The biomedicalization of pregnancy prevention, neoliberal feminism, and college women's experiences of the contraceptive paradox.

Research examining the "contraceptive paradox" has illuminated how contraception can be a source of empowerment for some and oppression for others. This study advances theorizing of the contraceptive paradox by illustrating how 45 young women experience contraception as both liberating and constraining due to a confluence of biomedicalization processes, gender inequality, and neoliberal feminism. Drawing on focus group data, we find that the biomedicalization of pregnancy prevention and neoliberal feminist discourse, in combination with experiences of social and economic privilege and gender inequality in fertility work, shape participants' interpretation of contraceptive technology as a key resource for individually liberating themselves from undesired pregnancy. At the same time, their experiences indicate prescription contraception plays an oppressive role in their lives. In addition to blaming themselves and their bodies for negative contraceptive side effects, participants take for granted that assuming sole responsibility for contraceptive use in their relationships with men is the price they must pay to feel free. The findings indicate that addressing a social problem using an individualized biomedical solution obscures the power that structural inequalities exert over pregnancy-capable people, including relatively privileged young women. As an expression of biopower, these dynamics prompted participants to emphasize distributive justice over social justice, foreclosing their engagement in collective action.

"It Means Being Safe, Having Power over One's Body": Black Female Adolescent Experiences with Reproductive Health Counseling in Primary Care.

STUDY OBJECTIVE: There is limited research examining the sexual and reproductive health (SRH) care needs and experiences of Black adolescents who are assigned female at birth (AFAB). This study aimed to understand the perspectives of Black AFAB adolescents in their receipt of SRH counseling in primary care and elicit preferences for SRH-related communication with clinicians. METHODS: We interviewed English-speaking Black AFAB adolescents, ages 13-17, living in North Carolina between February and June 2022 about their SRH care experiences. The interviews were conducted via video conferencing, audio-recorded, professionally transcribed, and analyzed using a thematic approach. RESULTS: We interviewed 23 adolescents (mean age 15.8 years) across 10 geographically diverse counties in North Carolina. Most conveyed positive perceptions of clinicians regarding trust and comfort. However, many expressed concerns about clinicians not doing enough to ensure patient confidentiality, provide them with enough information to make informed and autonomous decisions, and destigmatize discussing SRH issues during the clinical encounter. Suggested improvements include sociodemographic congruence between patients and clinicians (eg, younger Black women), ensuring time alone with clinicians across adolescence, and proactively sharing information to promote respect and autonomy. CONCLUSION: Although Black AFAB adolescents had positive perceptions of their health care providers regarding relational components of care, many participants shared significant gaps and areas for improvement in the quality of care received to better align services with their preferences for SRH care. These findings can inform the development of SRH counseling best practices and clinician education to support respect and autonomy, which are routinely denied to Black AFAB adolescents.

The Biomedical Subjectification of Women of Advanced Maternal Age: Reproductive Risk, Privilege, and the Illusion of Control.

The United States is experiencing a demographic transition toward older motherhood. Biomedicine classifies pregnancies among all women of advanced maternal age (AMA) as high-risk; paradoxically, women having first births at AMA are typically economically and racially privileged, which can reduce the risk of risks. This article examines the implications of the biomedicalization of AMA for first-time mothers, age 35 and older, using qualitative interviews. We find participants had substantial cultural health capital, which informed their critiques of AMA and the medical model of birth. When they found themselves subjected to biomedical protocols and concerned about reproductive risk as their pregnancies progressed, their subsequent biomedical subjectification compelled most to accept biomedical interventions. Consequently, some participants had traumatic birth experiences. Our findings illustrate that while first-time mothers of AMA anticipated that they would have more control over the birth process because of their advantages, ultimately, most did not.

U.S. college students' perspectives on contraception and abortion post-Dobbs: the influence of socioeconomic privilege and gender inequity.

