“Perceptions and experiences of (in)fertility, contraception, and reproductive health outcomes: A mixed methods study among women and men in Malawi”
Bio: Marta Bornstein recently defended her dissertation in the Department of Community Health Sciences in the School of Public Health at UCLA. Her research focuses on reproductive health and justice of under-served populations in the U.S. and globally. In her dissertation research, Marta collaboratively conducted a mixed-methods study in Malawi to examine the relationship between infertility and reproductive health outcomes, contributing to a growing body of work on infertility as a public health issue. In her time at UCLA, Marta has published on infertility-related stigma and contraceptive preferences and use in Malawi, as well as additional research focused on the reproductive health needs of women in methadone treatment in Los Angeles. Prior to Marta’s doctoral studies, she worked in the private, non-profit, and government sectors, most recently at the CDC in the Department of STD Prevention. Marta earned her BA from Beloit College and MPH from Tulane University. Beginning in Fall 2021, Marta will be a President’s Postdoctoral Scholar at The Ohio State University, where she will collaborate with faculty in the College of Public Health and the Population Research Center on a research agenda focused on perceived and experienced infertility.
Abstract: Infertility and unintended pregnancy are dual burdens in Malawi, where approximately 40% of pregnancies are unintended and 20% of women report that they have experienced infertility or sub-fecundity. While public health has focused intently on promoting contraceptive use to prevent unintended pregnancy, infertility remains largely unaddressed in public health. The studies that form this dissertation fills a gap in the public health literature by examining the intersections of unintended fertility and infertility under a holistic reproductive life-course model. This hybrid explanatory-exploratory mixed methods dissertation uses in-depth interview, cross-sectional, and longitudinal data from the Umoyo Wa Thanzi (UTHA) cohort in Malawi (2014-2019).
Findings from the dissertation studies suggest that women’s perceptions and experiences of fertility influenced not only whether they used contraception or not, but how they used contraception as a way to manage their fertility (i.e., their ability to prevent and achieve pregnancies when desired). Additionally, findings suggest that both perceptions and experiences around fertility and fecundity have a role in contraceptive use/decision making, such that women who had experienced infertility (AOR: 0.56; p<0.01) or perceived themselves to be subfecund (AOR: 0.30; p<0.05) were less likely to be using contraception. In longitudinal analyses, however, women who had experienced infertility were just as likely as women who had not experienced infertility to experience a subsequent planned or unplanned pregnancy.