second child ‘as it came’, without the old mindset that ‘men are superior to women’ and ‘only boys can carry on family lines’. Advanced maternal age and gestational complications were the major difficulties facing these women. Chinese medicine and regimens were recognised as effective and conducive. Following the birth of their second child, the women experienced both positive feelings (joy due to the arrival of the new baby) and negative feelings (pressures and challenges on family finances, demands for more living space, and balancing their affections between two children).Conclusions and implications for practicewomen of advanced age who choose to have a second child have sensible motives and, for the most part, their experience is positive. That said, the participants faced and overcame many difficulties before, during and after the birth of their second child. They were in need of help from the government and their employers in terms of policy, and proper education on care-taking and recuperation from medical professionals. Families who have a second child should treat the second child calmly and with common sense, make quick adjustments to family structural changes, and strike a proper balance in an effort to divide love and care equally between the two children.     

Experiences of women who travel to England for abortions: an exploratory pilot study

Objectives: Restrictive policies that limit access to abortion often lead women to seek services abroad. We present results from an exploratory study aimed at documenting the socio-demographic characteristics, travel and abortion-seeking experiences of non-resident women seeking abortions in the UK.

Methods: Between August 2014 and March 2015, we surveyed a convenience sample of 58 non-UK residents seeking abortions at three British Pregnancy Advisory Service (BPAS) abortion clinics in England in order to better understand the experiences of non-resident women who travel to the UK seeking abortion services.

Results: Participants travelled to England from 14 countries in Europe and the Middle East. Twenty-six percent of participants reported gestational ages between 14 and 20 weeks, and 14% (n?=?8) were beyond 20 weeks since their last menstrual period (LMP). More women from Western Europe sought abortions beyond 13 weeks gestation than from any other region. Women reported seeking abortion outside of their country of residence for a variety of reasons, most commonly, that abortion was not legal (51%), followed by having passed the gestational limit for a legal abortion (31%). Women paid an average of £631 for travel expenses, and an average of £210 for accommodation. More than half of women in our study found it difficult to cover travel costs.

Conclusions: Understanding how and why women seek abortion care far from their countries of residence is an important topic for future research and could help to inform abortion-related policy decisions in the UK and in Europe.     

Risk factors for repeat abortion in Nepal

ObjectiveTo examine the incidence of and risk factors for repeat abortion in Nepal.MethodsData were analyzed from a survey of 1172 women who had surgical abortions between December 2009 and March 2010 in 2 clinics in Kathmandu, Nepal. Bivariate and multivariate logistic regressions were performed to estimate odds ratios for the risk factors.ResultsAmong the respondents, 32.3% (95% confidence interval, 29.6–34.9) had repeat abortions. This incidence rose sharply with age and parity, and was higher among those with no intention of having a future child, those attaining primary or secondary level education, and those attending the non-governmental sector clinic. Women with repeat abortion were similar to those with 1 abortion in terms of contraceptive practice. Among women not using contraceptives at the time of the unintended pregnancy, the 3 most commonly cited reasons were ill health, non-compliance with the method intended for use, and dislike of the method. Women with repeat abortion showed a pattern of contraceptive acceptance immediately after the procedure similar to that of women who had 1 abortion.ConclusionRepeat abortion is emerging as a major public health issue in Nepal, with implications for counseling and provision of abortion, and for family planning services.     

The wish for a child among individuals who conceive with assisted reproduction technologies

Objective: The objective of the present study was to explore the wish for a child among Greek individuals who had procreated through various assisted reproductive methods. Background: Research has mainly focused on the motives of people to have children, with little attention given to their desire for a child, which has been debated mostly by psychoanalysts, philosophers and anthropologists. Methods: A hermeneutic phenomenology design was used with the large study from which the present data were derived. The sample comprised 19 women who had conceived with assisted reproduction methods, and retrospectively described their overall experience, during an in-depth interview. Results: According to findings, the awareness of the wish to reproduce becomes poignant when women realise that this might not be possible to fulfil. The participants’ motives to reproduce were: (a) appropriate life conditions, and (b) acquisition of social status, whereas their desire to have a child was: (a) to be like the mother of their early years, (b) to become pregnant in order to prove one’s fecundity, and (c) to compensate for guilt over an abortion. Conclusion: Findings suggest that women have both unconscious desires and conscious motives when they embark on the road for parenthood. The identification of both concepts may be of value to researchers, theoreticians, and clinicians who support individuals who wish to become parents.     

Does ovulation induction and intrauterine insemination affect perinatal outcomes in singletons?

Aim: To evaluate the effect of solely intrauterine insemination on perinatal outcomes.

Methods: A total of 3830 OI/IUI cycles between January 2007 and December 2012 were included in the study. Three hundred and fifty-eight pregnancies following intrauterine insemination were encountered during the study period. Data from 246 pregnancies conceived through OI/IUI treatment were available. A total of 438 singletons with no maternal risk constituted the control group. The two groups were compared according to perinatal outcomes.

Results: There was a statistically significant difference between the groups in first trimester abortion and intrauterine demise. At least one or more perinatal adverse outcomes occurred in study and control groups with the rates of 38.4% and 18.5%, respectively. There were significant differences in preterm delivery rate and oligohydramnios between the groups. There were also significant differences in the rate of neonates with a birth weight Conclusion: In general, women’s health perspective, to have a pregnancy is the main target in infertility work-ups, but physicians should be aware of the risks and couples should be counseled that pregnancies after OI/IUI treatment even if singleton carries a risk of adverse perinatal outcome for both the mother and baby.     

