Perspectives on Sexual and Reproductive Health最新文献

Objective(s): The experience of pain during intrauterine insertion can be highly variable, ranging from none to severe. The objective of this study was to explore the experience of intrauterine device (IUD) insertion from the perspective of contraceptive users.

Study design: We conducted a qualitative study using individual semi-structured Zoom interviews with women living in Australia. We recruited participants from a larger study exploring the information needs of contraceptive users. We audio-recorded and transcribed interviews and thematically analyzed the data.

Results: Eighteen women described their experiences of IUD insertion. Although most participants described mild to moderate pain, some described severe pain exceeding their expectations and reported being unprepared for this experience. In some cases, these experiences had unexpected short and long-term consequences such as impacts on intimate relationships and fear of other gynecological procedures.

Conclusion: Intrauterine device users should be informed of the range of pain experiences that may occur during insertion, including the risk of a vasovagal reaction, and all pain management options available to them. Experiences of pain during insertion did not appear to deter contraceptive users' continued IUD use or planned future use.

Background: Women experiencing homelessness have higher rates of unintended pregnancies than stably housed women. Given that some of this may be attributed to nonuse or inconsistent use of contraception, we explored the behavioral cognitions for contraceptive use among women experiencing homelessness. The Information-Motivation-Behavioral Skills (IMB) model can examine health behavior cognitions, while acknowledging the macro-level context. Therefore, this study explored the IMB characteristics related to contraception use among women experiencing homelessness.

Methods: We conducted interviews (n = 19) among pregnancy-capable women 18-45 years old experiencing homelessness. We recruited women between 2019 and 2020 in North Texas. Interviews were thematically analyzed based on the IMB framework.

Results: The mean age of women in the study sample was 33.4 years (SD = 7.6). In the information construct, most women were aware of different contraceptive methods; however, many desired to learn more about the side effects. For motivation, most women had a positive attitude toward their current contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. Additionally, their trusted social connections influenced their contraception decisions. When examining behavioral skills, uncertainty of being able to obtain contraception was a barrier, especially with macro-level context related to lack of adequate insurance coverage and transportation.

Conclusions: Improving knowledge about side effects of contraceptive methods, addressing misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy may be effective strategies to improve equitable access to contraception and reduce unintended pregnancies among this population.

Objectives: Starting January 1 2004, contraception was removed from the Dutch social health insurance for people aged 21 years and over. This study investigated the effect of social health insurance coverage for contraception on unplanned births.

Methods: Data from the Generation R Study was used, a population-based birth cohort of pregnant people with delivery dates between 2002 and 2006 (N = 2516) in Rotterdam, the Netherlands. Logistic regression models were constructed with a pre-post policy variable, date of the last menstruation relative to January 12,004 and the interaction between them to allow the model to change over time with unplanned births as outcome, adjusted for age, migration background, educational level, household income and financial difficulties.

Results: Removing contraception coverage from the social health insurance in 2004 showed a small increase in the odds ratio for unplanned birth, which was not statistically significant (OR = 1.18; 95% CI = 0.79-1.75). When participants with the last menstruation between January 1, 2004 and July 1, 2004 were excluded, a significant increase in the odds ratio for unplanned birth was found (OR = 2.69; 95% CI = 1.09-6.66).

Conclusions: In our population of pregnant participants aged 21 years and older, we found tentative evidence that removal of contraception from the social health insurance may have led to a small increase in unplanned births with a time lag of 6 months. As this study only included pregnant people who gave birth, our results should be interpreted with caution and further research is needed for a definite conclusion on the effect of health insurance coverage on unplanned pregnancies.

Background: Accurate, timely, and supportive information is important for high-quality abortion care. Limited research explores how people find and use online sources of information (OSI) during the abortion process, particularly in Britain. Understanding experiences of using OSI is important for the development of person-centered services and resources.

Methods: We conducted a thematic analysis of qualitative data from 41 semi-structured interviews carried out in 2021/2022 with people who had recent experience of abortion in Britain.

