International Perspectives On Sexual And Reproductive Health[JOURNAL]
Sun
200 papers
A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies.
Vargas SE, Midoun MM, Guillen M … +4 more , Getz ML, Underhill K, Kuo C, Guthrie KM
Int Perspect Sex Reprod Health · 2019 Oct · PMID 31592770 · Full text
CONTEXT: Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and exp...
CONTEXT: Vaginal rings are available for contraception and hormone replacement, and are being developed as HIV/STD or multipurpose prevention technologies. A comprehensive understanding of women's expectations of and experiences with rings is urgently needed to inform product development and to optimize ring use. METHODS: Three databases (PubMed, Global Health and CINAHL) were searched for English-language, peer-reviewed articles published between January 1996 and November 2017 that reported qualitative data on barriers to and facilitators of use of female-controlled contraceptive methods. Data on study methods, findings and conclusions pertaining to contraceptive rings were extracted, organized and analyzed. RESULTS: Twenty-six articles, all published since 2008, met the inclusion criteria. Seven studies focused largely or entirely on rings (and involved current, former or potential users), while the others focused on other contraceptive methods but included ring-specific data. Familiarity with the ring was low, and women commonly had initial concerns about the method-often related to insertion and removal, cleanliness and discomfort with touching their vagina-that were typically overcome over time. Other major themes were issues related to ring use and discontinuation, the importance of ring-related properties and characteristics, and considerations related to sexual partners and health care providers. CONCLUSIONS: Qualitative data have the potential to inform ring design and promotion. Future research should further explore women's expectations and experiences with the ring, the value of involving male partners in ring evaluation, and evaluation of interventions to improve patient-provider communication concerning ring choice and use.
Reproductive Autonomy and Modern Contraceptive Use at Last Sex Among Young Women in Ghana.
Loll D, Fleming PJ, Manu A … +4 more , Morhe E, Stephenson R, King EJ, Hall KS
Int Perspect Sex Reprod Health · 2019 Aug · PMID 31498115 · Publisher ↗
CONTEXT: Variability in the conceptualization and measurement of women's empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Repr...
CONTEXT: Variability in the conceptualization and measurement of women's empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy-a specific measure of empowerment-and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. METHODS: Survey data were collected from a sample of 325 urban Ghanaian women aged 15-24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales-decision making and communication-and women's use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. RESULTS: In multivariable analyses, reproductive autonomy decision making-but not reproductive autonomy communication-was positively associated with women's modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1-9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. CONCLUSIONS: The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context.
Sterilization Regret Among Married Women in India: Trends, Patterns and Correlates.
Singh A
Int Perspect Sex Reprod Health · 2018 Dec · PMID 31381500 · Publisher ↗
CONTEXT: Female sterilization has been the dominant contraceptive method in India since the late 1970s; however, evidence on sterilization regret-including on trends and on changes in correlates-is limited. METHODS: Data...
CONTEXT: Female sterilization has been the dominant contraceptive method in India since the late 1970s; however, evidence on sterilization regret-including on trends and on changes in correlates-is limited. METHODS: Data from the 1992-1993, 2005-2006 and 2015-2016 rounds of the Indian National Family Health Survey were used to examine trends in sterilization regret among ever-married women aged 15-49. Multivariable binary logistic regression analyses were conducted to examine the correlates of sterilization regret in 2005-2006 and 2015-2016, and multivariate decomposition was used to estimate the contribution of correlates to the change in sterilization regret between surveys. RESULTS: Sterilization regret in India increased by 2.3 percentage points, from 4.6% in 2005-2006 to 6.9% in 2015-2016. Most variables associated with regret in 2005-2006 remained so in 2015-2016: For example, women who lost a child after sterilization were more likely than those who had not experienced child loss to express regret (odds ratios, 2.8 in 2005-2006 and 1.9 in 2015-2016). Other associations were significant only in 2015-2016: For example, women informed that they would not be able to have children after sterilization had elevated odds of expressing regret (1.4). Changes in the composition of women by parity and by being informed of not being able to have children after sterilization each contributed 5-6% of the increase in sterilization regret between surveys. CONCLUSIONS: Efforts to increase use of reversible contraceptive methods and to reduce infant and child mortality may help reduce rising sterilization regret in India.
