Chung Stephanie, Tumlinson Katherine, Palmquist Aunchalee, Senderowicz Leigh
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251358983. doi: 10.1177/17455057251358983. Epub 2025 Jul 28.
People have contraceptive autonomy when they can obtain their preferred contraceptive method. Non-preferred method use may result from inappropriate medical contraindications, which occur when providers apply incorrect contraceptive eligibility criteria during consultations. Non-preferred method use and inappropriate medical contraindications are understudied in the Global South, partially due to measurement challenges.
This study provides the first evidence in over two decades that inappropriate medical contraindications are still a barrier to preferred method use in the Global South and offer a new conceptual frame for a neglected medical barrier to contraceptive use.
We collected qualitative data from 49 in-depth interviews and 17 focus group discussions (n = 146) with women of reproductive age (15-49) in an anonymized African country.
We deductively identified instances of preferred method denial for medical reasons, then analyzed these episodes to determine whether the medical reasons for denial were evidence-based.
We found that many women who reported preferred method denial described being offered medical reasons discordant with evidence-based guidelines, often resulting in what we determined to be contraceptive coercion. Specifically, we identified that (1) women experienced bi-directional contraceptive coercion with medical rationales, (2) women trusted providers' medical authority and felt unable to ask for more information, and finally, (3) women's personal reasons for their contraceptive preferences were rendered illegitimate by providers' use of biomedical language and (often incorrect) medical rationales. Consequentially, some women self-reported information indicating a legitimate contraindication to the non-preferred method their provider encouraged them to use.
Inappropriate medical contraindications are an under-studied facility-level barrier to contraceptive access that can result in contraceptive coercion, negative health outcomes, discontinuation of wanted methods, and loss of reproductive autonomy. Addressing inappropriate medical contraindications will require solutions that negotiate both structural factors and individual provider behavior to improve the quality of contraceptive service provision.
当人们能够获得他们偏爱的避孕方法时，他们就拥有了避孕自主权。使用非偏爱的避孕方法可能是由于不恰当的医学禁忌，这发生在医疗服务提供者在咨询过程中应用了错误的避孕适用标准时。在全球南方地区，非偏爱的避孕方法使用情况以及不恰当的医学禁忌尚未得到充分研究，部分原因是测量方面存在挑战。
本研究提供了二十多年来的首个证据，表明不恰当的医学禁忌仍然是全球南方地区获得偏爱的避孕方法的障碍，并为一个被忽视的避孕使用医学障碍提供了新的概念框架。
我们在一个匿名的非洲国家，对49名育龄期（15 - 49岁）女性进行了深入访谈，并开展了17次焦点小组讨论（n = 146），收集了定性数据。
我们通过演绎法确定因医学原因而拒绝使用偏爱方法的实例，然后分析这些情况以确定拒绝的医学原因是否基于证据。
我们发现，许多报告称被拒绝使用偏爱方法的女性描述说，她们被告知的医学原因与循证指南不一致，这往往导致我们所认定的避孕强制行为。具体而言，我们发现：（1）女性经历了具有医学理由的双向避孕强制；（2）女性信任医疗服务提供者的医学权威，觉得无法询问更多信息；最后，（3）医疗服务提供者使用生物医学语言和（通常不正确的）医学理由，使女性避孕偏好的个人原因变得不合理。结果，一些女性自行报告了一些信息，表明她们对医疗服务提供者鼓励她们使用的非偏爱方法存在合理的禁忌。
不恰当的医学禁忌是一个未得到充分研究的机构层面的避孕获取障碍，可能导致避孕强制、负面健康结果、停止使用期望的方法以及丧失生殖自主权。解决不恰当的医学禁忌问题需要采取能够兼顾结构因素和个体医疗服务提供者行为的解决方案，以提高避孕服务的提供质量。
