Hormonal contraceptives and behavior: Updating the potent state of the nascent science.

Hundreds of millions of people worldwide use hormonal contraceptives (HCs), which have been an essential part of women's reproductive health care for decades. Throughout that time, however, research on the neural and behavioral consequences of HCs was minimal and plagued by poor methodology. HC effects - and users - were assumed to be homogenous. Fortunately, there has been a recent upswell in the number and quality of investigations, affording tentative conclusions about the roles of HCs in spatial cognition and mental health, particularly depression. Thus, this paper leverages findings from the past few years to highlight the heterogeneous aspects of use that seem to matter for behavior - ranging from variation in hormonal contraceptive formulations and routes of administration to individual differences among users linked to age and reproductive health history. This paper closes with five tips for future research that will help capture and clarify heterogeneity in potential relations between HCs and behavior, namely data collection, regional access, lifespan factors, gender, and collaboration. HCs are sociopolitically provocative and research on their potential behavioral neuroendocrine impacts is becoming increasingly popular. It is, therefore, imperative for scientists to conduct replicable and robust empirical investigations, and to communicate findings with the nuance that the heterogeneity among users and effects requires.

The Impact of a Digital Contraceptive Decision Aid on User Outcomes: Results of an Experimental, Clinical Trial.

BACKGROUND: Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. PURPOSE: To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. METHODS: In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. RESULTS: Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. CONCLUSIONS: Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. CLINICAL TRIALS REGISTRATION #: NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.

Digital decision aids that help women and their physicians choose contraceptive options that women are most comfortable with present one promising way to improve contraceptive use outcomes, such as avoiding unplanned pregnancies. However, current decision aids have been found to struggle in helping improve women's satisfaction with and confidence in their contraceptive choices. The aim of this study was to test the effectiveness of a new digital decision aid, named Tuune, at helping improve women's confidence and comfort with contraception. Three hundred and ten adult women were randomly assigned to use and then receive a contraceptive recommendation from either the Tuune decision aid or a control aid designed after leading traditional health intake forms. Women's confidence and satisfaction with the aids, as well as their contraceptive recommendation, were then compared between groups. We found good evidence to suggest that women using the Tuune contraceptive decision aid were more satisfied and positive about their contraceptive choices and reported greater intentions to use contraception with increased confidence compared to women who used the control decision aid. New online decision aids, like Tuune, may be an effective tool for increasing women's comfort and experiences using contraception.

Family Planning Counseling for Women Living with HIV in Low- and Middle-Income Countries: A Systematic Review of the Impact on Contraceptive Uptake, Intention to Use Contraception and Pregnancy Incidence, 2011 to 2022.

Women's ability to control their fertility and have the number of children they want when they want them is an internationally recognized human right. This right has been the driving force behind family planning programs in low- and middle-income countries for more than five decades. The HIV epidemic added greater urgency to those efforts once the risk of vertical transmission of the virus from mothers to their infants was recognized. In 2013, we published a systematic review of the evidence of effectiveness of family planning counseling for women living with HIV, emphasizing HIV related behaviors. In this updated review, we examined 23 studies, primarily from sub-Saharan Africa. The evidence we uncovered reflected efforts to integrate services provided to women. These showed that providing contraceptive services, including intensified counseling and support, in the HIV clinics where women living with HIV received their care increased the likelihood of subsequent use of modern contraception by as much as fourfold. These studies reflected a greater focus on women's family planning decisions and behaviors and less focus on HIV-related behaviors. Among the possible causes of this noted difference we include the widespread coverage of antiretroviral treatment for HIV. This advance has apparently changed the rationale and the approach to integrating family planning and HIV services in ways that may not have been fully appreciated. The results, however, are beneficial: greater coverage of family planning for women who wish to control their fertility and a more equal partnership between family planning services and HIV services in pursuit of the mutual goal of providing integrated services to meet women's needs.

Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya.

Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15-20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26-item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor-variable associations. The total SRE-Kenya (SRE-K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29-3.10). The SRE-K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.

Depression, Contraception, and Ambivalence Concerning Fertility.

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Assessing the impact of contraceptive use on mental health among women of reproductive age - a systematic review.

