Contraceptive Attitudes and Beliefs of Women With Sickle Cell Disease: A Qualitative Study.

OBJECTIVES: We aimed to qualitatively explore factors influencing contraceptive use in women living with sickle cell disease (SCD). STUDY DESIGN: We conducted a semi-structured qualitative study using data from interviews with reproductive-aged women with SCD. The Theory of Planned Behavior, which describes an individual's attitudes, subjective norms, and perceived behavioral control as drivers of a health behavior, served as a framework for data collection and thematic analysis. RESULTS: We analyzed interviews from 20 participants. Attitudes toward contraception showed skepticism regarding hormonal contraception and concern about adverse effects of contraception related to SCD. The role of subjective norms in contraceptive choice depended on whether participants possessed trusted sources of information, such as health care providers, family, and friends, or whether they relied on themselves alone in their contraceptive decision-making. The influence of health care providers was complicated by inconsistent and sometimes conflicting counseling. Finally, with regard to participants' perceived control in their contraceptive choices, some were motivated to alleviate menstrual pain or prevent SCD-related pregnancy risks, but many reported feeling disempowered in contraceptive decision-making settings because of their demographic characteristics or pressure from health care providers. CONCLUSIONS: Women living with SCD are influenced by many factors similar to those documented for other populations when making decisions about contraception. However, SCD amplifies both the importance and risks of contraception and may also complicate individuals' autonomy and contraceptive access. Hematology and reproductive health providers should recognize the risk of coercion, maximize patients' reproductive agency, and coordinate reproductive health counseling for patients with SCD.

Growing on (in)fertile ground: an evolutionary concept analysis of Black female fertility.

Female fertility is a complex phenomenon. Biological, personal, social and political factors shape this experience. Race, a social construction, was created to justify discriminative political and economic practices. Therefore, 'Black' differentiates the fertility experiences of Black women from other racial/ethnic groups, a group often marginalized in the United States. We explored a contemporary understanding of Black female fertility using Rodgers' evolutionary method of concept analysis. A total of 36 articles were included in the final analysis extracted from PubMed, CINAHL Complete, PsychINFO, Web of Science and Google Scholar. Data and themes were categorized into groups within attributes, antecedents and consequences from multidisciplinary literature. Attributes were biological instability and sociopolitical influences on Black female fertility. Racial and bioethical injustices were notable antecedents. The consequences of racial and bioethical injustices persist in reproductive health disparities today. This review documents the need for health practices that end institutional racism that contribute to negative experiences for Black women seeking fertility related care. Many interdisciplinary professionals are perfectly positioned to be part of health care solutions to reduce contemporary health disparities.

Stress and Anxiety in Couples Who Conceive via In Vitro Fertilization Compared With Those Who Conceive Spontaneously.

OBJECTIVE: To determine the feasibility of recruitment and explore whether women and their partners who conceive via in vitro fertilization (IVF) experience greater levels of stress and anxiety during pregnancy compared to each other and compared to couples who conceive spontaneously. DESIGN: Longitudinal, descriptive, pilot study. SETTING: Recruitment was conducted at three sites in the United States (two fertility clinics and one well-woman clinic). PARTICIPANTS: Informed consent was obtained from 48 women and their partners (22 IVF couples and 26 spontaneous conception [SC] couples). METHODS: During each trimester, participants completed the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Pregnancy-Related Anxiety Measure to assess their levels of stress and anxiety. We used hierarchical linear mixed-effects models for repeated measures adjusting for woman and partner nesting effects to conduct trajectory analyses to test for group differences in stress and anxiety levels. RESULTS: Recruitment goals were met (31 IVF and 27 SC couples gave informed consent and 22 IVF and 26 SC couples completed questionnaires). We found no significant group main or group by time interaction effects on anxiety and stress. However, pregnant women had significantly higher mean state and pregnancy-related anxiety scores than their male partners. Of interest, the women showed a gradual reduction in state and pregnancy-related anxiety across trimesters, whereas pregnancy-related anxiety of their partners gradually increased. CONCLUSION: Among our participants, IVF did not increase risk for stress, state anxiety, or pregnancy-related anxiety, which provides reassurance during patient counseling. Although pregnant women overall experienced greater state and pregnancy-related anxiety than men, we found that levels in women decreased closer to birth, which may contribute to successful emotional transition to parenthood. Men's experiences with anxiety require additional investigation given the recent attention to male postpartum depression.

Are There Differences in Marital-Role Quality between Women and Their Male Partners Who Conceived Via IVF and Those Who Did Not?

OBJECTIVES: Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are inconclusive. This study compared MRQ across pregnancy in these two groups. METHODS: The sample's two groups: (a) 26 women and 26 male partners who conceived via IVF; and (b) 25 women and 20 male partners who conceived spontaneously. All 97 participants completed a MRQ scale during each trimester of pregnancy. Trajectory analyses were conducted to test for between-group differences in the changes in subscales across pregnancy within dyads. RESULTS: Scores did not reveal any significant differences in subscales in those who conceived via IVF compared to non-IVF groups across the three trimesters in each dyad. The observed effect sizes were small, with exception that males in the non-IVF comparison group had greater concerns during the first trimester than did males in the IVF group (Cohen d= 0.51, moderate effect size). CONCLUSIONS: Though the IVF population perceives pregnancy differently and experiences more anxiety than those who conceive spontaneously, their marital-role quality during pregnancy does not seem to be affected. Their perceptions before conception and in early parenting are worthy of investigation.