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Reddington C, Dior UP, Stafford L, McNamara HC, Rasaratnam P, Karri R, Karahalios A, Healey M, Cheng C. The impact of age and parity on the experience of relief and regret in women who have undergone hysterectomy for benign disease: A cross sectional survey. BJOG 2024; 131:1102-1110. [PMID: 38212141 DOI: 10.1111/1471-0528.17745] [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: 04/04/2023] [Revised: 07/18/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To investigate the impact of age and parity on the experience on relief and regret following elective hysterectomy for benign disease, and to explore the factors that impact relief and regret. DESIGN Retrospective cross-sectional survey of a cohort. SETTING Single-centre tertiary hospital in Melbourne, Australia. POPULATION Patients who underwent elective hysterectomy for benign indications from 01 January 2008 - 31 July 2015 (inclusive) with age <51 years at time of admission. METHODS Eligible participants completed a retrospective survey regarding their experience of relief and regret following hysterectomy. MAIN OUTCOME MEASURES Regret was defined as a positive response to "Do you regret the decision to have a hysterectomy?". Relief was defined as responding "agree/strongly agree" to "I feel relieved I had a hysterectomy". RESULTS 268 of 1285 (21%) eligible participants completed the study questionnaire. Of these, 29 were aged <36 years at the time of hysterectomy. Seven percent (n=18/262) reported regretting having a hysterectomy and 88% (n=230/262) reported experiencing relief. We did not observe associations between age at hysterectomy and regret (aOR 0.93; 95% CI 0.85, 1.03), age at hysterectomy and relief (aOR 1.01; 95% CI 0.93, 1.09), nulliparity and regret (aOR 0.32; 95% CI 0.06, 1.59) or nulliparity and relief (aOR 2.37; 95% CI 0.75, 7.51). Desire for future pregnancy at the time of hysterectomy was more frequently reported in those who experienced regret vs no regret (46.7% vs 12.1%, OR: 6.33; 95% CI: 2.12, 18.90; p=0.001). CONCLUSIONS Age and parity are not associated with relief nor regret following elective hysterectomy for benign disease.
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Affiliation(s)
- Charlotte Reddington
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Uri P Dior
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Hadassah Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen C McNamara
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Prakashini Rasaratnam
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Oceania University of Medicine, Brisbane, Queensland, Australia
| | - Roshan Karri
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Healey
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claudia Cheng
- Gynaecology Unit 2, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Rodowa MS, Waddington A, Pudwell J. Regret in the Modern Contraceptive Landscape: Evaluating Regret in Patients Undergoing Tubal Ligation or Bilateral Salpingectomy for Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102362. [PMID: 38272216 DOI: 10.1016/j.jogc.2024.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To estimate the prevalence of regret among Canadians undergoing tubal ligation or bilateral salpingectomy for contraception in the context of widely available, highly effective, and tolerable reversible contraceptive methods including long-acting reversible contraceptives. METHODS We performed an online cross-sectional survey of regret following tubal sterilization using Qualtrics software. A convenience sample was used to recruit Canadian residents between the ages of 18 and 60 years who had undergone tubal ligation or salpingectomy for contraception. The online survey was advertised on 3 social media platforms: Facebook, Twitter, and Instagram. RESULTS We obtained survey results for 844 Canadian residents. Regret was reported by 15.9% of respondents. Consistent with existing literature, factors associated with regret included younger age at the time of the procedure, a change in relationship status, and having the procedure performed at the time of a pregnancy. Surprisingly, 9.5% of respondents reported an element of coercion, 4.5% were unaware the procedure was considered permanent contraception, and 33.3% did not recall their provider discussing alternative forms of contraception with them prior to surgery. CONCLUSION We found that the prevalence of regret following tubal sterilization has not changed with the widespread availability of highly effective reversible contraceptive methods. However, most patients choosing permanent contraception will be satisfied with their decision. Shared decision-making should respect the autonomy of each patient to make their own decisions regarding the most acceptable family planning method for their circumstances.
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Affiliation(s)
- Melinda-Sue Rodowa
- Department of Obstetrics and Gynecology, Huron Perth Health Alliance, Stratford, ON, Canada.
| | - Ashley Waddington
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada
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Ellison JE, Brown-Podgorski BL, Morgan JR. Changes in Permanent Contraception Procedures Among Young Adults Following the Dobbs Decision. JAMA HEALTH FORUM 2024; 5:e240424. [PMID: 38607642 PMCID: PMC11065151 DOI: 10.1001/jamahealthforum.2024.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
This cross-sectional study evaluates changes in tubal ligation and vasectomy procedures among younger adults following the Dobbs v Jackson Women’s Health Organization decision.
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Affiliation(s)
- Jacqueline E. Ellison
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
- Center for Innovative Research on Gender Health Equity, Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brittany L. Brown-Podgorski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Jake R. Morgan
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts
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Borrero S, Mosley EA, Wu M, Dehlendorf C, Wright C, Abebe KZ, Zite N. A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women: The MyDecision/MiDecisión Randomized Clinical Trial. JAMA Netw Open 2024; 7:e242215. [PMID: 38502127 PMCID: PMC10951734 DOI: 10.1001/jamanetworkopen.2024.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/22/2024] [Indexed: 03/20/2024] Open
Abstract
Importance Tubal sterilization is common, especially among individuals with low income. There is substantial misunderstanding about sterilization among those who have undergone the procedure, suggesting suboptimal decision-making about a method that permanently ends reproductive capacity. Objective To test the efficacy of a web-based decision aid for improving tubal sterilization decision quality. Design, Setting, and Participants This randomized clinical trial conducted between March 2020 and November 2023 included English- or Spanish-speaking pregnant cisgender women aged 21 to 45 years who had Medicaid insurance and were contemplating tubal sterilization after delivery. Participants were recruited from outpatient obstetric clinics in 3 US cities. Intervention Participants were randomized 1:1 to usual care (control arm) or to usual care plus a web-based decision aid (MyDecision/MiDecisión) (intervention arm). The aid includes written, audio, and video information about tubal sterilization procedures; an interactive table comparing contraceptive options; values-clarifying exercises; knowledge checks; and a summary report. Main Outcomes and Measures The co-primary outcomes were tubal sterilization knowledge and decisional conflict regarding the contraceptive decision. Knowledge was measured as the percentage of correct responses to 10 true-false items. Decisional conflict was measured using the low-literacy Decision Conflict Scale, with lower scores on a range from 0 to 100 indicating less conflict. Results Among the 350 participants, mean (SD) age was 29.7 (5.1) years. Compared with the usual care group, participants randomized to the decision aid had significantly higher tubal sterilization knowledge (mean [SD] proportion of questions answered correctly, 76.5% [16.9%] vs 55.6% [22.6%]; P < .001) and lower decisional conflict scores (mean [SD], 12.7 [16.6] vs 18.7 [20.8] points; P = .002). The greatest knowledge differences between the 2 groups were for items about permanence, with more participants in the intervention arm answering correctly that tubal sterilization is not easily reversible (90.1% vs 39.3%; odds ratio [OR], 14.2 [95% CI, 7.9-25.4]; P < .001) and that the tubes do not spontaneously "come untied" (86.6% vs 33.7%; OR, 13.0 [95% CI, 7.6-22.4]; P < .001). Conclusions and Relevance MyDecision/MiDecisión significantly improved tubal sterilization decision-making quality compared with usual care only. This scalable decision aid can be implemented into clinical practice to supplement practitioner counseling. These results are particularly important given the recent increase in demand for permanent contraception after the US Supreme Court decision overturning federal abortion protections. Trial Registration ClinicalTrials.gov Identifier: NCT04097717.
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Affiliation(s)
- Sonya Borrero
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth A. Mosley
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michaella Wu
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christine Dehlendorf
- Department of Family & Community Medicine, University of California, San Francisco
| | - Catherine Wright
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville
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Villiger D. Informed Consent Under Ignorance. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-13. [PMID: 38181212 DOI: 10.1080/15265161.2023.2296429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process.
