Caroline Deignan,Angela Odiachi,Peter Kisaakye,N I Emma Woks,Dinah Amongin,Esther Spindler,Junior Agbor Ayuk Agbor,Paul Bukuluki,Alex Bagabo,Eresi Awor,Madeleine Short Fabic,Courtney McLarnon,Rebecka Lundgren,Shannon Pryor,Elizabeth Larson,Jean Christophe Fotso,Hidayatou Mohamadou,Leah Saleta,Lotus McDougal
Although empowerment-focused reproductive health measures have expanded in recent years, gaps exist in measuring person-centered contraceptive desire and demand. We address this gap by examining the degree to which individuals feel that contraception is acceptable. This study explores women's and men's experiences of contraceptive acceptability and tests the applicability of the "5C" framework of vaccine hesitancy to contraceptive demand and behaviors. We conducted 60 in-depth interviews and 12 focus group discussions with women and men in Kenya and Cameroon. A multi-country team thematically coded and analyzed data using inductive and deductive approaches. Our findings show that three domains of the "5C" vaccine hesitancy framework were particularly salient to participants' experiences of contraceptive acceptability. Perceptions of contraceptive safety and effectiveness (confidence), personal and others' experiences with contraception (calculation), and contraceptive services quality (constraints) all influenced contraceptive acceptability. Additionally, three new domains emerged: family responsibility, partner engagement, and childbearing expectations. Taken together, these six domains comprise the construct of contraceptive acceptability, which influences contraceptive demand and consequent contraceptive behaviors. This work offers a conceptual underpinning to inform the development of a contraceptive acceptability measure that centers choice and agency in family planning programs and research.
{"title":"Capturing the Dynamic Nature of Choice: Qualitative Perspectives on Contraceptive Acceptability from Cameroon and Kenya.","authors":"Caroline Deignan,Angela Odiachi,Peter Kisaakye,N I Emma Woks,Dinah Amongin,Esther Spindler,Junior Agbor Ayuk Agbor,Paul Bukuluki,Alex Bagabo,Eresi Awor,Madeleine Short Fabic,Courtney McLarnon,Rebecka Lundgren,Shannon Pryor,Elizabeth Larson,Jean Christophe Fotso,Hidayatou Mohamadou,Leah Saleta,Lotus McDougal","doi":"10.1111/sifp.70030","DOIUrl":"https://doi.org/10.1111/sifp.70030","url":null,"abstract":"Although empowerment-focused reproductive health measures have expanded in recent years, gaps exist in measuring person-centered contraceptive desire and demand. We address this gap by examining the degree to which individuals feel that contraception is acceptable. This study explores women's and men's experiences of contraceptive acceptability and tests the applicability of the \"5C\" framework of vaccine hesitancy to contraceptive demand and behaviors. We conducted 60 in-depth interviews and 12 focus group discussions with women and men in Kenya and Cameroon. A multi-country team thematically coded and analyzed data using inductive and deductive approaches. Our findings show that three domains of the \"5C\" vaccine hesitancy framework were particularly salient to participants' experiences of contraceptive acceptability. Perceptions of contraceptive safety and effectiveness (confidence), personal and others' experiences with contraception (calculation), and contraceptive services quality (constraints) all influenced contraceptive acceptability. Additionally, three new domains emerged: family responsibility, partner engagement, and childbearing expectations. Taken together, these six domains comprise the construct of contraceptive acceptability, which influences contraceptive demand and consequent contraceptive behaviors. This work offers a conceptual underpinning to inform the development of a contraceptive acceptability measure that centers choice and agency in family planning programs and research.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"53 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joe Strong, Ernestina Coast, Jamaica Corker, Michelle Weinberger
Emergency contraceptive pills (ECP) are an essential and unique postcoital method of preventing pregnancy. Trends in supply data show that sales of ECP are increasing at faster rates globally than many other contraceptives. Yet nationally representative survey data suggest that ECP use has remained relatively static overtime, suggesting significant measure and reporting issues. Accurate measurement of ECP use is critical for informing policies and programs that provide people the choice and freedom to exercise their reproductive rights. There is an urgent need for a revision of ECP measurement to better capture the realities of people's contraceptive needs and desires. In this commentary, we outline the key reasons why surveys may be underreporting and misreporting ECP. We focus on issues around current method‐specific measurements, definition issues around “use” and problems with survey questions and prompt phraseology. We illustrate the importance of recognizing other postcoital methods and strategies that people use when trying to prevent a pregnancy, and the implications this has for ECP measurement. As ECP use evolves, we offer recommendations for survey revisions and further research that can ensure that ECP measurement is robust and able to provide accurate reporting in the future.
