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Validation of the Fertility Norms Scale and Association with Fertility Intention and Contraceptive Use in India. 印度生育规范量表的验证及其与生育意愿和避孕药具使用的关系。
IF 1.9 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-01-23 DOI: 10.1111/sifp.12227
Nandita Bhan, Nicole E Johns, Sangeeta Chatterji, Edwin E Thomas, Namratha Rao, Mohan Ghule, Rebecka Lundgren, Anita Raj

Social norms related to fertility may be driving pregnancy desire, timing and contraceptive use, but measurement has lagged. We validated a 10-item injunctive Fertility Norms Scale (FNS) and examined its associations with family planning outcomes among 1021 women and 1020 men in India. FNS captured expectations around pronatalism, childbearing early in marriage and community pressure. We assessed reliability and construct validity through Cronbach's alpha and exploratory factor analysis (EFA) respectively, examining associations with childbearing intention and contraceptive use. FNS demonstrated good reliability (α = 0.65-0.71) and differing sub-constructs by gender. High fertility norm among women was associated with greater likelihood of pregnancy intention [RRR = 2.35 (95% CI: 1.25,4.39); ARRR = 1.53 (95% CI: 0.70,3.30)], lower likelihood of delaying pregnancy [RRR = 0.69 (95% CI: 0.50,0.96); ARRR = 0.72 (95% CI: 0.51,1.02)] and greater ambivalence on delaying pregnancy [RRR = 1.92 (95% CI: 1.18,3.14); ARRR = 1.99 (95% CI: 1.21,3.28)]. Women's higher FNS scores were also associated with higher sterilization [RRR = 2.17 (95% CI: 1.28,3.66); ARRR = 2.24 (95% CI: 1.32,3.83)], but the reverse was noted for men [RRR = 0.61 (95% CI: 0.36,1.04); ARRR = 0.54 (95% CI: 0.32,0.94)]. FNS indicated better predictive value among women compared to men for key reproductive outcomes. This measure may be useful for social norms-focused evaluations in family planning and warrants cross-contextual study.

与生育相关的社会规范可能会影响怀孕意愿、时间安排和避孕药具的使用,但测量工作却一直滞后。我们验证了 10 项强制性生育规范量表(FNS),并研究了它与印度 1021 名女性和 1020 名男性的计划生育结果之间的关系。FNS 反映了对早育、早婚早育和社区压力的预期。我们分别通过 Cronbach's alpha 和探索性因子分析 (EFA) 评估了可靠性和建构有效性,研究了与生育意愿和避孕药具使用的关联。FNS 显示出良好的可靠性(α = 0.65-0.71)和不同性别的不同子结构。妇女的高生育规范与更高的怀孕意愿[RRR = 2.35 (95% CI: 1.25,4.39);ARRR = 1.53 (95% CI: 0.70,3.30)]、更低的推迟怀孕意愿[RRR = 0.69 (95% CI: 0.50,0.96);ARRR = 0.72 (95% CI: 0.51,1.02)],对推迟怀孕的矛盾心理更强[RRR = 1.92 (95% CI: 1.18,3.14);ARRR = 1.99 (95% CI: 1.21,3.28)]。女性 FNS 分数越高,绝育率越高[RRR = 2.17 (95% CI: 1.28,3.66);ARRR = 2.24 (95% CI: 1.32,3.83)],但男性则相反[RRR = 0.61 (95% CI: 0.36,1.04);ARRR = 0.54 (95% CI: 0.32,0.94)]。与男性相比,FNS 对女性主要生殖结果的预测价值更高。这一指标可能有助于以社会规范为重点的计划生育评估,并值得进行跨背景研究。
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引用次数: 0
A Welcome Message from the New Editors. 新任编辑的欢迎辞
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 DOI: 10.1111/sifp.12238
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引用次数: 0
Introduction to the Special Issue: Indicators in Sexual and Reproductive Health and Rights. 特刊导言:性健康和生殖健康及权利指标。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 DOI: 10.1111/sifp.12239
Jeffrey B Bingenheimer, Karen Hardee, Michelle Hindin, Aparna Jain, Joyce Mumah, Johannes van Dam
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引用次数: 1
Measuring Fertility Intentions During Times of Crisis: An Example Using Survey Data Amid the Covid-19 Pandemic. 危机时期生育意愿的衡量:以科维德-19 大流行病期间的调查数据为例。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-02-04 DOI: 10.1111/sifp.12219
Letícia J Marteleto, Molly Dondero, Sneha Kumar, David C Mallinson

Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.