This study examined college students' perspectives about contraception and abortion in the context of the United States Supreme Court's decision to eliminate the constitutional right to abortion in June 2022. Individual, semi-structured interviews were conducted between October 2022 and February 2023 with a convenience sample of 20 college students, ages 18-22, attending a public university in the southeastern United States. Qualitative data analysis revealed three main themes. First, most participants conveyed fear, dismay, and anger about the decision in Dobbs v. Jackson Women's Health Organization to overturn Roe v. Wade and a few expressed concerns about potential restrictions on contraception. Second, women participants felt heightened pressure to continue or initiate use of a highly effective contraceptive method, with some lamenting inequitable experiences of the gendered contraceptive burden in their relationships with men. Third, when asked what they would do if they or their partner became pregnant while in college, most asserted they would seek abortion. Notably, participants assumed their socioeconomic advantages would ensure their or their partner's access to abortion, regardless of growing restrictions. The findings illustrate that among a group of relatively privileged young adults, the Dobbs decision simultaneously compelled their increased vigilance regarding contraceptive use and conferred the perception that they would not be personally impacted should they need an abortion.

Doctor knows best? Provider bias in the context of contraceptive counseling in the United States.

OBJECTIVES: The study examined how clinicians described their patients in relation to their practices of contraceptive counseling. STUDY DESIGN: This qualitative study involved individual interviews with 15 clinicians working in obstetrics and gynecology in South Carolina about their approaches to contraceptive counseling. We analyzed the data using a combination of deductive and inductive approaches. RESULTS: Clinicians attributed challenges of working with diverse patient populations to patients' race/ethnicity, socioeconomic status, and age. Clinicians often interpreted patient concerns about or refusal to use effective contraceptive methods as a problem with patients themselves. When clinicians described patients in disparaging ways, they often focused on adolescent patients. CONCLUSION: Bias informed by structural inequalities and power relations influences how clinicians perceive their patients and approach counseling them about contraception. Such practices may limit patients' informed decision-making and autonomy regarding initiating or continuing contraceptive use. IMPLICATIONS: Greater attention to redressing structural inequalities and power relations that inform provider bias in the context of contraceptive counseling is needed to ensure patients receive person-centered healthcare free from prejudice and discrimination. Fostering structural competency among clinicians may improve provider-patient interactions and support patients' reproductive autonomy.

A qualitative exploration of men's perceptions of the terms "male sterilization" versus "vasectomy" in the southern United States.

OBJECTIVES: Clinical literature and contraception information guides use the terms "male sterilization" and "vasectomy" interchangeably. We investigate the meanings men attach to "sterilization" and how those meanings compare to perceptions of "vasectomy." STUDY DESIGN: Cisgender, heterosexual men, ages 25 to 67, living across seven U.S. southern states participated in individual telephone interviews from May to December 2019. Interviews explored men's experiences with contraception, including their perception of the term "sterilization." We audio-recorded and transcribed the interviews and conducted thematic analyses using an inductive approach. RESULTS: While most participants described "vasectomy" as a relatively benign procedure, they described "sterilization" as "sinister," "bleak," and "barbaric." Participants' discussions of sterilization invoked associations with eugenicist practices and specific historical examples of forced sterilization. While some participants recognized that vasectomy is a means of achieving sterilization, most viewed the term "sterilization" as incongruous with the modern medical procedure of "vasectomy," precisely because sterilization has been used as a form of reproductive oppression. CONCLUSION: Our findings suggest that men have strong affective responses to the term "sterilization." Participants' knowledge of historical eugenicist practices has implications for the acceptability of vasectomy as a permanent contraceptive option in our contemporary context. IMPLICATIONS: The phrase "male sterilization" can be associated with eugenics and coercive reproductive practices. Using the term for reproductive counselling, education, or research purposes may have implications for the acceptability of vasectomy as a permanent contraceptive option.

Efficacy as safety: Dominant cultural assumptions and the assessment of contraceptive risk.

To reduce rates of unintended pregnancy, medical and public health associations endorse a contraceptive counseling model that ranks birth control methods by failure rate. This tiered model outlines all forms of birth control but recommends long-acting reversible contraceptives (LARC) to eliminate user error and increase continuation. Our critical discourse analysis of gynecology textbooks and medical recommendations examines how gendered and neoliberal ideas influence risk assessments underlying the tiered contraceptive counseling model. Specifically, we explore how embodied, lifestyle, and medical risks are constructed to prioritize contraceptive failure over adverse side effects and reproductive autonomy. We find that the tiered model's focus on contraceptive failure is justified by a discourse that speciously conflates distinct characteristics of pharmaceuticals: efficacy (ability to produce intended effect) and safety (lack of unintended adverse outcomes). Efficacy discourse, which filters all logic through the lens of intended effect, magnifies lifestyle and embodied risks over medical risks by constructing two biased risk assessments. The first risk assessment defines ovulation, menstruation, and pregnancy as hazardous (i.e., embodied risk); the second insinuates that cisgender women who do not engage in contraceptive self-management are burdensome to society (i.e., lifestyle risk). Combined, these assessments downplay side effects (i.e., medical risks), suggesting that LARC and other pharma-contraceptives are worth the risk to protect cisgender women from their fertile bodies and to guard society against unintended pregnancy. Through this process, ranking birth control methods by failure rates rather than by side effects or reproductive autonomy becomes logical as efficacy is equated with safety for cisgender women and society. Our analysis reveals how technoscientific solutions are promoted to address social problems, and how informed contraceptive choice is diminished when pharma-contraceptives are framed as the most logical option without cogent descriptions of their associated risks.