Contraceptive Method Attributes and Married Women's Intention to Use the Pill or the Injectable in Rural Bangladesh.
Huda FA, Casterline JB, Ahmmed F … +4 more , Machiyama K, Mahmood HR, Ahmed A, Cleland J
Int Perspect Sex Reprod Health · 2018 Dec · PMID 31381499 · Publisher ↗
CONTEXT: The factors underlying contraceptive method choice are poorly understood in many countries, including Bangladesh. It is important to understand how Bangladeshi women's perceptions of a method's attributes are as...
CONTEXT: The factors underlying contraceptive method choice are poorly understood in many countries, including Bangladesh. It is important to understand how Bangladeshi women's perceptions of a method's attributes are associated with their intention to use that method. METHODS: Data on 2,605 married women aged 15-39 living in rural Matlab were taken from a baseline survey conducted in 2016. Conditional logit analysis was used to examine associations between 12 method attributes and intention to use the pill or the injectable among the 583 fecund women not currently using a method. Method attributes included those relating to ease of obtainment and use, efficacy, health effects, husband's approval, the experiences of the respondent and the experiences of women in the respondent's social network. RESULTS: Women tended to perceive the pill more positively than the injectable. For example, greater proportions of women reported believing that the pill is easy to use (90% vs. 72%) and does not cause serious health problems (75% vs. 38%). The likelihood that a woman intended to use a method was positively associated with her perception that it is easy to use (odds ratio, 2.9) and does not cause serious health problems (1.7) or affect long-term fertility (2.9). Satisfied past users of a method were more likely than never users to report intending to use the method (5.2). Intention to use the pill rather than the injectable was positively associated with education (2.0-3.6) and having a migrant husband (1.7). CONCLUSIONS: Negative beliefs not supported by evidence, particularly about the injectable, are associated with women's intention to use a contraceptive method. The results may be useful in improving contraceptive care, counseling and training.
The Impact of Respondent-Interviewer Familiarity and Repeated Survey Participation on Abortion Reporting: Evidence from Rajasthan, India.
Bell SO, Bishai D
Int Perspect Sex Reprod Health · 2018 Dec · PMID 31294696 · Publisher ↗
CONTEXT: Researchers have long assumed that familiarity between an interviewer and a survey participant reduces the validity of responses, especially for such sensitive behaviors as abortion. However, little empirical ev...
CONTEXT: Researchers have long assumed that familiarity between an interviewer and a survey participant reduces the validity of responses, especially for such sensitive behaviors as abortion. However, little empirical evidence exists on this issue. METHODS: Data on 6,041 women aged 15-49 and 133 interviewers who took part in the second (2017) round of the Performance Monitoring and Accountability 2020 survey in Rajasthan, India, were used to examine the effect of interviewer-respondent acquaintance and participation in the prior survey round on women's reporting of induced abortion. Associations were identified using multivariate, multilevel models that adjusted for respondent, interviewer and community characteristics, and that included interviewer random effects. RESULTS: On average, interviewers completed interviews with 41 respondents from their assigned cluster; they reported that they were acquainted with 61% of respondents and that 13% of respondents had participated in the prior survey round. Four percent of women reported having had an abortion. Neither interviewer-respondent acquaintance nor participation in the previous survey round was associated with abortion reporting in any of the multivariate models or in additional sensitivity analyses. CONCLUSIONS: The findings do not support the hypothesis that respondent familiarity with the interviewer or the survey process is associated with lower reporting of sensitive behaviors, like abortion. Future studies should further explore these and other design features to identify those that provide statistically significant improvements in the reporting of abortion and other sensitive behaviors.
Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis.
Peterson AJ, Donze M, Allen E … +1 more , Bonell C
Int Perspect Sex Reprod Health · 2018 Sep · PMID 31251724 · Publisher ↗
CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence sugge...
CONTEXT: School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS: Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS: Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS: Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.
Ethnolinguistic Concordance and the Receipt of Postpartum IUD Counseling Services in Sri Lanka.
Karra M, Pearson E, Canning D … +3 more , Shah I, de Silva R, Samarasekera A
Int Perspect Sex Reprod Health · 2018 Dec · PMID 31246564 · Publisher ↗
CONTEXT: Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outc...
