Psychometric evaluation of the desire to avoid pregnancy scale in India

Contraception · 2025-05-08

OBJECTIVE: This study aimed to evaluate the psychometric performance of the Desire to Avoid Pregnancy (DAP) scale in India. STUDY DESIGN: We utilized survey data from married women enrolled in a family planning intervention in Maharashtra, India, who provided responses to the 14-item DAP scale at 18-month intervention study follow-up. We assessed scale internal consistency using Cronbach α and used exploratory factor analysis to evaluate scale unidimensionality and item response theory (IRT) to assess item performance. We used regression models to assess whether DAP predicts current reported contraceptive use, as well as future contraceptive use and pregnancy, to evaluate construct validity. RESULTS: A total of 1088 participants responded to 18-month intervention study follow-up survey; 99% of eligible participants (887/888) provided the full-scale response. One item, "makes me smile," performed in the reverse direction as anticipated (negative item-test correlation) and was excluded for use in this analysis. The mean 13-item DAP score (DAP-13) was 2.14 of 4 (SD 0.95, range 0-4); internal consistency was high (Cronbach α = 0.92). Most items fit the partial credit model on IRT. Exploratory factor analyses supported either a one- or two-factor model; the unidimensional model was considered acceptable for use as the single factor explained 71% of all variance, and all items had stable absolute factor loadings ≥0.38. DAP-13 score only differed by parity; nulliparous women had the lowest scores (0.56), followed by women with one (1.94), two (2.60), or three or more births (2.56; p < 0.001). A one-point increase in DAP-13 was associated with greater odds of current contraception use reported at time of DAP assessment (adjusted odds ratio [aOR] 1.79, 95% CI 1.43-2.26), subsequent contraception use reported 18 months after DAP assessment (aOR 1.88, 95% CI 1.44-2.44), and half the odds of subsequent pregnancy in the 18-month period after DAP assessment (aOR 0.57, 95% CI 0.46-0.71). CONCLUSIONS: The DAP scale demonstrated good reliability and unidimensionality in this population. Higher DAP scores were associated with higher odds of contraception use and lower odds of pregnancy, supporting construct validity. Future research on the DAP scale in Maharashtra should explore alternative translations of the "makes me smile" item that better capture local expressions of joy about potential childbearing. IMPLICATIONS: A modified version of the DAP scale is acceptable for use in an Indian population and can be utilized in future research and program evaluation that focus on contraception and pregnancy prevention in this context. One item was excluded and requires additional formative research to better capture the intended emotional valence in this cultural context. CLINICAL TRIAL REGISTRATION NUMBER: NCT03514914.

Pain With Early Postpartum Intrauterine Device Placement

O&G Open · 2025-06-01

OBJECTIVE: To compare pain between early and interval postpartum intrauterine device (IUD) placement. METHODS: This is a planned secondary outcome analysis of a randomized trial among 404 participants randomized to early (14–28 days) or interval (42–56 days) postpartum IUD placement. Participants reported pain using a 100-mm visual analog scale at three times during IUD placement (bimanual examination, speculum placement, and IUD placement). We estimated that 112 participants would be required to achieve 80% power with an α of 5% to detect a 15-mm difference in pain with IUD placement. We used linear mixed models adjusting for demographic differences to compare mean pain scores between groups and per-protocol sensitivity analyses to account for crossover. RESULTS: We enrolled 404 participants between March 2018 and July 2021; 325 received IUDs and were included in the analysis of pain with placement. Mean pain scores reported were not different between the early and interval groups: bimanual (9.2 mm vs 6.95 mm, mean difference 2.25 mm [95% CI, −2.68 to7.17], P =.37, respectively); speculum (16.95 mm vs 15.86 mm, mean difference 1.09 mm [95% CI, −3.38 to 6.0], P =.66); and IUD placement (18.43 mm vs 20.9 mm, mean difference −2.47 mm [95% CI, −7.39 to 2.44], P =.32). In the per-protocol analysis, pain scores were not meaningfully different from those in the primary intention-to-treat analysis. CONCLUSION: Pain reported is not different among people who are postpartum having early and interval IUD placement. Understanding the experience of pain with early and interval placement may help clinicians support patients in making informed choices about the timing of IUD placement. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03462758.