生育意愿--关于是否生育和何时生育的意愿--可预测生殖健康结果。衡量生育意愿是困难的,尤其是在宏观结构冲击期间,原因至少有两个:(1)生育意愿在不确定时期可能特别不稳定;(2)宏观结构冲击可能限制数据收集。我们提出了一套指标,以捕捉宏观结构冲击如何直接改变生育意愿,并特别关注 2019 年冠状病毒病(Covid-19)大流行。我们从三个方面推进了生育意愿衡量指标的概念化和构建。首先,我们证明了直接询问妇女是否将生育意愿的变化归因于大流行的价值。其次,我们强调了划分生育推迟、提前、放弃和犹豫不决类型的重要性。第三,我们证明了在两年时间内纳入一个细化的时间窗口以捕捉生育意愿短期变化的重要性。我们使用巴西伯南布哥州 18-34 岁女性概率样本的调查数据来说明我们提出的测量方法的价值。我们讨论了第一波 Covid 导致的自我报告的生育意愿变化以及跨波的面板变化。通过揭示社会出身和均等的重要差异,我们进一步确定了我们的贡献。
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引用次数: 0
Characteristics Associated with Reliability in Reporting of Contraceptive Use: Assessing the Reliability of the Contraceptive Calendar in Seven Countries. 与避孕药具使用报告可靠性相关的特征:评估七个国家避孕药具日历的可靠性。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-01-30 DOI: 10.1111/sifp.12226
Philip Anglewicz, Dana Sarnak, Alison Gemmill, Stan Becker

Although the reproductive calendar is the primary tool for measuring contraceptive dynamics in low-income settings, the reliability of calendar data has seldom been evaluated, primarily due to the lack of longitudinal panel data. In this research, we evaluated the reproductive calendar using data from the Performance Monitoring for Action Project. We used population-based longitudinal data from nine settings in seven countries: Burkina Faso, Nigeria (Kano and Lagos States), Democratic Republic of Congo (Kinshasa and Kongo Central Provinces), Kenya, Uganda, Cote d'Ivoire, and India. To evaluate reliability, we compared the baseline cross-sectional report of contraceptive use (overall and by contraceptive method), nonuse, or pregnancy with the retrospective reproductive calendar entry for the corresponding month, measured at follow-up. We use multivariable regressions to identify characteristics associated with reliability or reporting. Overall, we find that the reliability of the calendar is in the "moderate/substantial" range for nearly all geographies and tests (Kappa statistics between 0.58 and 0.81). Measures of the complexity of the calendar (number of contraceptive use episodes, using the long-acting method at baseline) are associated with reliability. We also find that women who were using contraception without their partners/husband's knowledge (i.e., covertly) were less likely to report reliably in several countries.

尽管生殖日历是衡量低收入环境中避孕动态的主要工具,但日历数据的可靠性很少得到评估,主要是由于缺乏纵向面板数据。在这项研究中,我们使用行动绩效监测项目的数据评估了生育日历。我们使用了来自七个国家九个地区的基于人口的纵向数据:布基纳法索、尼日利亚(卡诺州和拉各斯州)、刚果民主共和国(金沙萨和孔戈中部省)、肯尼亚、乌干达、科特迪瓦和印度。为了评估可靠性,我们将避孕使用(总体和按避孕方法)、未使用或怀孕的基线横断面报告与随访时测量的相应月份的回顾性生殖日历条目进行了比较。我们使用多变量回归来识别与可靠性或报告相关的特征。总体而言,我们发现,几乎所有地区和测试的日历可靠性都在“中等/实质性”范围内(Kappa统计数据在0.58和0.81之间)。日历复杂性的衡量标准(基线时使用长效方法的避孕使用次数)与可靠性相关。我们还发现,在几个国家,在伴侣/丈夫不知情的情况下(即秘密)避孕的女性不太可能可靠地报告。
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引用次数: 5
Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi. 测量个人避孕需求中的裸体:来自马拉维一个队列的案例研究。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-01-31 DOI: 10.1111/sifp.12223
Marta Bornstein, Sarah Huber-Krum, Jessica D Gipson, Alison H Norris

Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need ("do you feel it is necessary for you to be using contraception right now?") We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017-2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.001). Women who directly reported contraceptive need had a higher average composite score than women who directly reported they had no need (mean = 7.4 vs. 6.3; p < 0.01), but nearly all participants had scores indicating some risk of unintended pregnancy. Contraceptive counseling protocols should consider assessing women's direct report of contraceptive need, along with risk factors for unintended pregnancy, such as sexual frequency, perceived fecundity, and desire to avoid pregnancy, to better counsel clients.