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Jana A, Shekhar C. Female sterilisation in India: Examining the role of women's own decision making and information given to client. J Biosoc Sci 2023; 55:960-979. [PMID: 36330846 DOI: 10.1017/s0021932022000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
India has a very high prevalence of female sterilisation compared to other countries in the world, with a prevailing situation of very low level of information about contraceptive options given to women. It is well established in demographic research that, there exists a strong association between knowledge of contraceptive methods and type of contraception chosen. Present study uses data from 3 consecutive rounds of National Family Health Survey (3, 4 & 5). The sample contains currently married women who started using the current method 5 years prior to each round of survey. Multilevel Logistic Regression and Fairlie Decomposition Model are used to analyse the effect of information given to respondents and decision-making power regarding contraceptive methods on choice of female sterilisation. Women, who are informed about available methods, have lower chance (45.8%, 37.5% & 40% for NFHS 3, 4 & 5 respectively) to opt for sterilisation after controlling all other factors. If woman is the sole decision maker for contraceptive choice, the chance of sterilisation reduces than cases where decision is taken only by husband or jointly. Information about other methods also contributes towards reducing the chance of female sterilisation over the time. Information about contraceptive methods is found to be a major factor in controlling choice of temporary or permanent method. Thus, major focus for the policy makers should be to make information regarding contraceptives more accessible for women.
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Affiliation(s)
- Arjun Jana
- PhD Scholar, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Professor, Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India
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7
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Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med 2023; 12:4791. [PMID: 37510905 PMCID: PMC10381146 DOI: 10.3390/jcm12144791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
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Affiliation(s)
- Sarah Anne Howard
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Soumya Rahima Benhabbour
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Gelderblom ME, Jaspers V, Akkermans RP, Slangen B, Oei ALM, van Ginkel AA, Ngo H, IntHout J, Hermens RPMG, de Hullu JA, Piek JMJ. First step in implementation of opportunistic salpingectomy for prevention of ovarian cancer: Current care and its determinants. Acta Obstet Gynecol Scand 2023; 102:257-269. [PMID: 36661074 PMCID: PMC9951340 DOI: 10.1111/aogs.14507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Opportunistic salpingectomy (OS) refers to additional removal of the fallopian tubes during abdominal surgery performed for another medical indication, as prevention for ovarian cancer. As OS has been inconsistently implemented, its clinical practice varies worldwide. To reduce this variation, insight is required into current clinical practice and its determinants. Therefore, the study aim was to determine the implementation of counseling and performance of OS between 2015 and 2018, and its patient, surgical, physician, and hospital characteristics. MATERIAL AND METHODS Retrospective study using electronic medical records from six different Dutch hospitals: two academic, two large teaching, and two non-teaching hospitals. Patients were considered eligible for OS if they underwent elective non-obstetric abdominal surgery for a gynecological indication from January 2015 through December 2018. Primary outcomes were uptake of counseling and performance of OS. Multilevel multivariable logistic regression analyses were conducted to identify characteristics associated with OS. RESULTS A total of 3214 patients underwent elective non-obstetric abdominal surgery for a gynecological indication and were eligible for OS. Counseling on OS increased significantly from 2.9% in 2015 to 29.4% in 2018. In this period, 440 patients were counseled on OS, of which 95.9% chose OS. Performance of OS increased significantly from 6.9% in 2015 to 44.5% in 2018. Counseling for and performance of OS were more likely in patients who had surgery by laparoscopic approach, were counseled by a gynecological resident, or had more than three contact moments before surgery. Additionally, OS was less likely in patients who had vaginal surgery. CONCLUSIONS Although the uptake of OS increased from 2015 to 2018, the majority of patients who were eligible for OS were not counseled and did not undergo OS. Its clinical practice varies on patient, surgery, and physician characteristics. Therefore, an implementation strategy tailored to associated determinants is recommended.
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Affiliation(s)
- Malou E. Gelderblom
- Department of Obstetrics and Gynecology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Veerle Jaspers
- Department of Obstetrics and Gynecology and Catharina Cancer InstituteCatharina HospitalEindhovenThe Netherlands
| | - Reinier P. Akkermans
- Radboud Institute for Health Sciences, Department of IQ health careRadboud University Medical CenterNijmegenThe Netherlands,Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Brigitte Slangen
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Angele L. M. Oei
- Department of Obstetrics and GynecologyBernhoven HospitalUdenThe Netherlands
| | | | - Huy Ngo
- Department of Obstetrics and GynecologyElkerliek HospitalHelmondThe Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Rosella P. M. G. Hermens
- Radboud Institute for Health Sciences, Department of IQ health careRadboud University Medical CenterNijmegenThe Netherlands
| | - Joanne A. de Hullu
- Department of Obstetrics and Gynecology, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen M. J. Piek
- Department of Obstetrics and Gynecology and Catharina Cancer InstituteCatharina HospitalEindhovenThe Netherlands
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Female sterilization in the life course: Understanding trends and differentials in early sterilization. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.47.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Siemons SE, Vleugels MPH, van Balken MR, Braat DDM, Nieboer TE. Male or female sterilization - the decision making process: Counselling and regret. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100767. [PMID: 36027724 DOI: 10.1016/j.srhc.2022.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) To analyze the decision-making process of both male and female sterilization in order to improve counselling and prevent regret after sterilization in the future. STUDY DESIGN An online questionnaire regarding sterilization (counselling, sources of information and regret) was promoted on Facebook, Twitter and LinkedIn. A total of 1107 men and women who had undergone or considered sterilization in the Netherlands filled in the questionnaire. RESULTS A total of 88.9 % of the sterilized group and 67.4 % in the considered group responded that they felt well informed when they considered sterilization. However, less than half of the participants in both groups knew about all different sterilization methods. In both groups participants reported they consulted their partner the most when they considered sterilization. After sterilization 7.7 % reported having regret. Regret was reported more often when participants were sterilized ≤ 30 years. Most important reasons for regret reported by males were complications, pain, a new wish to conceive and divorce/remarriage. Most important reasons for regret reported by females were pain, complications, a new wish to conceive and menstrual symptoms. A total of 21.1 % in the sterilized and 38.0 % in the considered group responded they would have liked to use a decision aid when they considered sterilization. CONCLUSIONS Findings of this study provide insight in the decision-making process regarding sterilization. There is a lack of knowledge of different methods of sterilization and 7.7% regrets their sterilization afterwards. Furthermore, the results show an importance of developing a decision aid for couples considering sterilization.
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Affiliation(s)
- Sara E Siemons
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Michel P H Vleugels
- Dept. of Obstetrics and Gynecology, Hospital Clinica Benidorm, Avinguda Alfonso Puchades 8, 03501 Benidorm, Spain
| | - Michael R van Balken
- Dept. of Urology, Rijnstate Arnhem, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| | - Didi D M Braat
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Theodoor E Nieboer
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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11
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Bansal A, Dwivedi LK, Shirisha P. Sterilization incentives and associated regret among ever married women in India, NFHS, 2015–16. BMC Health Serv Res 2022; 22:1063. [PMID: 35986319 PMCID: PMC9392240 DOI: 10.1186/s12913-022-08401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Sterilization is the only family planning method that involves relatively large amount compensation. So, the study attempts to examine the role of incentives received against the sterilization procedures on the reporting of sterilization regret in India. Methods The study used data from the fourth round of National Family Health Survey, 2015–16, which gathered the information on sterilization regret from 1,94,207 ever-married women. Multivariate logistic analysis and predicted probabilities approach was used to study the effect of compensation received on the sterilization regret in India. Results Results show that women who have received compensation were 33% less likely to report sterilization regret. It was found that 70% of women who undergone sterilization in public facility didn’t incur any expenditure, rather received incentives. It is observed that women who had undergone operation in private facility spent a large amount than women who had done their operation in public facility. The regret in the private facility mainly results from high out of pocket expenditure on sterilization procedures. Around eight percent of women regretted getting sterilized in a private hospital and received some compensation amount, vis a vis the six percent who regretted undergoing sterilization in public facility and received compensation. Conclusion The study calls for a need to standardize the cost of sterilization procedure in India's health facilities. A good alternative for reducing the cost could be Public–Private Partnership.