Expulsion rates 12 months after early versus interval postpartum intrauterine device placement: a randomized trial

AJOG Global Reports · 2025-07-20

: The early postpartum period, 2-4 weeks postpartum, is an optimal time for intrauterine device (IUD) initiation; placement can be co-located with early postpartum or infant visits. We aimed to compare expulsion rates at 12 months postpartum for IUDs placed early compared to the standard interval 6-week visit. : This is a randomized controlled trial conducted at four U.S. medical centers. Participants were randomly assigned to early (14-28 days) or interval (42-56 days) postpartum IUD placement after vaginal or cesarean birth. We used transvaginal ultrasound to confirm IUD presence and position at 6 months. Chart review and telephone surveys were used to verify IUD presence and position at 12 months. : Between March 2018 and June 2021, 203 participants were assigned to early and 201 to interval IUD placement; 238 (58.9%) contributed outcome data by phone survey (and electronic medical record review) at 12-months postpartum. Among participants who received an IUD and provided 12-month outcome data, complete expulsion rates were 4 in 124 (3.2%; 95% confidence interval [CI], 0.90 to 8.2) and 0 in 114 (0%; 95% CI, 0 to 3.2) in the early and interval groups; a between-group difference of 3.2 percentage points (95% CI, −0.01 to 8.0, p=0.054). Partial expulsion counts and rates were 16 (12.9%; 95% CI, 7.6 to 20.1) and 13 (11.4%; 95% CI, 6.2 to 18.7) in the early and interval groups; a difference of 1.5 percentage points (95% CI, −7.2 to 10.2, p=0.75). Among all 404 participants, IUD utilization rates at 12-month follow-up were 113 (55.7%; 95% CI, 48.5 to 62.6 among participants in the early group) compared to 95 (47.3%; 95% CI, 40.2 to 54.1, p=0.10 among participants in the interval group). Participants were more satisfied with early compared to interval placement, 107 (86.3%; 95% CI 79.0 to 91.8) vs 87 (76.3%, 95% CI 67.4 to 83.8 95%) p=0.048 . : Complete expulsion rates at 12 months are low (<5%) when IUDs are placed in the early and interval postpartum period. Satisfaction is higher with early postpartum IUD placement.

A qualitative analysis of women’s reproductive agency and postpartum family planning in Maharashtra, India

PLoS ONE · 2025-11-07

BACKGROUND: Despite the benefits of healthy birth spacing for mothers and infants, the use of postpartum family planning (PPFP) by women in India remains low. We qualitatively examined barriers to PPFP access and use to understand the intersections between women's reproductive agency, fertility and contraceptive norms, and community interactions with health providers in rural Maharashtra, India. METHODS: We conducted 62 qualitative in-depth interviews with postpartum women, husbands and mothers-in-law of postpartum women, frontline health workers (FLWs) and key community stakeholders in rural Maharashtra from March to May 2022. Semi-structured interview guides included probes related to knowledge of and access to PPFP services, contraceptive decision-making dynamics, interactions with health providers, community norms related to fertility and family planning, and existing and aspirational models for PPFP service delivery. We used an inductive approach to organize emerging codes into themes using Bronfenbrenner's Ecological Systems Theory, categorizing findings into a thematic framework to inform PPFP programming. RESULTS: Five key themes emerged: (1) Few women received PPFP counseling or services, with marginalized communities disproportionately affected by poor access. (2) Postpartum women lacked agency in contraceptive decision-making and often needed their husband's approval to access PPFP services. (3) Clinicians identified misinformation, lack of education, and community beliefs in contraceptive myths for lack of informed choice. (4) While norms for limiting family size were strong, contraception was considered a 'sensitive' subject and sparked concerns regarding confidentiality in discussing PPFP. (5) Community reported that counseling services were prescriptive and lacked information on the side effects of contraception, leading to the perception of low-quality care and dissatisfaction with PPFP health services. CONCLUSIONS: There is an urgent need to enhance PPFP counseling and service provision within family planning programs in India, emphasize reproductive choice among women, broaden the public dialogue on contraceptive use and find ways to engage men in contraceptive decision making. Interventions that can enhance knowledge and change acceptability of contraception in the community will enhance informed choice for contraceptive use among couples as well as PPFP access and use.

