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Maghalian M, Nikanfar R, Nabighadim M, Mirghafourvand M. The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study. Reprod Health 2024; 21:79. [PMID: 38840155 PMCID: PMC11155095 DOI: 10.1186/s12978-024-01821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles. METHODS This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables. RESULTS The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001). CONCLUSIONS The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies.
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Affiliation(s)
- Mahsa Maghalian
- Student Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahsan Nabighadim
- Medical School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Woesner ME, Wilson SM. Comment on "Access to Abortion After Dobbs v. Jackson Women's Health Organization: Advocacy and a Call to Action for the Profession of Psychiatry". ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:689-690. [PMID: 38036936 PMCID: PMC10703972 DOI: 10.1007/s40596-023-01901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
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Aragaw FM, Amare T, Teklu RE, Tegegne BA, Alem AZ. Magnitude of unintended pregnancy and its determinants among childbearing age women in low and middle-income countries: evidence from 61 low and middle income countries. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1113926. [PMID: 37533507 PMCID: PMC10393037 DOI: 10.3389/frph.2023.1113926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Unintended pregnancy is one of the most serious health issues in low and Middle-Income Countries (LMICs), posing significant health, economic, and psychosocial costs to individuals and communities. However, there is limited evidence on the prevalence of unintended pregnancies and their determinants in LMICs. Hence, this study aimed to assess the prevalence of unintended pregnancy and its associated factors among childbearing-age women in LMICs. Method Data for the study were drawn from a recent 61 Demographic and Health Surveys (DHS) conducted in LMICs. A total sample of 187,347 mothers who gave birth in the five years preceding the survey was included. STATA version 16 was used to clean and analyze the data. Multilevel multivariable logistic regression was employed to identify individual and community-level factors of unintended pregnancy in LMICs. In the multivariable analysis, an adjusted odds ratio with a 95% confidence level was reported to indicate statistical association. Results The pooled magnitude of unintended pregnancy in LMICs was 26.46%% (95% CI: 25.30%, 27.62%), ranging from 19.25%% in Egypt to 61.71% in Bolivia. Working status (AOR = 1.03; 95% CI: 1.01, 1.06), having a husband with no education (AOR = 1.07; 95% CI: 1.00, 1.15), and primary education (AOR = 1.05; 95% CI: 1.01, 1.11), women from male-headed households (AOR = 1.04; 95% CI: 1.00, 1.08), media exposure (AOR = 1.05; 95% CI: 1.02, 1.08), unmet need for contraception (AOR = 1.05; 95% CI: 1.02, 1.08), distance from a health facility (AOR = 1.03; 95% CI: 1.00, 1.06) were significantly associated with unintended pregnancy. Conclusion Unintended pregnancy rates remain high in LMICs. Women whose husband has no education and primary education, women with media exposure, working status, women who live in a household headed by male, women with unmet need for contraception, and women with a big problem of distance to health facilities were variables that were significant predictors of unintended pregnancy. When attempting to minimize unintended pregnancy in LMICs, these factors need to be considered. Furthermore, most of these attempts should be driven by government entities in low and middle-income countries.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biresaw Ayen Tegegne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hyzak KA, Bunger AC, Herrmann SA, Kerlek A, Lauden S, Dudley S, Underwood A, Berlan ED. Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:147-161. [PMID: 38293653 PMCID: PMC10827339 DOI: 10.1007/s43477-023-00082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 02/01/2024]
Abstract
Implementation blueprints are comprehensive plans that describe implementation strategies, goals, timelines, and key personnel necessary for launching new interventions. Although blueprints are a foundational step in driving intervention rollout, little is known about how blueprints are developed, refined, and used in practice. The objective of this study was to describe a systematic, collaborative approach to developing, refining, and utilizing a formal implementation blueprint for scaling up the Contraception Care at Behavioral Health Pavilion (CC@BHP) intervention for adolescents hospitalized in psychiatric units within a pediatric hospital in the United States. In Stage 1 (Planning/Preparation), we assembled a Research Advisory Board (RAB) of 41 multidisciplinary members and conducted a formative evaluation to identify potential barriers to CC@BHP implementation. Barriers were mapped to implementation strategies using the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) tool and used to create an initial blueprint. In Stage 2 (Development/Implementation), RAB members used activity logs to track implementation activities over the 18-month study period, which were then mapped to formal implementation strategies used to further develop the blueprint. About 30% of strategies were situated in the 'Train and Educate Stakeholders' ERIC category, 20% in 'Use Evaluative and Iterative Strategies,' and 16% in 'Develop Stakeholder Interrelationships' category. In Stage 3 (Synthesis/Refinement), the final blueprint was refined, consisting of 16 goals linked to 10 strategies for pre-implementation and 6 strategies for implementation. Feedback on the blueprint emphasized the role of the project champion in translating the blueprint into smaller, actionable steps for implementers.
