Transmasculine people—those assigned female at birth and having a male or masculine gender identity—can experience unintended pregnancy, yet research on contraception among these individuals is scarce. To better understand the barriers to and facilitators of contraceptive use, Madina Agénor and colleagues conducted in‐depth interviews with transmasculine individuals aged 18–29 who had had, in the last five years, a sexual partner who was assigned male at birth (page 7). The majority of participants believed that contraception was needed for pregnancy prevention, yet said their beliefs and decisions occurred in the context of a lack of information about contraception among transmasculine people, especially those using testosterone. Many chose a method on the basis of whether it mitigated their gender dysphoria or stopped menstruation. Participants reported gender bias, discrimination and stigma in accessing contraceptive care. The authors note that this underserved population has unique contraceptive concerns and needs, and that providers and facilities should offer tailored information and patient‐centered reproductive health care in supportive, inclusive settings.
Also in This Issue
• Most U.S. states require adolescents younger than 18 to involve a parent prior to obtaining an abortion, yet adolescents’ reasons for choosing abortion, and the support received by those who seek judicial bypass of parental consent, have received little attention. Kate Coleman‐Minahan et al. explored these issues by conducting interviews with young women aged 16–19 who had sought judicial bypass in Texas between 2015 and 2016, when they were 16 or 17 years old (page 15). The authors found that these individuals had involved others in their decisions, and had chosen abortion because they believed parenting would limit their opportunities and they worried about being able to provide for a child. After disclosing their abortion decision, some experienced stigma, including shame and emotional abuse, sometimes from their own parents. The researchers state that “fears of disclosing their pregnancies and abortion decisions are justified,” and recommend that “policymakers should consider how laws requiring parental notification may harm adolescents.”
• Receptive anal intercourse has become increasingly common among U.S. heterosexual women, and when unprotected and coercive, it is associated with increased incidence of STDs, including HIV. Childhood traumatic experiences may lead to sexually risky behavior, but the relationship between trauma and anal intercourse among women has not been studied. Joy D. Scheidell and colleagues employed data from nearly 5,000 female participants in three waves of the National Longitudinal Study of Adolescent to Adult Health to examine associations between childhood traumas and engaging in anal intercourse after age 18 (page 23). Eight of the nine traumas assessed were correlated with an increased likelihood of reporting such behavior, with the strongest association being with experience of violence. The authors highlight the importance of screening and trauma‐informed education in sexual health settings.
• People with disabilities may have limited access to sex education and the full range of reproductive health services because of persistent negative societal views about their sexuality and reproduction. As a result, women with disabilities may be at increased risk for unintended pregnancy; however, pregnancy intendedness has not been examined at the national level among these women. To address this, Willi Horner‐Johnson et al. analyzed pregnancy data from two waves of the National Survey of Family Growth and calculated the proportion of pregnancies that were unintended among women with each of five types of disability (page 31). Women with any disability had elevated odds of reporting unintended pregnancy compared with women with no disabilities, as did women with a hearing, cognitive or independent living disability. These researchers recommend that the discussion of reproductive planning be incorporated into routine care for people with disabilities.
• Pregnancy intention is usually measured retrospectively, but this may result in misreporting. To determine the extent to which pregnancy intentions may change over time, Lauren J. Ralph and colleagues used longitudinal data from the Turnaway Study to assess the magnitude and direction of changes in intendedness as reported in prospective and retrospective versions of the London Measure of Unplanned Pregnancy (page 39). Women's assessments of the same pregnancy both before and after conception revealed that categorization of the intendedness of nearly half of the 174 pregnancies considered changed—intendedness increased in 38% of cases and decreased in 10%. Moreover, changes in intendedness differed by pregnancy outcome and several sociodemographic characteristics. This study is the first to directly compare prospective and retrospective assessments using a purposefully developed and evaluated instrument, and the authors advise researchers and policymakers to interpret retrospective intention measurements with caution.
• Pregnancy resource centers aim to convince women to continue their pregnancies, sometimes resorting to deceptive practices. Many reproductive health advocates view these centers as problematic, and little is known about who visits them or what they experience there. Katrina Kimport conducted phone interviews with pregnant women in Louisiana and Maryland who had visited a pregnancy resource center before going to a prenatal care clinic; nearly all were planning to continue their pregnancy (page 49). Interviewees were primarily low income, and had gone to a center seeking free pregnancy‐related services, goods and social support. They were generally satisfied with their experiences, even though the goods and services offered were limited. Kimport concludes that, although pregnancy resource centers are not a reliable source of support, they can help meet some needs of low‐income pregnant women, and she suggests caution on the part of those seeking to regulate these centers.