BACKGROUND: Contraceptive use is the principal method by which women avoid unintended pregnancy. An unintended pregnancy can induce long-term distress related to the medical, emotional, and social consequences of carrying that pregnancy to term. OBJECTIVES: This review investigates the effects of modern contraception techniques such as birth control pills, long-acting reversible contraceptives (e.g., intrauterine devices, implants), and condoms on mental health status. METHODS: We searched multiple databases from inception until February 2022, with no geographical boundaries. RCTs underwent a quality assessment using the GRADE approach while the quality of observational studies was assessed using the Downs and Black scoring system. Data were analyzed through meta-analysis and relative risk and mean difference were calculated and forest plots were created for each outcome when two or more data points were eligible for analysis. MAIN RESULTS: The total number of included studies was 43. In women without previous mental disorders, both RCTs (3 studies, SMD 0.18, 95% CI [0.02, 0.34], high quality of evidence) and cohort studies (RR 1.04 95% CI [1.03, 1.04]) detected a slight increase in the risk of depression development. In women with previous mental disorders, both RCTs (9 studies, SMD - 0.15, 95% CI [-0.30, -0.00], high quality of evidence) and cohort studies (SMD - 0.26, 95% CI [-0.37, -0.15]) detected slight protective effects of depression development. It was also noticed that HC demonstrated protective effects for anxiety in both groups (SMD - 0.20, 95% CI [-0.40, -0.01]). CONCLUSIONS: Among women with pre-existing mental disorders who use hormonal contraceptives, we reported protective association with decreased depressive symptoms. However, the study also draws attention to some potential negative effects, including an increase in the risk of depression and antidepressant use among contraceptive users, a risk that is higher among women who use the hormonal IUD, implant, or patch/ring methods. Providers should select contraceptive methods taking individual aspects into account to maximize benefits and minimize risks.

Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders.

BACKGROUND: In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours. METHODS: Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women). RESULTS: Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method. DISCUSSION: The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies. CONCLUSION: The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.

Decisional needs and interventions for young women considering contraceptive options: an umbrella review.

BACKGROUND: Although women face a wide range of contraceptive options, globally, young women are at risk of unintended pregnancies. Our umbrella review aimed to determine the decisional needs of nulligravida women aged 11 to 30 considering contraceptive options and identify effective interventions to support their involvement in making decisions about contraceptive use. METHODS: We followed Joanna Briggs Institute methods for umbrella reviews, theoretically guided by the Ottawa Decision Support Framework. We searched six electronic databases. Two reviewers independently screened citations, extracted data, and appraised quality using AMSTAR2. We analysed findings descriptively. RESULTS: Of 124 citations, we identified 11 reviews of variable quality (critically low to moderate quality): Six reported decisional needs and 5 reported on interventions. Decisional needs of young women were: (a) information needs about contraceptive options (e.g., mechanism of actions, eligibility, administration, side effects); (b) unclear values (concerns about hormone use) and features of different options (based on their religious values); and (c) need for support and resources (support from society and need for privacy). Compared to controls, decision support interventions including patient decision aids and patient education material increased knowledge and improved discussion of options with their clinicians. CONCLUSION: Young women making contraceptive decisions experience unmet decisional needs. Effective interventions such as patient decision aids and general patient education materials may address their decisional needs and enhance their level of participation in making contraception decisions. Implications and contribution to the field: Young women's decisional needs when considering contraceptive use are informational needs, unclear values (including religious influences), need for support and resources when facing this decision. Interventions, such as patient decision aid and patient education material can, address decisional needs by improving young women's knowledge about contraceptive options.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study.

INTRODUCTION: Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake. METHODS: A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. RESULTS: We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out. CONCLUSIONS: This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees. TRIAL REGISTRATION: This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.

Direct and indirect estimation of adolescent sexual intercourse and contraceptive use in Rajasthan India: an application of the best friend methodology.

BACKGROUND: Existing estimates of adolescent sexual and reproductive health (ASRH) behaviors may be a gross undercount given the sensitivity of this behavior in Indian culture. The objective of this study was to estimate ASRH behaviors in Rajasthan, India using direct questions and the best friend approach that seeks to reduce social desirability bias. METHODS: We used population-based data of adolescents aged 15-19 in Rajasthan collected between September and December 2022. Data include whether the respondent and her closest female friend ever had a partner, ever had sex, ever used contraception, and were currently using contraception. We estimated respondent and best friend ASRH outcomes separately, overall and among unmarried adolescents for whom we anticipate social desirability bias is greatest. RESULTS: The best friend approach performed well, with method assumptions largely met even before adjustments. Respondent and best friend estimates were similar among all adolescents except for current contraceptive use, which was higher for friends (though not significantly so). However, we observed large differences in ASRH behaviors between unmarried respondents and friends, with a significantly higher percentage of friends who ever had a partner (4.3% respondents, 11.6% friends), and a slightly higher percentage who ever had sex (2.4%, 3.8%) and who were currently using contraception (17.0%, 19.7% among those in need of contraception). CONCLUSIONS: We observed potential benefits of using the best friend methodology in estimating premarital sexual activity, but further work is needed to refine social network-based measures of sensitive adolescent behaviors in larger study samples to better understand ASRH needs.

Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger.

BACKGROUND: Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS: Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS: Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION: Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

BACKGROUND: Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. METHODS: We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. RESULTS: Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. CONCLUSIONS: While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

What are the associated factors of low husbands/partners independent decision-maker in women's contraceptive use decision-making process in Ethiopia? Multilevel analysis.

