Evolving the Preconception Health Framework: A Call for Reproductive and Sexual Health Equity.

2021

234-239

2021 Feb 01

1873-233X

<p>Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people. We describe a novel "Reproductive and Sexual Health Equity" framework, defined as an approach to comprehensively meet people's reproductive and sexual health needs, with explicit attention to structural influences on health and health care and grounded in a desire to achieve the highest level of health for all people and address inequities in health outcomes. Principles of the framework include centering the needs of and redistributing power to communities, having clinical and public health systems acknowledge historical and ongoing harms related to reproductive and sexual health, and addressing root causes of inequities. We conclude with a call to action for a multisectoral effort centered in equity to advance reproductive and sexual health across the reproductive life course.</p>

10.1097/AOG.0000000000004255

Obstet Gynecol

33416289

"It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning.

2015

150-6

2015 Feb

1879-0518

OBJECTIVE: Unintended pregnancy is common and disproportionately occurs among low-income women. We conducted a qualitative study with low-income women to better typologize pregnancy intention, understand the relationship between pregnancy intention and contraceptive use, and identify the contextual factors that shape pregnancy intention and contraceptive behavior.

STUDY DESIGN: Semistructured interviews were conducted with low-income, African-American and white women aged 18-45 recruited from reproductive health clinics in Pittsburgh, PA, to explore factors that influence women's pregnancy-related behaviors. Narratives were analyzed using content analysis and the constant comparison method.

RESULTS: Among the 66 participants (36 African-American and 30 white), we identified several factors that may impede our public health goal of increasing the proportion of pregnancies that are consciously desired and planned. First, women do not always perceive that they have reproductive control and therefore do not necessarily formulate clear pregnancy intentions. Second, the benefits of a planned pregnancy may not be evident. Third, because preconception intention and planning do not necessarily occur, decisions about the acceptability of a pregnancy are often determined after the pregnancy has already occurred. Finally, even when women express a desire to avoid pregnancy, their contraceptive behaviors are not necessarily congruent with their desires. We also identified several clinically relevant and potentially modifiable factors that help to explain this intention-behavior discrepancy, including women's perceptions of low fecundity and their experiences with male partner contraceptive sabotage.

CONCLUSION: Our findings suggest that the current conceptual framework that views pregnancy-related behaviors from a strict planned behavior perspective may be limited, particularly among low-income populations.

IMPLICATIONS: This study identified several cognitive and interpersonal pathways to unintended pregnancy among low-income women in Pittsburgh, PA, including perceptions of low reproductive control, perceptions of low fecundity and male partner reproductive coercion.

10.1016/j.contraception.2014.09.014

Contraception

25477272

Racial and ethnic differences in young men's sex and contraceptive education.

2015

464-7

2015 Apr

1879-1972

<p><strong>PURPOSE: </strong>Racial/ethnic disparities exist in young men's contraceptive knowledge. This study examines whether the likelihood of receiving sexual health education varies by race/ethnicity.</p>

<p><strong>METHODS: </strong>We examined racial/ethnic differences in sex and contraceptive education both in school and from parents with multivariable logistic regression models among 4,104 men aged 15-24 years using data from the 2006-2010 National Survey of Family Growth.</p>

<p><strong>RESULTS: </strong>Nearly all respondents (96.6%) reported formal sex education. Fewer reported formal birth control education (66.6%), parental sex discussions (66.8%), and parental discussions specifically about birth control (49.2%). In multivariable analysis, black men were less likely than white men to report receiving formal contraceptive education (adjusted odds ratio [aOR], .70; 95% CI, .51-.96). Both black and U.S.-born Hispanic men reported more parental sex discussions than white men (aOR, 1.44; 95% CI, 1.07-1.94, aOR, 1.47; 95% CI, 1.09-1.99, respectively).</p>

<p><strong>CONCLUSIONS: </strong>Nearly all respondents reported having received formal sexual health education. Fewer reported receiving education about birth control either at school or at home. Black men were less likely to report receiving formal contraceptive education.</p>

10.1016/j.jadohealth.2014.12.014

J Adolesc Health

25797633

Barriers to Long-Acting Reversible Contraceptive Uptake Among Homeless Young Women.

2016

104-10

2016 Apr

1873-4332

<p><strong>STUDY OBJECTIVE: </strong>To identify barriers to long-acting reversible contraception (LARC) uptake among homeless young women.</p>

<p><strong>DESIGN: </strong>In this mixed methods study surveys and guided interviews were used to explore women's contraceptive and reproductive experiences, interactions with the health care system, and their histories of homelessness.</p>

<p><strong>SETTING: </strong>All surveys and interviews were conducted at a homeless drop-in center or shelter.</p>

<p><strong>PARTICIPANTS: </strong>Fifteen women between 18 and 24&nbsp;years of age with a past year history of homelessness.</p>

<p><strong>INTERVENTIONS: </strong>None.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Perceived barriers to contraceptive use, including knowledge and access barriers and interactions with the health care system around reproductive health.</p>

<p><strong>RESULTS: </strong>Confusion about the possibility of early termination of LARC, and the perception that providers deliberately withhold selective information about contraceptive options to bias contraceptive decision-making, were 2 key new findings. Women also reported interest in visual aids accompanying verbal contraceptive counseling. Pregnancy attitudes and history of reproductive and sexual coercion also influenced contraceptive decision-making and reported interest in LARC methods.</p>

<p><strong>CONCLUSION: </strong>Comprehensive counseling about all contraceptive options, including LARC, are important for targeting the perceived gaps in contraceptive education and care among homeless young women.</p>

10.1016/j.jpag.2015.07.003

J Pediatr Adolesc Gynecol

26210293