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Affiliation(s)
- Kathryn A. Hyzak
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43215, USA
| | - Alicia C. Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43215, USA
| | - Samantha A. Herrmann
- Division of Hospital Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Anna Kerlek
- Department of Psychiatry and Behavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Lauden
- Division of Pediatric Hospital Medicine, Children’s Hospital Colorado, Aurora, CO, United States
| | - Sam Dudley
- Division of Hospital Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abigail Underwood
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43215, USA
| | - Elise D. Berlan
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Adolescent Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
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Lundin C, Wikman A, Wikman P, Kallner HK, Sundström-Poromaa I, Skoglund C. Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 62:665-674. [PMID: 36332846 DOI: 10.1016/j.jaac.2022.07.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of becoming teenage mothers. Adverse effects of hormonal contraception (HC), including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD. The current study analyzed whether girls and young women with ADHD are at increased risk for depression during HC use compared with non-ADHD women. METHOD A linkage of Swedish national registers covering 29,767 girls and young women with ADHD aged 15 to 24 years and 763,146 without ADHD provided measures of ADHD and depression diagnoses (International Classification of Diseases [ICD] code) and prescription of stimulant medication, HC, and antidepressant medication (Anatomical Therapeutic Chemical [ATC] code). Cox regression models applying an interaction term (ADHD diagnosis × HC use) evaluated the excess risk of HC-induced depression in women with ADHD. RESULTS Women with ADHD had a 3-fold higher risk of developing depression, irrespective of HC use (adjusted hazard ratio [aHR] = 3.69, 95% CI = 3.60-3.78). Oral combined HC users with ADHD had a 5 times higher risk of depression compared with non-ADHD women who were not using oral combined HC (aHR = 5.19, 95% CI = 4.94-5.47), and a 6 times higher risk in comparison with non-ADHD women who were on oral combined HC (aHR = 6.10 (95% CI = 5.79-6.43). The corresponding risk of depression in women with AHDH who used a progestogen-only pill (aHR = 5.00, 95% CI = 4.56-5.49). The risk of developing depression when using non-oral HC was similarly moderately increased in both groups. CONCLUSION Girls and young women with ADHD have an increased risk of developing depression when using oral HC compared with their unaffected peers. Information on risks with HCs as well as potential benefits with long-acting reversible contraceptives needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.
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Callegari LS, Mahorter SS, Benson SK, Zhao X, Schwarz EB, Borrero S. Perceived Contraceptive Counseling Quality Among Veterans Using VA Primary Care: Data from the ECUUN Study. J Gen Intern Med 2022; 37:698-705. [PMID: 36042079 PMCID: PMC9481768 DOI: 10.1007/s11606-022-07586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-quality contraceptive counseling is critical to support Veterans' reproductive autonomy and promote healthy outcomes. OBJECTIVE To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling. DESIGN Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey. PARTICIPANTS Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506). MAIN MEASURES Perceived quality of contraceptive counseling was captured by assessing Veterans' agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2). KEY RESULTS Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women's Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling. CONCLUSIONS Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA. .,Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, USA.