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Hellwig F, Ewerling F, Coll CVN, Barros AJD. The role of female permanent contraception in meeting the demand for family planning in low- and middle-income countries. Contraception 2022; 114:41-48. [PMID: 35568087 DOI: 10.1016/j.contraception.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Our aim was to describe the reliance on female permanent contraception among women with demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries (LMICs) and to describe socio-economic and demographic patterns of permanent contraception in countries with high use. METHODS Using data from the latest national health survey carried out in LMICs we estimated mDFPS and the share of each contraceptive method used. Countries with a share of more than 25% of female permanent contraception were further explored for differences by wealth, number of living children, woman's age, and by the intersection of woman's age and number of living children. RESULTS In the 20 countries studied, between 6% and 94% of the contracepting population used modern methods. Female permanent contraception accounted for more than half of women using modern contraceptives in India, Dominican Republic, El Salvador, Mexico, and Colombia. In India and Tonga, more than 20% of women using contraceptives with fewer than two living children were using female permanent contraception. Among women with two living children, countries with the highest reliance on permanent contraception were India (79%), El Salvador (61%), Cuba (55%), Colombia (52%), and Thailand (51%). Dominican Republic, El Salvador, India, and Mexico presented high levels of permanent contraception among younger women, with reliance higher than 30% among women aged 25 to 29 and 50% or more among women aged 30 to 34. CONCLUSIONS Reliance on permanent contraception was high in several countries and among women aged less than 35 years.
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Affiliation(s)
- Franciele Hellwig
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil.
| | - Fernanda Ewerling
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Carolina V N Coll
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas; International Center for Equity in Health; Pelotas Brazil; Federal University of Pelotas; Post-graduation Program in Epidemiology; Pelotas Brazil
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Rahaman M, Singh R, Chouhan P, Roy A, Ajmer S, Rana MJ. Levels, patterns and determinants of using reversible contraceptives for limiting family planning in India: evidence from National Family Health Survey, 2015-16. BMC Womens Health 2022; 22:124. [PMID: 35439954 PMCID: PMC9020013 DOI: 10.1186/s12905-022-01706-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Demand for family planning is predominantly for birth limiting rather than birth spacing in India. Despite several family planning programmes in India, the use of reversible contraception for limiting family planning has been stagnant and largely depends on female sterilization. Though many researchers have examined patterns and determinants of using modern contraception for total family planning, studies on patterns and determinants of contraceptive use for birth limiting are limited in India. This paper examines the patterns of contraceptive use for liming demand and its determinants in India. Methods The National Family Health Survey-4, 2015–16 data was used. Bivariate chi-square significant test and multivariate binary logistic regression model used to accomplish the study objectives. Results Majority of women (86.5%) satisfied limiting demand (SLD) in India; the SLD was found significantly low among the women’s age 15–19 years (53.1%) and parity 0 (42%). The satisfied limiting demand by modern reversible contraception (mrSLD) was found significantly high in age group 15–19 years (49.1%), Muslims (30.6%) and North-east region (45.4%). The satisfied limiting demand by traditional contraception (tSLD) was almost three times higher in North-east region (26.1%) than national average of India (8.7%). The women’s years of schooling, wealth status, religion and presence of son child found to be significant determinants of mrSLD. The likelihood of tSLD was found significantly high among the women who had no son child (AOR = 1.41; 95% CI:1.34, 1.48), Muslim (AOR = 1.78; 95% CI:1.70, 1.87). A considerable regional variability in levels of SLD, mrSLD and tSLD was found in India. Conclusion Public investment in family planning is required to promote and provide subsidized modern reversible contraception (MRC) services, especially to women from North-east region, Muslim, Scheduled tribe, poor household and who had no son child. Improving the quality and availability of MRC services in public health centre will be helpful to increase SLD among the above mentioned women. Besides, the promotion of MRC will be supportive to overcome the issues of sterilization regrets in India. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01706-0.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration and Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
| | - Risha Singh
- Centre for the Study of Regional Development (CSRD), Jawaharlal Nehru University, New Delhi, 110067, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga (UGB), Malda, 732103, India
| | - Avijit Roy
- Department of Geography, University of Gour Banga (UGB), Malda, 732103, India
| | - Sumela Ajmer
- Department of Geography, Tilka Manjhi Bhagalpur University, Bhagalpur, 812001, India
| | - Md Juel Rana
- College of Health Science, Korea University, Seoul, 028401, South Korea
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14
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Risk of Sterilization Regret and Age: An Analysis of the National Survey of Family Growth, 2015-2019. Obstet Gynecol 2022; 139:433-439. [PMID: 35115436 DOI: 10.1097/aog.0000000000004692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the risk of sterilization regret based on age at the time of sterilization in a contemporary group of women. METHODS We conducted a retrospective analysis of cross-sectional data from the 2015-2017 and 2017-2019 National Survey of Family Growth, Female Respondent Files, to estimate the proportion of women who experience sterilization regret. Descriptive statistics were used to describe the population and the proportion with regret. Sterilization regret was defined as someone who either underwent sterilization reversal or who definitely wanted sterilization reversal. Multivariable logistic regression models were used to assess associations with sterilization regret. RESULTS A total of 1,549 women who underwent sterilization were included in the analysis; 8% were aged 21-30 years, and 92% were aged older than 30 years. Of the participants, 16.9% identified as Black, 22.0% as Hispanic, and 57.2% as White. Most (58.4%) underwent a tubal sterilization procedure between age 21 and 30 years. The cumulative proportion of regret was 10.2% (12.6% for women who underwent sterilization at age 21-30 years and 6.7% for those who underwent sterilization at older than age 30 years). After controlling for covariates including age, race, parity, educational attainment, and medical reason for sterilization, the only variable that had a statistically significant association with regret was age at the time of the interview (P<.001). As women got older, they were less likely to report sterilization regret. CONCLUSION Younger women experience more sterilization regret. As women get older, sterilization regret decreases. Counseling about sterilization should reveal the unpredictability of future desire, but age alone must not be a barrier to performing sterilization.
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15
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van Bommel MHD, Steenbeek MP, IntHout J, Hermens RPMG, Hoogerbrugge N, Harmsen MG, van Doorn HC, Mourits MJE, van Beurden M, Zweemer RP, Gaarenstroom KN, Slangen BFM, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, Prins JB, Custers JAE, de Hullu JA. Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors. Support Care Cancer 2022; 30:3409-3418. [PMID: 34997316 PMCID: PMC8857097 DOI: 10.1007/s00520-021-06726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06726-4.
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Affiliation(s)
- Majke H D van Bommel
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marline G Harmsen
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Monique M A Brood-van Zanten
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Caroline Vos
- Gynaecologic Oncologic Center South Location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000 LC, Tilburg, The Netherlands
| | - Jurgen M Piek
- Gynaecologic Oncologic Center South Location Catharina Hospital, Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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16
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Oben AG, Walker ZW, Blanchard CT, Szychowski JM, Maier JG, Rajapreyar I, Cribbs MG, Tita A, Sinkey RG. Racial disparities in reliable contraceptive use in women with heart disease. EUR J CONTRACEP REPR 2021; 27:174-179. [PMID: 34870553 DOI: 10.1080/13625187.2021.2010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the differences in reliable contraceptive use between black women and white women with maternal cardiac disease. METHODS The study comprised a retrospective cohort of women with maternal cardiac disease managed by the University of Alabama at Birmingham (UAB) Comprehensive Pregnancy and Heart Program (CPHP). Women were included if they had attended one or more prenatal visits at the UAB CPHP and delivered at the UAB hospital between March 2015 and June 2019. The primary outcome was reliable contraceptive use within 2 months postpartum, defined by receipt of long-acting reversible contraception (i.e., an intrauterine contraceptive device or an etonogestrel implant) or female sterilisation. All outcomes were compared based on self-reported race. RESULTS One hundred and forty-nine women met the inclusion criteria. Black women (n = 63) were more likely than white women (n = 86) to use reliable contraception (65% vs 43%; p = 0.008). Black women were less likely than white women to be undecided or decline contraception at the time of admission (13% vs 27%; p = 0.037). There was no difference in reliable contraceptive use between black women (n = 20, 63%) and white women (n = 23, 72%) with modified World Health Organisation (WHO) class III/IV lesions (p = 0.42). CONCLUSION Black women with maternal cardiac disease were more likely than white women to receive reliable contraception. Interventions to prevent unintended pregnancy in women with maternal cardiac disease should focus on improving reliable contraceptive use, especially for women with modified WHO class III/IV lesions.
