In Nepal, the legalization and expansion of safe abortion services have significantly reduced severe abortion-related complications. However, despite the availability of safe abortion care, many individuals face challenges in accessing these services. This study aims to explore the complexities of abortion decision-making among women seeking abortion care in Nepal, focusing on the socio-cultural, economic, and interpersonal dynamics that influence their decisions. As part of a longitudinal cohort study, we conducted 43 in-depth interviews with women accessing abortion services in 2022. Among these women, 19 received abortion services, while 24 were denied abortions and continued their pregnancies. Using the socio-ecological model (SEM) as the analytical framework, we employed thematic analysis to examine how individual characteristics, interpersonal relationship, community norms and health system factors influenced abortion decision-making. Our findings reveal a complex interplay of factors, including individual health concerns, financial limitations, partner influence, family dynamics, and societal norms, such as gender preference for sons that influence abortion decision-making. Among these, societal norms and partner influence had the most significant impact while making decisions. This study underscores the urgent need for targeted interventions to enhance access to reproductive health information, empower women to advocate for their reproductive rights, guide family engagement, and challenge cultural biases at the individual, interpersonal, and community levels.
In South Africa, HIV incidence and unintended pregnancy among adolescent girls and young women (AGYW) remain high, driven by a range of shared biological, behavioural, and structural factors. This study aimed to investigate AGYW’s uptake of and adherence to non-barrier contraceptives and dual condom and contraception use to identify associated barriers and facilitators and inform programming. We analysed baseline data collected between July and September 2022 for the evaluation of a combination HIV and pregnancy prevention programme in 14 South African schools. Building on the theory-driven HIV prevention cascade, a cascade describing (1) Knowledge (2) Motivation (3) Access and (4) Effective use of condoms, contraceptives and dual methods was constructed among AGYW who reported having sex in the past six months, not living with HIV and not planning to become pregnant. For contraceptives and dual methods, the relationship between cascade steps was explored using path analysis and the barriers to and facilitators of motivation, access and effective use were investigated using generalised linear models. For contraceptives, perceived access was high (71
Preconception care (PCC) improves reproductive outcomes; however, adolescents in sub-Saharan Africa remain largely excluded from such interventions, despite adolescence being a critical period for establishing lifelong health behaviors. This study assessed adolescents’ knowledge, attitudes, and barriers regarding PCC in Cape Coast, Ghana, to inform strategies for adolescent-inclusive preconception health promotion. This was a sequential mixed-methods (QUANT–Qual) study. Quantitative data were collected from 373 adolescents aged 10 – 19 years using a semi-structured questionnaire. Subsequently, a face-to-face focus group discussion was conducted among 11 adolescents (six females and five males). Categorical data were compared using chi-square test; p < 0.05 was considered statistically significant. Qualitative data were analyzed thematically, and findings from both quantitative and qualitative phases were integrated during interpretation. Respectively, 51.5
Intimate partner violence (IPV) is a major global health issue and limits women’s reproductive autonomy. Despite high IPV and contraception prevalences in Colombia, the link between specific types of IPV and contraceptive methods remains understudied. This study aimed to examine associations between IPV and the type of contraceptive method used by Colombian women. This cross-sectional study used data from the 2015 Colombian Demographic and Health Surveys. The sample included 13,896 ever-partnered women aged 15–49 who were not pregnant, infecund, or used permanent methods. Contraceptive method was categorised as: no contraception, traditional/fertility awareness methods (FAM), intrauterine devices (IUDs)/implants, oral/injectables, and external condoms. Exposure variables included any IPV, physical, sexual and emotional violence, and controlling behaviour in the past 12 months. Adjusted multinomial logistic regressions were conducted, with a significance level of p < 0.05. Physical and emotional IPV were associated with higher relative risks of using traditional/FAMs and IUDs/implants, and lower probabilities of using oral/injectables or external condoms. Sexual IPV was associated with higher relative risk and controlling behaviour with lower relative risk of using all contraceptive methods. IPV-exposed women were more likely to use long-acting methods that can be used covertly, are less susceptible to partner interference, and require fewer healthcare visits, which may reflect increased contraceptive vigilance. Understanding the impact of IPV on contraceptive methods is necessary to improve women’s reproductive autonomy. Integrating IPV screening into family planning services and further research into contraceptive decision-making in abusive relationships is recommended. Intimate partner violence (IPV) is a common problem that can affect women’s health and wellbeing, including their ability to make decisions about contraception. Women who experience IPV may face pressure, control, or fear that limits their reproductive choices. However, little is known about how different forms of IPV influence the type of contraception women use. This study examined the relationship between IPV and contraceptive method choice among women in Colombia. We analyzed data from a large national survey of women aged 15–49 years who had ever been in a relationship. We looked at several forms of violence, including physical, sexual, and emotional violence, as well as controlling behaviors by a partner. We found that women who experienced IPV were more likely to use some contraceptive methods than others. In particular, women exposed to physical, emotional, or sexual violence were more likely to use long-acting methods such as intrauterine devices (IUDs) and implants. These methods can be used without a partner’s knowledge and are less vulnerable to interference. Women who experienced controlling behavior from a partner were generally less likely to use contraception. Our findings suggest that women may adapt their contraceptive choices in response to violence and control within partner relationships. Family planning services should consider the impact of IPV on women’s reproductive decisions. Integrating support and screening for violence into contraceptive services may help women access methods that best meet their needs and strengthen their reproductive autonomy.
Delayed childbearing is an increasingly important reproductive health issue. Beyond its effect on period fertility, postponement shifts childbearing towards ages at which natural fecundity declines and later recuperation may become more constrained. We quantified how additional postponement could affect fertility in France through 2040, distinguishing timing effects from an illustrative assumption of incomplete recuperation. Using the 2026 INSEE central projection, births in 2026–2040 were transported along birth-cohort diagonals using exact annual interval allocation and official female population exposures. Additional postponement was set at zero, 0.5, 1.0, and 1.5 times the observed 2014–2025 increase in mean maternal age (0.08373 years/year). Full recuperation was compared with an illustrative 0.97 multiplier per additional year of delay. Outcomes included total fertility rate (TFR), maternal age, age-specific fertility rates, birth-event accounting, and cumulative cohort fertility through age 40. In 2040, reference TFR was 1.450. At the benchmark postponement rate, TFR decreased to 1.327 with full recuperation and 1.283 with incomplete recuperation; at 1.5 times the benchmark, corresponding values were 1.273 and 1.212. For the 2000 cohort, cumulative fertility through age 40 was 1.484 in the reference versus 1.423 and 1.403 under benchmark postponement. Births deferred beyond 2040 were distinguished from unrecuperated births. Further postponement could substantially reduce fertility observed through 2040 even with full recuperation. Although incomplete recuperation remains assumption-dependent, these findings highlight the reproductive-health relevance of later childbearing and support realistic, non-coercive communication about reproductive ageing and reproductive choices.
