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Gomez AM, Reed RD, Bennett AH, Kavanaugh M. Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data. JMIR Public Health Surveill 2024; 10:e58009. [PMID: 39163117 PMCID: PMC11372330 DOI: 10.2196/58009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/29/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. OBJECTIVE We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. METHODS We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. RESULTS Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. CONCLUSIONS Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.
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Affiliation(s)
- Anu Manchikanti Gomez
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Reiley Diane Reed
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Ariana H Bennett
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
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Bell S, Gibbs S, Winskell A, Villarino X, Gill H, Little K. Acceptability of an on-demand pericoital oral contraceptive pill: a systematic scoping review. Reprod Health 2024; 21:93. [PMID: 38943120 PMCID: PMC11212445 DOI: 10.1186/s12978-024-01829-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Access to an on-demand pericoital oral contraceptive pill - used to prevent pregnancy within a defined window around sexual intercourse - could offer women more reproductive agency. A contraceptive with this indication is not currently available in any market. This review aims to understand international user appeal for an on-demand pericoital oral contraceptive pill. METHODS Systematic scoping review, comprising 30 peer-reviewed papers published between 2014-2023. RESULTS Data from 30 papers reporting on research from 16 countries across five World Health Organisation regions suggests widespread user appeal for on-demand oral contraceptive pills that can be used peri- or post-coitally, especially among women who are younger, more educated or who have less frequent sex. Women of varying age, wealth, employment or relationship status, and with different prior experience of using modern contraceptives, were also interested. Women identified clear rationale for use and preference of these types of product: close alignment with women's sexual lives that comprised unplanned, spontaneous or occasional sex; perceived convenience and effectiveness; discreet use of pills to negotiate contextual circumstances that constrained their reproductive agency. Factors inhibiting use included knowledge barriers and attitudes of service providers, a lack of knowledge and misinformation among end-users, women's dislike of menstrual side effects and myths related to the effects of hormone content on future fertility. CONCLUSIONS Introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency. Priorities for future research include: broadening the geographical scope of evidence to include SE Asia and the Pacific, and international rural and peri-urban settings; documenting the perspectives of adolescents and unmarried young people; identifying opportunities for innovation in the supply channels to enhance appropriate, affordable access to on-demand oral contraceptives; and unpacking how to bring new pericoital contraceptives to the market in a variety of international settings.
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Affiliation(s)
- Stephen Bell
- Independent Research Consultant, Sunshine Coast, QLD, Australia
- Burnet Institute, Melbourne, Australia
| | - Susannah Gibbs
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | - Abigail Winskell
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | | | - Halle Gill
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA
| | - Kristen Little
- Population Services International, 1120 19 Street NW, Suite 600, Washington, DC, 20036, USA.
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Cartwright AF, Wallace M, Su J, Curtis S, Angeles G, Speizer IS. Neighborhood-level racialized socioeconomic deprivation and contraceptive use in the United States, 2011-2019. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:182-196. [PMID: 38853371 PMCID: PMC11260244 DOI: 10.1111/psrh.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
INTRODUCTION The social and structural environments where people live are understudied in contraceptive research. We assessed if neighborhood measures of racialized socioeconomic deprivation are associated with contraceptive use in the United States. METHODS We used restricted geographic data from four waves of the National Survey of Family Growth (2011-2019) limited to non-pregnant women ages 15-44 who had sex in the last 12 months. We characterized respondent neighborhoods (census tracts) with the Index of Concentration at the Extremes (ICE), a measure of spatial social polarization, into areas of concentrated privilege (predominantly white residents living on high incomes) and deprivation (predominantly people of color living on low incomes). We used multivariable binary and multinomial logistic regression with year fixed effects to estimate adjusted associations between ICE tertile and contraceptive use and method type. We also assessed for an interactive effect of ICE and health insurance type. RESULTS Of the 14,396 respondents, 88.4% in neighborhoods of concentrated deprivation used any contraception, compared to 92.7% in the most privileged neighborhoods. In adjusted models, the predicted probability of using any contraception in neighborhoods of concentrated deprivation was 2.8 percentage points lower than in neighborhoods of concentrated privilege, 5.0 percentage points higher for barrier/coital dependent methods, and 4.3 percentage points lower for short-acting methods. Those with Medicaid were less likely to use any contraception than those with private insurance irrespective of neighborhood classification. CONCLUSIONS This study highlights the salience of structural factors for contraceptive use and the need for continued examination of structural oppressions to inform health policy.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maeve Wallace
- Mary Amelia Center for Women’s Health Equity Research, Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jessica Su
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siân Curtis
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S. Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ahmed S, McLoughlin Dymond A, Correa M, Willcox ML. Views and experiences of long-acting reversible contraception among ethnic minorities in high-income countries: a systematic review of qualitative studies. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:53-66. [PMID: 37949640 DOI: 10.1136/bmjsrh-2023-201864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BackgroundEthnic minorities in high-income countries have higher rates of unintended pregnancies but are less likely to use highly efficacious long-acting reversible contraception (LARC). The reasons for this are unclear. AIM To understand the views and experiences of ethnic minorities within high-income countries about LARC. METHODOLOGY Medline, CINAHL, EMBASE and Sociological Abstracts were searched systematically to find qualitative articles about views on LARC. Titles and abstracts were screened to select qualitative studies about LARC whose participants were mainly from ethnic minorities in high-income countries. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis was conducted. RESULTS Seventeen studies (19 articles) met the inclusion criteria, 14 of which were from the USA (227 participants identified as Latina, 222 Black, 15 multiracial, 4 Asian). Two studies included 32 Chinese women in the UK and Australia and one included 20 Aboriginal women in Australia. Factors influencing uptake of LARC included side effects, convenience, and perceived efficacy of LARC compared with other methods; women's ideas, concerns and expectations; and external influences (partner, family/friends, health professionals and society). Convenience of LARC, control over reproductive decisions, and desire to prevent pregnancy were the main facilitators. Barriers included specific cultural concerns about irregular bleeding, concerns about racial discrimination, and family/friends having negative views on LARC. CONCLUSIONS Ethnic minority women often have additional needs and concerns about LARC compared with the White majority. Further research is needed to develop and evaluate customised respectful counselling on contraception options for ethnic minority women and their partners.
