Beyond knowledge: Introducing embodied aversion through the case of contraception.

Family planning programs have largely operated at the individual level, seeking to enhance individuals' knowledge of, change attitudes towards, and improve consistent use of efficacious contraception. Social science research has added to these efforts by emphasizing the structural influences that shape individuals' contraceptive attitudes, beliefs, and behaviors. Such work highlights the importance of embodied knowledge which is informed by social contexts and provides individuals with a sense of assuredness in knowing which contraception works well for them (and within their bodies). However, through qualitative analysis of in-depth interviews with 59 self-identified women conducted from 2017 to 2018 across the state of Delaware in the United States, we argue that there is a powerful facet of contraceptive decision-making that lies beyond articulatable, conscious knowledge, which we name "embodied aversion." We draw on affect theory and stigma theory to introduce embodied aversion as an influential feeling and orientation away from implantable and insertable contraceptive methods that arises from internalized stigma around the reproductive body. Embodied aversion overpowers conscious understanding of contraceptive benefits like efficacy, ease of use, and longevity. Our research presents embodied aversion as a missing piece of contraceptive understanding that we argue is vital in more fully conceptualizing experiential dimensions of contraceptive use. Doing so enhances patient-centered care, shared decision-making, and reproductive autonomy.

Intersections between culture, contraception, knowledge and the body in the USA.

Women's contraceptive use is a central feature of US culture around reproduction as evinced by high usage rates and nationwide public health efforts to further increase its use. Paradoxically, women know little about contraception within its biomedical framing, and successive public health-related educational campaigns have produced only moderate knowledge gains. Drawing on 86 in-depth interviews with a diverse sample of reproductive-age women, we set out to understand this persistent learning lag. In doing so, we found that women's limited contraceptive knowledge extended beyond simply being uneducated about various methods. Rather, these learning lags can be attributed to many women's lack of knowledge or misunderstandings about their anatomical bodies and reproductive processes. Employing feminist perspectives, we argue that these misunderstandings derive from factors beyond individual women's control. Indeed, they are rooted in cultural norms that stifle and stigmatise women's reproductive learning. Traditional public health efforts may inevitably fail to overcome these cultural barriers, perpetuating women's gaps in knowledge. Recognising the cultural dimensions of contraceptive knowledge and education reveals how critical action is needed around sexuality education in the USA as well as the limitations of on-going educational efforts.

Comparing methods of long-acting reversible contraception: A qualitative study of Delaware women's perceptions of intrauterine devices and the implant.

OBJECTIVE: To distinguish Delaware women's perceptions of the intrauterine device (IUD) relative to the subdermal arm implant (implant) as well as to compare their perceptions of various IUD types. STUDY DESIGN: In this qualitative study, we conducted in-depth interviews with 86 self-identified women between 16 and 44 years old who resided in the state of Delaware. We used quota sampling to ensure a diversity of perspectives using age, socioeconomic status, race/ethnicity, and county of residence to do so. We analyzed the data for content and themes using deductive and inductive techniques. RESULTS: Of the 47 participants who would use long-acting reversible contraception (LARC), 36 favored IUDs over the implant, and 11 felt more comfortable with the implant. Participants' perceptions were primarily influenced by device side effects, body placement, and the removal process. Those favoring a specific IUD prioritized the presence of exogenous hormones, device size, and maximum duration of use. Thirty-nine women would not use IUDs or the implant, citing safety risks and the availability of "simpler" methods. CONCLUSIONS: Clinicians often use tier-based descriptions when counseling patients about contraception, particularly when emphasizing the similar efficacy levels of LARC devices. Participants in our study did not perceive LARC as a homogeneous category; rather, they consistently differentiated between IUDs and implants as well as between IUD types. Such findings demonstrate the need to understand which device features inform these distinct preferences and how providers' contraceptive counseling practices can be adjusted in response. IMPLICATIONS: Given these findings, scholars should compare and further distinguish across methods, including IUDs, whenever possible. The findings also reinforce the benefits of stocking a variety of LARC devices at clinic and practice sites and encouraging provider counseling that emphasizes method-specific concerns and features. Doing so centers users' needs and preferences.

Contextualizing barriers to long-acting reversible contraception in Delaware.

OBJECTIVE: We conducted this study to examine barriers to long-acting reversible contraception (LARC) that persist in the context of a large-scale LARC program, Delaware Contraceptive Access Now (Del-CAN), that has actively endeavored to remove such barriers. STUDY DESIGN: In 2016-2017, we conducted in-depth interviews with 86 self-identified women of reproductive age, diverse along the lines of age, race, and class, in the state of Delaware on their attitudes, beliefs, and behaviors regarding contraception. We analyzed the interviews using an inductive coding process. RESULTS: We found that, even in the midst of Del-CAN's efforts, meso and macro-level contexts, including provider-patient communication and clinic/practice structures, reinforced LARC barriers related to knowledge, access, and side effects. CONCLUSIONS: The multi-level contexts and nuances we illuminate in our study currently fall outside the purview of well-intentioned, large-scale initiatives such as Del-CAN, that attempt to address and ameliorate oft-researched barriers. Thus, these barriers persist within provider-patient interactions and clinic/practice policies and structures. IMPLICATIONS: The evaluated LARC-based intervention, Del-CAN, cannot fully address issues around provider autonomy, inadequate provider-patient communication, or practice-specific policies and criteria. In order for this intervention, and others like it, to be successful, they must be aware of and prepared to address such dimensions in their efforts.

Drying Climates and Gendered Suffering: Links Between Drought, Food Insecurity, and Women's HIV in Less-Developed Countries.

HIV/AIDS represents the leading cause of death among women of reproductive age globally, and gender inequalities in the burden of HIV/AIDS are most pronounced in poorer countries. Drawing on ideas from feminist political ecology, we explore linkages between suffering from drought, food insecurity, and women's vulnerability to HIV. Using data from 91 less-developed countries, we construct a structural equation model to analyze the direct and indirect influence of these factors, alongside other socio-economic indicators, on the percentage of the adult population living with HIV that are women. We find that droughts are significant in shaping gender inequalities in the HIV burden indirectly through increased food insecurity. We draw on prior research to argue that due to gendered inequalities, food insecurity increases women's vulnerability to HIV by intensifying biological susceptibilities to the disease, reducing access to social and health resources, and motivating women to engage in risky sexual behaviors, such as transactional sex. Overall, our findings demonstrate that droughts serve as an important underlying factor in promoting HIV transmission among vulnerable women in poor countries, and that food insecurity is a key mechanism in driving this relationship.

"This is what the truth is": Provider-patient interactions serving as barriers to contraception.

Contraception is a vital component of women's reproductive health, but not all women use it consistently and effectively. Many studies explore individual-level barriers to contraceptive use, yet interactional barriers are important to understand since contraception is primarily obtained through provider-patient interactions. Thus, through interviews with 86 women and 51 providers in the United States, we employ a framework of biomedicalization to study how such interactions, including the knowledge bases that inform them, shape women's contraceptive decision-making. We find that when women's embodied knowledge and providers' biomedical knowledge differ, providers' preferences supersede women's. Providers, however, overlook this hierarchy, instead viewing their relationships with patients as empowering equal partnerships. This pattern precludes women from achieving their desired contraceptive method and highlights the process through which women's concerns become barriers to contraceptive use. Moreover, these findings reflect how provider-patient hierarchies continue to thrive despite purported patient-centered care models.