Bornstein Marta, Norris Alison, Shaba Gomezgani, Huber-Krum Sarah, Gipson Jessica D
The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA.
University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA.
SSM Qual Res Health. 2022 Dec;2. doi: 10.1016/j.ssmqr.2022.100071. Epub 2022 Mar 27.
Approximately one-third of contraceptive users in Malawi use the Depo-Provera injection, a method that must be re-injected every three-months to prevent pregnancy and may reduce fecundity for a time after discontinuation. Little is known about women use the injection to achieve their desired family size. In 2018, we conducted 20 in-depth interviews with women who were part of a cohort study in rural Malawi. Interviews focused on contraceptive decision-making. Data were indexed (summarized) and coded using narrative, process, and thematic codes. Women described the importance of knowing about their "natural" fertility by having children prior to ever using contraception because women considered contraception to have a potential negative effect on fertility. Women then applied what they learned about their fertility (i.e., how easy/difficult it was to become pregnant) to manage their fertility over their reproductive life-course. As part of fertility management, women frequently described using the injection less frequently than clinically recommended, using signs from their body (e.g., menstruation) to determine when to reinject. Managing fertility through subclinical injection use was viewed as a way to optimize women's' chances of preventing unintended pregnancy while maintaining their ability to become pregnant when they wanted to. Women wanted to play an active role in managing their fertility and were not passive consumers of contraception. It is therefore critical that family planning programs provide contraceptive counseling to women that engages their desire to manage their fertility, acknowledges their concerns about fertility, and helps them choose a method that best fits their needs.
在马拉维，约三分之一的避孕药具使用者采用醋酸甲羟孕酮注射法，这种方法必须每三个月重新注射一次以防止怀孕，并且在停药后的一段时间内可能会降低生育能力。对于女性使用这种注射法来实现理想家庭规模的情况，人们了解甚少。2018年，我们对马拉维农村地区一项队列研究中的女性进行了20次深入访谈。访谈聚焦于避孕决策。数据采用叙述性、过程性和主题性编码进行索引（总结）和编码。女性们表示，在开始使用避孕措施之前生育子女对于了解自身“自然”生育能力很重要，因为她们认为避孕可能会对生育能力产生潜在负面影响。随后，女性们将所了解到的自身生育能力情况（即怀孕的难易程度）应用于整个生殖生命历程中的生育管理。作为生育管理的一部分，女性们经常表示注射的频率低于临床推荐水平，而是根据身体信号（如月经）来确定何时再次注射。通过非临床标准的注射方式进行生育管理，被视为一种既能优化女性预防意外怀孕的几率，又能保持她们在想要怀孕时的受孕能力的方法。女性希望在生育管理中发挥积极作用，而不是被动地接受避孕措施。因此，至关重要的是，计划生育项目要为女性提供避孕咨询服务，这种咨询要契合她们管理生育的愿望，承认她们对生育的担忧，并帮助她们选择最适合自身需求的避孕方法。
