Objective Restrictive policies on abortion and gender-affirming care have increased in recent years, particularly in some Midwest states, and can have a disproportionate impact on young people. We sought to explore adolescent perspectives on such policies. Study Design We conducted virtual semi-structured interviews with 39 participants aged 16-19 residing in the Midwest between April and June 2023, exploring participant reactions to state policies on abortion and gender-affirming care. Results Analysis revealed most participants opposed these restrictions, expressing concerns about the politicization of health care and the impact on their lives and the lives of loved ones. Policies also influenced future living decisions, with many expressing that a state’s policies on abortion and gender-affirming care would impact whether they wanted to attend college or live there. Conclusion This study highlights the largely negative responses of young people who will be voting for the first time in the 2024 elections to restrictive policies on abortion and gender-affirming care in the Midwest.
Objective Evaluate the relationship between women's empowerment and the use of modern contraceptive methods. Methods A secondary analysis was conducted using the 2022 Demographic and Health Survey of Peru, selecting women who were married, ever married, or cohabiting with a partner. The survey-based Women’s Empowerment Index was employed to assess empowerment, and the dependent variable was the use of modern contraceptives at the time of the interview. Regression analysis was performed using generalized linear models of the Poisson family. Results Sixty percent of the selected women were using a contraceptive method at the time of the survey. We found an association between low empowerment levels and lower frequency of modern contraceptive use (aPR = 0.87, p = 0.001). Additionally, among the empowerment domains, we observed that lower levels of independence (aPR = 0.89, p = 0.001) and tolerance of intimate partner violence (aPR = 0.75, p = 0.003) were associated with a lower frequency of modern contraceptive use. Conclusion Women's empowerment is related to the use of modern contraceptive methods, as well as its various domains. Future studies should evaluate different perspectives, such as empowerment and decision-making in the sexual and reproductive aspects.
Objectives:To estimate levels of person-centered contraceptive counseling among current and recent contraceptive users, assess for whom counseling differs, and examine the relationship between counseling and contraceptive practices, specifically use of provider-dependent methods and use of one's preferred method, among women in Ethiopia. Study design:This cross-sectional study uses nationally representative data collected by the Performance Monitoring for Action Ethiopia project among current and recent contraceptive users (n = 2731) aged 15-49 between October and November 2021. Descriptive analyses estimated person-centered counseling levels via the recently validated quality of contraceptive counseling short scale (QCC-10). Bivariable and multivariable logistic regression estimated associations with contraceptive practices. Results:Contraceptive users in Ethiopia receive moderate quality counseling (mean QCC-10 score = 2.69, range: 1.1-4.0) with significant social inequities in the receipt of person-centered care. Women who are younger, uneducated, not in union, from poorer households, or who sourced their method from a non-public facility reported less person-centered care. Strong relationships were observed between higher quality counseling and women's contraceptive practices. Those receiving highest quality counseling had nearly double the odds of using provider-dependent methods compared to those reporting lowest quality counseling (AOR: 1.92; 95% CI: 1.16-3.18). Among current users, women reporting highest quality counseling had 62% higher odds of using their preferred method relative to women receiving poorest quality care (95% CI: 1.06-2.48). Conclusion:Poorer quality care is associated with use of non-preferred methods and reliance on provider-independent methods. Efforts to reduce reproductive health disparities and promote contraceptive autonomy should prioritize a person-centered approach to contraceptive counseling for all. Implications:Inequitable delivery of person-centered contraceptive care based on individuals' sociodemographic characteristics, such as education or marital status, undermines women's reproductive autonomy and hinders contraceptive experiences. Person-centered contraceptive counseling should be provided to all women in Ethiopia, regardless of their background, to support individuals in achieving their reproductive goals.
Objectives Adapting and testing a novel measure of family planning self-efficacy (FPSE) capturing reproductive agency and examining its association with fertility intention and contraceptive use in India. Study Design Data were analyzed from 13,901 non-sterilized, currently married women of reproductive age (15-49 years) in the Bihar Integrated Family Planning Survey (BIFS) 2021. We adapted an FP Self Efficacy measure previously developed in Guatemala comprising women’s agency to overcome barriers to accessing, discussing and using contraception, regardless of family pressure and social judgment. We used factor analyses to assess construct metrics including reliability and validity. Regression analyses were used to examine the associations of FPSE with key family planning outcomes, adjusted for age, education, caste/tribe status, religion, parity, age at marriage and family type. Results The BIFS women’s sample was relatively young (35% below 25 years of age), with 43% reporting no education and over half (52%) married before 18 years of age. The 9-item FPSE scale demonstrated high reliability (Cronbach’s α=0.82) with two factors – self-efficacy to access and discuss contraception versus self-efficacy to use contraception in the face of resistance. Higher FPSE was associated with spousal communication [AOR: 2.35 (95% CI: 2.18, 2.54), traditional [AOR: 1.24 (95% CI: 1.12,1.36)] and reversible modern contraception [AOR: 1.58 (95% CI: 1.43,1.75)], and fertility intention [AOR: 1.13 (95% CI: 1.01,1.25)]. Conclusion FP Self Efficacy was found to be a reliable and valid measure associated with spousal communication, reversible contraception use and fertility intention. Implications Innovations in measurement to understand reproductive agency, such as family planning self efficacy, place women’s choice as important goals of FP programming. Placing women’s choice and agency as goals of FP programs can help in meeting community needs and the demand for contraceptive use.
Objectives There is currently a gap in literature on the perspectives of sexual and reproductive health clinicians and administrators in the South toward telehealth abortion services. This research seeks to explore these perspectives to understand clinician and administrator attitudes toward importance and priority of telehealth abortion to contribute to the development of a richer understanding of telehealth abortion in the South. Study Design This study conducts a secondary analysis of data from the Provider Readiness for Virtual Implementation and Delivery of Medication Abortion Services (PROVIDA) study. We collected qualitative data regarding perspectives of 13 clinicians and 7 administrators toward importance and priority of telehealth abortion during a series of in-depth interviews that took place from June 2021-2022 and analyzed data using MAXQDA. Results We identified four main themes: telehealth abortion is important for patient benefit in mitigating physical, administrative, financial, and privacy-related barriers; telehealth abortion is important for clinic benefit in improving clinic flow and sustainability; the political climate affects personal prioritization of telehealth abortion; and staff hesitance affects clinic prioritization of telehealth abortion. Conclusions Our analysis revealed telehealth abortion to be particularly important in mitigating physical access barriers for patients and for clinic sustainability. We found the political climate to be the most notable factor influencing personal prioritization of telehealth abortion, with most participants noting it made telehealth abortion less of a priority. Additionally, our analysis found participant perception of staff hesitation to implement telehealth abortion to be the most notable factor affecting clinic prioritization. Future research should utilize these findings to inform studies examining the implementation climate of telehealth abortion in the South.
