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Intimate partner violence and contraceptive behaviors among young women
Abstracts / Contraception 90 (2014) 292–297 result of “heart winning out over head,” but for some women, it was the product of reluctance to admit negative feelings, influenced by a social imperative of viewing children as “a blessing.” Contraceptives were universally used, and almost all women desired a more highly effective method than they could afford. Conclusions: Women may express happiness at the prospect of pregnancy while earnestly trying to prevent conception. Understanding and engaging with how women conceptualize feelings and intentions is critical for accurate measurement of unintended pregnancy, effective contraceptive counseling and design of strategies for prevention. http://dx.doi.org/10.1016/j.contraception.2014.05.211
O11 Are women aware of religious restrictions on reproductive health at faith-based hospitals? A survey of women's expectations and preferences for family planning care Guiahi M University of Colorado Anshutz Medical Center, Aurora, CO, USA Sheeder J, Teal S Objectives: To understand if women anticipate a difference in reproductive health care when attending a faith-based medical institution. Methods: A convenience sample of reproductive-aged women in the Denver metro area completed a 35-item online survey. Women were randomized to hypothetical women's health clinics at either a secular or faith-based hospital and asked about expectations for family planning care. Questions covered contraception and management of abnormal or unintended pregnancy. We also assessed provider and site preferences for care. Results: A total of 236 surveys were completed; 115 women were randomized to a secular hospital and 121 were randomized to a faithbased hospital. More than 90% of participants expected to receive contraceptive services, and more than half expected uterine evacuation procedures including elective termination. The only different expectation between groups was that participants randomized to the faith-based hospital were more likely to expect natural family planning advice (odds ratio: 7.4, 95% confidence interval 1.6–33.7). At least half of respondents reported that they would seek care from their own gynecologist for all family planning services, with the exceptions of emergency contraception (41%) and elective abortion (45%); “my OB/ GYN” was still the most frequent response for these, followed by “a clinic like Planned Parenthood.” Conclusions: Overall, this convenience sample of women did not anticipate differences in reproductive health care based on institution type. Many communities are primarily served by faith-based health care organizations, and mergers between faith-based and secular hospitals continue to rise. If women who enroll at faith-based hospitals do not receive information related to potential health care restrictions, their ability to act as informed health care consumers may be constrained. http://dx.doi.org/10.1016/j.contraception.2014.05.212
O12 Family planning and reproductive autonomy among highly religious women: a qualitative study Kahn C University of Michigan, Ann Arbor, MI, USA Torell E, Zochowski M, Stidham Hall K, Dalton V, Harris L Objectives: Reproductive autonomy is the ability to control one's own fertility desires. Identification in a religious community may impact a woman's ability
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to make decisions regarding family planning, yet the role of religiosity in reproductive autonomy has not been considered. This study qualitatively explored how women's religious values and identification in a religious community influenced their reproductive decision making and autonomy. Methods: We conducted semistructured individual and group interviews with 25 married women aged 18–45 years from the Midwest who self-identified as highly religious Christian, Jewish or Muslim. Interviews were recorded and transcribed and thematically analyzed using a modified grounded theory approach, with the assistance of Dedoose. Results: Women reported that decisions related to family planning were intimately connected to gender roles within their religions and communities, especially their identities as wives and mothers. This sometimes produced tension between their own reproductive goals and their desires to please God and fulfill the roles that their religious communities expected of them. Additionally, women reported receiving inadequate education about sex and contraception because of silence and stigma in their communities regarding these topics, which at times prevented them from realizing their reproductive goals. Conclusions: Reproductive autonomy among highly religious women is influenced by a multitude of factors other than partnership dynamics, including gender role conflicts and poor access to information about sex and contraception. A broader conceptualization of reproductive autonomy that accounts for religious values and norms is needed to better assess reproductive autonomy among highly religious women. http://dx.doi.org/10.1016/j.contraception.2014.05.213
O13 Intimate partner violence and contraceptive behaviors among young women Kusunoki Y University of Michigan, Ann Arbor, MI, USA Barber J, Gatny H, Melendez R Objectives: To investigate the effects of intimate partner violence (IPV) on contraceptive use, consistency of use and the specific method used. Methods: Data were drawn from a longitudinal cohort study of 992 women aged 18–19 years. Women completed baseline and weekly surveys assessing relationships, contraceptive use and pregnancy. Our analytic sample included 711 women contributing 12,008 journals in 18 months. Weekly experiences with IPV and contraceptive behaviors were selfreported. Logistic regression models estimated the effects of IPV on contraceptive behaviors, with a focus on the following three time dimensions of IPV: current week, history with current partner and history with prior partners. Results: IPV is prevalent in our sample; 45% of women experienced psychological violence (disrespect, threats), and 16% physical violence (hitting, throwing) during the study. Twenty-one percent of relationships involved any IPV: 21% psychological and 6% physical. Also, among relationships that included any violence, it occurred, on average, in 29% of weeks. Women used fewer contraceptives and used them less consistently, during weeks in which they experienced violence and, more generally, with current partners who were ever violent. Violence was associated with less pill and condom use, and more use of withdrawal. Although women who experienced violence had higher rates of intrauterine device (IUD) use than those who did not, IUD use was very low among both populations. Conclusions: Violent relationships increase the risk of unintended pregnancy because they involve notably reduced and less consistent contraceptive use and use of less effective methods.