Results: Using OSI was common amongst participants. Our analysis generated four distinct motivations for doing so. People used OSI to find information about accessing abortion services. OSI was also used to demystify abortion, as many participants did not understand what the process involved or know what to expect. Connection and solidarity were sought through OSI, and some participants felt supported by the content they found, particularly through the accounts of others. Finally, people used OSI to explore their relationship with their pregnancy during the abortion process. Using OSI brought benefits-including finding non-judgmental and supportive resources-and challenges, including struggling to find relevant information or encountering negative stories and anti-abortion views. Nonetheless, participants appreciated OSI and expressed a desire for more real-life stories and online spaces where they could connect with others.

Conclusions: People having abortions want and need different things from the online resources they consult. However, OSI have the potential to provide valuable information, connection, and a place for exploration around the topic of abortion. Future work should explore how OSI can meet these different needs, guided by the motivations of users.

Objective: We aimed to examine how TikTok videos tagged with #postbirthcontrolsyndrome (PBCS) made by different types of creators communicate health risks and coping strategies, using the Extended Parallel Process Model (EPPM) to assess threat, fear, and efficacy appeals.

Methods: We conducted a content analysis of the top 100 TikTok videos using the hashtag #postbirthcontrolsyndrome by coding videos for EPPM variables (threat, fear, efficacy), creator type (healthcare provider, content creator, regular user), and engagement metrics (likes, comments, saves).

Results: Content creators frequently portrayed PBCS as severe (40/49) and highlighted side effects (44/49). Healthcare providers emphasized that PBCS is common (13/33) and provided management strategies (14/33; e.g., tips after discontinuing hormonal contraception). Videos describing severe symptoms received higher comments. Preparatory strategy videos garnered more saves.

Discussion: PBCS content on TikTok often uses fear-based messaging with limited efficacy information, which may influence contraceptive decisions. Differences in framing between creators and providers suggest a need for more evidence-based communication. Engagement trends indicate that both fear appeals and actionable advice drive more user interaction, reinforcing the importance of balancing emotional salience with credible guidance in social media health messaging.

Objectives: This study aims to develop a greater understanding of why unintended pregnancies happen by exploring views on contraceptive use of both care providers and women with lived experience of an unintended pregnancy in the Netherlands.

Methods: We interviewed seven care providers involved in the care of women with unintended pregnancy in a focus group and individually interviewed 10 women with unintended pregnancy. We used reflexive thematic analysis.

Results: Four themes emerged around the understanding of (lack of) contraceptive use in unintended pregnancies: "contraception perceived as unnecessary," "psychosocial adversities," "absence of suitable contraception," and "failing contraception." Among the care providers, the first two themes were most clearly present. Among women with unintended pregnancy, the last two themes were mainly emphasized.

Conclusions: Women with unintended pregnancies mention a lack of suitable contraceptive options and failing contraception as important factors for unintended pregnancy, whereas care providers view the perception of contraception as being unnecessary and psychosocial adversity as important factors in unintended pregnancies. These differences point to the importance of explicitly asking about and addressing the perspectives of women in contraceptive counseling.

Objective: Pregnancy is associated with adverse maternal and fetal outcomes for women with chronic kidney disease (CKD). Yet few women with CKD report receiving information about pregnancy and often experience difficulties making informed childbearing decisions and optimizing pregnancy outcomes. The aim of this study was to identify the fertility and childbearing concerns and related information needs and preferences of women with CKD living in Australia.

Methods: We completed an exploratory qualitative study. Women with CKD, recruited from a public health service in metropolitan Melbourne, Australia, participated in an online discussion group hosted on WhatsApp. We analyzed the discussion group transcript for key findings.

Results: Participants (N = 8) reported wanting children but often had fewer children than desired due to concerns about the impact of pregnancy on their CKD and the possible impact of CKD on a pregnancy or their child, including their baby inheriting CKD, how CKD medications may affect their baby, and the potential effects of a kidney transplant. Participants found it difficult to access relevant, up-to-date information about CKD and pregnancy.

Conclusions: Women with CKD often have concerns about getting pregnant or having a baby but find it difficult to access information especially from their healthcare team. Women with CKD would benefit from relevant and current information provided at specific times such as before and after a kidney transplant or when considering pregnancy to assist them in making informed decisions and achieving their reproductive goals.

Background: Emotional touchpoints are moments during perinatal care that evoke an emotional response in a woman. There is a lack of knowledge regarding the centrality of how touchpoints and emotions are framed in the real-life experiences of childbearing women.