CONTEXT: Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outcomes and patient-provider concordance is limited, especially in low- and middle-income settings. METHODS: To examine how concordance between women and their primary health midwife is associated with women's receipt of postpartum IUD counseling, observational data from a cluster-randomized trial assessing an intervention to increase postpartum IUD counseling were used. Data on 4,497 women who delivered at six hospitals in Sri Lanka between September 2015 and March 2017 were merged with data on 245 primary health midwives, and indicators of linguistic concordance, ethnic concordance and their interaction were generated. Multivariate logistic regression analyses were used to assess the associations between concordance and women's receipt of counseling. RESULTS: Women from non-Sinhalese groups in Sri Lanka face disparities in the receipt of postpartum IUD counseling. Compared with the ethnolinguistic majority (Sinhalese women who speak only Sinhala), non-Sinhalese women have lower odds of having received postpartum IUD counseling, whether they speak both Sinhala and Tamil (odds ratio, 0.6) or only Tamil (0.5). Ethnic discordance- rather than linguistic discordance-is the primary driver of this disparity. CONCLUSIONS: The findings highlight the need for interventions that aim to bridge the sociocultural gaps between providers and patients. Matching women and their providers on ethnolinguistic background may help to reduce disparities in care.
Middle-Aged Iranian Women's Accounts of Their Sexual Health Care Practices: A Conventional Content Analysis.
Moghasemi S, Ozgoli G, Simbar M … +1 more , Nasiri M
Int Perspect Sex Reprod Health · 2018 Sep · PMID 30835237 · Publisher ↗
CONTEXT: Little research has been done to examine sexual health care among middle-aged women, particularly in developing countries that are socioculturally conservative, such as Iran. METHODS: In 2015, as part of a descr...
CONTEXT: Little research has been done to examine sexual health care among middle-aged women, particularly in developing countries that are socioculturally conservative, such as Iran. METHODS: In 2015, as part of a descriptive qualitative study, face-to-face interviews were conducted with 17 women aged 40-65 residing in Golestan Province, Iran. Graneheim and Lundman's approach to conventional content analysis was used to interpret the sexual health care narratives of the women. RESULTS: Sexual health care for middle-aged Iranian women often took the form of self-care to preserve their privacy and confidentiality, and in general, any information on sexual health was appreciated. Data analysis identified three main categories of strategies for sexual self-care: sexual risk protection, prevention of sexual problems and undesirability, and sexual information seeking. Also, sexual self-care emerged as the central theme. CONCLUSIONS: To meet the needs of middle-aged Iranian women, health care providers should become familiar with such women's sexual health care and self-care practices. Socioculturally sensitive policies and interventions should be developed to improve the sexual and reproductive health care conditions of middle-aged women.
The Association Between Women's Social Position and the Medicalization of Female Genital Cutting in Egypt.
Van Eekert N, Leye E, Van de Velde S
Int Perspect Sex Reprod Health · 2018 Sep · PMID 30789821 · Publisher ↗
CONTEXT: Medicalization of female genital cutting (i.e., having the procedure done by a medical professional) has increased in Egypt in recent years. The relationship between a woman's social position and the decision to...
CONTEXT: Medicalization of female genital cutting (i.e., having the procedure done by a medical professional) has increased in Egypt in recent years. The relationship between a woman's social position and the decision to use a trained health professional to perform genital cutting is not well understood. METHODS: Data from the 2005, 2008 and 2014 Egypt Demographic Health Surveys on 11,455 women whose daughter had undergone female genital cutting were used to examine relationships between mothers' social position and medicalization. Logistic regression models were used to identify associations between measures of social position and the decision to have genital cutting done by a trained provider. RESULTS: Seventy-nine percent of women had had their daughter cut by a trained health professional. The odds of medicalization were greater among women who had a primary education (odds ratio, 1.2) or a secondary or higher education (1.8) rather than no education; who lived in wealthier households rather than in the poorest ones (1.4-2.6); and who shared decision making on large household purchases rather than had no say in such decisions (1.2). In addition, working for pay and the magnitude of the age difference between women and their husband were negatively associated with medicalization (0.99 and 0.9, respectively). CONCLUSIONS: A woman's social position in Egypt is associated with medicalization of her daughter's genital cutting. Research is needed to explore the social meaning attributed to medicalized genital cutting, which may inform campaigns that could decrease the prevalence of the procedure.
Pharmacy Provision of Medication Abortion in Nepal: Pharmacy Owner and Worker Perspectives.