http://dx.doi.org/10.1016/j.contraception.2014.05.214
O11 Are women aware of religious restrictions on reproductive health at faith-based hospitals? A survey of women's expectations and preferences for family planning care Guiahi M University of Colorado Anshutz Medical Center, Aurora, CO, USA Sheeder J, Teal S Objectives: To understand if women anticipate a difference in reproductive health care when attending a faith-based medical institution. Methods: A convenience sample of reproductive-aged women in the Denver metro area completed a 35-item online survey. Women were randomized to hypothetical women's health clinics at either a secular or faith-based hospital and asked about expectations for family planning care. Questions covered contraception and management of abnormal or unintended pregnancy. We also assessed provider and site preferences for care. Results: A total of 236 surveys were completed; 115 women were randomized to a secular hospital and 121 were randomized to a faithbased hospital. More than 90% of participants expected to receive contraceptive services, and more than half expected uterine evacuation procedures including elective termination. The only different expectation between groups was that participants randomized to the faith-based hospital were more likely to expect natural family planning advice (odds ratio: 7.4, 95% confidence interval 1.6–33.7). At least half of respondents reported that they would seek care from their own gynecologist for all family planning services, with the exceptions of emergency contraception (41%) and elective abortion (45%); “my OB/ GYN” was still the most frequent response for these, followed by “a clinic like Planned Parenthood.” Conclusions: Overall, this convenience sample of women did not anticipate differences in reproductive health care based on institution type. Many communities are primarily served by faith-based health care organizations, and mergers between faith-based and secular hospitals continue to rise. If women who enroll at faith-based hospitals do not receive information related to potential health care restrictions, their ability to act as informed health care consumers may be constrained. http://dx.doi.org/10.1016/j.contraception.2014.05.212
O12 Family planning and reproductive autonomy among highly religious women: a qualitative study Kahn C University of Michigan, Ann Arbor, MI, USA Torell E, Zochowski M, Stidham Hall K, Dalton V, Harris L Objectives: Reproductive autonomy is the ability to control one's own fertility desires. Identification in a religious community may impact a woman's ability
295
to make decisions regarding family planning, yet the role of religiosity in reproductive autonomy has not been considered. This study qualitatively explored how women's religious values and identification in a religious community influenced their reproductive decision making and autonomy. Methods: We conducted semistructured individual and group interviews with 25 married women aged 18–45 years from the Midwest who self-identified as highly religious Christian, Jewish or Muslim. Interviews were recorded and transcribed and thematically analyzed using a modified grounded theory approach, with the assistance of Dedoose. Results: Women reported that decisions related to family planning were intimately connected to gender roles within their religions and communities, especially their identities as wives and mothers. This sometimes produced tension between their own reproductive goals and their desires to please God and fulfill the roles that their religious communities expected of them. Additionally, women reported receiving inadequate education about sex and contraception because of silence and stigma in their communities regarding these topics, which at times prevented them from realizing their reproductive goals. Conclusions: Reproductive autonomy among highly religious women is influenced by a multitude of factors other than partnership dynamics, including gender role conflicts and poor access to information about sex and contraception. A broader conceptualization of reproductive autonomy that accounts for religious values and norms is needed to better assess reproductive autonomy among highly religious women. http://dx.doi.org/10.1016/j.contraception.2014.05.213
O13 Intimate partner violence and contraceptive behaviors among young women Kusunoki Y University of Michigan, Ann Arbor, MI, USA Barber J, Gatny H, Melendez R Objectives: To investigate the effects of intimate partner violence (IPV) on contraceptive use, consistency of use and the specific method used. Methods: Data were drawn from a longitudinal cohort study of 992 women aged 18–19 years. Women completed baseline and weekly surveys assessing relationships, contraceptive use and pregnancy. Our analytic sample included 711 women contributing 12,008 journals in 18 months. Weekly experiences with IPV and contraceptive behaviors were selfreported. Logistic regression models estimated the effects of IPV on contraceptive behaviors, with a focus on the following three time dimensions of IPV: current week, history with current partner and history with prior partners. Results: IPV is prevalent in our sample; 45% of women experienced psychological violence (disrespect, threats), and 16% physical violence (hitting, throwing) during the study. Twenty-one percent of relationships involved any IPV: 21% psychological and 6% physical. Also, among relationships that included any violence, it occurred, on average, in 29% of weeks. Women used fewer contraceptives and used them less consistently, during weeks in which they experienced violence and, more generally, with current partners who were ever violent. Violence was associated with less pill and condom use, and more use of withdrawal. Although women who experienced violence had higher rates of intrauterine device (IUD) use than those who did not, IUD use was very low among both populations. Conclusions: Violent relationships increase the risk of unintended pregnancy because they involve notably reduced and less consistent contraceptive use and use of less effective methods.
http://dx.doi.org/10.1016/j.contraception.2014.05.214