"It changed the atmosphere surrounding the baby I did have": Making sense of reproduction during the COVID-19 pandemic.

Objective: This study examines the schemas that women employed during the COVID-19 pandemic to make sense of their reproductive desires. Background: Existing research on reproduction during epidemics suggests that there are variable population responses to periods of long-term social uncertainty. However, less is known about how individuals make sense of maintaining or adapting their reproductive desires during periods of social upheaval. Method: Twenty-nine women aged 25-35 from a mid-sized Midwestern county in the United States were recruited and interviewed about their experiences during the first 8 months of the COVID-19 pandemic. They were asked about their daily lived experiences and their reproductive desires during in-depth interviews. These interviews were transcribed and analyzed using thematic coding. Results: Participants used three normative schemas to describe their reproductive desires during the COVID-19 pandemic. Heteronormative schemas were used by many participants to articulate their commitment to a heteronormative aged-staged timeline of life events. Schemas of social support around being pregnant and giving birth were used by participants, primarily those who were currently or recently pregnant, to express grief and loss over the relational experience of having a new baby. Medicalized schemas were expressed by most participants to describe feelings of fear and risk at real or imagined encounters with medical institutions. Conclusion: The schemas that participants used to make sense of their reproductive desires demonstrate how sense-making during a profound event that affects everyday realities allows participants to (re)articulate commitments to existing narratives that reinforce heterosexual, social, and medicalized hierarchies in reproduction.

Sexual Functioning, Satisfaction, and Well-Being Among Contraceptive Users: A Three-Month Assessment From the HER Salt Lake Contraceptive Initiative.

Few large, longitudinal studies document multiple contraceptive methods' effects on sexual functioning, satisfaction, and well-being. We leveraged data from the HER Salt Lake Contraceptive Initiative, a prospective cohort study with patient surveys at baseline, one month, and three months. Surveys assessed bleeding changes, contraceptive-related side effects, sexual functioning and satisfaction, and perceptions of methods' impact on sexual well-being. Individuals in the final sample (N = 2,157) initiated either combined oral contraceptives, levonorgestrel intrauterine devices (IUDs), copper IUDs, implants, injectables, or vaginal rings. Across methods, participants exhibited minimal changes in sexual function (Female Sexual Function Index-6 scores) or satisfaction (New Scale of Sexual Satisfaction scores) over three months. However, many perceived contraception-related changes to sexual well-being. Half (51%) reported their new method had made their sex life better; 15% reported it had made their sex life worse. Sexual improvements were associated with decreased vaginal bleeding, fewer side effects, and IUD use. Negative sexual impacts were associated with physical side effects (e.g., bloating and breast tenderness), increased bleeding, and vaginal ring use. In conclusion, contraceptive users did not experience major changes in sexual functioning or satisfaction over three months, but they did report subjective sexual changes, mostly positive, due to their method.

A Rapid Review of Sexual Pleasure in First Sexual Experience(s).

While researchers have thoroughly studied the who, what, and when of first sexual experiences, we know much less about how people construct, experience, and proceed (or not) with sexual pleasure in these experiences and beyond. To address this knowledge gap, the Global Advisory Board for Sexual Health and Wellbeing (GAB) coordinated a rapid review of published peer-reviewed research to determine what is currently known about sexual pleasure in first sexual experiences. We found 23 papers exploring this subject and its intersections with sexual health and sexual rights. The results reveal significant gaps in erotic education, gender equity, vulnerability and connection, and communication efficacy; and highlight important domains to consider in future research. Our findings draw out the key features of pleasurable first sexual experience(s), namely that individuals with the agency to formulate their definition and context of what pleasure means to them are more likely to experience pleasure at first sex. This finding points to promising ways to improve first sexual experiences through erotic skills building and through addressing knowledge gaps about having sex for the first time among disadvantaged groups.

Contraceptive selection and practice: Associations with self-identified race and socioeconomic disadvantage.

Many researchers and policymakers have linked contraceptive programs to improvements in women's and children's socioeconomic outcomes. However, these studies have overlooked how socioeconomic status may be an initial driver of contraceptive choice and behavior. Here, I examine the relationship between a comprehensive measure of socioeconomic disadvantage, self-identified race, and contraceptive method selection at enrollment in a unique longitudinal study of contraceptive clients who received a new type of method at no cost. I then examine whether socioeconomic disadvantage has an association with contraceptive switching or discontinuation. I demonstrate that socioeconomic disadvantage decreases the chance of selecting any IUD, while Black racial membership increases the chance of selecting the 3-month injectable and Multiracial membership increases the chance of selecting the Vaginal Ring. I then demonstrate that socioeconomic disadvantage and self-identified race have intersectional and variable associations with switching, and, to a lesser extent, discontinuing methods. These findings offer an important insight for implementation in contraceptive programs: eliminating financial barriers to access contraceptive services does not eliminate the socioeconomic contexts that influence method selection and use that occur as part of everyday lived experiences. Taken cumulatively, these results suggest that contraceptive services should be offered to women in ways that ensure access to reproductive justice without obscuring the need for social changes in the institutions that create disadvantage and shape contraceptive use itself.

Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection.

OBJECTIVES: Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection. STUDY DESIGN: Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18-45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates. RESULTS: Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as quite or extremely important were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection. CONCLUSIONS: Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities. IMPLICATIONS: Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.

Community Health Workers' Provision of Family Planning Services in Low- and Middle-Income Countries: A Systematic Review of Effectiveness.

This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.