Samari G, Puri M, Cohen R … +2 more , Blum M, Rocca CH
Int Perspect Sex Reprod Health · 2018 Sep · PMID 30698524 · Publisher ↗
CONTEXT: Medication abortion has the potential to transform the provision of safe abortion care in low- and middle-income countries, and can be provided with minimal clinical skills and equipment. In Nepal, first-trimest...
CONTEXT: Medication abortion has the potential to transform the provision of safe abortion care in low- and middle-income countries, and can be provided with minimal clinical skills and equipment. In Nepal, first-trimester abortion using mifepristone and misoprostol is legally available at government-certified health facilities, but little is known about pharmacy workers' perspectives regarding pharmacy-based provision. METHODS: In-depth interviews were conducted in 2015 with 19 pharmacy owners and auxiliary nurse-midwives in two districts of Nepal to examine respondents' views on medication abortion and on potential legal provision of medication abortion from pharmacies. Two coders independently reviewed interview transcripts, and coded and analyzed them using a thematic approach. RESULTS: Participants were confident that they could provide safe medication abortion and felt that they filled an important niche by providing affordable, convenient and confidential services to women in their communities. They saw benefits of integrating pharmacies into legal abortion networks in Nepal, such as improved access to medication abortion and greater privacy. Participants also felt that the quality of the care they provided could be improved through ongoing training of pharmacy-based providers and formal incorporation of such providers into existing networks of abortion provision to streamline referrals. CONCLUSIONS: Integration of pharmacies into the legal abortion provision system could aid in regulation and training. Consideration of pharmacy workers' perspectives can help to ensure the sustainability and success of safe abortion programs.
Education, Place of Residence and Utilization of Legal Abortion Services in Mexico City, 2013-2015.
Senderowicz L, Sanhueza P, Langer A
Int Perspect Sex Reprod Health · 2018 Jun · PMID 30562159 · Publisher ↗
CONTEXT: Although abortion is illegal in most of Mexico, it was decriminalized in Mexico City in 2007, creating an island of legal abortion in a sea of restricted access. The characteristics of women seeking abortions in...
CONTEXT: Although abortion is illegal in most of Mexico, it was decriminalized in Mexico City in 2007, creating an island of legal abortion in a sea of restricted access. The characteristics of women seeking abortions in Mexico City-notably their socioeconomic status and place of residence-have not been well documented. METHODS: Medical records from 22,732 women who sought abortions at one of four primary-level clinics in Mexico City in 2013-2015 were used to examine characteristics of women seeking legal abortion. Linear regression analyses were used to explore differences between women from Mexico City and those from elsewhere in Mexico, using education as a proxy for socioeconomic status. Because of geographic differences in population structure, women's education level was normalized in some models. RESULTS: Most abortion seekers came from Mexico City (66%) or its surrounding metropolitan area (22%), while the remainder came from bordering states (7%) or the rest of Mexico (5%). Abortion seekers from the rest of Mexico had, on average, 1.4 more years of education than did those from Mexico City. In regression models that normalized education levels, the difference in educational attainment between women from the rest of Mexico and those from Mexico City was 4.9 years (unadjusted model) and 3.2 years (adjusted model). CONCLUSIONS: These findings, in conjunction with the literature on unsafe abortion in Mexico, suggest that women from outside Mexico City who have low levels of education may be less likely than their more educated peers to benefit from the safe abortion services provided in the city.
Prevalence of Induced Abortion in Iran: A Comparison of Two Indirect Estimation Techniques.
Ghofrani M, Asghari F, Kashanian M … +2 more , Zeraati H, Fotouhi A
Int Perspect Sex Reprod Health · 2018 Jun · PMID 30475213 · Publisher ↗
CONTEXT: Surveys that use direct questions to ascertain women's history of induced abortion tend to underestimate abortion prevalence, especially in such contexts as Iran where the procedure is legally restricted and hig...
