Date of Award

2020

Embargo Period

3-8-2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Julie Barroso

Second Advisor

Melody Reibel

Third Advisor

Eun-Ok Im

Abstract

Purpose: The purpose of this dissertation was to explore the reproductive health needs, concerns, and priorities of women. The integrative review serves to explore this topic among adult women at large and identified a dearth of evidence specifically around women in midlife. The qualitative research that is represented by the second and third manuscripts is an attempt to begin filling in the knowledge gap regarding reproductive health in women in midlife.

Problem: Research in the reproductive health field rarely includes women in midlife for a variety of reasons. Lower levels of fertility, perceptions about sexual activity and risk for sexually transmitted infections, and bias against older women are a few reasons why little original research has included or focused on women in midlife. Women in midlife are not immune to reproductive health issues, however, and need age-specific counseling and guidance from their health care provider.

The specific aims of this dissertation were:

  • Aim 1: To investigate midlife women’s reproductive health goals, including pregnancy achievement, avoidance, or ambivalence, and their contraceptive preferences and concerns.
  • Aim 2: To investigate contraceptive issues that may be unique to midlife women, including management of perimenopausal changes, age-specific reasons for pregnancy avoidance or achievement, and contraceptive decision-making in the final reproductive years.

Design: Both the integrative review and the original qualitative research conducted for this dissertation were done within the feminist poststructuralist framework. In addition, qualitative descriptive methodology guided data collection and analysis.

Findings: The integrative review identified themes of power imbalance between partners and healthcare providers, societal and communal discourses on femininity and motherhood, distrust of hormonal contraception, the ability to enhance personal agency through contraceptive decision making, and a need for open, patient-focused communication. The qualitative research conducted within the feminist poststructuralist framework identified 1) priorities included family formation, the natural body, and healthy aging; 2) concerns regarding sexually transmitted infections, barriers to contraception, problematic dialogue regarding aging and menopause, and concerns regarding birth control interacting with their body; and 3) needs including open communication with health care providers, birth control that fits their life, and the ability to use contraception through midlife. Analysis of data over the arc of time identified several additional themes, including 1) pivotal early experiences; 2) changing versus continuing methods over the decades; and 3) evolution in contraceptive behaviors, beliefs and priorities over time.

Conclusions: As with any age, women in midlife are not a monolith. Research on women in midlife can, however, identify some of the ways in which older reproductive age women are similar to their younger peers and ways in which they are unique. Continued targeted research regarding reproductive health for women in midlife can improve health outcomes, assist clinicians in providing individualized and evidence-based care, and ensure that women in midlife receive the information and care they deserve regardless of age.

Rights

Copyright is held by the author. All rights reserved.

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