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Perspectives in Sexual and Reproductive Health

Randomized Controlled Trial of Home‐Based Hormonal Contraceptive Dispensing for Women At Risk of Unintended Pregnancy
CONTEXT Women frequently experience barriers to obtaining effective contraceptives from clinic‐based providers. Allowing nurses to dispense hormonal methods during home visits may be a way to reduce barriers and improve ‐effective contraceptive use. METHODS Between 2009 and 2013, a sample of 337 low‐income, pregnant clients of a nurse home‐visit program in Washington State were randomly selected to receive either usual care or enhanced care in which nurses were permitted to provide hormonal contraceptives postpartum. Participants were surveyed at baseline and every three months postpartum for up to two years. Longitudinal Poisson mixed‐effects regression analysis was used to examine group differences in gaps in effective contraceptive use, and survival analysis was used to examine time until a subsequent pregnancy. RESULTS Compared with usual care participants, enhanced care participants had an average of 9.6 fewer days not covered by effective contraceptive use during the 90 days following a first birth (52.6 vs. 62.2). By six months postpartum, 50% of usual care participants and 39% of enhanced care participants were using a long‐acting reversible contraceptive (LARC). In analyses excluding LARC use, enhanced care participants had an average of 14.2 fewer days not covered by effective contraceptive use 0–3 months postpartum (65.0 vs. 79.2) and 15.7 fewer uncovered days 4–6 months postpartum (39.2 vs. 54.9). CONCLUSION Home dispensing of hormonal contraceptives may improve women's postpartum contraceptive use and should be explored as an intervention in communities where contraceptives are not easily accessible.

Perceived Costs and Benefits of Early Childbearing: New Dimensions and Predictive Power
CONTEXT Understanding the causes of early childbearing is important for reducing the persistently high rates of early births in the United States. Perceptions of possible benefits may contribute to these rates, while high opportunity costs may dissuade women from early childbearing. METHODS Perceptions of costs and benefits of pregnancy, as well as later experiences of pregnancy, were assessed for 701 nulligravid women aged 18–22 who entered the Relationship Dynamics and Social Life study in 2008–2009 and were interviewed weekly for up to 30 months. Bivariate t tests, chi‐square tests and multivariable discrete‐time event history analyses were used to assess associations of perceived personal consequences of childbearing (e.g., predicted financial costs), goals in potentially competing domains (opportunity costs) and social norms with subsequent pregnancy. RESULTS Twenty percent of women reported that early childbearing would have more positive than negative personal consequences. Compared with other women, those who had a pregnancy during follow‐up had, at baseline, more positive perceptions of the personal consequences of pregnancy and of their friends’ approval of pregnancy, and greater desire for consumer goods. In multivariable analyses, only the scales assessing perceived personal consequences of childbearing and friends’ approval of childbearing were associated with pregnancy (odds ratios, 2.0 and 1.2, respectively). Goals in potentially competing domains were not associated with pregnancy. CONCLUSION Young women's perceptions of consequences of early childbearing predict subsequent pregnancy. That these perceptions are distinct from childbearing desires and from other dimensions of costs and benefits illustrates the complex attitudinal underpinnings of reproductive behavior.

Guttmacher Policy Report

In Countering Zika, Women’s Right to Self-Determination Must Be Central

In Latin America and the Caribbean, as well as in the United States, the Zika epidemic has exposed the often hostile policy, programmatic and legal environment women face on issues surrounding pregnancy, argues a new analysis in the Guttmacher Policy Review

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