Backwards by Design Retreat and Teaching Mini-Assessment

At the Backwards by Design (BbD) retreat last fall for every topic and assignment, I focused on a class I was about to teach the coming fall that is a core class at Fairhaven college. Every student entering Fairhaven, whether a student in their first year of college or a transfer student from main campus or another college or university, must take this class in the first quarter as a Fairhaven student. The class is 201: Critical and Reflective Inquiry. At Fairhaven, professors are encouraged to select a content area of their choosing – as the focus in the class is on writing and it is felt that this focus can be taught along with, or integrated with, any content area. I chose to focus on this class for the retreat, and resulting changes in my teaching, since the class is about writing and I feel a particular pressure to prepare new Fairhaven students for the writing-intensive classes they will be engaging in for the remainder of their college experience. I have, and still do, feel a tension in teaching this class between the focus on content and the focus on teaching writing; therefore, at the BbD retreat I struggled with this tension. In particular, I struggled in identifying a threshold concept to latch on to – should it be a content threshold concept (health as pervasive) or a writing threshold concept (writing research papers is an act of creatively joining a scholarly conversation). In the end, I focused more on the writing threshold concept and the majority of assignments revolved around writing practice – with a particular emphasis on writing research papers

Ambiguities in Washington State Hospital Policies, Irrespective of Catholic Affiliation, Regarding Abortion and Contraception Service Provision

Background: In 2014, the governor of Washington State mandated that all hospitals publically post a reproductive health policy amidst concerns about the lack of clarity among the public how hospitals handled various aspects of reproductive health care. Methods: The objective of this study is to assess the clarity of abortion and contraception service provision in the hospital reproductive health policies for the public in Washington State. All Washington State hospital reproductive health policies (n = 88) were analyzed in 2016 using content analysis. Results were stratified by Catholic religious affiliation of the hospital. Results: There were more similarities than differences between the non-Catholic and Catholic hospital reproductive health policies; however, there were a few differences. Non-Catholic hospitals were more likely than Catholic hospitals to use legal language (except for emergency contraception), include conscientious clause for providers (44% vs. 0%), and were less likely to specify that emergency contraception use was available for sexual assault victims only (16% vs 54%). Most hospital reproductive health policies, regardless of Catholic affiliation, provided more confusion than clarity in terms of abortion and contraception service provision. Conclusions: The impact of Catholic, and non-Catholic, affiliated hospital care on patients who need abortion and contraceptive services is concerning. Given the difficulties in meeting the goals of increased transparency for the public through hospital policy language, the government should instead mandate hospitals use a standardized checklist. Additionally, patients are in dire need of positive rights to information about and services to avoid the potential gap in care that the negative rights afforded to providers and facilities to opt-out of providing abortion and contraceptive services have created

Perceived Risks Associated with Contraceptive Method Use among Men and Women in Ibadan and Kaduna, Nigeria

Research shows that side effects are often the most common reason for contraceptive non-use in Nigeria; however, research to date has not explored the underlying factors that influence risk and benefit perceptions associated with specific contraceptive methods in Nigeria. A qualitative study design using focus group discussions was used to explore social attitudes and beliefs about family planning methods in Ibadan and Kaduna, Nigeria. A total of 26 focus group discussions were held in 2010 with men and women of reproductive age, disaggregated by city, sex, age, marital status, neighborhood socioeconomic status, and—for women only—family planning experience. A discussion guide was used that included specific questions about the perceived risks and benefits associated with the use of six different family planning methods. A thematic content analytic approach guided the analysis. Participants identified a spectrum of risks encompassing perceived threats to health (both real and fictitious) and social concerns, as well as benefits associated with each method. By exploring Nigerian perspectives on the risks and benefits associated with specific family planning methods, programs aiming to increase contraceptive use in Nigeria can be better equipped to highlight recognized benefits, address specific concerns, and work to dispel misperceptions associated with each family planning method

Contraceptive Service Provider Imposed Restrictions to Contraceptive Access in Urban Nigeria

Background: Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods: Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results: Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions: Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use

Contraceptive service provider imposed restrictions to contraceptive access in urban Nigeria