{"title":"Capturing Emergency Contraceptive Pill Use: Critical Reflections on Measurement and Reporting","authors":"Joe Strong, Ernestina Coast, Jamaica Corker, Michelle Weinberger","doi":"10.1111/sifp.70026","DOIUrl":"https://doi.org/10.1111/sifp.70026","url":null,"abstract":"Emergency contraceptive pills (ECP) are an essential and unique postcoital method of preventing pregnancy. Trends in supply data show that sales of ECP are increasing at faster rates globally than many other contraceptives. Yet nationally representative survey data suggest that ECP use has remained relatively static overtime, suggesting significant measure and reporting issues. Accurate measurement of ECP use is critical for informing policies and programs that provide people the choice and freedom to exercise their reproductive rights. There is an urgent need for a revision of ECP measurement to better capture the realities of people's contraceptive needs and desires. In this commentary, we outline the key reasons why surveys may be underreporting and misreporting ECP. We focus on issues around current method‐specific measurements, definition issues around “use” and problems with survey questions and prompt phraseology. We illustrate the importance of recognizing other postcoital methods and strategies that people use when trying to prevent a pregnancy, and the implications this has for ECP measurement. As ECP use evolves, we offer recommendations for survey revisions and further research that can ensure that ECP measurement is robust and able to provide accurate reporting in the future.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"29 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Vincent, Catalina Herrera‐Almanza, S. Anukriti, Mahesh Karra
We propose an indicator of contraceptive concordance that identifies the alignment between stated preferences for contraception and concurrent contraceptive behavior. Our indicator departs from traditional approaches to measurement in family planning that infer concordance to be the alignment between women's contraceptive (non‐)use and their fertility preferences. We estimate our indicator using data from a cross‐sectional survey that was conducted with 1,958 married women in rural India. More than half of all women in our sample (51.2 percent) report that they are currently using a contraceptive method. More than three in five women (60.8 percent) were classified as wanting to use a contraceptive method at the time of the survey. We find that 60 percent of women in our sample are classified to be concordant (either wanted users or wanted nonusers), while almost 1 in 4 women (24.8 percent) state a preference for using contraception but are not users (unwanted nonusers), and 15.2 percent of women in our sample state a preference for not using contraception but are users (unwanted users). We discuss the comparative advantages and limitations of our approach relative to traditional measures and other recently developed indicators.
{"title":"Contraceptive Concordance","authors":"Sarah Vincent, Catalina Herrera‐Almanza, S. Anukriti, Mahesh Karra","doi":"10.1111/sifp.70018","DOIUrl":"https://doi.org/10.1111/sifp.70018","url":null,"abstract":"We propose an indicator of contraceptive concordance that identifies the alignment between stated preferences for contraception and concurrent contraceptive behavior. Our indicator departs from traditional approaches to measurement in family planning that infer concordance to be the alignment between women's contraceptive (non‐)use and their fertility preferences. We estimate our indicator using data from a cross‐sectional survey that was conducted with 1,958 married women in rural India. More than half of all women in our sample (51.2 percent) report that they are currently using a contraceptive method. More than three in five women (60.8 percent) were classified as wanting to use a contraceptive method at the time of the survey. We find that 60 percent of women in our sample are classified to be concordant (either wanted users or wanted nonusers), while almost 1 in 4 women (24.8 percent) state a preference for using contraception but are not users (unwanted nonusers), and 15.2 percent of women in our sample state a preference for not using contraception but are users (unwanted users). We discuss the comparative advantages and limitations of our approach relative to traditional measures and other recently developed indicators.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"158 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the global community looks beyond the 2030 Sustainable Development Goals agenda, there is a critical opportunity to refine and elevate indicators focused on sexual and reproductive health and rights (SRHR) and to shift nations away from fertility and contraceptive targets. This commentary presents four key frameworks—drawn from a panel at an International Union for the Scientific Study of Population (IUSSP) meeting focused on SRHR measurements—that offer distinct yet complementary lenses for understanding and measuring reproductive choice and agency. These include the EMERGE Empowerment Framework (focused on measurement and evaluation), Patient‐Centered Care (focused on clinical practice), the Human Rights Framework (focused on policy), and Reproductive Justice (focused on social change). While not an exhaustive list, these frameworks reflect a diversity of disciplinary perspectives and emphasize the importance of grounding reproductive health indicators in concepts of choice and agency. The empowerment framework centers on individual decision‐making and collective action, while person‐centered and rights‐based approaches evaluate how health systems and policies support or constrain that agency. Reproductive justice expands the lens further, highlighting how structural inequalities shape differential access and outcomes across race, class, and other social determinants of health. Together, these frameworks underscore the need for multilevel, intersectional indicators or reproductive agency—spanning individuals, health systems, communities, and policies—to effectively guide and evaluate the impact of reproductive health programs and policies at scale.