Are university health services meeting the needs of transgender college students? A qualitative assessment of a public university.

OBJECTIVE: This exploratory study sought to assess transgender college students' experiences accessing primary, gynecological, and/or mental health care through university health services (UHS). PARTICIPANTS AND METHODS: Individual interviews were conducted with eleven transgender undergraduate students attending a large public university in the United States in Spring 2017. RESULTS: The structure, organization, and practices of UHS are not adequately meeting transgender college students' health care needs. Students reported being repeatedly misgendered and addressed by the incorrect name by staff at UHS. Some providers asked inappropriate and irrelevant questions about their gender identity during clinical encounters. These and related experiences deterred many participants from returning to UHS for health care services. CONCLUSION: UHS could improve health care delivery to transgender college students by adopting standardized and inclusive practices consistent with those recommended by The Fenway Institute.

Experiences with Achieving Pregnancy and Giving Birth Among Transgender Men: A Narrative Literature Review.

Despite the burgeoning scholarship on transgender health and health care, the literature on transgender reproduction and reproductive medicine remains limited. In this narrative literature review, we examine recently published studies focused on the pregnancy and birth experiences of transgender men to provide an overview of the literature's major contributions and illuminate the gaps that exist within this research. Our review reveals that transgender men face substantial obstacles to achieving pregnancy and significant challenges during pregnancy and birth, which are informed by institutionalized cisnormativity embedded within medical norms and practices. This article demonstrates the importance of better understanding transgender men's reproductive health care needs in order to improve the quality of pregnancy-related health care delivery to this population. Our findings also provide insight for researchers, health care providers, and educators seeking to create and enhance gender-affirming medical education and training.

Men's Vasectomy Knowledge, Attitudes, and Information-Seeking Behaviors in the Southern United States: Results From an Exploratory Survey.

Vasectomy is one of the few options men have to manage their reproductive capacity and take on a more equitable role in pregnancy prevention. While the method is underused throughout the United States, the southern states have a lower prevalence rate compared to the rest of the country. Existing survey research does not assess what men know or think about the procedure as a means of understanding why this is the case. We created and conducted an exploratory survey to assess men's knowledge, attitudes, and information-seeking behaviors about vasectomy in the Southern United States. We used targeted Facebook advertising to recruit men ages 25-70 years living in 7 southern states to complete an online survey (n = 397). Using regression analyses, we identify that participants who had a vasectomy knew more about the procedure than participants who had not. Participants who had not had a vasectomy had less positive attitudes about the procedure across all six attitude subscales compared to participants with vasectomies. We highlight potential avenues for future research to understand why this may be the case. Finally, the majority of participants knew someone who had had a vasectomy. This suggests that men disclose having a vasectomy to others. The interpersonal dynamics around vasectomy decision-making and disclosure remain unknown and a viable area for future research. Findings from this exploratory survey may be used by public health officials interested in implementing campaigns to increase knowledge about vasectomy and reduce stigma, which may encourage more positive attitudes about the procedure.

Moving Oral Contraceptives over the Counter: Theory-based Formative Research to Design Communication Strategy.

The American College of Obstetricians and Gynecologists (ACOG) recommends that oral contraceptives (OC) should be available over the counter (OTC). This study explored women's attitudes toward OC OTC in rural South Carolina. In-depth, individual interviews were conducted with 52 women ages 18-44 years old. Data analysis was informed by a reproductive justice theoretical framework and included an inductive, constant-comparative approach using HyperRESEARCH 3.7.5. Participants self-identified as either Black (62%) or White (28%). Participants believed that OC OTC would prevent unintended pregnancy by improving anonymity, convenience, and access to contraception. Many participants faced barriers to receiving a prescription, including time, transportation, cost, stigma, embarrassment, and clinician refusal based on religious reasons. Participants believed OC OTC would improve women's control over their fertility and emphasized the importance of health insurance coverage for OC OTC. Some participants expressed concerns about the risk of side effects, contraindications, and the potential for abuse. Some participants believed women, especially adolescents, required physician guidance and an annual exam to use OC. Findings suggest that a lack of knowledge and misinformation about the risks of OC serve as a barrier among some women in rural areas. Widespread acceptance of OC OTC will require messaging strategies to dispel safety concerns about OC OTC and empower women.

