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Sylvest R, Koert E, Balslev J, Steenberg M, Schmidt L, Ziebe S. How to talk to young adults about fertility. Reprod Biomed Online 2024; 49:103937. [PMID: 38744029 DOI: 10.1016/j.rbmo.2024.103937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 05/16/2024]
Abstract
RESEARCH QUESTION How knowledgeable are Danish young adults about fertility and what are their attitudes towards learning about their reproductive biology? DESIGN The study was conducted at different educational institutions with 11 focus-group discussions that included a total of 47 participants (aged 18-29 years). Qualitative content analysis was used. The participants' fertility knowledge score was measured using the Cardiff Fertility Knowledge Scale. RESULTS The participants had an overall fertility knowledge score of 54%. Focus-group data showed that they thought it was important to learn about fertility and how to protect their fertility potential regardless of whether or not they wanted children. Providing knowledge is like planting a seed in the young adults. They wanted to hear about fertility in multifaceted ways and formats, and believed the information should be delivered by professionals, but developed in partnership with young people. The double-edged sword of knowledge and the consequence of knowledge made them hesitant or less open to learning. CONCLUSIONS Recommendations from this study are to tailor fertility information to young people, with due cognisance of their developmental stage, and ideally from an earlier age.
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Affiliation(s)
- Randi Sylvest
- Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Denmark.
| | - Emily Koert
- Department of Public Health, University of Copenhagen, Denmark
| | - Julie Balslev
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Denmark
| | - Søren Ziebe
- Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Bodin M, Plantin L, Schmidt L, Ziebe S, Elmerstig E. The pros and cons of fertility awareness and information: a generational, Swedish perspective. HUM FERTIL 2023; 26:216-225. [PMID: 34423731 DOI: 10.1080/14647273.2021.1968045] [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: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.
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Affiliation(s)
- Maja Bodin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lars Plantin
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, København, Denmark
| | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
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Grace B, Shawe J, Stephenson J. Exploring fertility knowledge amongst healthcare professional and lay population groups in the UK: a mixed methods study. HUM FERTIL 2023:1-10. [PMID: 36600193 DOI: 10.1080/14647273.2022.2153349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As the average age of first-time parents continues to rise, there has been a concerted effort by educators, policy makers and several reproductive health groups to improve fertility awareness. This study explored fertility knowledge of lay men and women and healthcare professionals (HCPs) using the same test instrument, providing a new and unique perspective compared with previous studies. Results were obtained from 1082 survey respondents: 347 HCPs, 319 men and 413 women, 105 of whom were trying to conceive (TTC). A total of 35 interviewees were purposively sampled to include 9 HCPs, 13 men and 13 women from the reproductive age range and of varying ethnic and educational backgrounds. Interview data were transcribed and analysed using the framework method. The proportion of HCPs correctly answering the survey knowledge questions was 47.1 (95% CI = 41.7%, 52.5%) compared to 44.4% for women (95% CI = 38.9%, 50.1%); 49.9% (95% CI = 39.0, 59.9%) for women TTC; and 32.5% (95% CI = 27.1%, 37.9%) for men. HCPs were ranked as the most trusted source for seeking fertility information. Overall HCPs did not demonstrate better fertility knowledge than lay participants, with inconsistencies regarding where responsibility lies for providing the right information to patients. HCPs need to improve their knowledge about fertility to help improve patient's fertility awareness.