避孕咨询协议往往狭隘地关注怀孕意图,而这可能会忽略其他影响个人是否想要或需要避孕的因素。在这份报告中,我们展示了两种衡量个人避孕需求的指标的潜力,这两种指标可以作为避孕咨询的一部分进行评估:(1)根据怀孕意图、性频率、,以及感知的繁殖力和(2)避孕需求的直接衡量标准(“你觉得你现在有必要避孕吗?”)我们使用马拉维中部队列研究Umoyo wa Thanzi的数据比较了这两种衡量标准(N=906;2017-2018)。更频繁的性行为、对更多产的感知以及更强烈的避免怀孕的愿望与直接报告避孕需求有关(p<0.001)。直接报告避孕需要的女性的平均综合得分高于直接报告不需要的女性(平均值=7.4对6.3;p<0.01),但几乎所有参与者的评分都表明有意外怀孕的风险。避孕咨询协议应考虑评估女性对避孕需求的直接报告,以及意外怀孕的风险因素,如性频率、感知繁殖力和避免怀孕的愿望,以更好地为客户提供咨询。
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引用次数: 0
Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It. 评估未满足的需求作为获得避孕药具和使用避孕药具的愿望的替代物是否合适。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-02-26 DOI: 10.1111/sifp.12233
Leigh Senderowicz, Brooke W Bullington, Nathalie Sawadogo, Katherine Tumlinson, Ana Langer, Abdramane Soura, Pascal Zabré, Ali Sié

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.

未满足的避孕需求是一个被广泛使用但经常被误解的指标。尽管未满足的需求是根据怀孕意愿和当前避孕药具使用情况计算得出的,但它通常被用作(1)无法获得避孕药具和(2)使用避孕药具意愿的替代衡量标准。利用布基纳法索的调查数据,我们研究了未满足需求与这两个概念的对应和偏离程度,计算了灵敏度、特异性和阳性/阴性预测值。在传统的未满足需求女性中,67% 的女性表示没有使用避孕药具的意愿,61% 的女性表示可以获得多种负担得起的避孕药具。结果显示,未满足需求的敏感性和特异性较低,无法将缺乏避孕方法和/或希望使用避孕方法的妇女与不希望使用避孕方法的妇女区分开来。这些结果表明,未满足的需求对计划生育计划的指导作用有限,而且可能会导致利益相关者高估需要扩大计划生育服务的妇女比例。我们的结论是,在人口层面采取更直接的措施是可行的,因此没有必要采用未满足需求的替代措施。如果获得避孕药具的机会和/或避孕愿望才是我们真正关心的结果,那么就应该使用更直接的测量方法。
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引用次数: 0
Is the Decision Not to Use Contraception an Indicator of Reproductive Agency? 不采取避孕措施是生育能力的指标吗?
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 DOI: 10.1111/sifp.12235
Madeleine Short Fabic, Lotus McDougal, Anita Raj, Apoorva Jadhav

Women's engagement in the decision to use contraception, an indicator captured in the Demographic and Health Surveys (DHS), is frequently used to assess women's reproductive agency. In 2014, DHS added a corollary question to the women's questionnaire on decision-making not to use contraception. Study authors hypothesize that women's engagement in decision-making not to use contraception is also indicative of reproductive agency. Analyzing DHS microdata from 30 countries collected between 2015 and 2020 (n = 292,141), this country-level study examines data quality in terms of missingness of data (t-tests), indicator utility in terms of response pattern variability (descriptive statistics), and construct validity in terms of associations between engagement in the decision not to use contraception and engagement in household decision-making (multivariable linear regression). Findings indicate the measure is of good quality, provides nuanced insight, and has construct validity. Importantly, the new measure deepens our understanding of women's reproductive agency.