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Sam K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Xinhua Zhao
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA
| | | | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Belay DG, Aragaw FM. Trend, multivariate decomposition and spatial variations of unintended pregnancy among reproductive-age women in Ethiopia: evidence from demographic and health surveys. Trop Med Health 2022; 50:47. [PMID: 35854397 PMCID: PMC9295486 DOI: 10.1186/s41182-022-00440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background The magnitude of unintended pregnancy is unacceptably high and more than half of it end up with abortions. This may limit lower and middle-income countries to achieve the sustainable development goal targets of reduction of neonatal and maternal mortalities. Evidence on trends and spatial distribution of unintended pregnancy is limited. Therefore, this study aimed to assess the trend, multivariate decomposition, and spatial variations of unintended pregnancy among reproductive-age women in Ethiopia from 2000 to 2016. Methods Ethiopian Demographic and Health Data of 2000 to 2016 were used. A total weighted sample of 30,780 reproductive-age women participated. A multivariate decomposition analysis was employed to identify factors contributing to the change in the rate of unintended pregnancy in Ethiopia for 20 years from (1996 to 2016). The concentration index and graph were used to assess wealth-related inequalities, whereas spatial analysis was done to identify the hotspot of unintended pregnancy in Ethiopia. Results The 20-year trend analysis showed that the magnitude of unintended pregnancy among reproductive-age women decreased by 13.19 percentage points (from 39.76% in 2000 to 26.57% in 2016 EDHS). About 84.97% of the overall decrement was due to the difference in coefficient of the variables, whereas the remaining 15.03% was due to the difference in composition of the respondent. The differences in coefficient of the variables were decomposed by living metropolitan cities, having previous terminated pregnancy, and not having exposure to media; whereas, the change due to the composition, was expressed by having a household size of 1–3, living in metropolitan cities, being multipara and grand para, being unmarried and having no terminated pregnancy. Moreover, unintended pregnancies were more clustered in Addis Ababa and disproportionately concentrated in the poor groups. Conclusions In Ethiopia, a substantial decrement in unintended pregnancy was observed in the past decade. More than four-fifths of this overall decrement was due to the difference in the coefficient of the variables. There was spatial clustering of unintended pregnancy in Ethiopia. A program intervention is needed for high-risk regions such as Addis Ababa. Health education and media campaign should perform for high-risk women such as those having terminated pregnancy, and professing Islam faith. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-022-00440-5.
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Affiliation(s)
- Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bhatta M, Bian A, Norwood J, Shepherd BE, Ransby I, Nelson J, Turner M, Sterling TR, Castilho JL. Low rates of contraception use in women with HIV. Open Forum Infect Dis 2022; 9:ofac113. [PMID: 35392458 PMCID: PMC8982767 DOI: 10.1093/ofid/ofac113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Women with human immunodeficiency virus (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time. Methods We examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cisgender women aged 18–45 years in care at Vanderbilt’s human immunodeficiency virus (HIV) clinic in Nashville, Tennessee, from 1998 through 2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy. Results Of the 737 women included, median age at clinic entry was 31 years; average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percentage of time on any contraception use among nonpregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted hazard ratio [aHR], 0.52 [95% CI {confidence interval}, .29–.93]) and increased likelihood of pregnancy (aHR, 1.77 [95% CI, .97–3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy. Conclusions Most WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.
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Affiliation(s)
- Manasa Bhatta
- School of Medicine, Vanderbilt University, Nashville, TN, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jamison Norwood
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Imani Ransby
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Nelson
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan Turner
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy R Sterling
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
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McCloskey LR, Wisner KL, Cattan MK, Betcher HK, Stika CS, Kiley JW. Contraception for Women With Psychiatric Disorders. Am J Psychiatry 2021; 178:247-255. [PMID: 33167674 DOI: 10.1176/appi.ajp.2020.20020154] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices. METHODS A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. RESULTS The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. CONCLUSIONS Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.