CONTEXT: Surveys that use direct questions to ascertain women's history of induced abortion tend to underestimate abortion prevalence, especially in such contexts as Iran where the procedure is legally restricted and highly stigmatized. No previous study has compared two indirect techniques for estimating abortion prevalence. METHODS: A sample of 708 married women were recruited from one public hospital in Tehran between August and December 2013. Participants completed a survey, which included induced abortion estimation using the randomized response technique (RRT) and the unmatched count technique (UCT), as well as questions about demographic characteristics, trust in direct questions about abortion, and comprehensibility of and trust in RRT and UCT. Prevalence of induced abortion was calculated for each technique. Spearman correlation was used to evaluate whether comprehensibility of and trust in estimation methods were associated with women's age and education. RESULTS: The prevalence of induced abortion was estimated to be 14% using RRT and 12% using UCT; the estimates were not significantly different. Ninety-one percent of women reported that UCT was very easy to comprehend; the proportion for RRT was 78%. Sixty-three percent of women reported completely trusting in the confidentiality of UCT; the proportion for RRT was 50%. Age was inversely associated with comprehensibility for UCT (correlation coefficient, -0.13), and with trust for both RRT and UCT (-0.12 and -0.08, respectively); education was directly associated with trust for both methods (0.24 and 0.22). CONCLUSIONS: Of the two indirect methods, UCT may be simpler and more dependable for the estimation of induced abortion prevalence in low-literacy, abortion-restricted settings.
Women's Autonomy and Intimate Partner Violence in Ghana.
Tenkorang EY
Int Perspect Sex Reprod Health · 2018 Jun · PMID 30321136 · Publisher ↗
CONTEXT: Previous studies have established women's autonomy as an important determinant of several demographic outcomes in Sub-Saharan Africa, yet very few have considered intimate partner violence as one of these outcom...
CONTEXT: Previous studies have established women's autonomy as an important determinant of several demographic outcomes in Sub-Saharan Africa, yet very few have considered intimate partner violence as one of these outcomes. METHODS: Data collected in 2017 from 2,289 women residing in 40 communities in Ghana were used to examine associations between three types of autonomy-economic decision making, family planning decision making and sexual autonomy-and women's experiences with physical, sexual, emotional and economic violence. Multilevel logistic regression was used to identify associations. RESULTS: All three types of autonomy were associated with having experienced intimate partner violence, although in different ways, at the individual level or community level. At the individual level, after adjustment for theoretically relevant variables, family planning decision-making autonomy was negatively associated with all four types of violence (odds ratios, 0.7-0.8), while economic decision-making autonomy was positively associated with emotional and economic violence (1.2 for each). At the community level, living in a community where women had higher levels of sexual autonomy was associated with reduced odds of having experienced physical and economic violence (0.5 and 0.4, respectively). CONCLUSIONS: The findings underscore the relevance of women's empowerment programs as potential mechanisms for reducing intimate partner violence in Ghana. They also point to the need to move beyond individual-level interventions and consider community-level programs that empower women to be autonomous.
A New Composite Index to Measure National-Level Quality of Family Planning Programs.
Jain AK
Int Perspect Sex Reprod Health · 2018 Jun · PMID 30307890 · Publisher ↗
CONTEXT: Despite efforts to use facility surveys to measure the quality of family planning programs, routine, reliable measurement and monitoring of national-level quality has not been possible. METHODS: A new composite...
CONTEXT: Despite efforts to use facility surveys to measure the quality of family planning programs, routine, reliable measurement and monitoring of national-level quality has not been possible. METHODS: A new composite index to measure national-level quality, the National Quality Composite Index (NQCI), is proposed and used to compare program quality in 30 developing countries. Index scores represent the unweighted average of scores from indicators of three different dimensions of quality-structure, process and outcome. The structural indicator, the Method Availability Index, used data from the 2014 Family Planning Effort survey, while the process indicator (the Method Information Index) and outcome indicator (the Method Success Index) used data from the most recent Demographic Health Surveys conducted in the included countries. Correlations between these and other indicators were examined. RESULTS: The unweighted average NQCI score for the 30 countries was 60; scores ranged from 50 in Pakistan to 72 in Cambodia. The average scores for the three NQCI components were 52 for Method Availability (range, 40-73), 41 for Method Information (range, 13-71) and 86 for Method Success (range, 70-99). Scores for these components were not correlated with each other, suggesting that they measure distinct dimensions of program quality. Overall NQCI scores were correlated with existing measures of national-level quality, but not with total fertility rate and modern contraceptive prevalence rate. CONCLUSIONS: The NQCI and its three components use data routinely collected through national surveys, and can be used to measure and monitor national-level quality of family planning programs.
