Patients Report Infrequent Counseling by Physicians and Inadequate Knowledge about Inflammatory Bowel Disease and Reproductive Health Issues

Objective Inflammatory bowel disease (IBD) reproductive health counseling is associated with higher knowledge, lower voluntary childlessness, greater medication adherence during pregnancy, and improved outcomes of pregnancy. Our aims were to assess counseling and knowledge about IBD and reproductive health in a tertiary care IBD patient population. Study Design We anonymously surveyed women and men ages 18 to 45 cared for at the Stanford IBD clinic about reproductive health and administered the CCPKnow questionnaire. STATA was used to summarize descriptive statistics and compare categorical variables using Fisher's exact test. Results Of the 100 patients (54% women) who completed the survey, only 33% reported prior reproductive health counseling. Both men and women considered not having a child due to IBD (31% women, 15% men) and most (83%) had no prior counseling. A minority of patients had an adequate (>8/17) CCPKnow score (45% women, 17% men). The majority of women with prior pregnancy had pre-existing IBD (67%), yet many did not seek gastrointestinal (GI) care (38% preconception, 25% during pregnancy) and 33% stopped/changed medications, with 40% not discussing this with a physician. Prior counseling was significantly associated with education level (p = 0.013), biologic use (p = 0.003), and an adequate CCPKnow score (p = 0.01). Overall, 67% of people wanted more information on IBD and reproductive health. Conclusion In an educated tertiary care cohort, the majority of patients had low CCPKnow scores and rates of IBD reproductive health counseling. Many patients with IBD prior to pregnancy reported no GI care preconception or during pregnancy and stopped/changed medications without consulting a physician. There is an urgent need for proactive counseling by gastroenterologists and obstetricians on IBD and reproductive health. Key Points

Childfree in the Reproductive Strategies of Saratov Youth

The intensification of the process of depopulation of the population in Russia, the demographic crisis, exacerbated by the pandemic, actualize the importance of the sociological analysis of reproductive behavior “childfree”, especially considering this from the point of view of the prospects of social and family policy of the state. Childfree is interpreted as a voluntary refusal of individuals, married couples from childbearing. According to the results of an empirical study by the method of questioning Saratov youth (the volume of the quota sample was 486 respondents), it is shown that the modern transformation of reproductive relations and parenthood in modern society has led to the fact that voluntary childlessness is not considered as a social deviation and does not act as a basis for conflict in society. The sexual, gender characteristics of young childfree adherents are analyzed. Objective factors (high level of education, median income, nonreligiosity) that contribute to the development of this strategy are revealed. For them, cohabitation and celibacy act as the most comfortable ways of organizing everyday life, although they do not deny the traditional form of marriage. In a pregnancy situation, they are prone to abortion. Children in the representations of childfree supporters are associated primarily with difficulty, fear, loss of freedom, forced denial of material comfort, risk, suffering. Hostility to the children was not revealed. Most of all, they are frightened by great responsibility (91.9%), which demonstrates not so much selfishness as fears of being untenable in this regard

Men’s Explanations for Being Childless; a dynamic perspective

Research on childlessness in contemporary society still focuses mainly on women. This article conversely examines childlessness among men in Czechia – a European post-socialist country in which becoming a parent was a strong social norm before 1989. This article asks how men’s explanations for being childless or childfree change over time and what this says about changing norms attached to parenthood in different historical and social contexts. It draws on an analysis of 24 problem-centred interviews conducted in two rounds about a decade apart on the same sample of child-less or free men. This approach is not usually applied in research on this subject. In the first interviews, the men’s narratives mainly reveal their different views on the impact the post-1989 social transformation had on their lives in relation to their perceived resources and life chances. The follow-up interviews show how the men’s views on their lives change with age, the different emphasis they place on free choice versus the effect of external factors over time, and the narrow line that they construct between ‘involuntary’ and ‘voluntary’ childlessness. The narratives of child-less or free men unveil that the norm of becoming a parent is growing weaker in Czech society, but age norms and the norms regarding pathways to parenthood are still strong. The article seeks to understand how Czech men construct their childlessness over time, thus contributing to the discussion of childlessness among men and filling the gap in knowledge on men’s childlessness in CEE.

