Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.

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Background Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. Methods We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. Results A person’s contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any “right” method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. Conclusions Contraception is a unique health intervention that requires ongoing decision-making without a particular “right” answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person’s contraceptive journey.

The needs of Urban American Indian/Alaska Native (AI/AN) populations are often not well understood. In order to inform programs and services, the Urban Indian Center of Salt Lake (UIC-SL), in cooperation with researchers from the University of Utah, undertook a community needs assessment of AI/AN living along Utah's Wasatch Front. A 60-item questionnaire was developed to capture information about health status, services used, unmet needs, and common sources of information about AI/AN community events and activities. Study participants (n = 336) were a convenience sample. Descriptive statistics, including mean, standard deviation, percentage, and 95% confidence intervals, were calculated. The most common health provider diagnosed medical conditions included hypertension, obesity, and diabetes. The prevalence of violence, substance abuse, and mental health conditions were also high among study participants and their families. Compared to the general Utah population, study participants experienced disparities relative to diabetes prevalence, cognitive and visual disabilities, and access to health care. In addition to health care services, respondents indicated a need for cultural, social, and educational programs. They also reported high levels of technology use, suggesting a possible avenue for communicating with this population. This community-based participatory research project provided rich information about the unmet needs of this urban AI/AN population. The results will be used to guide UIC-SL strategic planning, and a database created for this project will be available for future data collection, allowing for comparison of results between sites and over time.

IntroductionMany individuals in the USA do not have access to the contraceptive methods they desire. Contraceptive initiatives have emerged at the state and national levels to remove barriers to access, and many initiatives have reported success. Other initiatives may want to build on or replicate that success, but data are scarce on the details of how and why certain interventions work. This paper describes the protocol for the planned process evaluation of Family Planning Elevated (FPE), a statewide contraceptive initiative in Utah.MethodsFPE will conduct a process evaluation during the planning and implementation phases of the programme. The process evaluation will document (1) the community, state and national contexts in which the programme is implemented, (2) how FPE is implemented and (3) the mechanism by which FPE creates impact. We will collect qualitative data via interviews with FPE staff, providers and staff participating in the programme, and key stakeholders and policy-makers throughout the state. The team process evaluator will record FPE decision making and implementation activities by taking field notes during weekly FPE meetings. Quantitatively, we will collect monthly data reports from FPE-participating clinics, analytics reports from the media campaign and survey results from patients in FPE-participating clinics. The findings of the process evaluation will allow other contraceptive initiatives to learn from FPE’s efforts and replicate successful components of the programme.Ethics and disseminationThe study received approval from the University of Utah’s Institutional Review Board. Findings from the process evaluation and outcome evaluation will be published, shared with other contraceptive initiatives and presented at conferences.Trial registration numberNCT03877757.