“I know my body and I just can't get pregnant that easily” – Women's use and non-use of the injection to manage fertility

“…This approach assumes that contraceptive use is positive, even if it does not align with people's stated desires to not use contraception (Potter et al 2019;Senderowicz 2020). In reality, some people, particularly in highly pronatalist settings, may prefer to err on the side of becoming pregnant, and thus decide not to use contraception even if they indicate that they do not currently intend to become pregnant (Bornstein et al 2022). Indeed, attitudes toward a hypothetical pregnancy may be more predictive of contraceptive use, in some settings, than perceived importance of pregnancy prevention (Geist et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi

Bornstein

Huber‐Krum

Gipson

et al. 2023

Studies in Family Planning

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Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need (“do you feel it is necessary for you to be using contraception right now?”) We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017–2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.001). Women who directly reported contraceptive need had a higher average composite score than women who directly reported they had no need (mean = 7.4 vs. 6.3; p < 0.01), but nearly all participants had scores indicating some risk of unintended pregnancy. Contraceptive counseling protocols should consider assessing women's direct report of contraceptive need, along with risk factors for unintended pregnancy, such as sexual frequency, perceived fecundity, and desire to avoid pregnancy, to better counsel clients.

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“…Researchers must also consider the complex factors that inform an individual's self-reported response to an infertility survey question, including how PLOS GLOBAL PUBLIC HEALTH they might define actively and consistently 'trying' to become pregnant and using/not using contraceptive methods consistently. Evidence from this and other populations indicate that contraceptive behavior does not necessarily align with fertility preferences, nor indicate that contraceptive use is used according to clinical guidelines even when a pregnancy is not desired [39]. Lastly, there is a need for longitudinal data that allows the examination of the reproductive life course and how the meaning and consequences of reproductive experiences may differ based preceding or proceeding experiences [44].…”

Section: Discussionmentioning

confidence: 99%

“…However, given the commonality of contraceptive use in the cohort overall [38], it is likely that women's exposure to the possibility of becoming pregnant was less than the time presumed in the analysis (i.e., the length of time a woman persisted in the cohort). Although many methods of contraception are vulnerable to imperfect use or intentionally inconsistent use (e.g., injectables) [39], some women likely used these methods efficaciously or used methods of contraception with close to perfect efficacy (e.g., the implant) [40]. These women may have been almost entirely invulnerable to pregnancy for part of or even for the entirety of the follow up period; however, we are unable to assess this from the available data.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi

Bornstein,

Gemmill,

Norris

et al. 2023

PLOS Glob Public Health

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Background Infertility is a common experience among individuals and couples. Infertility may resolve without intervention, but little is known about pregnancy intentions and incidence of pregnancy following infertility, particularly in low-resource settings. Methods Data come from UTHA, a longitudinal cohort study in Central Malawi, with baseline and follow up surveys conducted from 2014–2019 (N = 1,030 reproductive-aged women). We assessed bivariable and multivariable relationships between reported infertility at baseline and subsequent pregnancy and retrospective pregnancy intentions. Pregnancy intention was measured with the London Measure of Unplanned Pregnancy (LMUP), a scale validated in Malawi (Range = 0–12). Results Approximately 20% of the sample reported that they had ever experienced infertility (tried to become pregnant for at least two years without conceiving in that time) at baseline. The proportion of women who reported a new pregnancy during the follow up period (mean = 4.3 years) was the same (65%) for women who had and had not experienced infertility. Among women who became pregnant, levels of pregnancy intendedness were similar between women who had and had not experienced infertility. Prospective desire for a/another child at baseline was associated with subsequent pregnancy (AOR: 1.59; 95%CI: 1.06–2.39) and was also associated with higher levels of pregnancy intendedness measured retrospectively (LMUP of 9.4 vs. 8.4). Conclusions Experienced infertility was not associated with differential odds of having a subsequent pregnancy or the intendedness of a subsequent pregnancy. Thus, women who have experienced infertility should be included in family planning programs and research to support all women in achieving their reproductive goals.

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“I know my body and I just can't get pregnant that easily” – Women's use and non-use of the injection to manage fertility

Cited by 5 publications

References 36 publications

Family planning method discontinuation among Nigerian women: Evidence from the Nigeria Demographic and Health Survey 2018

Family planning method discontinuation among Nigerian women: Evidence from the Nigeria Demographic and Health Survey 2018

Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi

Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi

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