The Severity and Management of Complications Among Postabortion Patients Treated in Kinshasa Health Facilities.
Bankole A, Kayembe P, Chae S … +3 more , Owolabi O, Philbin J, Mabika C
Int Perspect Sex Reprod Health · 2018 Mar · PMID 30138102 · Full text
CONTEXT: Unsafe abortion is common in Kinshasa, which contributes to high rates of maternal morbidity and mortality. Little is known about the complications and treatment experienced by women seeking postabortion care at...
CONTEXT: Unsafe abortion is common in Kinshasa, which contributes to high rates of maternal morbidity and mortality. Little is known about the complications and treatment experienced by women seeking postabortion care at health facilities in the city. METHODS: Data from 867 women admitted to a sample of health facilities providing postabortion care in Kinshasa in 2016 were drawn from a Prospective Morbidity Survey. A measure of severity of postabortion complications was developed on the basis of information from these women and their primary care provider. Generalized ordered logistic regression analyses were used to examine associations between the characteristics of postabortion care patients and complication severity. RESULTS: Nearly three-fourths (72%) of postabortion care patients were classified as certainly having had an induced abortion, and another 16% as probably having had one. Sixteen percent of postabortion care patients experienced severe complications, 46% moderate complications and 33% mild complications; 5% had no evidence of complications. Severity of complications was associated with certain patient characteristics: For example, poor patients and those who had never been married had elevated odds of having experienced severe or moderate complications rather than mild or no complications (odds ratios, 1.8-1.9). Patients' complications were most commonly treated with such outdated methods as dilation and curettage and digital curettage (49% and 23%, respectively); only 11% of patients received medication for pain. CONCLUSIONS: Policies and programs promoting contraceptive use and safe legal abortion are needed in Kinshasa to reduce women's recourse to unsafe abortion. Improved quality postabortion care provision is also needed, including World Health Organization-recommended methods.
Bias in Contraceptive Provision to Young Women Among Private Health Care Providers in South West Nigeria.
Sieverding M, Schatzkin E, Shen J … +1 more , Liu J
Int Perspect Sex Reprod Health · 2018 Mar · PMID 30028307 · Publisher ↗
CONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to e...
CONTEXT: Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. METHODS: Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. RESULTS: In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. CONCLUSIONS: Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.
Benefits and Challenges of Safer-Conception Counseling for HIV Serodiscordant Couples in Uganda.
Mindry D, Woldetsadik MA, Wanyenze RK … +4 more , Beyeza-Kashesya J, Finocchario-Kessler S, Goggin K, Wagner G
Int Perspect Sex Reprod Health · 2018 Mar · PMID 30028306 · Publisher ↗
CONTEXT: Safer-conception counseling may help people living with HIV to reduce the risk of transmission to partners and children. However, such counseling is rarely offered or evaluated in low-income countries. METHODS:...
CONTEXT: Safer-conception counseling may help people living with HIV to reduce the risk of transmission to partners and children. However, such counseling is rarely offered or evaluated in low-income countries. METHODS: In 2014-2015, in-depth qualitative interviews were conducted at a Ugandan HIV clinic with 42 HIV-positive clients and 16 uninfected partners who had participated in a safer-conception counseling intervention for serodiscordant couples seeking to have a child. Participants attended up to six monthly counseling sessions in which they received instruction and ongoing support in using the safer-conception method they selected. Content analysis of interview transcripts was used to identify themes related to the benefits and challenges of safer-conception counseling. RESULTS: Almost two-thirds of participants felt that safer-conception counseling was an empowering experience that enabled them to make informed choices regarding childbearing, learn how to conceive safely and understand how to stay healthy while trying to conceive. Timed unprotected intercourse was the most frequently used safer-conception method. Seven couples had successful pregnancies, and no uninfected partners seroconverted. Participants' primary concerns and challenges regarding counseling and method use were issues with manual self-insemination, difficulty with engaging partners and fear of HIV infection. CONCLUSIONS: Counseling can help HIV-infected individuals make informed choices about childbearing and safer-conception methods; however, a controlled clinical trial is needed to determine whether clients use such methods correctly and to assess rates of pregnancy and transmission. Policymakers need to consider including safer-conception counseling as part of routine HIV care.
Correlates of Rapid Repeat Pregnancy Among Adolescents and Young Women in Uganda.
