Do Indian women receive adequate information about contraception?

This study analysed the recent changes and patterns of information received about contraceptive methods by contraceptive users in India - an important indicator of quality of care in family planning services. Data were taken from the third and fourth rounds of National Family and Health Surveys (NFHS) conducted in India during 2005-06 and 2015-16. The Method Information Index (MII) was used to capture the information received by respondents on three aspects of contraceptive method use: information about the side-effects of the method, what to do if they experienced any complication from using the method and information received about other methods of contraception. A separate analysis of information received by users about the permanency of sterilization was also carried out. Logistic regression models were applied to assess the independent effects of users' background characteristics and their states and union territories of residence on method information received by them. The value of the MII nearly doubled from about 16% in 2004-05 to 31% in 2015-16, indicating a marked increase in the information received by contraceptive users in India over the period between 2005-06 and 2015-16. In addition, the percentage of sterilized women who received information about the permanency of the method also increased, from 67% to 80%, over the period. While considerable progress has been made in the last decade, there is still plenty of scope for improvement in the information received by contraceptive users to advance a voluntary approach to family planning.

The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia.

Objectives: This study aimed to analyse the association between the decision-making pattern and the use of long-acting and permanent methods of contraception (LAPMs) among married and cohabiting women in Indonesia, by controlling for variables at the individual and community or regional level, and geographical area (province).Methods: A cross-sectional survey was conducted using secondary data from Performance Monitoring and Accountability 2020 (PMA2020) which involved 4724 married or cohabitating women aged 15-49 years. Data were analysed using bivariate and multivariate analysis. Multilevel logistic regression was performed to investigate the determinants by taking geographical area into account.Results: The majority of women (63.8%) had made their own decision on current contraceptive use, 30.1% had made a joint decision with their partner or health care provider, and 6.1% had not been involved in the decision-making process. Multilevel analysis showed that the decision-making pattern and individual level factors were significantly associated with LAPM use, and variables at community or regional level were not significant predictors. Compared with women who had made their own decision on contraceptive use, LAPM use was 2.3 times higher in women who had made a joint decision with their partner or health care provider (odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0, 2.7; p < .001) and more than three times higher in women not involved in the decision-making process (OR 3.1; 95% CI 2.3, 4.1; p < .001).Conclusion: Coercion potentially occurs in the contraceptive decision-making process. Our findings suggest that LAPM use may be increased by encouraging joint contraceptive decision making. Increasing women's participation in the decision-making process is an integral part of respecting women's reproductive autonomy.

Voluntary sterilisation and access to IVF in Québec.

Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec's healthcare in general and in vitro fertilisation (IVF) in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion-prior voluntary sterilisation-has prompted little critical commentary. The two justifications offered for restricting funding for IVF on the basis of voluntary sterilisation are that (1) there are cheaper options than IVF for sterilised individuals who want children, and (2) society should not have to pay for IVF for persons who are infertile by choice. I argue that both of these justifications are unsatisfactory, insofar as they contravene the chief value underlying, and current practices of, Canadian healthcare, and rely on problematic ascriptions of personal responsibility for health.

Regret, shame, and denials of women's voluntary sterilization.

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well-studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret.

Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes.

BACKGROUND: Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. METHODS: Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). RESULTS: From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. CONCLUSION: Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians.

BACKGROUND: Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. METHODS: A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. RESULTS: The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. CONCLUSION: Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. TRIAL REGISTRATION NUMBER: This study is not a randomized control trial so the study has not been registered as such.

Practice and Intention to use long acting and permanent contraceptive methods among married women in Ethiopia: Systematic meta-analysis.

BACKGROUND: The long acting and permanent contraceptive methods (LAPCMs) has not used unlike that of short-acting methods in Ethiopia. Ethiopia is the second most populous country in Sub Saharan Africa with a high total fertility rate, and high maternal and child mortality rates. This study summarized the evidence of practice and intention to use long acting and permanent family planning methods among women in Ethiopia using systemic review and meta-analysis. METHODS: A systematic review and meta-analysis of the published and unpublished observational studies were conducted. Original studies were identified using databases of Medline/Pubmed, and Google Scholar. Heterogeneity across studies was checked using Cochrane Q test statistic and I(2)test. The pooled proportion of intention to use and the practice of long acting and permanent contraceptive methods were computed using a/the random effect model. RESULTS: Based on the ten observational studies included in the meta-analysis, the pooled prevalence of intention to use long acting and permanent contraceptive methods among married women according to the random effect model was 42.98 % (95 % CI 32.53, 53.27 %). On the other hand, the pooled practice of long acting and permanent methods of contraceptive among the study participants was 16.64 % (95 % CI 12.4 to 20.87 %). CONCLUSION: This meta-analysis revealed that women's intention to use LAPCMs is generally good but their utilization is low. It is recommended, therefore, that LAPMCs must be made more readily available and accessible to women at the lower level of health service delivery who are in need of it.

