Understanding women's views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis

BACKGROUND

Nearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women's views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.

METHODS

Five databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.

RESULTS

Of 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.

CONCLUSIONS

Most women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.

Views of clinicians towards providing contraceptive advice and contraception to women following early pregnancy loss: a qualitative study

INTRODUCTION

National guidelines advise that clinicians caring for women post-pregnancy should give women opportunities to discuss contraception, regardless of pregnancy outcome, and provide contraception to women who choose to take up a method. This study aimed to explore knowledge, views and needs of Early Pregnancy Unit (EPU) clinicians around discussing and offering contraception and discussing pregnancy intendedness with women after early pregnancy loss using a qualitative approach.

METHODS

Semi-structured, audio-recorded interviews with 11 clinicians from a single regional EPU in Edinburgh, Scotland. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Clinicians were reluctant to discuss contraception as they believed women would find the topic overwhelming and distressing. Thoughts on discussing pregnancy intendedness were polarised; some considered it insensitive, and others essential. Barriers to discussing contraception and providing it were numerous and included time pressure, and inadequate knowledge and training on contraception. Participants suggested training on contraception, closer working with sexual and reproductive health (SRH) services, and availability of information on contraception specifically aimed at women who have experienced an early pregnancy loss could facilitate discussions and method provision.

CONCLUSIONS

EPU clinicians require ongoing training and support to be effective at discussing pregnancy intendedness and discussing and providing post-pregnancy contraception. This will require close working with SRH services and development of sensitive information around contraception for women experiencing an early pregnancy loss.

A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial

Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulness-based stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery.

Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups.

Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories.

Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancy-related anxiety is recommended to increase the birth rate.

Timing of the decision to remain voluntarily childless: evidence for continuous socialization

This study contrasts different types of voluntary childlessness. Women who decided to remain childless relatively early in life, before marriage ( early articulators) were compared with women who did not decide until after they had married and developed a preferred life style that did not include children ( postponers). The comparison centered on a previously formulated model that explained the decision to remain childless in terms of family background factors, autonomy and achievement orientation in adulthood, and reference group support. The major difference disclosed by this research was with respect to family background factors. In addition to the early versus later decision to remain childless, socialization patterns in the family of orientation differentiate the two types of voluntarily childless women.

Fertility pattern of women in China: a parity progression analysis

"Using the 1% sample data from China's fourth census and [the] period parity progression method...,this paper analyzes the reproductive age and parity patterns of Chinese women. In addition to the commonly used period parity progression and the total fertility rate obtained through the usage of this method, some other frequently ignored means of deducing and calculating statistical indexes are introduced here."

Couple formation and fertility outside marriage in Great Britain: differences and similarities with the French situation

"In this paper, we shall attempt to give a detailed presentation of the recent evolution of the mechanisms of family formation in Great Britain. Basing our investigations on an original use of retrospective longitudinal data, we shall, in effect, explore the changes in the behaviours of successive generations and, as far as possible, relate these to comparable data on the French situation. This study aims at a more specific analysis of the respective evolutions in the two countries in order to show how, despite similarities in trends, these evolutions remain profoundly marked by their own socio-political and cultural traits. This will also bring to light the differences and similarities between France and Great Britain in family formation and, more specifically, in the evolution of extra-marital births and cohabitation."

The impact of first-birth timing on divorce: new evidence from a longitudinal analysis based on the Central Population Register of Norway

"The association between divorce risks in first marriage and the timing of the first birth is inspected in a life-table analysis of registered birth and marriage histories from Norway. One of the main conclusions is that the high propensity to divorce among women who have had a premarital birth is not confined to those who marry someone other than the father of their child. Also, women who have had a premarital child with their husband, run a much higher risk of marital breakup than do those who had their first baby in wedlock.... It is argued that couples who postpone childbearing beyond two years of marriage may have particularly low divorce rates." (SUMMARY IN FRE)

Fertility, sex role attitudes, and labor force participation

Data from the 1970 National Fertility Study were used to investigate the relationships between sex role attitudes and the childbearing and labor force participation of women. While several relevant dimensions of sex role attitudes were identified, it was found that the most crucial aspect for working and fertility was the extent to which the woman identified the female role as that of housewife and homemaker. Those having traditional definitions concerning this role were less likely to be working, and had fewer plans to work in the future. In addition, as expected, women with traditional sex role definitions had more children than others. While the orientation of the woman toward the home was the primary correlate of work and fertility, those who felt that women had little control over their lives had higher fertility than others—a relationship which could be explained partially, but not entirely, in terms of unplanned childbearing.