Abstract Background Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use

Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria

Abstract Background Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population – interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use

“Doctors are in the best position to know…”: The perceived medicalization of contraceptive method choice in Ibadan and Kaduna, Nigeria

Objectives The medicalization and clinic-based distribution of contraceptive methods have been criticized as barriers to increasing levels of contraceptive use in Nigeria and other settings; however, our understanding of how clients themselves perceive the contraceptive method decision-making process is very limited. Methods Focus group discussions among men and women in Ibadan and Kaduna, Nigeria, were used to examine attitudes and norms surrounding contraceptive method decision-making in September and October of 2010. Results Choosing a family planning method was presented as a medical decision: best done by a doctor who conducts clinical tests on the client to determine the best, side effect free, contraceptive method for each client. An absolute trust in health professionals, hospitals, and governments to provide safe contraception was evident. Conclusion The level of medicalization placed on contraceptive method choice by urban Nigerians is problematic, especially since a test that can determine what contraceptive methods will cause side effects in an individual does not exist, and side effects often do occur with contraceptive method use. Practice implications Provider and client education approaches would help to improve client involvement in contraceptive decision-making and method choice

Inadequate Birth Spacing is Perceived as Riskier than All Family Planning Methods, Except Sterilization and Abortion, in a Qualitative Study among Urban Nigerians

Background Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. Methods A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. Results The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. Conclusion Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants’ risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items’ perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. Trial registration Number: This study is not a randomized control trial so the study has not been registered as such

Family Planning in Rwanda is Not Seen as Population Control, But Rather as a Way to Empower the People : Examining Rwanda\u27s Success in Family Planning from the Perspective of Public and Private Stakeholders

Background: Rwanda has made significant strides in improving the health of its people, including increasing access to and use of family planning. Contraceptive use has increased from 17% to 53% in just one decade, from 2005 to 2015. Methods: The data consist of 13 in-depth interviews conducted with family planning program experts in Rwanda to better understand the mechanisms for success, elucidate remaining challenges, speculate on the future of the program, and discuss potential applicability for translating aspects of the program in other settings. Results: All respondents first noted the positive aspects of government will, leadership, and management of the family planning program when asked to describe the reasons for success. The challenges that loomed the largest for the program were service accessibility for rural Rwandans, adolescent access to and use of contraceptives, opposition from religious institutions, as well as inadequate human resources and funding. These challenges were openly acknowledged and are in the process of being addressed. Conclusion: The importance of government leadership and focus in the success of Rwanda’s family planning program was prominent. All positive aspects of the program are based upon the strong foundation the government has built and nurtured. Since innovation is welcomed and program evaluation is considered essential, the outlook for Rwanda’s family planning program is favorable. The issues that remain are common and persistent challenges for family planning programs. Other nations could learn tangible practices from Rwanda’s success and follow Rwanda’s efforts to mitigate the remaining challenge

Levels, Trends, and Reasons for Contraceptive Discontinuation

Contraceptive discontinuations contribute substantially to the total fertility rate, unwanted pregnancies, and induced abortions. This study examines levels and trends in contraceptive switching, contraceptive failure, and abandonment of contraception while still in need of pregnancy prevention. Data come from the two most recent Demographic and Health Surveys in Armenia, Bangladesh, Colombia, the Dominican Republic, Egypt, Indonesia, Kenya, and Zimbabwe. Results show that contraceptive discontinuation in the first year of use is common (18 to 63 percent across countries), and that the majority of these discontinuations are among women who are still in need of contraception: between 12 and 47 percent of women stop using contraception within one year even though they do not want to become pregnant. We found discontinuation to be strongly associated with the type of contraceptive method used. Additionally, age, parity, education, partner’s desired fertility, community-level contraceptive prevalence, and the region in which women live were all associated with contraceptive switching, failure, or discontinuing while still in need of contraception. In summary, rates of contraceptive discontinuation, even among women who want to avoid pregnancy, remain high and are increasing in some countries where family planning efforts have decreased. This contraceptive discontinuation study, along with future research in this area, can help policymakers and program managers track family planning progress and refocus efforts to meet the goal of reproductive health for all