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Affiliation(s)
- Sumayyah Ahmed
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Abigail McLoughlin Dymond
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Michele Correa
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Merlin L Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
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Nathan SF, Berglas NF, Kaller S, Mays A, Biggs MA. Reasons for Having Unprotected Sex Among Adolescents and Young Adults Accessing Reproductive Health Services. Womens Health Issues 2022; 33:222-227. [DOI: 10.1016/j.whi.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
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Scharmanski S, Hessling A. Sexuality education for young people in Germany.Results of the 'Youth Sexuality' representative repeat survey. JOURNAL OF HEALTH MONITORING 2022; 7:21-38. [PMID: 35891937 PMCID: PMC9275519 DOI: 10.25646/9875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/29/2022] [Indexed: 11/05/2022]
Abstract
The Federal Centre for Health Education (BZgA) has been conducting the 'Youth Sexuality' representative survey on a regular basis since 1980. This continuous monitoring generates insights into the sexual and reproductive health of young people in Germany and constitutes an important basis for evidence-based health communication. A total of N=6,032 young people between the ages of 14 and 25 participated in a combination of oral and written interviews (Computer Assisted Personal Interviews (CAPI)). As primary sources of knowledge for, adolescents state that they obtain information through school lessons (69%), personal discussions (68%), and the Internet (59%). In addition to these sources, professional gynaecological counselling and sexuality education at home are also important sources of information. To what extent trusted contact persons are available in the family depends heavily on the adolescents' sociocultural backgrounds. Providing information and disseminating knowledge to young people in the field of sexual and reproductive health is organised intersectorally in Germany. In this way, it is possible to also reach those who do not have any contact persons at their disposal in their direct family. Maintaining and strengthening the current commitment in promoting sexual health is of key importance, as only this will ensure the next generation's sexual and reproductive health, and provide an evidence-based counterbalance to anecdotal information, especially in the digital domain.
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Affiliation(s)
- Sara Scharmanski
- Federal Centre for Health Education, Department S – Sexuality Education, Contraception and Family Planning, Unit S3 – Task Coordination, National and International Cooperation, Research and Training, Cologne, Germany
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Watchirs Smith L, Liu B, Degenhardt L, Richters J, Bateson D, Yeung A, Guy R. Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study. Sex Health 2021; 18:475-486. [PMID: 34863328 DOI: 10.1071/sh21151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Background Dual protection refers to the simultaneous prevention of sexually transmissible infection (STI) and unintended pregnancies. Optimal contraception and STI prevention strategies sometimes fail to align. Methods Using data from a large nationally representative population-based survey, we analysed the contraception and STI prevention behaviours at the last vaginal intercourse among 2420 heterosexually active women aged 16-34years who had participated in the Second Australian Study of Health and Relationships, 2012-13. Results At their last vaginal intercourse, most women (95%) used contraception and half (49%) used condoms, either as a sole multipurpose method or in conjunction with another type of contraception. Condom use was highest (72%) among women whose most recent partner was a casual or occasional partner, followed by women with a regular partner (59%) and women with a cohabiting regular partner (40%). One-third of the women (34%) used condoms as a sole method, and 14% used oral contraceptives together with a condom. Few women used implants or intrauterine devices (8%) and, among them, very few women also used condoms (<1%). Among the women who used a condom at their last vaginal intercourse, 49% reported both the correct use for STI prevention and consistent condom use during the previous 6months. Among women using condoms, correct and consistent use was also highest among women whose most recent partner was a casual or occasional partner (76%). Conclusions Although almost all women used contraception and half used dual protection, few benefited from the protective effects of using condoms together with highly effective contraception.
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Affiliation(s)
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Juliet Richters
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, Australia; and Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Anna Yeung
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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[Sexual and contraceptive behavior of adolescents and young adults in Germany. Current results of the representative survey "Youth Sexuality"]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1372-1381. [PMID: 34596702 PMCID: PMC8485313 DOI: 10.1007/s00103-021-03426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/03/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 1980, the Federal Centre for Health Education (BZgA) has regularly conducted the "Youth Sexuality" representative surveys. This continuous monitoring generates insights on the sexual and reproductive health of young people in Germany. The survey provides an important basis for the development of sexuality education and family planning measures. AIM The current sexual and contraceptive behavior of adolescents and young adults will be summarized using initial descriptive results from the ninth iteration of the survey. METHODS A total of N = 6032 adolescents and young adults participated in the survey. Data collection was conducted by computer-assisted personal interviewing (CAPI) in 2019. RESULTS A key finding of this iteration is that with regards to the age of the first sexual intercourse, the proportion of adolescents younger than 17 years has been declining for several years. For contraception, adolescents most frequently used condoms, and use of the pill has decreased. DISCUSSION The data from the current iteration indicate safe and responsible contraceptive behavior among young people in Germany. Nevertheless, it is important to maintain the commitment in the field of sexual health promotion and expand prevention measures for specific target groups. This is the only way to ensure the sexual and reproductive health of the next generation.
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