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Affiliation(s)
- Ayamo G Oben
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary W Walker
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia G Maier
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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de Souza RS, Berger GS. Fallopian tube anatomy predicts pregnancy and pregnancy outcomes after tubal reversal surgery. Stat Methods Med Res 2021; 30:2004-2014. [PMID: 34232836 DOI: 10.1177/09622802211023543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We conducted this study to determine whether fallopian tube anatomy can predict the likelihood of pregnancy and pregnancy outcomes after tubal sterilization reversal. We built a flexible, non-parametric, multivariate model via generalized additive models to assess the effects of the following tubal parameters observed during tubal reparative surgery: tubal lengths; differences in tubal segment location and diameters at the anastomosis sites; and fibrosis of the tubal muscularis. In this study, population, age, and tubal length-in that order-were the primary factors predicting the likelihood of pregnancy. For pregnancy outcomes, tubal length was the most influential predictor of birth and ectopic pregnancy, while age was the primary predictor of miscarriage. Segment location and diameters contributed slightly to the odds of miscarriage and ectopic pregnancy. Tubal muscularis fibrosis had little apparent effect. This study is the first to show that a statistical learning predictive model based on fallopian tube anatomy can predict pregnancy and pregnancy outcome probabilities after tubal reversal surgery.
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Affiliation(s)
- Rafael S de Souza
- Key Laboratory for Research in Galaxies and Cosmology, Shanghai Astronomical Observatory, Chinese Academy of Sciences, Shanghai, China
| | - Gary S Berger
- Department of Obstetrics and Gynaecology, University of North Carolina at Chapel Hill, NC, USA
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18
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Smith M, McCool-Myers M, Kottke MJ. Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy. Matern Child Health J 2021; 25:1361-1368. [PMID: 34109490 DOI: 10.1007/s10995-021-03180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The postpartum period is a time of high unmet contraception need. Providing long-acting reversible contraception (LARC), particularly in the immediate postpartum period, is one strategy to meet contraceptive needs. This practice may also prevent unintended and short interpregnancy interval pregnancies. In recent years, state Medicaid programs have implemented reimbursement policies for LARC use in the inpatient setting. The purpose of this study was to assess the uptake of inpatient postpartum LARCs at a large urban hospital with a sizable Medicaid population, before and after policy implementation. METHODS Using billing records from January 2015 and December 2017, we extracted data on patient demographics and LARC uptake before Medicaid policy change (2015) and after policy change (2016 and 2017). Implant and intrauterine device insertions were classified as inpatient postpartum (0-7 days after birth), outpatient postpartum (1-8 weeks after) or interval (9+ weeks after). RESULTS In the 3-year study period, 2091 LARC insertions occurred, of which 700 (33.5%) were inpatient postpartum, 429 (20.5%) outpatient postpartum, and 962 (46.0%) interval. After policy implementation, inpatient postpartum LARC insertions increased from 2.6 per 100 deliveries to 16.8 per 100 deliveries. Significant differences in uptake were seen in Black and Hispanic populations. The number of outpatient postpartum LARCs remained stable and tubal sterilizations decreased. CONCLUSIONS FOR PRACTICE Implementation of reimbursement policies contributed to a sharp uptake of inpatient postpartum LARCs. Improved access to effective, reversible contraception could reduce the number of unplanned and short interpregnancy interval pregnancies, ultimately lowering rates of maternal morbidity and mortality.
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Affiliation(s)
- Madeline Smith
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, 46 Armstrong Street SE, Atlanta, GA, 30303, USA.
| | - Melissa J Kottke
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, 46 Armstrong Street SE, Atlanta, GA, 30303, USA
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19
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Bergeron C, Laberge PY, Boutin A, Thériault MA, Valcourt F, Lemyre M, Maheux-Lacroix S. Endometrial ablation or resection versus levonorgestrel intra-uterine system for the treatment of women with heavy menstrual bleeding and a normal uterine cavity: a systematic review with meta-analysis. Hum Reprod Update 2020; 26:302-311. [PMID: 31990359 DOI: 10.1093/humupd/dmz051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Endometrial ablation/resection and the levonorgestrel intra-uterine system (LNG-IUS) are well-established treatment options for heavy menstrual bleeding to avoid more invasive alternatives, such as hysterectomy. OBJECTIVE The aim was to compare the efficacy and safety of endometrial ablation or resection with the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and to investigate sources of heterogeneity between studies. SEARCH METHODS We searched the databases MEDLINE, EMBASE, CENTRAL, Web of Science, Biosis and Google Scholar as well as citations and reference lists published up to August 2019. Two authors independently screened 3701 citations for eligibility. We included randomized controlled trials published in any language, comparing endometrial ablation or resection to the LNG-IUS in the treatment of premenopausal women with heavy menstrual bleeding and a normal uterine cavity. OUTCOMES Thirteen studies (N = 884) were eligible. Two independent authors extracted data and assessed the quality of included studies. Random effect models were used to compare the modalities and evaluate sources of heterogeneity. No significant differences were observed between endometrial ablation/resection and the LNG-IUS in terms of subsequent hysterectomy (primary outcome, risk ratio (RR) = 1.13, 95% CI 0.60 to 2.11, P = 0.71, I2 = 14%, 12 studies, 726 women), satisfaction, quality of life, amenorrhea and treatment failure. However, side effects were less common in women treated with endometrial ablation/resection compared to the LNG-IUS (RR = 0.52, 95% CI 0.37 to 0.71, P < 0.001, I2 = 0%, 10 studies, 580 women). Three complications were reported in the endometrial ablation/resection group and none in the LNG-IUS group (P = 0.25). Mean age of the studied populations was identified as a significant source of heterogeneity between studies in subgroup analysis (P = 0.01). In fact, endometrial ablation/resection was associated with a higher risk of subsequent hysterectomy compared to the LNG-IUS in younger populations (mean age ≤ 42 years old, RR = 5.26, 95% CI 1.21 to 22.91, P = 0.03, I2 = 0%, 3 studies, 189 women). On the contrary, subsequent hysterectomy seemed to be less likely with endometrial ablation/resection compared to the LNG-IUS in older populations (mean age > 42 years old), although the reduction did not reach statistical significance (RR = 0.51, 95% CI 0.21 to 1.24, P = 0.14, I2 = 0%, 5 studies, 297 women). Finally, sensitivity analysis taking into account the risk of bias of included studies and type of surgical devices (first and second generation) did not modify the results. Most of the included studies reported outcomes at up to 3 years, and the relative performance of endometrial ablation/resection and LNG-IUS remains unknown in the longer term. WIDER IMPLICATIONS Endometrial ablation/resection and the LNG-IUS are two excellent treatment options for heavy menstrual bleeding, although women treated with the LNG-IUS are at higher risk of experiencing side effects compared to endometrial ablation/resection. Otherwise, younger women seem to present a lower risk of eventually requiring hysterectomy when treated with the LNG-IUS compared to endometrial ablation/resection.
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Affiliation(s)
- Catherine Bergeron
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
| | - Philippe Y Laberge
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
| | - Amélie Boutin
- University of British Columbia, 2329 West Mall, Vancouver, BC, Canada V6T 1Z4
| | - Marie-Anne Thériault
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
| | - Florence Valcourt
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
| | - Madeleine Lemyre
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
| | - Sarah Maheux-Lacroix
- Université Laval, 2325 Rue de l'Université, QC, Québec, Canada G1V 0A6.,CHU de Québec, 2705, boul. Laurier, QC, Québec, Canada GIV 4G2
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20
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Welch EK, Lindberg M, Mauney D, McLeod F. Bring back the tubal: An intervention to provide postpartum tubal ligation in the underserved population. Health Care Women Int 2020; 45:113-128. [PMID: 32897839 DOI: 10.1080/07399332.2020.1805747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
We aimed to improve educational awareness of postpartum bilateral tubal ligation (PPBTL), which we defined as a 15% improvement between pre-/post-intervention questionnaire scores. We followed patients desiring and undergoing PPBTL and reason for unfulfilled procedures from 2017-2018. OB/GYN, Nursing, and Anesthesia participated in educational sessions with pre-/post-intervention questionnaires. Comparing the first and latter six months after study initiation, PPBTLs performed increased from 39% to 54%. Fifty-two staff participated in the interventions, with a 21% improvement in scores (OB/GYN p = 0.0117, Nursing p = 0.0001, Anesthesia p = 0.0002). We conclude multidisciplinary interventions improved educational awareness, an integral part to increasing PPBTL performance in the underserved.