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Affiliation(s)
- Leanne R McCloskey
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Katherine L Wisner
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Minaz Kolia Cattan
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Hannah K Betcher
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Catherine S Stika
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Jessica W Kiley
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
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Judge-Golden CP, Wolgemuth TE, Zhao X, Mor MK, Borrero S. Agreement between Self-Reported "Ideal" and Currently Used Contraceptive Methods among Women Veterans Using the Veterans Affairs Healthcare System. Womens Health Issues 2020; 30:283-291. [PMID: 32321666 DOI: 10.1016/j.whi.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women veterans who use the Veterans Affairs Healthcare System theoretically have access to the full range of contraceptive methods. This study explores match between currently used and self-reported "ideal" methods as a potential marker of contraceptive access and preference matching. METHODS This mixed methods study uses data from a nationally representative survey of reproductive-aged women veterans who use the Veterans Affairs Healthcare System for primary care, including 979 participants at risk of unintended pregnancy. Women reported all contraceptive methods used in the past month and were asked, "If you could choose any method of contraception or birth control to prevent pregnancy, what would be your ideal choice?" and selected a single "ideal" method. If applicable, participants were additionally asked, "Why aren't you currently using this method of contraception?" We used adjusted logistic regression to identify patient-, provider-, and system-level factors associated with ideal-current method match. We qualitatively analyzed open-ended responses about reasons for ideal method nonuse. RESULTS Overall, 58% were currently using their ideal method; match was greatest among women selecting an IUD as ideal (73%). Non-White race/ethnicity (adjusted odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and mental illness (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.92) were negatively associated with ideal-current match in adjusted analyses; the presence of a gynecologist at the primary care site was associated with an increased odds of match (adjusted odds ratio, 1.35; 95% confidence interval, 1.03-1.75). Modifiable barriers to ideal method use were cited by 23% of women, including access issues, cost concerns, and provider-level barriers; 79% of responses included nonmodifiable reasons for mismatch including relationship factors and pregnancy plans incongruent with ideal method use, suggesting limitations of our measure based on differential interpretation of the word "ideal." CONCLUSIONS Many women veterans are not currently using the contraceptive method they consider ideal. Results emphasize the complexity of contraceptive method selection and of measuring contraceptive preference matching.
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Affiliation(s)
| | | | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
- Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh School of Medicine 230 McKee Place, Pittsburgh, PA, USA.
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.
| | - Lisa Callegari
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, USA
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA
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Bello JK, Salas J, Meyer D, Heiden-Rootes K, Davis DM, Keegan Garrett E, White MM, Schmeidler P. Mental health diagnoses and early removal of long-acting reversible contraception. J Affect Disord 2020; 262:333-336. [PMID: 31740110 DOI: 10.1016/j.jad.2019.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/26/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Having a mental health diagnosis is associated with contraceptive non-adherence and user-related contraceptive failures of short-acting methods. There is a lack of research on the relationship between mental health diagnoses and early discontinuation of highly effective long-acting reversible (LARC) methods such as the intrauterine device (IUD) and subdermal implant (SDI). METHODS Using a Primary Care and Obstetrics and Gynecology Patient Data Registry, we conducted a cross-sectional analysis of the relationship between any mental health diagnosis (any anxiety disorder or depression) and early LARC removal (<1 year post-insertion) among 385 reproductive-aged (14-50 years) women in 2008-16. Adjusted logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Almost 10% (n = 37) of the sample had an early LARC removal, of which 62.2% were hormonal IUD and 37.8% were SDI. Women with a mental health diagnosis had a higher prevalence of early LARC removal (13.6% vs. 8.0%, p = =.090). Although non-significant, there was a trend in adjusted analyses indicating twice the odds of early removal for women with a mental health diagnosis versus no diagnosis (OR = =2.04, 95% CI = =0.97-4.27). LIMITATIONS This study is limited by a small sample size and availability of variables from a reportable medical record database. Pregnancy intentions and side effects of method use could not be accounted for which may have impacted timing of removal. CONCLUSIONS Understanding why women choose early LARC removal can inform counseling to help women make informed choices about their contraceptive method that meets their reproductive needs.
