Christine Bayly

Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey.

Objective: Mistimed, unexpected or unwanted pregnancies occur in Australia, despite widespread contraception use. The objective was to estimate prevalence and ascertain modifiable social factors for prevention of unintended pregnancy.

Key informant perceptions of youth-focussed sexual health promotion programs in Australia

BACKGROUND This paper explores key informant (KI) perceptions of the barriers to effective sexual health promotion programs in Australia and suggests strategies to overcome these barriers. Three types of sexual health promotion programs were explored in this study: those targeting all young people (under 30), Aboriginal young people, and young people from culturally and linguistically diverse (CALD) backgrounds. METHODS The study utilised a qualitative approach and involved 33 semistructured interviews with sexual health professionals involved in funding or delivering Australian sexual health promotion programs or working clinically with individuals diagnosed with sexually transmissible infections. RESULTS Fourteen barriers to effective sexual health promotion programs were identified. Barriers included: difficulties associated with program evaluation, lack of involvement of the target community, the short-term nature of programs, problems with program resources and concerns about the content of programs. Additional barriers to programs targeting Aboriginal and CALD young people were also identified and included: a lack of cultural sensitivity; a failure to acknowledge differences in literacy, knowledge, and language skills; stigma and shame associated with sexual health; and the continued use of programs that lack inclusivity. KIs suggested strategies to overcome these barriers. CONCLUSION Sexual health promotion in Australia suffers from several barriers that are likely to impede the effectiveness of programs. In particular, poor or nonexistent program evaluation and lack of community involvement are among the key areas of concern. It is hoped that the findings of this study will be useful in informing and shaping future Australian sexual health promotions.

Gestation sac size in in‐vitro fertilization pregnancies

Summary. The gestation sac size in pregnancies resulting from in‐vitro fertilization (IVF) and embryo transfer have been compared with those in spontaneous pregnancies. Small‐for‐dates gestational sac sizes were found in 36% of the IVF pregnancies. This proportion held for both singleton and multiple pregnancies. With increasing gestation beyond 8 weeks the gestation sac volume increasingly approached normal. In contrast to spontaneous conceptions, IVF pregnancies had a low rate of pregnancy loss once fetal heart movements were demonstrated, when the gestation sac size was small‐for‐dates. Small sac size in an IVF pregnancy may lead to the misdiagnosis of a failed pregnancy.

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Abstract Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia. Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use. Results: Most respondents (n = 1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p = .008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p = .026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p < .001), and not considering religion important to fertility choices (OR 0.43; 95%CI 0.31, 0.60; p < .001). A third used effective contraceptive methods (n = 534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p = .002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p < .001), and not have private health insurance (OR 0.52; 95% CI 0.38, 0.71; p < .001). Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.

Characteristics and circumstances of women in Australia who cryopreserved their oocytes for non-medical indications

Abstract Objective: This study aimed to explore the characteristics and circumstances of women who cryopreserved their oocytes for non-medical indications and their reasons for cryopreservation. Background: Oocyte cryopreservation for non-medical reasons is becoming increasingly common. Little is known about women who freeze their oocytes in this context. Methods: All women who had cryopreserved oocytes for non-medical indications at a large Australian fertility treatment centre from 1999 to 2014 were invited to complete an anonymous postal survey. Results: Of the 193 questionnaires mailed, 10 were returned to sender; 96/183 (53%) were completed and returned. Most respondents had completed tertiary education (90%) and were employed in professional occupations (89%). At the time of oocyte cryopreservation, 48% of women were aged at least 38 years (range 28–44 years). Most (90%) women were single when their oocytes were frozen. The lack of a partner or having a partner unwilling to commit to fatherhood were the most common reasons for oocyte freezing, which was viewed as an investment in hope against the possibility of remaining in these predicaments. Some women reported that discussions in the media and interactions with peers influenced their decisions. A few women were influenced by tests indicating a low ovarian reserve. Conclusion: These data provide new evidence about women’s characteristics, circumstances, and reasons for oocyte cryopreservation for non-medical indications that do not support pejorative conceptualisations of these women as selfish and hedonistic.

Women’s experiences of pelvic inflammatory disease: Implications for health-care professionals:

This study explored the health-care experiences of women diagnosed with pelvic inflammatory disease. Semi-structured interviews were conducted with 23 women diagnosed with pelvic inflammatory disease. Many women felt empowered about their health post-diagnosis; however, a smaller number reported becoming hyper-vigilant towards symptoms. Infertility was the greatest concern for women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively. The findings highlight the need for community education encouraging early presentation for the treatment of pelvic pain and emphasise the need for health practitioners to be responsive to the psychosocial aspects of pelvic inflammatory disease.

Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group.

Background As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. Objective To identify public opinion about sexual and reproductive health in Australia. Methods To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. Results There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Conclusions Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health.

Subjective meanings of ‘unintended’ pregnancy: interviews from understanding fertility management in contemporary Australia

Abstract Unintended pregnancy can be difficult to identify and conceptualise. We aimed to understand how unintended pregnancies are constructed, explained and situated in a reproductive life. A total of 41 women and 7 men aged 20–50 years were interviewed in depth. Transcripts were analysed using iterative hermeneutic techniques informed by narrative theory. Of 34 participants who had been pregnant or had a partner in pregnancy, 12 women and 1 man described 23 ‘unintended’ pregnancies, about half of which ended in abortion. Their accounts reveal that an unintended pregnancy is identified subjectively, that the same pregnancy may be identified by one partner in the pregnancy as unintended and by the other as intended, and that a researcher’s supposedly objective assessment of an unintended pregnancy may be inconsistent with the assessment of the woman who experienced it. A pejorative discourse was evident, predominantly among participants who did not report having an unintended pregnancy: women use an ‘unintended’ pregnancy to entrap men. Accounts from five participants reporting an unintended pregnancy were selected for illustration. An appreciation of the role such a pregnancy might play in an individual life requires a nuanced understanding of the complexity of human experience and a resistance to simple binary categorisation.

Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey

Background There are few reliable Australian abortion data. The aim was to investigate prevalence, sexual experiences and socioeconomic characteristics of women and men who report having had or being a partner in an abortion. METHODS A cross-sectional survey of women and men aged 18-50 years randomly selected from the Australian Electoral Roll was used. Weighted multivariable analyses were conducted. RESULTS Data from 2235 returned (of 15480) mailed surveys were analysed. One in six women and one in 10 men had experienced or been a partner in an abortion. In adjusted analyses, for women, experience of sexual coercion [adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) 1.46, 3.24] was associated with significantly increased odds of abortion, and socioeconomic advantage (AOR=0.57; 95% CI 0.39, 0.84), being comfortable negotiating contraceptive use (AOR 0.26; 95% CI 0.09, 0.73) and importance of religion in fertility choices (AOR=0.55; 95% CI 0.35, 0.87) were associated with significantly reduced odds. For men, sexual coercion (AOR=3.05; 95% CI 1.51, 6.18) and metropolitan residence (AOR=1.70; 95% CI 1.06, 2.75) significantly increased the odds of reporting being a partner in an abortion. CONCLUSIONS The findings contribute to scarce information about abortion in Australia. The high prevalence of abortion suggests that effective contraceptive counselling and accessible contraception services are not sufficient, and that there is a continuing need for universal pregnancy advice and abortion services. The association between sexual coercion and abortion warrants further investigation.

Factors contributing to pregnancies that end in termination of pregnancy: findings from the understanding fertility management in contemporary Australia survey

Introduction Information about factors that lead to pregnanciesthat end in termination of pregnancy (TOP) has the potential tocontribute to programmes that improve health literacy and assistpeople to manage their fertility effectively.Methods A population-based cross-sectional survey wasconducted. The questionnaire and a letter of invitation toparticipate were mailed to a random sample of people aged 18–50extracted from the Australian Electoral Roll. Information wascollected about management of fertility and participants wereasked to provide details about their pregnancies and factors whichcontributed to the timing and intendedness of conception.Results There were 2235 respondents to the survey, of whom 1543were women; 1045 women provided details on a total of 2786pregnancies, of which 290 ended in TOP for reasons other than fetalabnormality. This paper presents some features of these 290pregnancies. For most the pregnancy was considered accidental and44% did not or ‘not really’ think there was a risk of pregnancy at thetime of the sexual intercourse that caused it, while 38% thoughtthere was such a risk. Twenty-five percent of terminated pregnanciesoccurred following non-use of contraception for reasons includingforgetting, unexpected sex, dislike of side effects and partner refusal.Thirty-one percent occurred following contraceptive problemsincluding method failure, late withdrawal, missed pills and brokencondoms. Eleven percent occurred when women believed they couldnot conceive due to it being a non-fertile time, health conditions orother reasons. For 18% of the TOPs, women reported factors fromtwo or all three of the above groupings. For 6% the only contributingfactors reported were alcohol or drug use or forced sex or both, whilecontributing factors were not reported for 9% of TOPs.Conclusion There was a high rate of misperception of pregnancyrisk at the time of conception in this sample. Education directedtowards more accurate understanding of fertility has the potentialto support more effective use of contraception and possibly choiceof methods with lower failure rates.