A170 A NOVEL DECISION AID IMPROVES KNOWLEDGE AND QUALITY OF PREGNANCY-RELATED DECISION-MAKING IN IBD

Background Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more voluntary childlessness. Poor knowledge is associated with fear of IBD medications in pregnancy; this must be addressed as active IBD at preconception (PC) correlates with worse intrapartum disease and poor fetal outcomes. The Pregnancy IBD Decision Aid (PIDA), developed by an international multidisciplinary team following International Patient Decision Aids Standards, is an interactive online tool that offers personalised decision support on fertility, pregnancy, and medications in IBD (Fig). Aims To assess PIDA’s impact on knowledge and quality of decision-making among PC and pregnant patients with IBD, and to evaluate its feasibility as a tool for patients and clinicians. Methods PC and pregnant women aged 18–45 with IBD, recruited in Canada and Australia, completed questionnaires pre and post PIDA to assess quality of decision-making (Decisional Conflict Scale, DCS; Self-Efficacy Score, SES) and IBD in pregnancy knowledge (Crohn’s and Colitis Pregnancy Knowledge Score, CCPKnow). DCS assesses if a decision is informed, aligned with personal values, and would be implemented. SES measures belief in one’s ability to make informed decisions. Patients and clinicians (gastroenterology, obstetrics, primary care) also completed feasibility surveys. Paired t-test assessed for differences pre and post PIDA. Results DCS and SES were completed by 74 patients (42 Crohn’s disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post PIDA (effect size 0.44, p<0.0001); this was observed in PC patients regarding pregnancy planning with IBD, and in pregnant patients regarding peripartum IBD medication management. SES of PC but not pregnant patients improved significantly post PIDA (effect size 0.32 vs 0.24, p=0.0001 vs 0.0525). In both cohorts, CCPKnow improved significantly post PIDA (n=76, effect size 0.66, p<0.0001). Patients (n=73) assessed PIDA feasibility. Mean scores for length (3.05±0.44), readability (3.09±0.5), and content amount (2.91±0.81) were perceived as appropriate (1=limited, 5=excessive). Perceived usefulness of PIDA was high among all patients (4.09±0.93; 5=most useful). Clinicians (n=14) believed PIDA had appropriate length, readability, and content amount, and deemed PIDA useful to patients (4.6±0.8) and themselves (4.8±0.8) for clinical practice. Conclusions PIDA improved knowledge and quality of decision-making in PC and pregnant patients with IBD. Patients developed a strengthened belief in their ability to make informed, effective decisions, and both patients and clinicians found PIDA feasible. PIDA is an accessible tool that can empower women with IBD to make evidence-based decisions about pregnancy and may ultimately reduce voluntary childlessness. Funding Agencies Mount Sinai Hospital Resident Research Grant; Gastroenterological Society of Australia Rose Amarant Grant; Women and Children’s Health Research Institute (WCHRI); Clinical/Community Research Integration Support Program (CRISP); Merck Better Care, Healthy Communities Funding Program

Childless by Choice in Contemporary China: Reasons and Consequences

The article considers financial, social, and personal reasons for childlessness by choice among young Chinese and analyzes the consequences of such a decision. Voluntary childlessness is a new phenomenon for China that became more present even after the abolition of the one-child policy and an increase in the promotion of early marriages and childbirth. Traditional family values gradually ceased importance in society. Resembling developed Western countries, the majority of voluntary childless Chinese belongs to well-educated urban citizens who prioritize quality life and personal development over having children. However, many decide for childlessness under financial insecurity due to the high living costs in the first-and second-tier cities, lack of a developed social security system, and obligation to support elderly parents. Even though most voluntary childless are satisfied with their choice, they often feel pressured and pushed to childbirth by their families and even by the government. China is facing a growing aging population problem. Attempting to solve the emerging issue, the Party increases propaganda of childbirth, and voluntary childlessness receives more attention in society, which exerts more emotional pressure on childless Chinese, who fear additional stress and discrimination at the workplace and in personal life.

New normativity and reproductive choice: an attempt at comprehension

The article discusses two “special types” of reproductive choices – combating infertility through assisted reproductive technologies and voluntary childlessness. Particular attention is paid to the phenomenon of voluntary childlessness. Basing on the analysis of public opinion polls, reconstruction of historical realities of the second half of XX century, normogenesis studies, new psychodynamic theories of transgenerational transmission of traumatic experience, and philosophical ideas of intentionality of acceptance and hospitality, the author analyzes the existing reproductive practices in their connection with procreative norms. The reasons for the increasing spread of voluntary childlessness, according to the author of the article, are largely connected to the transgenerational transmission of experience of violence. The author’s hypothesis is based on psychodynamic ideas about transgenerational trauma and perverse maternal attitude and is that the spread of the voluntary childlessness in the generation of the 1990s may be caused by the impossibility of hospitality, acceptance, and vulnerability due to the lack of failure of the maternal functionary as a container and the lack of introjects of loving and guiding parent figures (“empty superego”). Thus, the new “shapeless” normativity, creating the illusion of “freedom to be oneself”, may prove to be a projection of a split, lifeless and empty collective unconscious superego, generated by a culture of violence that requires moral content, which has been abolished.

Psychological and pedagogical potential of life orientations of spouses with various dominant marital behavior

The article is devoted to the problem of transformation of family values, the emergence of new types of families in the context of modern marriage. The authors believe that in post-Soviet society in Russia, the axiological approach is the most heuristic in the study of marriage. The authors used a psychological analysis of the life-meaning orientations of spouses with a traditional type of marriage and spouses focused on voluntary childlessness. The results of the study showed that the specifics of life and life orientations of the husband and wife, their personal characteristics determine the attitudes and expectations of marital relations, the choice of the type of family. It was revealed that the life orientations of spouses who support voluntary childlessness are contradictory: men, when they are dissatisfied with their lives in the present and not confident in their abilities, focused on getting pleasure as the meaning of life here and now; and the wife, experiencing the riches of his life, demonstrating the confidence, commitment to the future, a higher meaning of life. Spouses from the traditional type of family are both happy with their lives. At the same time, husbands are characterized by an average level of meaningfulness of life, focus on the implementation of current tasks, and wives with a high sense of life are focused on the future, are confident in the possibility of building a life in accordance with their ideas about its meaning and life goals.