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Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Dixie Meyer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Katie Heiden-Rootes
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Dawn M Davis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Elizabeth Keegan Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mattie M White
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States; Veteran's Administration St. Louis Health Care System, Saint Louis, MO, United States
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Perceived Barriers and Facilitators to Contraceptive Use Among Women Veterans Accessing the Veterans Affairs Healthcare System. Womens Health Issues 2019; 30:57-63. [PMID: 31558352 DOI: 10.1016/j.whi.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although many studies evaluate factors influencing contraceptive use, little is known about barriers and facilitators that may be specific to or prevalent among women veterans using the Veterans Affairs Healthcare System (VA). DESIGN Semistructured telephone interviews with a national sample of 189 women veterans at risk for unintended pregnancy who receive care in the VA were used to explore barriers and facilitators to contraceptive use as well as elicit suggestions for improving VA contraceptive care. The sample consisted primarily of women with risk factors for adverse reproductive health outcomes, including belonging to ethnic/racial minority groups, having a medical or mental health condition(s), and/or reporting a history of military sexual trauma. Transcript narratives were analyzed using content analysis and the constant comparison method. RESULTS Five distinct themes emerged as barriers or facilitators to contraceptive use depending on participants' VA facility and provider, and women offered concrete suggestions to address each barrier. Most participants (56%) noted poor efficiency as a barrier; others (39%) felt hindered by limited contraceptive counseling and patient education. Approximately one-third (34%) noted that low patient awareness of services impeded care and another one-third (32%) stressed poor interaction with providers as a barrier. Finally, 31% noted feeling ostracized at VA, and emphasized fostering a woman-friendly environment to remove discomfort associated with seeking contraceptive care. CONCLUSIONS These findings suggest that, despite widespread access to low-cost contraception, many women veterans experience barriers to accessing high-quality contraceptive care. These barriers are system and provider specific and warrant further internal evaluation.
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Yecies E, Judge-Golden C, Callegari L, Borrero S. Contraceptive Care in the Veterans Health Administration. Semin Reprod Med 2019; 37:24-31. [PMID: 31185515 PMCID: PMC7047650 DOI: 10.1055/s-0039-1692201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In recent years, the number of women Veterans obtaining care in the Veterans Affairs (VA) Healthcare System has grown, expanding the need for provision of contraceptive care. Women Veterans are a diverse group of women with complex sociodemographic and medical backgrounds, and meeting their needs presents a unique challenge for VA. Efforts including the establishment of comprehensive women's health clinics and training practitioners in women's health have greatly improved healthcare services for women Veterans over the last few decades. Recent data from a large cross-sectional survey study suggest that contraceptive use in VA is similar to the general population and that rates of unintended pregnancy, while still significant, are not higher than that in the general population. Subgroup analyses of this survey data, however, suggest that ongoing efforts are needed to improve outcomes in vulnerable subpopulations of women Veterans, particularly ethnic/racial minorities and Veterans with complex medical backgrounds. Policy changes such as the elimination of copayments for contraceptive prescriptions and the dispensing of more months of contraceptive supply are evidence-based starting points for improvements, in addition to leveraging VA's integrated system and research infrastructure to improve patient-centered counseling and contraceptive access.
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Affiliation(s)
- Emmanuelle Yecies
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Lisa Callegari
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Drive Care, VA Health Services Research and Development, Seattle, WA
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Sonya Borrero
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- VA Pittsburgh Healthcare System, Pittsburgh, PA
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA
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