BACKGROUND: Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands' or partners' decision-making power on contraceptive use in Ethiopia. OBJECTIVE: This study aimed to assess the determinants of low involvement of husbands/partners in women's contraceptive use decision-making processes in Ethiopia. METHODS: This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands'/partners' independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as "Yes" or "No". A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance. RESULTS: Husbands'/partners' independent decision-making in women's contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31-59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3-5.4) and over 59 years (AOR = 2.3; CI 1.2-4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9-4.3), secondary education (AOR = 3.9; CI 2.7-4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2-5.4), History of pregnancy termination (AOR = 3.3; CI 2.6-4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7-4.7) and Urban residency (AOR = 3.5; CI 1.6-4.2). CONCLUSIONS: In Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency.

Emotional Fertility Intention and its correlates in Ethiopia among married contraceptive user women: using linked community and health facility data from performance monitoring for action; a generalized ordered logistics regression modeling.

BACKGROUND: Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country's population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility. METHODS: Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant's characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. RESULTS: The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23). CONCLUSION: Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.

Use of contraception during first sexual intercourse among Norwegian adolescents: a national cross-sectional study.

BACKGROUND: Most Norwegian adolescents experience their first sexual intercourse during late adolescence. Use of contraception is important to avoid unwanted pregnancy, while condoms can also protect against sexually transmitted diseases. There are few studies on the use of contraception at first sexual intercourse, most with varying results, and some studies have only examined the use of contraception among girls. In our study, we aimed to determine the use of contraception at first sexual intercourse, and to investigate associations between use of contraceptives at first sexual intercourse, sociodemographic factors, and alcohol and other substance use. METHODS: The study was based on data from the national electronic youth survey Ungdata, conducted in 2020-2022 among 113 049 upper secondary pupils (15-19 years) in Norway, which was around 65% of pupils attending upper secondary school during the study period. Descriptive analysis was used to estimate the prevalence of contraceptive use at first sexual intercourse, and multivariate logistic regression analyses to investigate the association between contraceptive use, sociodemographic factors, and alcohol intoxication and substance use. RESULT: 32% of Norwegian adolescents did not use contraception at first sexual intercourse. More girls (57.4%) than boys (42.6%) reported use of contraception. Factors associated with non-use of contraception during first sexual intercourse among boys were having parents with no college /university education (OR = 1.22: CI 1.13-1.32), perceived poor family finances (OR = 1.22: CI 1.06-1.40), alcohol intoxication, and use of cannabis or other narcotic substances during the past 12 months. The same factors were associated with non-use of contraception among girls. Additionally, being older than 16 years (OR = 1.13: CI 1.06-1.19) was also associated with non-use of contraception at first sexual intercourse. CONCLUSION: Many adolescents did not use contraception at first sexual intercourse. Alcohol intoxication and use of cannabis or other narcotic substances were associated with a lower likelihood of using contraceptives. This highlights the importance of preventive efforts including earlier prevention education that focuses more on the consequences of not using contraception in order to prevent unwanted pregnancies and sexually transmitted infections.

"An obedient wife never says "no" to her virtual god." High fertility conceptions and barriers to contraceptive use among mothers of Southern Pakistan: a qualitative study.

ISSUE: Biomedical approaches want to change locals' behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women's agency. OBJECTIVES: This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan. METHODOLOGY: Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data. FINDINGS: Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls' early marriages, in-laws' permission for contraception, women's concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers' perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children. SUGGESTIONS: We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.

Improving the sexual health of women with disabilities in sub-Saharan Africa: a scoping review of published studies.

BACKGROUND: An essential aspect of human well-being is positive sexual health outcomes. However, the issue of adverse sexual health outcomes continues to be a major public health concern, particularly for women with disabilities in sub-Saharan Africa (SSA). Therefore, this current scoping review mapped studies conducted in the last twenty-nine years on the sexual health of women with disabilities from these five dimensions: sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour, whilst seeking to identify the current state of knowledge and address the study gaps in SSA. METHODS: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in PubMed, Web of Science, African Journals Online, etc., to identify studies conducted in SSA that focus on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA since the inception of the International Conference on Population and Development in 1994 to 30th of March 2024. This process resulted in the inclusion of seventeen (17) studies. RESULTS: Of the 1362 identified through various databases, 34 studies were included for the full-text retrieval and screening; only 17 studies met the inclusion criteria. The eligible studies were conducted across six countries in SSA and published between 2008 and 2023. Eight studies used quantitative study type, six utilised qualitative approach, and three employed mixed-methods analysis. Two studies were conducted on sexual activity, ten were conducted on contraceptive use, four were conducted on sexual violence, and one study was conducted on risky sexual behaviour, whilst no study on sexual autonomy met the inclusion criteria. CONCLUSION: This review showed that there were few or scarce studies on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA and even where the studies were substantial (contraceptive use), the majority of the studies were conducted in a country. Future studies should consider examining dimensions of sexual health, such as sexual autonomy, sexual activity and risky sexual behaviour of women with disabilities that were not available or were scarce in the literature.

