Successful strategies that address gender-related barriers and promote bodily autonomy within efforts to scale up and sustain post-pregnancy contraception: A scoping review

IntroductionAcknowledging the integral role of bodily autonomy in advancing gender equality, our study aimed to assess the extent to which strategies used in postpartum and post-abortion contraception have effectively equipped women, girls, and gender-diverse individuals with the tools, knowledge, and resources required to make autonomous decisions that align with their diverse life experiences. MethodsWe conducted a scoping review using the databases PubMed, EBSCOhost, EMBASE, and SciSpace. We included implementation, evaluation, and experimental studies published in any language between 2013 and 2023 and excluded studies not meeting these criteria. We used a WHO scale to determine the level of gender responsiveness. ResultsWe found 30 implementation, evaluation, and experimental studies published in any language between 2013 and 2023. We categorized the strategies as gender-transformative (4 studies), gender-specific (24 studies), and gender-sensitive (2 studies). None of the studies reported strategies hindering reproductive health and rights. All strategies involved women and girls, and none explicitly targeted gender-diverse people capable of childbearing. ConclusionGender-transformative strategies shared a commitment to empowering women with the autonomy to make informed decisions about post-pregnancy contraception through a) delivering personalized counseling that respected each womans reproductive goals and ensured privacy during these discussions; b) integrating the cultural and familial context of womens health decisions; and c) promoting a rights-based approach that prioritized informed consent and defended womens reproductive rights. These interventions were delivered in contexts of quality improvement strategies integrating contraception services into the continuum of post-pregnancy care, offering women continuous access to information. Gender-specific strategies focused on informed contraceptive decision-making while recognizing the potential impact of gender dynamics on contraceptive use without actively challenging the underlying gender norms or power relations. Gender-sensitive strategies, although indicated gender awareness, did not address the process of informed contraceptive decision-making nor emphasize the provision of supportive environments that respect and enhance bodily autonomy. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSPrevious scoping and systematic reviews have explored strategies to increase post-pregnancy contraception uptake globally. However, none have specifically focused on strategies that promote bodily autonomy while addressing gender-related barriers. Our study addresses this gap by providing a comprehensive understanding of such strategies and their impact on scaling up and sustaining post-pregnancy contraception. What this study addsThis study provides new insights by being the first scoping review to focus on strategies promoting bodily autonomy in addressing gender-related barriers to scaling up and sustaining post-pregnancy contraception. The gender-transformative strategies reported in the studies shared a commitment to empowering women with the autonomy to make informed decisions about post-pregnancy contraception through a) delivering personalized counseling that respected each womans reproductive goals and ensured privacy during these discussions; b) integrating the cultural and familial context of womens health decisions; and c) promoting a rights-based approach that prioritized informed consent and defended womens reproductive rights. How this study might affect research, practice, or policyThis study highlights the importance of integrating gender-transformative activities into post-pregnancy contraceptive strategies. It underscores the necessity of understanding and addressing local gender norms and the broader health system context to effectively promote bodily autonomy. The findings suggest that success should not be solely measured by contraceptive uptake but also by how well interventions address gender-related barriers. Future research should focus on developing and validating indicators that evaluate these barriers and promote bodily autonomy, ensuring comprehensive strategies that truly empower women, girls, and gender-diverse individuals with the means, abilities, and assets to make informed choices that resonate with the broader spectrum of their lives.