{"title":"Moving Past a Legacy of Controlling Women: Key Frameworks to Center Women and Girls’ Choice and Agency in Sexual and Reproductive Health Measurement","authors":"Christine Dehlendorf, Karen Hardee, Evelyne Opondo, Anita Raj","doi":"10.1111/sifp.70027","DOIUrl":"https://doi.org/10.1111/sifp.70027","url":null,"abstract":"As the global community looks beyond the 2030 Sustainable Development Goals agenda, there is a critical opportunity to refine and elevate indicators focused on sexual and reproductive health and rights (SRHR) and to shift nations away from fertility and contraceptive targets. This commentary presents four key frameworks—drawn from a panel at an International Union for the Scientific Study of Population (IUSSP) meeting focused on SRHR measurements—that offer distinct yet complementary lenses for understanding and measuring reproductive choice and agency. These include the EMERGE Empowerment Framework (focused on measurement and evaluation), Patient‐Centered Care (focused on clinical practice), the Human Rights Framework (focused on policy), and Reproductive Justice (focused on social change). While not an exhaustive list, these frameworks reflect a diversity of disciplinary perspectives and emphasize the importance of grounding reproductive health indicators in concepts of choice and agency. The empowerment framework centers on individual decision‐making and collective action, while person‐centered and rights‐based approaches evaluate how health systems and policies support or constrain that agency. Reproductive justice expands the lens further, highlighting how structural inequalities shape differential access and outcomes across race, class, and other social determinants of health. Together, these frameworks underscore the need for multilevel, intersectional indicators or reproductive agency—spanning individuals, health systems, communities, and policies—to effectively guide and evaluate the impact of reproductive health programs and policies at scale.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"8 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francine Wood, Courtney McLarnon, Sarah Smith, Nitya Yerabandi, Lotus McDougal
Improving women's agency in family planning is an integral component of empowerment, requiring culturally relevant, reliable, and valid measures. Measuring agency—action towards the achievement of self‐determined goals—is key to tracking progress as highlighted by its inclusion in the Sustainable Development Goals. Yet, agency measurement within low‐ and middle‐income contexts has all too often involved applying measures developed and tested in high‐income contexts, and conceptual confusion has also led to both overlapping measures and those that omit key facets of agency. To examine the construction and application of agency measures in family planning research and programs, we conducted a scoping review of studies in low‐and middle‐income countries. Of 9,289 articles and abstracts screened, 72 met our inclusion criteria and included family planning outcomes. We identified 58 unique measures. Most measures were summative and described psychometric testing. Measures often included family planning‐specific items, generally focused on contraceptive use with less attention to areas such as communication, access to services, or fertility timing. While increased interest in measuring family planning agency is evident, inconsistencies in measurement hinder cross‐contextual comparisons. As family planning research and programs adopt empowerment‐focused benchmarks, validated measures of agency are needed to accurately assess impact.