Family planning knowledge, attitudes and practices in refugee and migrant pregnant and post-partum women on the Thailand-Myanmar border - a mixed methods study.

BACKGROUND: Lack of data in marginalized populations on knowledge, attitudes and practices (KAP) hampers efforts to improve modern contraceptive practice. A mixed methods study to better understand family planning KAP amongst refugee and migrant women on the Thailand-Myanmar border was conducted as part of an ongoing effort to improve reproductive health, particularly maternal mortality, through Shoklo Malaria Research Unit (SMRU) antenatal and birthing services. METHODS: Cross-sectional surveys and focus group discussions (FGDs) in currently pregnant women; and in-depth interviews (IDIs) in selected post-partum women with three children or more; were conducted. Quantitative data were described with medians and proportions and compared using standard statistical tests. Risk factors associated with high parity (>3) were identified using logistic regression analysis. Qualitative data were coded and grouped and discussed using identified themes. RESULTS: In January-March 2015, 978 women participated in cross-sectional studies, 120 in FGD and 21 in IDI. Major positive findings were: > 90 % of women knew about contraceptives for birth spacing, >60 % of women in the FGD and IDI reported use of family planning (FP) in the past and nearly all women knew where they could obtain FP supplies. Major gaps identified included: low uptake of long acting contraception (LAC), lack of awareness of emergency contraception (>90 % of women), unreliable estimates of when child bearing years end, and misconceptions surrounding female sterilization. Three was identified as the ideal number of children in the cross-sectional survey but less than half of the women with this parity or higher in the IDI actually adopted LAC leaving them at risk for unintended pregnancy. Discussing basic female anatomy using a simple diagram was well received in FGD and IDIs. LAC uptake has increased particularly the IUD from 2013-2015. CONCLUSION: Definitive contextual issues were identified during this study and a significant range of action points have been implemented in FP services at SMRU as a result, particularly in regard to the IUD. The importance of the role and attitudes of husbands were acknowledged by women and studies to investigate male perspectives in future may enhance FP practice in this area.

Low-income women's navigation of childbearing norms throughout the reproductive life course.

Shifts in family structure have affected age norms about both teenage childbearing and reproductive sterilization, but we lack research examining how childbearing norms are connected across the reproductive life course. Drawing on interviews from 40 low-income women in Colorado, we explored linkages between early childbearing and the desire for early sterilization. Specifically, we examined two narratives women use to negotiate competing norms throughout the reproductive life course. The low-income women in our study characterized their teenage childbearing experiences negatively and justified them using a "young and dumb" narrative. Women also asserted that reversible contraceptives do not work for them, using a "hyper-fertility" narrative to explain both their early childbearing and their desire for early sterilization. Our results illustrate the influence of mainstream social norms about childbearing timing on low-income women's lives and provide evidence of how women use narratives to explain and justify their violation of childbearing norms.

Surgical sterilization, regret, and race: contemporary patterns.

Surgical sterilization is a relatively permanent form of contraception that has been disproportionately used by Black, Hispanic, and Native American women in the United States in the past. We use a nationally representative sample of 4592 women ages 25-45 to determine whether sterilization continues to be more common and consequential by race for reproductive-age women. Results indicate that Native American and Black women are more likely to be sterilized than non-Hispanic White women, and Hispanic and Native American women are more likely than non-Hispanic White women to report that their sterilization surgeries prevent them from conceiving children they want. Reasons for sterilization differ significantly by race. These findings suggest that stratified reproduction has not ended in the United States and that the patterns and consequences of sterilization continue to vary by race.

Costs and benefits of trap-neuter-release and euthanasia for removal of urban cats in Oahu, Hawaii.