Sexual health is really important for people's overall well-being, and it includes aspects like how we feel socially, mentally, emotionally, and physically. In sub-Saharan Africa, especially for women with disabilities, sexual health is a big concern. So, this review looked at studies done over the last 29 years about the sexual health of women with disabilities in sub-Saharan Africa. It focused on five areas: sexual activity, contraceptive use, sexual autonomy, sexual violence, and risky sexual behaviour. Databases were searched for relevant studies and found 17 that fit the set criteria. These studies were from six countries in sub-Saharan Africa and were published between 2008 and 2023. Most of the studies were about contraceptive use, with fewer focusing on sexual activity, sexual violence, and risky behaviour. There weren't any eligible studies on sexual autonomy. The review concluded that there's not enough research on these sexual health dimensions among women with disabilities in sub-Saharan Africa, especially on sexual autonomy, and future studies should explore this further.

Examining contraceptive utilization behavior in Pakistani women.

BACKGROUND: There is a dearth of research examining the couple characteristics in determining contractive utilization behavior in developing countries. This study fills the gap by analyzing the roles of women's intra-household bargaining power and spousal age differentials in predicting contraceptive utilization behavior in Pakistani women. METHODS: A sample of 13,331, excluding pregnant and sexually inactive married women aged 15-49, was extracted from the Pakistan Demographic and Health Survey 2017-18. The dataset is cross-sectional. Exploratory analysis was used to examine the pattern of contraceptive knowledge, types of contraceptive utilization, and intention to use contraceptives among women. Furthermore, binary regressions were employed to examine the association of women's intrahousehold bargaining power and spousal age difference with contraceptive utilization without and after accounting for all potential covariates. RESULTS: Only 33% of women use contraceptives, while 30% express an intention to use contraceptives in the future. Almost all women (98%) knew about modern contraceptives. Compared to same-age couples, higher odds of current contraceptive use are observed among women whose husbands are at least 20 years older than them or whose husbands are young to them. The odds of the intention to use contraceptives tend to increase with the increase in spousal age difference. Women's intra-household bargaining is a significant predictor of current contraceptive utilization and intention to use contraceptives. CONCLUSION: Findings underscore the importance of considering the couple's characteristics in reproductive healthcare programming and policies. RECOMMENDATION: Greater women's intra-household bargaining power and smaller spousal age differences are associated with higher contraceptive usage. Empowering women and promoting their decision-making authority within households can enhance reproductive health outcomes.

Contraceptive behavior of women in India after induced abortion.

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15-49 years from fifth round of National Family Health Survey (2019-2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

Knowledge of non-contraceptive benefits of and willingness to consider taking oral contraceptive pills among a low-risk female population: a cross-sectional study.

BACKGROUND: In addition to its widely-appreciated contraceptive applications, the oral contraceptive pill (OCP) conveys both oncological and non-oncological benefits. Oncological benefits include a decreased risk of endometrial, ovarian, and colorectal cancer. Non-oncological benefits include reducing androgenic effects and alleviating menstruation-related problems. This study aimed to ascertain knowledge levels of non-contraceptive benefits and risks of OCP use among participants without contraindications to OCPs. This study also assessed factors associated with participants being more likely to consider taking OCPs. METHODS: 263 women aged 21 to 40 years old with no contraindications for OCP usage participated in this study. An anonymous questionnaire collected sociodemographic information and assessed participants' knowledge of the non-contraceptive benefits and risks associated with OCP use. Multivariate linear regression was used to assess factors associated with knowledge levels. Multivariate logistic regression was used to investigate factors associated with being more likely to consider taking OCPs among women who did not presently take them. RESULTS: Multivariate logistic regression revealed that participants who were more knowledgeable overall about the non-contraceptive benefits of OCPs were more likely to consider taking OCPs (coefficient = 0.184, p-value = 0.00). Knowledge of both oncological and non-oncological benefits of OCP use was relatively poor, especially among older women. Current OCP users were found to be more knowledgeable about their benefits. CONCLUSIONS: As women with greater knowledge of non-contraceptive benefits of OCPs are more likely to consider taking them, knowledge gaps regarding OCPs should be filled, so that more women may reap the non-contraceptive benefits of OCPs.

A sample of women with a low risk profile for oral contraceptive pills in Singapore demonstrated poor overall knowledge of their non-contraceptive benefits. Greater knowledge of the non-contraceptive benefits of oral contraceptive pills was associated with a greater willingness to consider taking oral contraceptive pills.