{"title":"Agency in Family Planning: A Scoping Review of the Measurement of Agency in Low‐ and Middle‐Income Countries","authors":"Francine Wood, Courtney McLarnon, Sarah Smith, Nitya Yerabandi, Lotus McDougal","doi":"10.1111/sifp.70025","DOIUrl":"https://doi.org/10.1111/sifp.70025","url":null,"abstract":"Improving women's agency in family planning is an integral component of empowerment, requiring culturally relevant, reliable, and valid measures. Measuring agency—action towards the achievement of self‐determined goals—is key to tracking progress as highlighted by its inclusion in the Sustainable Development Goals. Yet, agency measurement within low‐ and middle‐income contexts has all too often involved applying measures developed and tested in high‐income contexts, and conceptual confusion has also led to both overlapping measures and those that omit key facets of agency. To examine the construction and application of agency measures in family planning research and programs, we conducted a scoping review of studies in low‐and middle‐income countries. Of 9,289 articles and abstracts screened, 72 met our inclusion criteria and included family planning outcomes. We identified 58 unique measures. Most measures were summative and described psychometric testing. Measures often included family planning‐specific items, generally focused on contraceptive use with less attention to areas such as communication, access to services, or fertility timing. While increased interest in measuring family planning agency is evident, inconsistencies in measurement hinder cross‐contextual comparisons. As family planning research and programs adopt empowerment‐focused benchmarks, validated measures of agency are needed to accurately assess impact.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"33 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Apoorva Jadhav, Madeleine Short Fabic, Kerry MacQuarrie
Contraceptive prevalence among unmarried women—calculated from the response to a version of the question—“Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?” is most accurately measured among those who report sexual recency within the previous four weeks. This approach, long adopted by The Demographic and Health Surveys Program (DHS), has recently been adopted by groups such as FP2030 and Track20. Since this shift toward increased standardization, the DHS Program has included in its core questionnaire questions to better capture contraceptive use at last sex. We use these new DHS data from seven countries to explore whether a composite contraceptive use measure (i.e., current contraceptive use + contraceptive use at last sex) provides a more meaningful assessment of contraceptive use among unmarried women. Based on our findings, we recommend that the family planning field adopt the composite contraceptive use measure as its standard approach for measuring contraceptive prevalence among unmarried women. Our findings provide a guide for more accurately measuring, reporting, and most importantly, understanding the contraceptive practices of unmarried women.
{"title":"How It Was and How It Should Be: Moving Toward a Better Measurement of Contraceptive Prevalence Among Unmarried Women","authors":"Apoorva Jadhav, Madeleine Short Fabic, Kerry MacQuarrie","doi":"10.1111/sifp.70028","DOIUrl":"https://doi.org/10.1111/sifp.70028","url":null,"abstract":"Contraceptive prevalence among unmarried women—calculated from the response to a version of the question—<jats:italic>“Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?”</jats:italic> is most accurately measured among those who report sexual recency within the previous four weeks. This approach, long adopted by The Demographic and Health Surveys Program (DHS), has recently been adopted by groups such as FP2030 and Track20. Since this shift toward increased standardization, the DHS Program has included in its core questionnaire questions to better capture contraceptive use at last sex. We use these new DHS data from seven countries to explore whether a composite contraceptive use measure (i.e., current contraceptive use + contraceptive use at last sex) provides a more meaningful assessment of contraceptive use among unmarried women. Based on our findings, we recommend that the family planning field adopt the composite contraceptive use measure as its standard approach for measuring contraceptive prevalence among unmarried women. Our findings provide a guide for more accurately measuring, reporting, and most importantly, understanding the contraceptive practices of unmarried women.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"277 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Octavia Mulhern, Rubina Hussain, Joe Strong, Ann M. Moore, Mira Tignor, Kaosar Afsana, Pragna Paramita Mondal, Altaf Hossain
The standard measure of unmet need for contraception is not person‐centered and may not adequately represent women's contraceptive needs. To demonstrate the strength of a modified measure, we replicated the standard algorithm for unmet need, then created a person‐centered algorithm that considers (1) whether nonusers want to use contraception and (2) whether users want to use a different method. We applied the standard and person‐centered algorithms to a sample of 847 married Rohingya women aged 15–49 years living in camps in Cox's Bazar, Bangladesh, a population about whom little is known regarding contraceptive need. Forty‐six percent of respondents were currently using contraception. Among users, 14 percent wanted to use a different method and 36 percent of nonusers wanted to use a method. Using the standard algorithm, 39 percent had “unmet need,” 18 percent had “no need,” and 44 percent had “met need.” Using the person‐centered measure, 24 percent had “unmet need,” 38 percent had “no need,” and 38 percent had “met need.” The standard algorithm may overestimate unmet need among Rohingya nonusers, and the person‐centered measure provides evidence of method dissatisfaction among users. This measure also complements existing person‐centered measures of need and is an example of how incremental change can improve our understanding of women's contraceptive needs.