Our goal was to determine whether it is more cost-effective to control feral cat abundance with trap-neuter-release programs or trap and euthanize programs. Using STELLA 7, systems modeling software, we modeled changes over 30 years in abundance of cats in a feral colony in response to each management method and the costs and benefits associated with each method . We included costs associated with providing food, veterinary care, and microchips to the colony cats and the cost of euthanasia, wages, and trapping equipment in the model. Due to a lack of data on predation rates and disease transmission by feral cats the only benefits incorporated into the analyses were reduced predation on Wedge-tailed Shearwaters (Puffinus pacificus). When no additional domestic cats were abandoned by owners and the trap and euthanize program removed 30,000 cats in the first year, the colony was extirpated in at least 75% of model simulations within the second year. It took 30 years for trap-neuter-release to extirpate the colony. When the cat population was supplemented with 10% of the initial population size per year, the colony returned to carrying capacity within 6 years and the trap and euthanize program had to be repeated, whereas trap-neuter-release never reduced the number of cats to near zero within the 30-year time frame of the model. The abandonment of domestic cats reduced the cost effectiveness of both trap-neuter-release and trap and euthanize. Trap-neuter-release was approximately twice as expensive to implement as a trap and euthanize program. Results of sensitivity analyses suggested trap-neuter-release programs that employ volunteers are still less cost-effective than trap and euthanize programs that employ paid professionals and that trap-neuter-release was only effective when the total number of colony cats in an area was below 1000. Reducing the rate of abandonment of domestic cats appears to be a more effective solution for reducing the abundance of feral cats.

Control and constraint for low-income women choosing outpatient sterilization.

Little is known about Hispanics and their contraceptive choices in general, with some past studies detailing nonconsensual sterilization. This article is based on interviews with a mostly Hispanic sample of 44 women being sterilized at a public clinic in southeast Texas with the Essure device, which entails a new outpatient sterilization procedure. The women cited relationship factors, wanting to better their and their children's lives, and past reproductive histories as reasons for deciding on sterilization. They specifically chose Essure as a result of an apprehension of surgery and potential side effects from tubal ligation. Their choices, however, were limited by larger structural factors of work, family, the political economy, and the health care system. We concluded that this new sterilization technique provided more contraceptive choices for these women, yet more contraceptive decision-making autonomy and more equitable social structures are still needed.

"She made up a choice for me": 22 HIV-positive women's experiences of involuntary sterilization in two South African provinces.

Since 1998 South African law has provided that adults should have access to sterilization but only with their informed consent. However, the right to sterilization and other sexual and reproductive rights have not been fully realized as women struggle to access limited services, and there are allegations of discrimination and sterilization abuses. This qualitative study explores the experiences of 22 HIV-positive women in two provinces who reported being sterilized between 1996 and 2010 without their informed consent (n=18) or without their knowledge (n=4). Key issues reported by participants included failure to respect their autonomy, lack of information given about what sterilization entailed, and subtle or overt pressure to sign the consent form. Although the legal framework was intended to ensure informed decision-making regarding sterilization, these protections appear to have failed the HIV-positive women in this study. The findings suggest that some health professionals may consider a signature on a consent form as sufficient regardless of how it was obtained. Furthermore the women's perceptions that they were singled out as needing to be sterilized simply because they were HIV-positive warrants further investigation. More research is required on the nature of the problem and on other stakeholders' perceptions.

The pregnancy decisions of HIV-positive women: the state of knowledge and way forward.

Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.

Ethics of a Mandatory Waiting Period for Female Sterilization.

Due to a history of coerced sterilization, a federal Medicaid sterilization policy mandates that a specific consent form be signed by a patient at least thirty days prior to when the patient undergoes sterilization. However, in contemporary obstetrical practice, the Medicaid sterilization policy serves as a policy-level barrier to autonomously desired care. We review the clinical and ethical implications of the current Medicaid sterilization policy. After discussing the utility and impact of waiting periods for other surgical procedures, we explore the psychology of time required for decision-making and consider scientific understanding of regret. We argue that the current Medicaid sterilization waiting period is clinically and ethically unjustifiable and that the policy ought to be revised in light of the goals, preferences, and concerns of the people most affected by it. While the need for continued protection against coercion remains, the current mandated waiting period does little to enforce the high-quality shared decision-making that is desired for sterilization counseling.

Risk of Sterilization Regret and Age: An Analysis of the National Survey of Family Growth, 2015-2019.