Contraceptive self-efficacy: a primary prevention strategy

This paper discusses the development, implementation, and qualitative evaluation of an intervention designed to improve contraceptive self-efficacy (CSE) in a population at high risk for pregnancy. In a previous study, a relationship was found between CSE and a measure of contraceptive use for sexually active young women attending a family planning clinic. Here, the concept of CSE is further developed to identify contraceptive and sexual issues for adolescent males, for adolescents who show little or no motivation to obtain or use contraceptives, and for those adolescents who would plan to carry a pregnancy to term if they were to become pregnant. Implications are drawn for developing primary prevention programs.

[An analysis of Korean women's reproductivity]

An analysis of reproductivity is mainly concerned with the measurement of net force of fertility expressed in terms of a generation rather than in a given year. The present study examined current trends of Korean Women's reproductivity interpreting general reproduction and net reproduction rates, intrinsic rate of natural increase and mean length of gestation. The data used for this analysis were drawn from the national fertility surveys from 1970 through 1990 conducted by the Korea Institute for Population and Health. The figures of the present study revealed that the reproduction rates of Korea during the last 20 years decreased from 2.22 in 1970 to 0.71 in 1990 and net reproduction rates also dropped from 1.9 to 0.69 during the same period of time. Furthermore, from this study, it is noticed that the replacement level of fertility had been reached since the early 1980s. The intrinsic rate of natural increase as measure of population growth under existing conditions of fertility and mortality and free of the influence of the current age distribution, is computed. The level of rate was not much changed and was 0.3 in 1970 compared with 0.25 in 1990, which is still higher than other developed countries. The mean age of mother at the birth of their daughters defined as the length of generation has been slightly changed from 23.9 in 1971 to 25.8 in 1990.

Promoting family planning for better health: policy and programme implications

Renewed emphasis is being given to the role of family planning health care programs. This review of the lessons learned during the past decade provides guidance to policy makers and program managers on ways to improve maternal, infant, and child health through family planning and related health and development activities. It covers policies and laws, accessibility to services, acceptability and quality of services, provision for the special needs of high-risk groups, the use of communications programs, the importance of improving the status of women and the quality of life, and the resources needed to implement such a program globally. Practical steps for integrating family planning fully into maternal and child health care are described.

[Nuptiality and fertility differentials. Behavioral changes in the last three centuries. The case of Sul do Pico (Azores)]

"Through the application of...'parish reconstitution' differentials in demographic conducts are analysed. Those behaviours are related with marriage rate and fertility manifested in the population of Sul do Pico (Azores) during the last 3 centuries. Results show the existence of differences between 'the new' and 'the old' rural areas." (SUMMARY IN ENG AND FRE AND SPA)

The relationship between sex roles, fertility, and family size preferences

Interviews regarding sex-role attitudes, sex-role behaviors, fertility, and fertility preferences were conducted with 583 currently married women aged 18 through 49. Separate correlational analyses for blacks, Anglos, and Hispanic women revealed that for Anglos and blacks sex-role attitudes appeared to be more highly associated with children raised and desired fertility than did division of household tasks and decisions. Past and present role behavior outside of the family (i.e., employment experience) were related to fertility and fertility preferences for all three groups. A path analysis, applied for Anglos only, indicated that number of children raised may influence sex-role behavior and attitudes which, in turn, may influence current fertility desires. However, the variable with the largest direct effect on total children desired was the number of children one already has. Various dimensions of sex roles influenced fertility desires in different ways. Traditionalism of attitudes had a positive effect while relative performance of feminine tasks had a negative effect on total number of children wanted.

Judgment, 25 February 1986

The plaintiff, despite using contraceptives, became pregnant. She sought social insurance reimbursement for the costs of an abortion, which she had undergone because she did not want to have a child. The Court upheld the decision of a lower court denying reimbursement. It ruled that pregnancy is not an illness, unless the pregnancy presents for the woman a danger to life or health beyond that involved in normal pregnancies. It reasoned that since the pregnancy presented no such danger and the abortion had not been performed in order to protect the life or health of the plaintiff, the costs of the abortion were not eligible for reimbursement through social insurance, which by law could be used only to cover costs related to illness.