{"title":"Measuring Unmet Need for Contraception Using a Person‐Centered Algorithm: An Application With a Community‐Based Sample of Married Rohingya Women in Bangladesh","authors":"Octavia Mulhern, Rubina Hussain, Joe Strong, Ann M. Moore, Mira Tignor, Kaosar Afsana, Pragna Paramita Mondal, Altaf Hossain","doi":"10.1111/sifp.70024","DOIUrl":"https://doi.org/10.1111/sifp.70024","url":null,"abstract":"The standard measure of unmet need for contraception is not person‐centered and may not adequately represent women's contraceptive needs. To demonstrate the strength of a modified measure, we replicated the standard algorithm for unmet need, then created a person‐centered algorithm that considers (1) whether nonusers want to use contraception and (2) whether users want to use a different method. We applied the standard and person‐centered algorithms to a sample of 847 married Rohingya women aged 15–49 years living in camps in Cox's Bazar, Bangladesh, a population about whom little is known regarding contraceptive need. Forty‐six percent of respondents were currently using contraception. Among users, 14 percent wanted to use a different method and 36 percent of nonusers wanted to use a method. Using the standard algorithm, 39 percent had “unmet need,” 18 percent had “no need,” and 44 percent had “met need.” Using the person‐centered measure, 24 percent had “unmet need,” 38 percent had “no need,” and 38 percent had “met need.” The standard algorithm may overestimate unmet need among Rohingya nonusers, and the person‐centered measure provides evidence of method dissatisfaction among users. This measure also complements existing person‐centered measures of need and is an example of how incremental change can improve our understanding of women's contraceptive needs.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"27 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claire W Rothschild,Kelsey Holt,Funmilola M OlaOlorun,Julius Njogu,Abednego Musau,Christine Dehlendorf
Despite growing enthusiasm for measurement approaches that capture individuals' needs, values, and preferences, there remains a lack of conceptual clarity regarding person-centered measurement in the global field of contraception. In this commentary, we propose a working definition of person-centered measurement within the contraceptive field and describe how this definition can be applied to existing and novel contraceptive indicators. We argue that person-centered measures of contraception must both reflect an individual's self-identified values, needs, and/or preferences related to contraception and allow an individual to assess the extent to which these values, needs, and/or preferences have been fulfilled. As a result, a person-centered measure allows the individual to define for themselves whether a "good" outcome has been achieved. While person-centered measures are a critical component of measuring the performance of contraceptive programs, measurement frameworks must also include non-person-centered measures that allow evaluation of normative constructs such as human rights and reproductive justice.
{"title":"Person-Centered Measurement: Ensuring Prioritization of Individuals' Values, Needs, and Preferences Within the Global Contraceptive Measurement Ecosystem.","authors":"Claire W Rothschild,Kelsey Holt,Funmilola M OlaOlorun,Julius Njogu,Abednego Musau,Christine Dehlendorf","doi":"10.1111/sifp.70023","DOIUrl":"https://doi.org/10.1111/sifp.70023","url":null,"abstract":"Despite growing enthusiasm for measurement approaches that capture individuals' needs, values, and preferences, there remains a lack of conceptual clarity regarding person-centered measurement in the global field of contraception. In this commentary, we propose a working definition of person-centered measurement within the contraceptive field and describe how this definition can be applied to existing and novel contraceptive indicators. We argue that person-centered measures of contraception must both reflect an individual's self-identified values, needs, and/or preferences related to contraception and allow an individual to assess the extent to which these values, needs, and/or preferences have been fulfilled. As a result, a person-centered measure allows the individual to define for themselves whether a \"good\" outcome has been achieved. While person-centered measures are a critical component of measuring the performance of contraceptive programs, measurement frameworks must also include non-person-centered measures that allow evaluation of normative constructs such as human rights and reproductive justice.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"45 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin Pearson, Jasmine Uysal, Sabrina Boyce, Alexandra Robinson, Nora Piay‐Fernandez, Deekshita Ramanarayanan, Sarah Barnes, Jay G. Silverman
The term reproductive violence (RV) unifies forms of gender‐based violence that compromise reproductive autonomy. This study developed a multilevel quantitative measurement framework for RV comprised of indicators at the interpersonal, community, institutional, and law and policy levels. We conducted a systematized literature review, extracting and scoring existing indicators based on prior testing in a low‐ and middle‐income country setting, psychometric data, feasibility, and face validity. The literature review identified 84 peer‐reviewed studies, inclusive of 448 indicators that were extracted and scored. Ultimately, 112 indicators were included in the RV measurement framework. Indicators were organized by level of the social‐ecological model and across three categories: (1) pregnancy‐promoting RV, (2) pregnancy‐preventing RV, and (3) legal and social liabilities of pregnancy and parenthood. This study provides the first multilevel measurement framework for RV. Further research is needed to develop indicators for understudied RV constructs and validate the framework. The resulting framework will be used at the subnational, national, and regional levels to understand barriers to reproductive autonomy.