Burke HM, Santo LD, Bernholc A … +2 more , Akol A, Chen M
Int Perspect Sex Reprod Health · 2018 Mar · PMID 29995628 · Publisher ↗
CONTEXT: Short pregnancy intervals can contribute to maternal and child morbidity and mortality. No previous research has explored factors associated with short pregnancy intervals among young women in Uganda, where adol...
CONTEXT: Short pregnancy intervals can contribute to maternal and child morbidity and mortality. No previous research has explored factors associated with short pregnancy intervals among young women in Uganda, where adolescent pregnancy and short birth intervals are common. METHODS: Data on 626 married or cohabiting women aged 15-22 with one or two previous pregnancies were drawn from the 2011 Uganda Demographic and Health Survey. Bivariate and multivariable logistic regression analyses were used to examine characteristics associated with rapid repeat pregnancy, defined in two ways: a pregnancy occurring within 24 months or 12 months of a prior pregnancy outcome. RESULTS: Among women, 74% and 37% had experienced a rapid repeat pregnancy within 24 months and 12 months, respectively. Rural women were more likely than urban women to have had a rapid repeat pregnancy within 24 months (odds ratio, 2.4). Women aged 15-17 and those 18 or older at first union were more likely than women younger than 15 to have had a rapid repeat pregnancy within 24 months (3.8 and 3.4); those whose partner had at least a secondary education had lower odds than others of the outcome (0.6). The odds of rapid repeat pregnancy increased with the number of months between marriage and first birth (1.05). Variables associated with rapid repeat pregnancy within 12 months included urban-rural residence, region, age at first union and marriage-to-birth interval. CONCLUSIONS: Efforts to reduce rapid repeat pregnancy among young women in Uganda should focus on rural areas. Strategies to reach women during antenatal care and the postpartum period after their first birth should be prioritized.
"It's a Race Against the Clock": A Qualitative Analysis of Barriers to Legal Abortion in Bogotá, Colombia.
Brack CE, Rochat RW, Bernal OA
Int Perspect Sex Reprod Health · 2017 Dec · PMID 29990291 · Publisher ↗
CONTEXT: In 2006, the Colombian Constitutional Court issued a decision largely decriminalizing abortion; however, illegal abortion persists. Understanding the barriers that cause women to resort to unsafe, illegal aborti...
CONTEXT: In 2006, the Colombian Constitutional Court issued a decision largely decriminalizing abortion; however, illegal abortion persists. Understanding the barriers that cause women to resort to unsafe, illegal abortions could help improve access to legal services. METHODS: In-depth interviews were conducted in 2014 with 17 women aged 18 or older who had had legal abortions in the past year in Bogotá, Colombia, to identify barriers to abortion access and elucidate the ways in which these barriers affect women's decision making regarding abortion. Interview transcripts were coded and analyzed using standard techniques to find patterns, parallels and differences; a phenomenological approach guided the thematic analysis. RESULTS: Barriers related to knowledge and information, along with logistic, emotional, financial, cultural and religious barriers culminated in delays in obtaining comprehensive abortion services. Religion influenced social stigma, which manifested most powerfully in the obstructive behavior of health care providers and health insurance companies. Lack of understanding of current laws on abortion and conscientious objection was evident on the part of patients, health care providers and insurers. CONCLUSION: Dissemination of accurate information regarding the availability of clinical and legal abortion is needed. Better training may help physicians, nurses and insurance company personnel understand their roles and legal responsibilities in abortion care and reduce delays in women's access to services.
Expanding Method Choice in Africa with Long-Acting Methods: IUDs, Implants or Both?
Benova L, Cleland J, Daniele MAS … +1 more , Ali M
Int Perspect Sex Reprod Health · 2017 Dec · PMID 29874164 · Publisher ↗
The objective of this article is to review key components of LARC uptake in Sub-Saharan Africa with the aim of guiding policies and programs. We assess trends in access to the IUD and implant, including method knowledge...
The objective of this article is to review key components of LARC uptake in Sub-Saharan Africa with the aim of guiding policies and programs. We assess trends in access to the IUD and implant, including method knowledge and availability at facilities; examine trends in use, source of supply, discontinuation and characteristics of users; and discuss the prospects for expanding method choice by increasing the availability of LARCs in national programs and the policy implications of our results.
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