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Affiliation(s)
- Bola Grace
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
| | - Jill Shawe
- Faculty of Health, University of Plymouth, Plymouth, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Judith Stephenson
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
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Reproduktives Timing. Neue Formen und Ambivalenzen zeitlicher Optimierung von Fortpflanzung und ihre ethischen Herausforderungen. Ethik Med 2022. [DOI: 10.1007/s00481-022-00738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ZusammenfassungDer Beitrag befasst sich mit dem Zusammenhang von Fortpflanzung, Zeit und gutem Leben. Angebote der Reproduktionsmedizin und Konzeptionen des guten Lebens in der Zeit beeinflussen einander wechselseitig, wobei diese Wechselwirkung durch implizite oder explizite normative Setzungen und Erwartungen von angemessener Zeitlichkeit gekennzeichnet ist. Wir erörtern zunächst die Bedeutung von Zeit für Lebenslauf und Elternschaft aus einer soziologisch-sozialpsychologischen Perspektive. Fortpflanzungsmedizin kann die Spielräume für Elternwerden und für lebenszeitliche Autonomie vergrößern, aber im Kontext gesellschaftlicher Optimierungs- und Effizienzimperative auch gegenteilige Auswirkungen haben und Heteronomie verstärken. Insgesamt ergeben sich daraus veränderte Formen von Anpassung und Selbstbestimmung, neue Dilemmata und Ambivalenzen der zeitlichen Optimierung von Elternschaft. Vor diesem Hintergrund erläutern wir, wie die Ethik der Fortpflanzungsmedizin von einer interdisziplinären, das Leben in seinem zeitlichen Verlauf in den Blick nehmenden Forschung profitieren könnte.
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Harper JC, Botero-Meneses JS. An online survey of UK women's attitudes to having children, the age they want children and the effect of the COVID-19 pandemic. Hum Reprod 2022; 37:2611-2622. [PMID: 36210721 PMCID: PMC9619608 DOI: 10.1093/humrep/deac209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are women's views on having children, including the age they want to have them and other influences such as the coronavirus disease 2019 (COVID-19) pandemic? SUMMARY ANSWER Women's views on having children, at their preferred age of 30 years, included their maternal urge and concerns about their biological clock and stability, while 19% said COVID-19 had affected their views. WHAT IS KNOWN ALREADY Women globally are delaying the birth of their first child, with the average age of first birth approaching 32 years in some countries. The average age women have their first child in the UK is 30.7 years and over 50% of women aged 30 years are childless. The fertility rate stands at 1.3 in several European Union countries. Some people are not having their desired family size or are childless by circumstance. It is essential to understand people's attitudes to having children in different countries to identify trends so we can develop educational resources in an age-appropriate manner. STUDY DESIGN, SIZE, DURATION We conducted an anonymous, online survey of multiple choice and open-ended questions. The survey was live for 32 days from 15 May 2020 to 16 June 2020 and was promoted using social media. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 887 women from 44 countries participated in the survey. After filtering out women who did not consent, gave blank or incomplete responses, and those not in the UK, 411 responses remained. From the data, three areas of questioning were analysed: their views on having children, the ideal age they want to have children and the effects of the COVID-19 pandemic. Qualitative data were analysed by thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE The average age (±SD) of the women who completed the survey was 32.2 years (±5.9), and they were mainly heterosexual (90.8%) and 84.8% had a university education. One-third of women were married/in a civil partnership (37.7%) and 36.0% were cohabitating. In relation to their views on having children, the main themes identified were: the maternal urge, the ticking of the biological clock, why did no one teach us this?, the need for stability and balance in their life, pressure to start a family and considering other ways to have a family. When asked 'In an ideal world, at what age approximately would you like to have had or have children?' a normal distribution was observed with a mean age of 29.9 (±3.3) years. When asked 'What factors have led you to decide on that particular age?' the most frequent choice was 'I am developing my career'. Three themes emerged from the qualitative question on why they chose that age: the need for stability and balance in their life, the importance of finding the right time and life experiences. The majority of women felt that the COVID-19 pandemic had not affected their decision to have children (72.3%), but 19.1% said it had. The qualitative comments showed they had concerns about instability in their life, such as finances and careers, and delays in fertility treatment. LIMITATIONS, REASONS FOR CAUTION The survey was promoted on social media only and the women who answered the survey were highly educated. WIDER IMPLICATIONS OF THE FINDINGS The women surveyed ideally want children at age 30 years but there are obstacles in their way, such as the need to develop their career. Global tailored fertility education is essential to ensure people make informed reproductive choices. In addition, it is essential for supportive working environments and affordable childcare to be in place in every country. STUDY FUNDING/COMPETING INTEREST(S) J.C.H. is founder of www.globalwomenconnected.com and Reproductive Health at Work, and author of the book Your Fertile Years. This project was funded by the Institute for Women's Health, UCL. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Joyce C Harper