妇女参与使用避孕药具决定的情况是人口与健康调查(DHS)的一项指标,经常用于评估妇女的生殖机构。2014年,美国国土安全部在女性的调查问卷中增加了一个关于决定不采取避孕措施的推论问题。研究作者假设,女性参与不使用避孕措施的决策也表明了生殖代理。本国家级研究分析了2015年至2020年间收集的30个国家的DHS微数据(n = 292141),从数据缺失(t检验)方面检验了数据质量,从响应模式可变性(描述性统计)方面检验了指标效用,从参与不使用避孕措施的决定与参与家庭决策之间的关联(多变量线性回归)方面检验了结构效度。研究结果表明,测量是良好的质量,提供细致入微的洞察力,并具有结构效度。重要的是,这项新措施加深了我们对女性生殖能力的理解。
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引用次数: 3
Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. 误解、错误信息和错误认识:在讨论避孕观念时删除 "错误 "一词的理由。在讨论避孕观念时。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 Epub Date: 2023-02-08 DOI: 10.1111/sifp.12232
Rose Stevens, Kazuyo Machiyama, Constancia Vimbayi Mavodza, Aoife M Doyle

Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.

人们通常认为,避孕观念在避孕决策中起着重要作用。针对避孕观念的干预措施通常包括提供咨询,以消除任何 "神话 "或 "误解"。目前,几乎没有证据表明这些干预措施对减少信念有影响。本评论深入探讨了与使用隐含消极的术语来指代避孕观念相关的问题,这些术语带有对其有效性的假设。将妇女的观念视为错误或她们的信念视为无效,会使人们对妇女关注的问题产生怀疑,并妨碍设计富有成效的干预措施来解决这些问题。我们建议今后使用 "信念 "一词来取代众多术语,以保持无价值的好奇心,并消除对信念的起源或有效性的任何隐含假设。我们提供了衡量信念的建议,以帮助研究人员了解他们所衡量的信念的驱动因素和影响。最后,我们讨论了一旦更好地理解了不同类型的信念,对干预设计的影响。我们认为,根据信念类型采取有针对性的干预措施将有助于解决信念的根本原因,并更好地满足妇女更广泛的避孕需求,如避孕自主性和满意度的需求。
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引用次数: 0
Preference-Aligned Fertility Management as a Person-Centered Alternative to Contraceptive Use-Focused Measures. 以个人为中心替代以使用为重点的避孕措施的生育管理。
IF 2.1 3区 医学 Q2 DEMOGRAPHY Pub Date : 2023-03-01 DOI: 10.1111/sifp.12228
Kelsey Holt, Christine Galavotti, Elizabeth Omoluabi, Sneha Challa, Peter Waiswa, Jenny Liu

Equating contraceptive use with programmatic success is fundamentally flawed in failing to account for whether individuals desire contraceptive use; this is problematic because nonuse can reflect empowered decision-making and use may reflect an individual's inability to refuse or discontinue a method. A rights-based approach demands respect for individuals' freedom to weigh options and choose how their desire for pregnancy prevention can be accommodated by available methods and within the context of their own personal, social, and material constraints. We offer an alternative construct, preference-aligned fertility management (PFM), that provides a more holistic indicator of whether one's contraceptive needs are met. PFM is more person-centered and informative for programming than status quo measures of unmet need, demand satisfied, and contraceptive use which define a positive outcome in relation to pregnancy risk rather than one's stated preferences. The PFM approach goes beyond other recent proposals for modifying the concept of unmet need by refraining from judgment of legitimate reasons for nonuse of contraception and offers a straightforward way to capture whether people act in line with their preferences. We conclude with discussion of how we plan to measure PFM in the Innovations for Choice and Autonomy (ICAN) study in Nigeria and Uganda.

将避孕药具的使用等同于规划上的成功从根本上是有缺陷的,因为它没有考虑到个人是否希望使用避孕药具;这是有问题的,因为不使用可以反映授权决策,而使用可能反映个人无法拒绝或停止使用一种方法。基于权利的方法要求尊重个人权衡各种选择的自由,并在个人、社会和物质限制的情况下,选择现有方法如何满足其预防怀孕愿望的自由。我们提供了另一种结构,偏好一致的生育管理(PFM),它提供了一个更全面的指标,一个人的避孕需求是否得到满足。与未满足的需求、满足的需求和避孕药具使用的现状措施相比,PFM更以人为中心,为规划提供信息,这些措施定义了与怀孕风险相关的积极结果,而不是一个人陈述的偏好。PFM方法超越了最近其他修改未满足需求概念的建议,避免判断不使用避孕措施的正当理由,并提供了一种直接的方法来捕捉人们是否按照他们的偏好行事。最后,我们讨论了我们计划如何在尼日利亚和乌干达的“选择与自主创新”(ICAN)研究中衡量PFM。
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引用次数: 1
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Studies in Family Planning
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