以患者为中心的避孕护理的重要性：将提供者的避孕强制行为与患者的心理困扰和心理健康联系起来。
The importance of patient-centered contraceptive care: Linking provider contraceptive coercion to patient psychological distress and mental well-being.
作者信息
Swan Laura E T, Wasser Ortal, Cannon Lindsay M
机构信息
Reproductive Equity Action Lab, University of Wisconsin-Madison, 750 Highland Ave, Madison, WI 53726, USA; Department of Population Health Sciences, University of Wisconsin-Madison, 610 Walnut St, Madison, WI 53726, USA.
School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA.
出版信息
Sex Reprod Healthc. 2025 Mar;43:101073. doi: 10.1016/j.srhc.2025.101073. Epub 2025 Jan 30.
OBJECTIVE
Provider-based contraceptive coercion, or pressure from a healthcare provider to use or not to use birth control, undermines patient-centered care. We investigated the relationship between contraceptive coercion and mental health, which is previously unstudied.
METHODS
In 2023, we used Prolific to survey reproductive-aged people in the United States who were assigned female at birth. We conducted t-tests and linear regression to assess relationships between upward (pressure to use birth control) and downward contraceptive coercion (pressure to not use birth control) and psychological distress and mental well-being among participants who had ever received contraceptive counseling (N = 1,154).
RESULTS
In bivariate analyses, we found a significant association between contraceptive coercion and psychological distress (upward coercion: M = 8.31 vs. 9.82, t = -3.023, p = 0.003; downward coercion: M = 8.44 vs. 10.78, t = -2.634, p = 0.009) and between contraceptive coercion and emotional (upward coercion: M = 7.60 vs. 7.04, t = 2.613, p = 0.009; downward coercion: M = 7.56 vs. 6.52, t = 2.744, p = 0.006) and psychological well-being (upward coercion: M = 15.05 vs. 14.03, t = 2.339, p = 0.019; downward coercion: M = 15.00 vs. 12.66, t = 3.018, p = 0.003). When controlling for the effects of sociodemographic factors, both upward (B = 1.06, SE = 0.50, p = 0.034) and downward coercion (B = 1.94, SE = 0.88, p = 0.027) remained positively associated with psychological distress. Although downward coercion remained negatively associated with emotional (B = -0.78, SE = 0.37, p = 0.035) and psychological well-being (B = -1.89, SE = 0.75, p = 0.012), upward coercion did not.
CONCLUSION
People who perceived coercion in their contraceptive care reported higher levels of psychological distress and worse mental well-being, underscoring the importance of safeguarding patients' autonomy during contraceptive counseling to support reproductive decision-making and positive mental health outcomes.
目的
基于医疗服务提供者的避孕强制行为，即医疗服务提供者施加压力以促使患者使用或不使用避孕措施，破坏了以患者为中心的医疗服务。我们调查了避孕强制行为与心理健康之间的关系，此前这方面尚未有研究。
方法
2023年，我们通过Prolific平台对美国出生时被认定为女性的育龄人群进行了调查。我们进行了t检验和线性回归，以评估向上（使用避孕措施的压力）和向下避孕强制行为（不使用避孕措施的压力）与曾接受避孕咨询的参与者（N = 1154）的心理困扰和心理健康之间的关系。
结果
在双变量分析中，我们发现避孕强制行为与心理困扰之间存在显著关联（向上强制行为：M = 8.31对9.82，t = -3.023，p = 0.003；向下强制行为：M = 8.44对10.78），t = -2.634，p = 0.009），以及避孕强制行为与情绪（向上强制行为：M = 7.60对7.04，t = 2.613，p = 0.009；向下强制行为：M = 7.56对6.52，t = 2.744，p = 0.006）和心理健康（向上强制行为：M = 15.05对14.03，t = 2.339，p = 0.019；向下强制行为：M = 15.00对12.66，t = 3.018，p = 0.003）之间存在显著关联。在控制社会人口学因素的影响后，向上（B = 1.06，SE = 0.50，p = 0.034）和向下强制行为（B = 1.94，SE = 0.88，p = 0.027）与心理困扰仍呈正相关。尽管向下强制行为与情绪（B = -0.78，SE = 0.37，p = 0.035）和心理健康（B = -1.89，SE = 0.75，p = 0.012）仍呈负相关，但向上强制行为并非如此。
结论
在避孕护理中感受到强制行为的人报告的心理困扰水平更高，心理健康状况更差，这凸显了在避孕咨询过程中保护患者自主权以支持生殖决策和积极心理健康结果的重要性。
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