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This study aimed to evaluate the proportion of contraception users among Lebanese youth, and the extent of knowledge and perception on birth control; and to raise awareness and sensitise young adults to sexual health, which remains taboo in Lebanon. The 30-item questionnaire was broadcasted to students in private and public universities in Lebanon, through social media and it collected information on contraception use and student knowledge. Over 30% of responders were medical students, and 41% have ever used contraceptives (mostly women); among which, 52.1% for contraception versus 47.9% for medical reasons. According to responders, the pill ranked high in terms of effectiveness (72.4% of responders perceive the pill as effective), followed by the male condom (69.1%) and the hormonal intrauterine device (29.6%). Some would not use contraception in the future, for religious reasons (30.8%) or for fear of complications (46.2%); indeed, around a third of contraceptive users (all female) have experienced adverse effects. Finally, students expressed concern about long-term complications of contraceptive use (pulmonary embolism/phlebitis, breast/endometrial/ovarian cancer, stroke, depression and myocardial infarction). Though less frequent than in the Western world, contraception use in Lebanon is non-negligible and gaps in university students’ knowledge on contraception were identified; which should prompt sexual education and family planning initiatives in Lebanon.
In the 1870s and 1880s, some of Japan’s leading intellectuals and modernizers discussed human rights, reintroduced the binary difference between male and female, and declared motherhood the core principle of women’s nature. As gender displaced status as the primary system of social and legal classification, women began adopting the language of rights and representing themselves in public. By the beginning of the twentieth century, women forcefully entered and shaped a range of debates. Chapter 2, “Controlling Reproduction and Motherhood,” discusses women’s struggle to both define motherhood for themselves and take control of reproduction – the debate about motherhood being closely tied to the quest for legalizing abortions. Notably, this demand was increasingly at odds with the country’s advancing imperialism, which relied on rapid population growth. The end of the Japanese empire constituted a major rupture within the question of reproductive control, ultimately leading to today’s effects of rapid population decline and the lack of will among the young generation to have babies.
Historically, access to contraception has been supported in a bipartisan way, best exemplified by consistent congressional funding of Title X—the only federal program specifically focused on providing affordable reproductive health care to American residents. However, in an era of partisan polarization, Title X has become a political and symbolic pawn, in part because of its connection to family planning organizations like Planned Parenthood. The conflicts around Title X highlight the effects of intertwining abortion politics and contraception policy, particularly as they relate to reproductive justice and gendered policy making. Family planning organizations like Planned Parenthood have responded to these battles by bowing out of the Title X network. To what extent have contraception deserts—places characterized by inequitable access to Title X—developed or expanded in response to policy changes related to contraception and reproductive health? What is the demographic makeup of these spaces of inequality? We leverage data from the Office of Population Affairs and the U.S. Census Bureau and use the integrated two-step floating catchment area method to illustrate the effects of a major change in the Title X network in 10 states. Our results reveal the widespread human ramifications of increasing constraints on family planning organizations as a result of quiet but insidious federal bureaucratic rule changes.
This chapter shifts the focus of the book to non-reproductive desire in Palestine by comparatively examining relevant legal genealogies and coexisting layers of law on birth control, especially abortion, using a sweeping historical approach. The purpose is to undermine simplistic reliance on “religion” or “culture” to explain birth control ideologies, practices, and restrictions in historic and contemporary Palestine. This and the following chapter show that contraceptive use was licit and available and abortion, while often “technically illegal,” was always an important method of birth control for women in all communities. Most people made complex or simple anti-reproductive decisions best understood by accounting for personal situations and options, as well as material and structural conditions. The first section offers an abridged comparative overview of Muslim, Jewish, and Christian religious legal traditions on contraception, abortion, and sex. The second examines late Ottoman laws, policies, and priorities as they interacted with birth control practices. The third summarizes British law on birth control in Mandate Palestine. The final section discusses Israeli, Jordanian, and Palestinian National Authority abortion laws and policies applicable since 1948.
There is evidence that a significant proportion of pregnancies are unintended at conception. Pregnancy planning allows for optimization of a woman’s health prior to conception and is associated with improved outcomes for both mother and baby. Certain periods during the female life course are associated with an increased risk of unintended pregnancy, such as adolescence, or where the risk of pregnancy is under-recognized, such as post-pregnancy and the perimenopause. Interactions with obstetricians and gynaecologists may provide opportunities for prevention through education and enhanced contraceptive provision.
A 26-year-old woman, gravida 1, para 1, presents for removal of an etonogestrel (Nexplanon) contraceptive implant after utilizing it for contraception for 28 months. The device was initially placed by her primary care provider (PCP). In the referral notes, the PCP describes that she was not able to palpate the device. She ordered an ultrasound of the left arm, which confirmed the presence of the Nexplanon implant in the arm. The patient is requesting removal as she now desires another pregnancy. She reports satisfaction with Nexplanon as a contraceptive method. She does report menstrual irregularities since device placement, but since the result was lighter, less frequent menses, these changes were acceptable to her. She reports she has gained approximately 10 lb since the device was placed, but she attributes this to unhealthy eating habits and decreased physical activity. She denies any pain, numbness, tingling, or weakness in her upper extremity. Her past medical history is significant for childhood asthma and surgical history for wisdom tooth extraction. She is taking multivitamins and has no known drug allergies.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
Abortion training is a required component of US ob-gyn graduate medical education training and recommended in family medicine training. While individual residents may choose to opt out of training in certain conditions – namely personal or religious conflicts- this chapter describes the importance of facilitating participation of residents up to their comfort level in order to learn the essential and transferable skills in the provision of women’s health care. This chapter describes the history of partial participation and provides evidence from multiple studies which have found that learners who object to abortion but partially participate in training in family planning and abortion gain important clinical and professional skills and appreciate the training. It describes various protocols and guidance for teaching leadership to support partial participation, specifics on setting clear expectations, and suggestions for when to facilitate discussions for residents who aren’t certain about the participation level, or plan to opt out.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
A curriculum in reproductive and sexual health (SRH) serves as the foundation on which the learner builds and integrates knowledge in the family planning field. In the United States, accreditation organizations at all levels of medical education require written curricula with clearly defined educational objectives, methods, and evaluations to address core competencies in health care delivery. In this chapter, the authors describe a rigorous framework for developing a curriculum in sexual and reproductive health, beginning with conducing a general and targeted needs assessment, defining goals and objectives, outlining educational strategies, implementing the curriculum and collecting evaluation and feedback. Readers will have the tools they need to create a SRH curriculum in their own institution.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
This chapter describes the several important roles for simulation in sexual and reproductive healthcare training. First and foremost, simulation training can serve as a tool for basic skill acquisition to learn abortion, contraception, and sterilization procedures. Simulation can also provide opportunities for improving counseling and communication, and emergency response team training. Finally, simulation training can foster an environment for discussion, advocacy, and sparking interest in the field of sexual and reproductive health. Many low- and high-fidelity simulation tools have been developed, implemented, and evaluated for training purposes. The chapter details the many available family planning simulation models and evidence supporting their utility.