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Affiliation(s)
- Eva K Welch
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Mary Lindberg
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Donald Mauney
- Department of Anesthesiology, Geisinger Health System, Wilkes Barre, Pennsylvania, USA
| | - Francine McLeod
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
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Chua KH, Chan JKY, Liu S, Tan TY, Phoon JWL, Viardot-Foucault VC, Nadarajah S, Tan HH. Laparoscopic Tubal Re-anastomosis or In Vitro Fertilisation in Previously
Ligated Patients: A Comparison of Fertility Outcomes and Survey of
Patient Attitudes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2019214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction:
We aim to compare live birth rates, cost analysis and a survey of patient
attitudes between laparosopic tubal re-anastomosis and IVF.
Materials and Methods:
Retrospective study: A retrospective study was done in a single reproductive medicine
and IVF unit in Singapore, from January 2011 to December 2016. Previously ligated
patients underwent either laparoscopic tubal re-anastomosis or IVF. The primary
outcome was first live birth after treatment. Interval to first pregnancy, miscarriage
and ectopic pregnancies were also reported. Survey: Patients attending the subfertility
clinic completed a questionnaire on IVF and tubal re-anastomosis, on preferred choice
of treatment, before and after reading an information sheet.
Results:
Retrospective study: 12 patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group (P<0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was lower in the tubal surgery group (SGD27,109 vs SGD52,438). Survey: One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures.
Conclusion:
For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment.
Key words: Artificial reproductive technology, Laparoscopic tubal reversal, Previous
tubal ligation
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Affiliation(s)
- Ka-Hee Chua
- KK Women’s and Children’s Hospital, Singapore
| | | | - Shuling Liu
- KK Women’s and Children’s Hospital, Singapore
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Masella MA, Marceau E. La stérilisation volontaire chez les femmes sans enfant de moins 30 ans : dilemme éthique et déontologique. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1068764ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Avec les modifications sociales des dernières décennies, particulièrement avec l’avènement de l’avortement, de la contraception et de la libéralisation du marché du travail, les femmes ont pu trouver leur place hors de leur rôle de mère et se construire en tant qu’individu propre, non résumé à un rôle reproductif. Ainsi, pour bien des raisons que nous allons présenter, certaines femmes désirent et font le choix de rester sans enfant, elles sont, dans ce cas, appelées childfree (c’est-à-dire, sans enfant par choix). C’est notamment le cas de jeunes femmes de moins 30 ans qui, par peur notamment d’une grossesse non désirée, vont s’orienter vers la ligature tubaire plutôt que vers des méthodes dites non définitives. Cependant, nos sociétés occidentales sont encore assez pronatalistes, et cette décision de mettre un terme à leur capacité reproductive choque et interpelle. Le personnel soignant, et plus précisément les médecins, confronté à ces demandes de stérilisations les rejette souvent lorsqu’elles sont faites par des femmes sans enfants de moins 30 ans, en s’appuyant sur plusieurs justifications que nous allons expliciter, dont la peur d’apparition de regrets chez celle-ci. Il ressort de cette situation une confrontation entre le principe d’autonomie de la personne qui s’exprime par le respect de sa décision d’agent autonome d’une part et, d’autre part, la déontologie du médecin, encore parfois teintée d’un certain paternalisme. Nous allons donc analyser ce dilemme éthique et tenter d’apporter quelques pistes de recommandations pour une prise en charge plus adaptée de ces situations, grâce notamment à l’approche de l’éthique narrative et du partenariat relationnel, aussi appelé le Montreal Model.
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Affiliation(s)
- Marie-Alexia Masella
- Programmes de bioéthique, École de santé publique de l’Université de Montréal, Montréal, Québec, Canada
| | - Emmanuelle Marceau
- Programmes de bioéthique, École de santé publique de l’Université de Montréal, Montréal, Québec, Canada
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Bougie O, Suen MW, Pudwell J, MacGregor B, Plante S, Nitsch R, Singh SS. Evaluating the Prevalence of Regret With the Decision to Proceed With a Hysterectomy in Women Younger than Age 35. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:262-268.e3. [DOI: 10.1016/j.jogc.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/25/2022]
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Pant NC, Singh R, Gupta V, Chauhan A, Mavuduru R, Prabha V, Sharma P. Contraceptive efficacy of sperm agglutinating factor from Staphylococcus warneri, isolated from the cervix of a woman with inexplicable infertility. Reprod Biol Endocrinol 2019; 17:85. [PMID: 31656198 PMCID: PMC6815424 DOI: 10.1186/s12958-019-0531-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Voluntary control of fertility is of paramount importance to the modern society. But since the contraceptive methods available for women have their limitations such as urinary tract infections, allergies, cervical erosion and discomfort, a desperate need exists to develop safe methods. Vaginal contraceptives may be the answer to this problem, as these are the oldest ways of fertility regulation, practiced over the centuries. With minimal systemic involvement, these are also the safest. Natural substances blocking or impairing the sperm motility offer as valuable non-cytotoxic vaginal contraceptives. Antimicrobial peptides (AMPs) isolated from plants, animals and microorganisms are known to possess sperm immobilizing and spermicidal properties. Following this, in the quest for alternative means, we have cloned, over expressed and purified the recombinant sperm agglutinating factor (SAF) from Staphylococcus warneri, isolated from the cervix of a woman with unexplained infertility. METHODS Genomic library of Staphylococcus warneri was generated in Escherichia coli using pSMART vector and screened for sperm agglutinating factor (SAF). The insert in sperm agglutinating transformant was sequenced and was found to express ribonucleotide-diphosphate reductase-α sub unit. The ORF was sub-cloned in pET28a vector, expressed and purified. The effect of rSAF on motility, viability, morphology, Mg++-dependent ATPase activity and acrosome status of human sperms was analyzed in vitro and contraceptive efficacy was evaluated in vivo in female BALB/c mice. RESULTS The 80 kDa rSAF showed complete sperm agglutination, inhibited its Mg2+-ATPase activity, caused premature sperm acrosomal loss in vitro and mimicked the pattern in vivo showing 100% contraception in BALB/c mice resulting in prevention of pregnancy. The FITC labeled SAF was found to bind the entire surface of spermatozoa. Vaginal application and oral administration of rSAF to mice for 14 successive days did not demonstrate any significant change in vaginal cell morphology, organ weight and tissue histology of reproductive and non-reproductive organs and had no negative impact in the dermal and penile irritation tests. CONCLUSION The Sperm Agglutinating Factor from Staphylococcus warneri, natural microflora of human cervix, showed extensive potential to be employed as a safe vaginal contraceptive.
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Affiliation(s)
- Neeraj Chandra Pant
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Ravinder Singh
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Vijaya Gupta
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Aditi Chauhan
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | | | - Vijay Prabha
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India
| | - Prince Sharma
- Department of Microbiology, South Campus, Basic Medical Science (Block I), Panjab University, Sector 25, Chandigarh, 160014, India.
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Profile of Female Sterilization in Brazil. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study analyzes the profile of female sterilization in Brazil by age, parity, type of delivery, place of delivery, color/race, region of residence, years of schooling, marital status, number of unions, and desired number of children reported by women; (2) Methods: The descriptive analysis is based on the most recent Brazilian database on reproductive health: the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). This dataset has information on the history of pregnancies with live births from January 2001 to July 2007; (3) Results: The study suggests that (a) women with high levels of sterilization, high percentages of more than one pregnancy in the period, and larger parity than the desired number of children tend to have high parity, be black, brown, or indigenous, reside in the North or Northeast, have low levels of education, and have two or more unions; and (b) women with high levels of sterilization, low percentages of more than one pregnancy in the period, and lower parity than the desired number of children tend to have cesarean sections, give birth utilizing private health care obtained through a private insurance plan or direct out-of-pocket payment at private hospitals, and be married. (4) Conclusions: The 1997 family planning law could be altered in order to allow female sterilization in conjunction with childbirth, as a way to attend the demand of Brazilian women in public hospitals. Policies are necessary not only to regulate the public sector, but also to aim better services at private institutions. Female sterilization should be discussed in the context of fertility below the replacement level, as one of its associated factors.