Foreign objects in college bodies: young women's feelings about long-acting reversible contraception (LARC).

Long-acting reversible contraceptives (LARC) are now recommended for use among nulliparous young women to prevent unintended pregnancy. While research has explored LARC knowledge, attitudes, and use among young women in the United States, college women's feelings about LARC have received limited attention. This article reports findings from a focus group study conducted with a convenience sample of 45 women, ages 18-25 years, enrolled in a large public university in the southeastern USA in April 2017. Focus groups combined LARC users and non-users and elicited a range of positive and negative affective responses to LARC. Some participants had an aversion to LARC because they perceived them to be unnatural, while others felt a sense of security because of their long-term effectiveness. Feelings about the location and mode of insertion for the intrauterine device (IUD) versus the implant played a significant role in the decision to use a specific LARC method: some found being able to feel the implant in their arm reassuring, while others found it disturbing and preferred the IUD. College-going LARC users also appear to be effective advocates for LARC use among their peers.

The age of LARC: making sexual citizens on the frontiers of technoscientific healthism.

Routinely positioned as the 'first-line option' for contraceptive choice-making, long-acting reversible contraception (LARC) promotion efforts have come under critical scrutiny by reproductive justice advocates for the extent to which public health actors' preference for LARC devices may override potential users' ability to freely (not) choose to use contraception among an array of options. We identify LARC promotion discourse as constituting 'The Age of LARC': multifarious strategies for producing responsible sexual citizens whose health behaviours are empowered via a LARC-only approach to contraceptive use. We suggest that immediate postpartum LARC insertion policies, which have proliferated in the U.S. since 2012, exemplify the new era of LARC hegemony, in which urgency, efficiency, cost-effectiveness, and outcomes dominate both health policy and clinical practice around these contraceptive technologies. By following these efforts to facilitate access to and use of immediate postpartum LARC, we find a discourse on sexual citizenship that paradoxically constructs sexual health freedom through the use of a single class of contraceptive technologies.

Patients' experiences with South Carolina's immediate postpartum Long-acting reversible contraception Medicaid policy.

OBJECTIVES: We sought to examine women's experiences with immediate postpartum LARC counseling and use in the context of South Carolina's Medicaid policy. STUDY DESIGN: In 2016-18, we conducted semi-structured individual interviews with 25 women, ages 18-35, who gave birth within 2 years of the interview in South Carolina while insured by Medicaid and received contraceptive counseling about immediate postpartum LARC during their pregnancies. We analyzed the interviews using a combination of deductive and inductive coding approaches. RESULTS: Participants were counseled on immediate postpartum LARC during prenatal care (n=23) and/or while in the hospital for childbirth (n=16). Some expressed dissatisfaction with providers' approaches to contraceptive counseling because they either did not receive enough information to make a fully informed decision or felt they were being pressured to use LARC. Among those who received in-hospital contraceptive counseling, some objected to the timing because they were in labor and/or already had a non-LARC postpartum contraceptive plan. Three out of the 10 participants who elected to receive immediate postpartum LARC later desired removal but encountered barriers. CONCLUSIONS: Our findings suggest providers' timing, style, and content of contraceptive counseling about immediate postpartum LARC may not be sufficiently patient-centered. Additionally, lack of access to unfettered LARC removal limits patients' reproductive autonomy. IMPLICATIONS: If providers use a patient-centered approach to immediate postpartum LARC counseling, consistently engage in comprehensive contraceptive counseling during prenatal care, avoid pressuring patients to choose LARC, and collaborate with hospital staff to increase care coordination, they can improve Medicaid recipients' contraceptive care experiences and facilitate informed contraceptive decision-making.

Black US college women's strategies of sexual self-protection.