Sociodemographic,sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?

Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups.

Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n?= 18; 16–17 years, n?= 103; 18–19 years, n?= 103) who had an abortion. Data were collected from 16 health care services that provide abortion.

Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18–19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age.

Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.     

Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone

Introduction: Abortion is often a difficult and traumatic decision for a woman to make. Perhaps greater distress occurs when a woman commences a medical abortion but then changes her mind and wishes to keep the now-threatened pregnancy. One published case series detailed a potential method to counter/reverse the abortifacient effect of mifepristone by administering parenteral progesterone in such situations.

Objectives: The present report details cases of women in similar circumstances who have been treated with progesterone. The aims were to document occurrences of where women have changed their mind after commencing medical abortion, as well as to explore some of the controversies and clinical issues surrounding their circumstances.

Methods: Women who had commenced medical abortion by ingesting mifepristone but who had not taken misoprostol independently contacted a national pregnancy support service the same day. Those meeting criteria for treatment received progesterone pessaries per vaginum for two weeks.

Results: Cases: 28-year-old woman, 6 weeks plus 1?day gestation; 35-year-old woman, 8 weeks plus 5 days gestation; and 27-year-old woman, 7 weeks plus 3 days gestation. Outcomes respectively were: healthy male baby delivered at 39 weeks gestation; healthy male baby delivered at term; and completed medical abortion.

Conclusions: Women have changed their mind after commencing medical abortion. Progesterone use in early pregnancy is low risk and its application to counter the effects of mifepristone in such circumstances may be clinically beneficial in preserving her threatened pregnancy. Further research is required, however, to provide definitive evidence.     

The limits of compromise: the range of perspectives on women's reproductive rights in Poland

Objectives: A discourse analysis was carried out to identify how women's reproductive rights and needs are reflected in pro-life and pro-choice public debate in Poland.

Methods: The research procedure was based on the need to answer the question: how do pro-life and pro-choice discourses define women's reproductive rights in Poland (including the right to abortion)? Discourse analysis was applied to answer this question. The analysis covered materials published in rightist-conservative and leftist-feminist social-political portals and in popular media during the period 2009–2014, when the so-called ‘abortion compromise’ was in force, and the period 2016–2017, when a proposal for an absolute ban on abortion caused women to protest throughout Poland.

Results: Our research showed that construction of the analysed discourses is of a processual nature. Owing to social changes, both discourses have become strongly radicalised. The rightist-conservative discourse is emotional and criticising, restricting women's rights to the benefit of the rights of the fetus. The leftist-feminist view is oriented towards emphasising freedom of choice and observing women's rights.

Conclusion: The pro-life movement’s discourse may be defined as promoting the restriction of women’s reproductive rights, while leftist-feminist discourse may be seen as promoting women’s reproductive rights.     

Misperceptions About the Risks of Abortion in Women Presenting for Abortion

ObjectiveMisinformation about the risks and sequelae of abortion is widespread. The purpose of this study was to examine whether women having an abortion who believe that there should be restrictions to abortion (i.e., that some other women should not be allowed to have an abortion) also believe this misinformation about the health risks associated with abortion.MethodsWe carried out a cross-sectional survey of women presenting consecutively for an abortion at an urban abortion clinic in Vancouver, British Columbia, between February and September 2012.ResultsOf 1008 women presenting for abortion, 978 completed questionnaires (97% response rate), and 333 of these (34%) favoured abortion restrictions. More women who favoured restrictions believed that the health risk of an abortion was the same as or greater than the health risk of childbirth (84.2% vs. 65.6%, P < 0.001), that abortion caused mental health problems (39.1% vs. 28.3%, P < 0.001), and that abortion caused infertility (41.7% vs. 21.9%, P < 0.001). Using multivariate logistic regression analyses, believing that abortion should not be restricted was found to be a significantly correlated with correct answers about health risks, mental health problems, and infertility.ConclusionMisinformed beliefs about the risks of abortion are common among women having an abortion. Women presenting for abortion who favoured restrictions to abortion have more misperceptions about abortion risks than women who favour no restrictions.     

Long-acting reversible contraception: Findings from the Understanding Fertility Management in Contemporary Australia survey

Objectives The aim of this research was to investigate awareness, perceived reliability and consideration of use of long-acting reversible contraception (LARC) among Australians of reproductive age.

Methods A sample of 18- to 50-year-old women and men (N = 2235) was randomly recruited from the Australian electoral roll in 2013. Respondents completed a self-administered, anonymous questionnaire. Data were weighted to reduce non-response bias. Factors associated with perceived reliability and consideration of use of LARC were identified in multivariable analyses.

Results Most respondents had heard of implants (76.5%) and intrauterine contraception (63.7%). However, most did not think implants (56.3%) or IUDs (63.9%) were reliable and would not consider using implants (71.6%) or IUDs (77.5%). Those significantly more likely to perceive LARC as reliable were younger, did not regard religion as important in fertility choices, had private health insurance, had been pregnant and had had an abortion; and women who had a partner. Those more likely to consider using LARC were younger and did not regard religion as important in fertility choices; women who had private health insurance, lived in an area of socioeconomic advantage and had had an abortion; and men without a partner, born in Australia and comfortable talking to a health care provider about contraceptive matters.

Conclusions Despite high awareness of LARC among Australian adults, its perceived reliability and willingness to use it remain low in certain groups. Targeted interventions that aim to increase knowledge of the benefits and reliability of LARC and allow informed use are recommended.