OBJECTIVE: To estimate the risk of sterilization regret based on age at the time of sterilization in a contemporary group of women. METHODS: We conducted a retrospective analysis of cross-sectional data from the 2015-2017 and 2017-2019 National Survey of Family Growth, Female Respondent Files, to estimate the proportion of women who experience sterilization regret. Descriptive statistics were used to describe the population and the proportion with regret. Sterilization regret was defined as someone who either underwent sterilization reversal or who definitely wanted sterilization reversal. Multivariable logistic regression models were used to assess associations with sterilization regret. RESULTS: A total of 1,549 women who underwent sterilization were included in the analysis; 8% were aged 21-30 years, and 92% were aged older than 30 years. Of the participants, 16.9% identified as Black, 22.0% as Hispanic, and 57.2% as White. Most (58.4%) underwent a tubal sterilization procedure between age 21 and 30 years. The cumulative proportion of regret was 10.2% (12.6% for women who underwent sterilization at age 21-30 years and 6.7% for those who underwent sterilization at older than age 30 years). After controlling for covariates including age, race, parity, educational attainment, and medical reason for sterilization, the only variable that had a statistically significant association with regret was age at the time of the interview (P<.001). As women got older, they were less likely to report sterilization regret. CONCLUSION: Younger women experience more sterilization regret. As women get older, sterilization regret decreases. Counseling about sterilization should reveal the unpredictability of future desire, but age alone must not be a barrier to performing sterilization.

Deciding about sterilisation: perspectives from women with an intellectual disability and their families in Taiwan.

BACKGROUND: This qualitative study explores decision-making regarding sterilisation for women with intellectual disabilities (ID) living with their families, including how such decisions are made and who is involved in the decision-making. METHODS: Eleven families including sterilised women with ID participated in the study. Semi-structured interviews were conducted with family members and four of the women with ID; the interviews took place at the family homes during March 2009. The interview schedule sought information regarding decision-making on sterilisation including the reasons for the sterilisation, the identities of those involved in the decision-making, attitudes towards the sexuality of women with ID and the role of women with ID in decision-making about their own sterilisation. Additionally, women with ID were asked about their experiences of sterilisation. RESULTS: The data showed that most of the women who underwent tubal ligation were married and had mild ID; the decision to perform tubal ligation was mostly made by the husband or parents-in-law, and was made after the women had given birth. The reasons given by the families of these women for deciding on sterilisation included: the woman was unable to care for the children, the family could not afford to raise many children, the concern that the ID might be hereditary, or a perceived risk of pregnancy from rape. The two women who underwent hysterectomy were unmarried and had more severe ID than the married women with ID who received tubal ligation. In these two cases, the decisions were primarily made by the mothers of the women based on concerns about managing their menstruation. Almost none of the women with ID were involved in the decision-making process, and some were not even informed of the nature of the surgery. Health professionals and service workers contacted by the families were also influential in the decision-making. The autonomy of the women to engage in decision-making regarding sterilisation thus was constrained by their families and professionals, without considering either sterilisation or hysterectomy a violation of the essential human rights of the women involved. CONCLUSION: The results suggest that with respect to sexuality and body images among women with ID, concern should exist among society in general and among professionals in particular, regarding human rights; furthermore, more information and better educational programmes must be provided to relevant professionals, as well as to women with ID and their families.

Patient perceptions regarding effect of gynecological surgery on sexuality.

INTRODUCTION: Women undergoing surgery for benign gynecological conditions often voice concerns about how surgery will affect their sexuality. It is unclear what percentage of women shares these concerns, and how well they are addressed. AIMS: To identify what concerns women have about sexuality when they have gynecological surgery, and what factors affect these concerns. METHODS: Survey of women scheduled to undergo hysterectomy, oophorectomy, or any sterilization procedure at an academic medical center. Chi-square and Fisher's exact tests were used to analyze the data. MAIN OUTCOME MEASURE: A questionnaire was devised containing 10 statements regarding how surgery can affect sexuality and how concerns are addressed. Patients were asked to rate their agreement with each on a 5-point Likert scale. RESULTS: Patients undergoing oophorectomies were significantly more likely to agree that they would have less sexual desire (P = 0.01) and that they would be less able to enjoy sex (P = 0.002) than women undergoing hysterectomy or sterilization alone. Patients with a private physician were more likely to agree that their physician counseled them about sexual effects than patients of the resident clinic (P = 0.004). CONCLUSIONS: Women undergoing oophorectomy are more likely to have concerns regarding sexuality that need to be addressed by gynecological surgeons. These concerns are less frequently addressed by resident physicians, who need to be instructed to counsel their patients about sexuality.