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Makhathini BS, Makinga PN, Green-Thompson RR. Knowledge, attitudes, and perceptions of antenatal women to postpartum bilateral tubal ligation at Greys Hospital, KwaZulu-Natal, South Africa. Afr Health Sci 2019; 19:2615-2622. [PMID: 32127834 PMCID: PMC7040276 DOI: 10.4314/ahs.v19i3.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the associations between socio-demographic factors and the general knowledge, the attitudes and perceptions of women attending antenatal clinic at Greys Hospital regarding postpartum tubal ligation (BTL). METHODS A prospective cross-sectional study describing the perceptions about BTL in 241 pregnant women was conducted. RESULTS One hundred and sixty six (68.9%) participants needed to involve their partners before tubal ligation. Thirty five percent of 102 participants who would not have BTL against partner's wish were unemployed. Eighty three (34.4%) participants, mostly with secondary and tertiary education believed that successful reversal of BTL is guaranteed. Fifty two percent of participants, predominantly with no formal schooling and primary education levels were unaware of the risk of falling pregnant after BTL. Sixty seven (27.8%) participants, predominantly with primary education or no formal schooling believed that BTL protects against STIs and HIV. Seventy eight (32.4%) of participants would not have BTL due to religious beliefs, however, participants from the same religion gave different answers to the question. CONCLUSION The study showed a significant lack of knowledge on key points of BTL. Socio-demographic factors still influence this subject and should not be underestimated during counselling of the patients to reduce potential morbidity and litigation.
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Affiliation(s)
- Bongumusa Steven Makhathini
- Department of Obstetrics and Gynecology, Greys Hospital, Pietermaritzburg, and Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban,, South Africa
| | - Polycarpe N'djugumu Makinga
- Department of Family Medicine, Ladysmith Hospital, Ladysmith and University Of KwaZulu-Natal, Durban, South Africa
| | - Randolph Robert Green-Thompson
- Department of Obstetrics and Gynecology, King Edward VIII, and Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Garcia-Alexander G, Gonzales KL, Ferguson LE, Hauck E. Racial and Ethnic Disparities in Desire for Reversal of Sterilization Among U.S. Women. J Womens Health (Larchmt) 2019; 28:812-819. [DOI: 10.1089/jwh.2018.7157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Kelly L. Gonzales
- Oregon Health & Science University-Portland State University joint School of Public Health, Portland State University, Portland, Oregon
| | | | - Elizabeth Hauck
- Department of Sociology, Portland State University, Portland, Oregon
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Olakunde BO, Sam-Agudu NA, Patel TY, Hunt AT, Buffington AM, Phebus TD, Onwasigwe E, Ezeanolue EE. Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators. Contraception 2019; 99:205-211. [PMID: 30685286 DOI: 10.1016/j.contraception.2018.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa. STUDY DESIGN We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model. RESULTS We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level). CONCLUSIONS Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.
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Affiliation(s)
- Babayemi O Olakunde
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tanviben Y Patel
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T Hunt
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aurora M Buffington
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA; University of Nevada Cooperative Extension, Las Vegas, NV, USA
| | - Tara D Phebus
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | | | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria; HealthySunrise Foundation, Las Vegas, NV, USA
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Eeckhaut MCW, Sweeney MM, Feng L. Desire for Sterilization Reversal Among U.S. Females: Increasing Inequalities by Educational Level. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:139-145. [PMID: 30095859 PMCID: PMC6168384 DOI: 10.1363/psrh.12076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT For decades, high reliance on female sterilization in the United States has been accompanied by a high level of desire for sterilization reversal, and less-educated women have been more likely than better educated women to use the method and desire a reversal. Little is known about how levels of and educational differentials in such desire have changed in recent decades. METHODS Data from 4,147 women who reported being sterile from a tubal sterilization in the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth were analyzed using chi-square and Wald tests and binary logistic regression analyses. Predicted probabilities were calculated to determine the likelihood of desire for procedure reversal by wave and educational level. RESULTS The prevalence of desire for sterilization reversal rose by 41%, from 18% in 1995 to 23% in 2002 and 25% in 2006-2010. Overall, women with a bachelor's degree were less likely than those who had not finished high school to desire a reversal (odds ratio, 0.2), and this educational differential was larger in 2006-2010 than in earlier waves. Predicted probabilities indicate that 9% of sterilized women with less than a high school education and 8% of those with a bachelor's degree expressed a desire for procedure reversal in 1995, as did 15% and 3%, respectively, in 2006-2010. CONCLUSION Future research should consider how insurance coverage of all methods under the Affordable Care Act may affect use of sterilization and desire for reversal.
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Affiliation(s)
- Mieke C W Eeckhaut
- Assistant professor, Department of Sociology and Criminal Justice, University of Delaware, Newark
| | - Megan M Sweeney
- Professor, Department of Sociology and California Center for Population Research, University of California, Los Angeles
| | - Lei Feng
- Ph.D. candidate, Department of Sociology, University of California, Los Angeles
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Mallen A, Soong TR, Townsend MK, Wenham RM, Crum CP, Tworoger SS. Surgical prevention strategies in ovarian cancer. Gynecol Oncol 2018; 151:166-175. [PMID: 30087058 DOI: 10.1016/j.ygyno.2018.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
Given the current lack of effective screening for ovarian cancer, surgical removal of at-risk tissue is the most successful strategy to decrease risk of cancer development. However, the optimal timing of surgery and tissues to remove, as well as the appropriate patients to undergo preventive procedures are poorly understood. In this review, we first discuss the origin and precursors of ovarian epithelial carcinomas, focusing on high-grade serous carcinomas and endometriosis-associated carcinomas, which cause the majority of the mortality and incidence of ovarian cancer. In addition, we summarize the implications of current understanding of specific pathogenic origins for surgical prevention and remaining gaps in knowledge. Secondly, we review evidence from the epidemiologic literature on the associations of various surgical prevention strategies, including endometriosis excision, tubal procedures, and bilateral salpingo-oophorectomy, with risk of future ovarian cancer development, as well as the short- and long-term consequences of these strategies on women's health and quality and life. We conclude with recommendations for surgical prevention in women with high-risk genetic mutations and average-risk women, and a brief discussion of ongoing research that will help clarify optimal surgical approaches that balance risk-reduction with maintenance of women's quality of life.
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Affiliation(s)
- Adrianne Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - T Rinda Soong
- Department of Pathology, University of Washington, Seattle, WA, United States of America
| | - Mary K Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
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Jahanian Sadatmahalleh SH, Ziaei S, Kazemnejad A, Mohamadi E. Evaluation of Influencing Factors on Tubal Sterilization Regret: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:200-206. [PMID: 29935064 PMCID: PMC6018183 DOI: 10.22074/ijfs.2018.5272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/23/2017] [Indexed: 11/04/2022]
Abstract
BACHGROUND The aim of this study is to evaluate the menstrual pattern, sexual function, and anxiety, and depression in women with poststerilization regret, and potential influencing factors for regret following tubal ligation (TL) in Iranian women. MATERIALS AND METHODS In this cross-sectional study, 166 women with TL were subdivided into two groups including women with poststerilization regret (n=41) and women without poststerilization regret (n=125). They were selected from a health care center in Guilan province (Iran) during 2015-2016. Menstrual blood loss was measured using the Pictorial Blood Loss Assessment Chart (PBLAC) and through a self-administered questionnaire. In addition, sexual function was assessed by the Female Sexual Function Index (FSFI), and psychological distress was measured by employing the Hospital Anxiety and Depression Scale (HADS). Student's t test and Chi-square test were used to reveal the statistical differences between the two groups. We used logistic regression to determine the influencing factors associated with regretting sterilization. RESULTS Women with poststerilization regret had more menorrhagia (78 vs. 57.6%, P=0.03) than those who did not regret sterilization. A significant difference was found in sexual dysfunction in orgasm (P=0.02), satisfaction (P=0.004), pain (P=0.02), and total FSFI scores (P=0.007) between the two groups. Also, there was a significant difference between the two groups in anxiety, depression and total scores HADS (P=0.01). In the logistic regression model, age of sterilization [odds ratio (OR=2.67), confidence interval (CI): 1.03-7.81, P=0.04)], pre-sterilization counseling (OR=19.92, CI: 6.61-59.99, P<0.001), score of PBLAC (OR=1.01, CI: 1.004-1.01, P=0.001), the number of days of bleeding (OR=1.37, CI: 1.01-1.99, P=0.04), and the length of menstrual cycles (OR=0.91, CI: 0.84-0.99, P=0.03) were significantly associated with regretting sterilization. CONCLUSION Complications due to sterilization are the main causes of regret; therefore, it is necessary to pay due attention to mentioning the probable complications of the procedures such as menstruation disorders, sexual dysfunction, and anxiety and depression in women during pre-sterilization counseling.