Aim: To explore how birth-related emotional touchpoints interact and how the emotions in the context of these healthcare experiences interact.

Methods: We performed a systematic mixed studies review to capture childbearing women's prospective and retrospective reports of birth expectations and experiences. We conducted a literature search in CINAHL (EBSCO), Medline (EBSCO), PubMed, Web of Science, and Ovid, followed by hand searching and forward and backward citation searching from the included articles. We performed a quality appraisal using the Critical Appraisal Skills Program. We used Epistemic Network Analysis to model and visualize the connections and structure of the emotional touchpoints and the emotions.

Results: We included 28 articles, showing overall moderate quality. We constructed two models, one of emotional touchpoints and one of emotions. The emotional touchpoints model showed a strong connection between Coping and the Process of Labor & Birth and between the Process of Labor & Birth and Beliefs (belief systems) about Labor & Birth. The primary emotions model showed strong connections between Joy and Fear, between Fear and Sadness and between Sadness and Joy.

Conclusions: This paper illustrates how the multidimensionality of birth-related emotional touchpoints and the positive and negative emotions prospectively and retrospectively reported by pregnant and postpartum women were distilled-informing the conversation between care providers and childbearing women.

Context: Young adults experiencing homelessness (YAEH) have higher rates of pregnancy than stably housed young adults. Pregnant and parenting YAEH face several challenges, but little is known about outcome change over time.

Methods: 276 YAEH (aged 18-25, 28% female sex at birth) receiving services at drop-in centers in Los Angeles, California, participated in an intervention study to address substance use and sexual health. At each survey, participants reported whether they experienced pregnancy or got someone pregnant in the past 3 months. Regression models examined associations between pregnancy and several outcomes at 24 months (education, employment, income, health, substance use, service use, and housing), controlling for intervention and outcomes at baseline.

Results: Fifty-six participants (20%, n = 26 female sex, n = 30 male sex) reported being pregnant or getting someone pregnant over the course of the study. For women, pregnancy was associated with higher odds of staying in transitional housing (OR = 5.01, 95% CI: 1.22-20.60) and emergency shelters (OR = 8.32, 95% CI: 1.57-44.02) at 24 months, controlling for baseline. For men, getting someone pregnant was associated with greater importance of cutting down alcohol use (b = 2.06, SE = 0.89, p = 0.02) and higher odds of education service use at 24 months (OR = 3.00, 95% CI: 1.16-7.79).

Conclusions: Pregnancy may be associated with greater use of housing services among female YAEH, and increased importance of cutting down alcohol and use of education services among male YAEH. Continued support is needed to improve long-term outcomes of pregnant and parenting YAEH.

Trial registration: ClinicalTrials.gov identifier: NCT03735784. https://clinicaltrials.gov/ct2/show/record/NCT03735784.

Introduction: The United States (US) state of Texas uses two publicly funded programs to cover pregnant people-Medicaid for Pregnant Women and Children's Health Insurance Program (CHIP) Perinatal. While Medicaid offers more comprehensive coverage than CHIP Perinatal, it only includes US citizens and legally qualified residents. This tiered access to care, determined primarily by immigration status, generates stratified access. This paper explores how stratified access factors into reproductive experiences.

Methodology: Thirty-two pregnant and postpartum women who identified as first- or second-generation immigrants and had public insurance or no insurance coverage participated in a semi-structured in-depth interview. Interview questions explored topics related to immigration and border policies more broadly. This piece analyzes themes that emerged in relation to the type of healthcare coverage participants were able to access during pregnancy.

Results: Participants had a range of immigration statuses that factored into their eligibility for health programs. During pregnancy, 12 had CHIP Perinatal, 15 had Medicaid, and five had no coverage. Key themes shaping experiences of care included bureaucratic barriers in navigating health programs, inadequate coverage that reinforced health vulnerabilities, and feelings of limited autonomy.

Discussion: Women's narratives highlight the ways immigration status generates barriers to receiving health care coverage, including coverage for programs that individuals are entitled to regardless of immigration status. The type of coverage that a pregnant woman has dictates how comprehensive her care is and the degree to which she experiences coverage gaps outside of pregnancy.