- EGA Institute for Women's Health, University College London, London, UK
| | - Juan Sebastián Botero-Meneses
- EGA Institute for Women's Health, University College London, London, UK.,Universidad del Rosario, School of Medicine and Health Sciences, Neuroscience Center Neurovitae-UR, Neuroscience Research Group NEUROS, Bogotá, Colombia
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Bodin M, Björklund J. "Can I take responsibility for bringing a person to this world who will be part of the apocalypse!?": Ideological dilemmas and concerns for future well-being when bringing the climate crisis into reproductive decision-making. Soc Sci Med 2022; 302:114985. [PMID: 35468522 DOI: 10.1016/j.socscimed.2022.114985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 11/25/2022]
Abstract
In the wake of the ongoing climate crisis and its negative effects on public health, it has been questioned by climate activists whether it is right to bring more children into the world. Moreover, according to previous scholarship, having one fewer child is the most high-impact lifestyle change individuals in developed countries can make in order to reduce greenhouse gas emissions. But do climate awareness and recommendations to have fewer children have any impact on how lay people reason around reproductive decision-making? In this paper, which is based on focus group discussions with people from different generations, we show how various and sometimes conflicting discourses on reproductive norms and responsibility are negotiated. Even though participants were highly aware of the ongoing discussions around the climate crisis, in the end it had little bearing on their decision to have children or not, and they justified reproduction through addressing other ways to contribute to a better world.
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Affiliation(s)
- Maja Bodin
- Centre for Sexology and Sexuality Studies, Malmö University, Sweden.
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. HUMAN REPRODUCTION (OXFORD, ENGLAND) 2022. [PMID: 35238351 DOI: 10.1093/humrep/deac036/6541644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK.,SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Hammarberg K, de Silva R. Parenthood aspirations and understanding of factors that affect the chance of achieving them: A population survey. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:265-270. [PMID: 35419498 PMCID: PMC8904178 DOI: 10.1016/j.rbms.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Most women and men want and expect to have children. Parental age and some health behaviours affect fertility and the chance of conception. The aim of this study was to gauge people's parenthood aspirations and knowledge about the factors that affect their chance of achieving them. Members of an Australian probability-based online panel aged 18-45 years were invited to complete a survey with questions about parenthood goals and knowledge about factors known to affect fertility. Of the 965 eligible people, 716 (74.2%) completed the survey. Only 6% stated that they did not want biological children. Around one in 10 respondents had experienced infertility. Amongst respondents aged 35-45 years, almost one in five (18%) had experienced infertility. Overall, respondents reported high levels of confidence about their understanding of preventative measures associated with safe sex and avoiding unwanted pregnancies. However, confidence in understanding of factors affecting ability to conceive was lower. Almost one-third of respondents believed that female fertility starts to decline between the ages of 35 and 39 years, and another one-third of respondents believed that the decline starts at 40 years of age or later. One in four respondents believed that male fertility starts to decline at 50 years of age or later. Findings suggest that people of reproductive age in Australia have inadequate knowledge about the factors that affect the chance of achieving their parenthood goals. Fertility health education initiatives are needed to allow people to make informed decisions about childbearing, and reduce the risk of unfulfilled parenthood aspirations.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renee de Silva
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. OUP accepted manuscript. Hum Reprod 2022; 37:988-996. [PMID: 35238351 PMCID: PMC9071225 DOI: 10.1093/humrep/deac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- Correspondence address. UCL EGA Institute for Women’s Health, Faculty of Population Health Sciences, Room 236 Medical School Building, University College London, 74 Huntley Street, London WC1E 6AU, UK. E-mail:
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK
- SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
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