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Affiliation(s)
| | - Saeideh Ziaei
- Department of Pediatrics, Behbahan Faculty of Medical Sciences, Behbahan, Iran. Electronic Address:
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohamadi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Maskens M, Jouret M. Reconstructive Tubal Surgery as an Alternative to Assisted Reproductive Technology After Tubal Sterilization: Experience in a Secondary Belgian Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mathilde Maskens
- Department of Obstetrics and Gynecology, Centre Hospitalier de Wallonie Picarde, Tournai, Hainaut, Belgium
| | - Mathieu Jouret
- Department of Obstetrics and Gynecology, Centre Hospitalier de Wallonie Picarde, Tournai, Hainaut, Belgium
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Greenwood EA, Pasch LA, Hastie J, Cedars MI, Huddleston HG. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation. Fertil Steril 2018; 109:1097-1104.e1. [PMID: 29807657 DOI: 10.1016/j.fertnstert.2018.02.127] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/06/2018] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the degree of decision regret following elective oocyte cryopreservation (EOC) for social indications, and identify factors associated with regret. DESIGN Retrospective cohort survey study. SETTING Academic center. PATIENTS Two hundred one women who underwent EOC for fertility preservation between 2012 and 2016. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision Regret Scale (DRS) score, from 0-100, with a cut-off >25 indicative of moderate to severe regret; and attitudes regarding decision satisfaction. RESULTS Median DRS score was 0 (interquartile range 0-15) and the mean was 10 (range 0-90). Thirty-three women (16%) experienced moderate to severe decision regret. Factors associated with decision regret included: number of eggs frozen, perceived adequacy of information prior to EOC, adequacy of emotional support during EOC, and patient-estimated probability of achieving a live birth using their banked eggs. In a multivariate logistic model, increased perceived adequacy of information (adjusted odds ratio 0.63, 95% confidence interval 0.42-0.97) and patient-estimated probability of achieving a live birth (adjusted odds ratio 0.80, 95% confidence interval 0.67-0.96) were associated with reduced odds of regret. One hundred sixty-seven women (88%) reported increased control over reproductive planning following EOC. One hundred eighty-three (89%) affirmed they will be happy they froze eggs, even if they never use them. CONCLUSIONS The risk of decision regret following EOC is non-negligible. Low number of mature oocytes cryopreserved is a risk factor for increased regret, while perceptions of adequate information and emotional support, and increased patient-estimates of achieving a live birth using banked eggs are associated with reduced risk of regret.
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Affiliation(s)
- Eleni A Greenwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California.
| | - Lauri A Pasch
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Jordan Hastie
- University of California San Francisco School of Medicine, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
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Abstract
Globally, female sterilization is one of the most popular contraceptive methods despite concerns about quality of care for women who report being sterilized. In this study, informed choice among sterilized women was quantified using Demographic and Health Survey (DHS) data from 2000 to 2012 for countries in South Asia and Latin America. Three responses measured informed choice and knowledge about whether women were informed by a health worker or provider: that sterilization is permanent, the potential side-effects of sterilization and other methods of contraception. An ascending composite Method Information Index with scores ranging from 0 (women received no information) to 3 (women received information across all three indicators) was used. Using ordinal logistic regression analysis, the results indicated that women younger than 25 and older than 35 at the time of sterilization, and those at high parities, had lower odds of a high score on the index, while the opposite was true for women sterilized in the private sector in Latin America. Educated women in India had higher odds of a high score on the index, while the same was true for educated and wealthy women in Colombia. These findings indicate that not enough health care providers spend time informing women in South Asia and Latin America about different aspects of sterilization, and that there are specific groups of women that are more affected. There is an urgent need to improve quality of care within health systems providing sterilization for this very important and effective type of contraception.
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Jama-Alol KA, Bremner AP, Pereira G, Stewart LM, Malacova E, Moorin R, Preen DB. Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes. BMC WOMENS HEALTH 2017; 17:117. [PMID: 29178950 PMCID: PMC5702088 DOI: 10.1186/s12905-017-0470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. METHODS Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). RESULTS From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. CONCLUSION Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.
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Affiliation(s)
- Khadra A Jama-Alol
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Louise M Stewart
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Eva Malacova
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Rachael Moorin
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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Tubal Sterilization in Women Under 30: Case Series and Ethical Implications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:36-40. [PMID: 28870724 DOI: 10.1016/j.jogc.2017.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE According to the SOGC Contraception Consensus, it is recommended that permanent contraception be offered to women regardless of age or parity. Many women who desire sterilization at a young age experience barriers from physicians who decline to facilitate the request. METHODS As part of a quality assurance project, we performed a review of cases where tubal sterilization was performed in women under 30 over a 42-month period (September 2013-March 2017). We also performed a literature review on the ethical and clinical considerations with respect to young women requesting permanent contraception. RESULTS We identified 29 women under 30 who had consented for tubal sterilization; 27.5% of women were nulliparous, and 27.5% had a medical condition for which unintended pregnancy is associated with an increased risk of adverse event. As documented in the patients' records, many women expressed prior difficulty in obtaining the procedure. Despite being informed of the risk of regret, most women proceed with the surgical procedure. Three additional women had consented and subsequently cancelled their surgical procedure. CONCLUSION Women who are well-informed and desire permanent contraception should be offered the procedure, regardless of age or parity. Declining such requests is a form of conscientious refusal and is not a clinical decision.
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Travers CD, Spencer JB, Cwiak CA, Mertens AC, Howards PP. Urban-Rural Differences in Tubal Ligation Incidence in the State of Georgia, USA. J Rural Health 2017; 34:122-131. [PMID: 28731204 DOI: 10.1111/jrh.12259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the difference in tubal ligation use between rural and urban counties in the state of Georgia, USA. METHODS The study population included 2,160 women aged 22-45. All participants completed a detailed interview on their reproductive histories. County of residence was categorized using the National Center for Health Statistics Urban-Rural Classification Scheme. We estimated the association between urbanization of county of residence and tubal ligation using Cox regression. Among women with a tubal ligation, we examined factors associated with prior contraception use and the desire for more children. FINDINGS After adjustment for covariates, women residing in rural counties had twice the incidence rate of tubal ligation compared with women in large metropolitan counties (adjusted hazard ratio [aHR] = 2.0, 95% CI = 1.4-2.9) and were on average 3 years younger at the time of the procedure. No differences were observed between small metropolitan and large metropolitan counties (aHR = 1.1, CI = 0.9-1.5). Our data suggest that women from large metropolitan counties are slightly more likely than women from rural counties to use hormonal contraception or long-acting reversible contraception prior to tubal ligation and to desire more children after tubal ligation. CONCLUSIONS Women from rural counties are more likely to undergo a tubal ligation than their urban counterparts. Our results suggest that circumstances regarding opting for tubal ligation may differ between urban and rural areas, and recommendations of alternative contraceptive options may need to be tailored differently for rural areas.
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Affiliation(s)
- Curtis D Travers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica B Spencer
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Carrie A Cwiak
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ann C Mertens
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Burgart AM, Strickland J, Davis D, Baratz AB, Karkazis K, Lantos JD. Ethical Controversy About Hysterectomy for a Minor. Pediatrics 2017; 139:peds.2016-3992. [PMID: 28562274 DOI: 10.1542/peds.2016-3992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/24/2022] Open
Abstract
One of the most complicated ethical issues that arises in children's hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.