{"title":"Indicators for Reproductive Violence: A Systematized Review to Develop a Multilevel Measurement Framework","authors":"Erin Pearson, Jasmine Uysal, Sabrina Boyce, Alexandra Robinson, Nora Piay‐Fernandez, Deekshita Ramanarayanan, Sarah Barnes, Jay G. Silverman","doi":"10.1111/sifp.70021","DOIUrl":"https://doi.org/10.1111/sifp.70021","url":null,"abstract":"The term reproductive violence (RV) unifies forms of gender‐based violence that compromise reproductive autonomy. This study developed a multilevel quantitative measurement framework for RV comprised of indicators at the interpersonal, community, institutional, and law and policy levels. We conducted a systematized literature review, extracting and scoring existing indicators based on prior testing in a low‐ and middle‐income country setting, psychometric data, feasibility, and face validity. The literature review identified 84 peer‐reviewed studies, inclusive of 448 indicators that were extracted and scored. Ultimately, 112 indicators were included in the RV measurement framework. Indicators were organized by level of the social‐ecological model and across three categories: (1) pregnancy‐promoting RV, (2) pregnancy‐preventing RV, and (3) legal and social liabilities of pregnancy and parenthood. This study provides the first multilevel measurement framework for RV. Further research is needed to develop indicators for understudied RV constructs and validate the framework. The resulting framework will be used at the subnational, national, and regional levels to understand barriers to reproductive autonomy.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"15 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph E Potter,Kristen Lagasse Burke,Michelle A Eilers,Daniel A Powers
Many people at risk of an undesired pregnancy are not using their preferred contraceptive method. On its own, discordant use is an important indicator of reproductive autonomy. It may also affect reproductive outcomes, although little research has explored the consequences of unsatisfied contraceptive preferences. Using prospective data for the two years following delivery for a cohort of low-income postpartum women in Texas, many of whom would have preferred to be using a more effective method than the one they were using, we ask: How would the pregnancy trajectories of those not using their preferred contraceptive have differed had they been able to access their preferred method? Taking an inverse probability of treatment weighting approach, we show that using a preferred method was associated with half the likelihood of conceiving a pregnancy likely to result in a birth within 21 months postpartum (adjusted hazard ratio 0.43; 95 percent confidence interval 0.32, 0.57). Our findings highlight the consequences of failing to provide people with their preferred method and reveal how, in a context where people face substantial barriers to reproductive healthcare, discordant use increases the risk that people will have a baby that they did not desire at that time or, in some cases, ever.
{"title":"Meeting Contraceptive Preferences Among Low-Income Postpartum Texans: A Counterfactual Analysis of Pregnancy Trajectories.","authors":"Joseph E Potter,Kristen Lagasse Burke,Michelle A Eilers,Daniel A Powers","doi":"10.1111/sifp.70020","DOIUrl":"https://doi.org/10.1111/sifp.70020","url":null,"abstract":"Many people at risk of an undesired pregnancy are not using their preferred contraceptive method. On its own, discordant use is an important indicator of reproductive autonomy. It may also affect reproductive outcomes, although little research has explored the consequences of unsatisfied contraceptive preferences. Using prospective data for the two years following delivery for a cohort of low-income postpartum women in Texas, many of whom would have preferred to be using a more effective method than the one they were using, we ask: How would the pregnancy trajectories of those not using their preferred contraceptive have differed had they been able to access their preferred method? Taking an inverse probability of treatment weighting approach, we show that using a preferred method was associated with half the likelihood of conceiving a pregnancy likely to result in a birth within 21 months postpartum (adjusted hazard ratio 0.43; 95 percent confidence interval 0.32, 0.57). Our findings highlight the consequences of failing to provide people with their preferred method and reveal how, in a context where people face substantial barriers to reproductive healthcare, discordant use increases the risk that people will have a baby that they did not desire at that time or, in some cases, ever.","PeriodicalId":22069,"journal":{"name":"Studies in Family Planning","volume":"38 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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