Barriers and Facilitators to Telemedicine Contraception Among Patients Who Speak Spanish: A Qualitative Study [ID 2692431]

Obstetrics and Gynecology · 2024-05-01

INTRODUCTION: The objective of this study was to evaluate the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach. METHODS: We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California. Two coders analyzed the data using content analysis. RESULTS: Most participants had some college education (14, 65%) and public insurance (18, 90%). Most chose a short-acting contraceptive method (11, 55%). Five key themes were identified. 1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. 2) Participants did not report difficulty with Spanish interpreters using telemedicine. 3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. 4) Preference for comprehensive care with physical examination and familiarity of the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. 5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may affect choice for in-person care. CONCLUSION: Many patients who speak Spanish preferred audio-only technology for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers for care. There is a need for prospective studies comparing the quality of telemedicine among patients who speak Spanish for contraception care.

Editorial Board

Contraception · 2024-02-28

Barriers and facilitators to telemedicine contraception among patients that speak Spanish: a qualitative study

AJOG Global Reports · 2024-12-04

Background: Telemedicine contraception services have increased since the COVID-19 pandemic. There may be unique equity implications and language barriers for patients who speak Spanish. Objective: To identify the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach. Study Design: The study was designed and conducted in consultation with a community advisory board. We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California between April 2022 and May 2023. Telemedicine visits were conducted by audio only. Two coders analyzed the data using thematic analysis. Results: The average age of the participants was 32.5 years old (range 19-45). Most participants had some college education (13/20, 65.0%) and public insurance (18/20, 90.0%). Most chose a short-acting contraceptive method (11/20, 55.0%). Five key themes were identified. (1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. (2) Participants did not report difficulty with Spanish interpreters using telemedicine. (3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. (4) Preference for physical exam and preventative care and familiarity with the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. (5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may impact choice for in-person care. Conclusion: Among patients who speak Spanish, telemedicine contraception care was acceptable and had many conveniences. Many patients who speak Spanish preferred audio-only for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers to care.

Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians

Women s Health Issues · 2024-05-28 · 1 citations

COMPARISON OF BLEEDING PATTERNS WITH REPLACEMENT VERSUS EXTENDED USE OF THE CONTRACEPTIVE IMPLANT

Contraception · 2024-10-07

The impact of Dobbs v. Jackson on abortion training in obstetrics and gynecology residency programs: A qualitative study

Contraception · 2024-12-30 · 7 citations

OBJECTIVES: The Ryan Program collaborates with obstetrics and gynecology (OBGYN) residency programs in the United States (U.S.) to ensure that abortion and contraception care are incorporated into resident curriculum as required. We sought to understand the impact of the Dobbs v. Jackson decision on OBGYN residency abortion training programs from the perspective of Ryan directors and to understand barriers and facilitators to maintaining abortion training in OBGYN residency programs post-Dobbs. STUDY DESIGN: We conducted qualitative, semi-structured in-depth interviews with Ryan program directors at U.S. academic medical centers. We coded the data iteratively and analyzed the data thematically. RESULTS: From January to April 2023, we conducted 24 interviews, representing 21% (n = 23) of eligible U.S. Ryan directors. Participants were evenly distributed across four geographic regions of the U.S.; 50% (n = 12) of participants were from programs in abortion-restrictive settings. Two themes emerged: (1) Ryan directors experienced stressors related to the administration of Ryan programs post-Dobbs, including perceived difficulty satisfying requirements for abortion training in restrictive states, burnout, and increased financial needs to support training partnerships. (2) Directors face challenges in recruitment and clinical care post-Dobbs. CONCLUSIONS: Increased state restrictions on abortion place logistical and financial burdens on OBGYN abortion training programs. Dobbs impacted training experiences across the U.S. and made it more difficult for many OBGYN residencies to provide abortion training. IMPLICATIONS: The research findings will inform strategies for improving the delivery of abortion education post-Dobbs. We anticipate findings will enhance procedures to establish and maintain partnerships post-Dobbs and identify areas where philanthropy and advocacy can be effectively utilized.