While previous scholarship on the sexual practices of college students in the USA has explored how the co-constitution of whiteness, economic privilege and gender inequality are central to 'hooking up', less attention has been paid to how the sexual culture of predominantly white universities shape Black college women's sexual practices. In this article, we use an intersectional theoretical framework informed by Black feminism to analyse interviews with Black, cisgender, heterosexual women, aged 18-22, attending a university in the south-eastern USA. We explore how they interpret the university's sexual culture and in turn how that informs their sexual decision-making. We find that the intersection of racism and sexism limits Black college women's sexual partner options and leads them to pursue sexual relationships outside the university setting. While most do not engage in committed romantic relationships with off-campus partners, they do engage in a range of strategies to protect their social, emotional and sexual well-being. The study findings expand the scholarship on hook-up culture by centring the narratives of a group often excluded from the literature.

LGBTQ College Students' Experiences With University Health Services: An Exploratory Study.

Access to inclusive, equitable health care is central to the wellbeing of all college students yet little is known about LGBTQ students' experiences with university health services. In this article, individual interviews with a convenience sample of 14 LGBTQ students at a large public university were analyzed to explore their perceptions of and experiences with the university's health center and its services. Our findings demonstrate that the university is not adequately meeting their health care needs. Participants' narratives offer insights into how to improve campus-based health services for LGBTQ students.

Contraceptive knowledge, attitudes, and use among adolescent mothers in the Cook Islands.

BACKGROUND: While the adverse health outcomes and broader economic and social factors associated with adolescent motherhood are well documented globally, limited research on unplanned pregnancy and birth among young women in Pacific Island nations exists. The study addresses this gap in the literature by examining the social and contextual factors that inform contraceptive knowledge, attitudes, and use among young women in the Cook Islands. METHODS: Individual, in-depth interviews were conducted with ten women who became mothers before age twenty. Adolescents' contraceptive knowledge, attitudes, and behaviours were examined while taking into account the context in which they experienced an unplanned birth. FINDINGS: Five participants were not using a contraceptive method when they became pregnant, believing they would not become pregnant. The remaining participants were using oral contraception but doing so inconsistently. Four participants had a sexual debut prior to age 15. The findings suggest a need to expand comprehensive approaches to sexual and reproductive health education, increase access to long-acting reversible contraceptive methods, and decrease the stigma associated with accessing family planning services in order to more effectively prevent unplanned pregnancy among adolescents in the Cook Islands. INTERPRETATION: The findings provide insight into the factors contributing to high rates of adolescent pregnancy and birth in the Pacific region and suggest how public health advocates and health care providers might reduce reproductive health disparities in the Cook Islands and similar Pacific Island nations.

Sexual Scripts in Contemporary Mexican Cinema: A Quantitative Content Analysis.

While the literature on sexual scripts is substantive, with some scholarship examining the role of popular media in the production of dominant and divergent sexual practices and interactions, limited attention has been paid to the contemporary Mexican context. In this article, we share findings from a quantitative content analysis of popular Mexican films in order to explore how sexual behavior is portrayed and more specifically how relationship characteristics, condom use, and substance use interact with representations of sexual behavior. We find that more sexually explicit portrayals featured people engaged in heterosexual sexual interactions outside the context of marriage and also in age discordant relationships, where one partner was a minor. Few films featured safer sex practices or substance use in concert with sexual behavior. This research sheds light on how film as a powerful agent of socialization communicates sexual scripts in contemporary Mexican culture that may contribute to risky sexual behaviors among Mexican youth.

'You just have to learn to keep moving on': young women's experiences with unplanned pregnancy in the Cook Islands.

The Cook Islands is one of several countries in the Pacific region that has high rates of teenage pregnancy and birth. While the social determinants of pregnancy and early motherhood are well established in the global context, little is known about how Cook Islands young women who become pregnant before age 20 make sense of their experiences. Drawing on individual interviews with a purposive sample of 10 young mothers, this paper examines the phenomenology of early pregnancy from their perspectives. Structural, cultural and individual factors emerged as salient themes in participants' accounts. Qualitative analysis revealed that nearly all the pregnancies were unplanned and every participant reacted negatively when she learned she was pregnant. While some participants wanted to terminate their pregnancies, lack of access to safe, legal and affordable abortion care limited their options. Ultimately, while nearly all participants wished they had been able to delay motherhood, they expressed happiness and pride about their new-found status as mothers. These findings allow for a fuller understanding of factors shaping young women's experiences of pregnancy in the Cook Islands, which have policy implications for reproductive health and rights.