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Affiliation(s)
- Alyssa M Burgart
- Department of Anesthesia, Perioperative, and Pain Medicine.,Stanford Center for Biomedical Ethics, Stanford University, Palo Alto, California
| | | | - Dena Davis
- Department of Religious Studies and.,Program in Health, Medicine, and Society, Lehigh University, Bethlehem, Pennsylvania; and
| | - Arlene B Baratz
- Androgen Insensitivity Syndrome-Differences of Sex Development Support Group, Pittsburgh, Pennsylvania
| | - Katrina Karkazis
- Stanford Center for Biomedical Ethics, Stanford University, Palo Alto, California
| | - John D Lantos
- Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
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Mertes H. The role of anticipated decision regret and the patient's best interest in sterilisation and medically assisted reproduction. JOURNAL OF MEDICAL ETHICS 2017; 43:314-318. [PMID: 28442552 DOI: 10.1136/medethics-2016-103551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 06/07/2023]
Abstract
There is a clear discrepancy in the way those who request medical assistance in pursuit of their reproductive choices are treated. On the one hand, women who request a sterilisation are urged to consider possible future regrets and are sometimes refused treatment in anticipation of such regrets. This is despite the fact that for all age ranges, the majority of women undergoing a sterilisation do not regret the decision. Moreover, women who are voluntarily childless are likely to have a happier and more gratifying life than parents. On the other hand, women who request fertility treatment are not urged to second guess their desire for parenthood. Although the fact that the probability of regret is expected to be higher in the former case than in the latter justifies this difference in treatment to a certain extent, the gap between the two different approaches is wider than it ought to be if we also take future well-being into consideration, instead of focussing exclusively on anticipated decision regret.
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43
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McQueen P. Autonomy, age and sterilisation requests. JOURNAL OF MEDICAL ETHICS 2017; 43:310-313. [PMID: 27879292 DOI: 10.1136/medethics-2016-103664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/09/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Abstract
Sterilisation requests made by young, child-free adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper, I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes towards sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people's sterilisation requests differently in virtue of their gender.
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Albanese A, French M, Gossett DR. Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy. Contraception 2016; 95:234-238. [PMID: 27570140 DOI: 10.1016/j.contraception.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Female sterilization is one of the most prevalent methods of contraception in the United States. Prior studies have shown that nearly half of postpartum tubal ligation (PPTL) requests go unfulfilled. This study seeks to establish whether obstetric or medical risk status influences patients' request for or subsequent completion of PPTL. METHODS This study was a retrospective cohort study of women delivering at a university hospital in 2009-2010 who received prenatal care in the faculty and resident clinics. High-risk status was defined by Society for Maternal-Fetal Medicine guidelines. Documentation of contraceptive plan and administration of contraceptive methods was abstracted from patient records. Subsequent pregnancies through March 1, 2013, were abstracted. RESULTS Of 3063 participants (2048 low risk and 1015 high risk), 231 requested PPTL (7.5%). This was more likely among high-risk patients than low-risk patients (10.0% vs. 6.3%, p<.001), those with public insurance (13.8% vs. 3.2%, p<.001) and those with an unintended index pregnancy (13.8% vs. 4.1%, p<.001). Of the patients requesting PPTL, 118 (51.1%) underwent the procedure immediately postpartum. Completion was not associated with high-risk status (54.0%), or with race, insurance status or parity. Among 113 women with an unfulfilled PPTL request, there were 17 subsequent pregnancies (15.0%) during the 27 months of follow-up. CONCLUSIONS Though women with high-risk pregnancies were more likely to request PPTL, they were not more likely to complete the procedure. Over one third of high-risk patients' requests were unfulfilled, indicating that significant barriers may remain. IMPLICATIONS Though women with high-risk pregnancies were more likely to request PPTL, they were not more likely to complete the procedure. Providers should consider these procedures urgent, especially in high-risk women, and advocate for their patients' access to this procedure.
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Affiliation(s)
- Alexandra Albanese
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Maureen French
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Dana R Gossett
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, USA.
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Wildemeersch D, Andrade A, Goldstuck N. Femilis(®) 60 Levonorgestrel-Releasing Intrauterine System-A Review of 10 Years of Clinical Experience. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2016; 10:19-27. [PMID: 27547046 PMCID: PMC4979586 DOI: 10.4137/cmrh.s40087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to update the clinical experience with the Femilis® 60 levonorgestrel-releasing intrauterine system (LNG-IUS), now up to 10 years in parous and nulliparous women, particularly with regard to ease and safety of insertion, contraceptive performance, retention, acceptability, continuation of use, impact on menstrual blood loss (MBL), and duration of action. STUDY DESIGN Using the Femilis® 60 LNG-IUS releasing 20 µg of levonorgestrel/day, the following studies were conducted: an open, prospective noncomparative contraceptive study, an MBL study, a perimenopausal study, a study for the treatment of endometrial hyperplasia, and early cancer of the uterus, a residue study. RESULTS A total of 599 Femilis LNG-IUS were inserted in various clinical trials, the majority for contraceptive purposes. The total exposure in the first and second contraceptive studies, covering 558 parous and nulliparous women, was 32,717 woman-months. Femilis has high contraceptive effectiveness as only one pregnancy occurred. Expulsion of the LNG-IUS was rare with only two total and no partial expulsions (stem protruding through the cervical canal) occurred. Femilis was well tolerated, with continuation rates remaining high. Several MBL studies were conducted, totaling 80 heavy and normal menstrual bleeders, using the pictorial bleeding assessment chart method or the quantitative alkaline hematin technique. Virtually all women responded well with strongly reduced menstrual bleeding. Amenorrhea rates were high, up to 80% after three months, and ferritin levels simultaneously increased significantly. The Femilis LNG-IUS was tested in 104 symptomatic perimenopausal women for seamless transition to and through menopause, adding estrogen therapy when required. Patient tolerability appeared high as >80% requested a second and a third LNG-IUS. Twenty women presenting with nonatypical and atypical hyperplasia and one woman presenting with early endometrial carcinoma were treated with Femilis LNG-IUS. All histology specimens showed full regression, and patients remained in remission without signs of hyperplasia or cancer at yearly and ongoing follow-up examinations up to 10 years. Residual content of LNG was measured in 37 women having the Femilis LNG-IUS for up to 10 years. In 10 of the 102 women who had the Femilis 60 in situ for 10 years between 20% and 30% of the original 60 mg was recovered confirming the long duration of action of the Femilis 60 LNG-IUS. CONCLUSION These studies suggest that the Femilis 60 LNG-IUS releasing 20 µg of LNG/day is an effective, well-tolerated, and well-retained contraceptive both in parous and in nulliparous women. The design of the LNG-IUS, with flexible transverse arm(s) length of 28 mm, allows for a simplification of the insertion technique and training requirements facilitating the use by nonspecialist providers in either developed or developing countries. For nulliparous women, additional evaluation of devices with a 24 mm transverse arm(s), as it relates to tolerability, retention, and continuation of use, still needs to be undertaken.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Amaury Andrade
- Center for Reproductive Biology, Federal University Juiz de Fora, Juiz de Fora, Brazil
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
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Shreffler KM, Greil AL, McQuillan J, Gallus KL. Reasons for tubal sterilisation, regret and depressive symptoms. J Reprod Infant Psychol 2016; 34:304-313. [PMID: 28133405 DOI: 10.1080/02646838.2016.1169397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the associations between sterilisation reasons, regret, and depressive symptoms. STUDY DESIGN Black, Hispanic, and non-Hispanic White US women ages 25-45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n=837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation, and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors, and depressive symptoms. RESULTS Findings revealed that 28 percent of U.S. women who have undergone tubal sterilisation report regret. Time since sterilisation and having a reason for sterilisation other than simply not wanting (more) children (e.g., situational factors, health problems, encouragement by others, and other reasons) are associated with significantly higher odds of sterilisation regret. Finally, sterilisation regret is significantly associated with depressive symptoms after controlling for sociodemographic characteristics. CONCLUSION Sterilisation regret is relatively common among women who have undergone tubal sterilisation, and regret is linked to elevated, but not necessarily clinical depressive symptoms. The reasons for sterilisation can have important implications for women's sterilisation regret and associated depressive symptoms.
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Affiliation(s)
- Karina M Shreffler
- Oklahoma State University, 700 N. Greenwood Ave. Tulsa, OK 74106, 918-594-8389
| | - Arthur L Greil
- Alfred University, 1 Saxon Drive, Alfred, NY 14802, 607-871-2085
| | - Julia McQuillan
- The University of Nebraska at Lincoln, 706 Oldfather Hall, Lincoln, NE 68588, 402-730-1935
| | - Kami L Gallus
- Oklahoma State University, 233 Human Sciences, Stillwater, OK 74078, 405-744-8351
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Abstract
Permanent methods of contraception are used by an estimated 220 million couples worldwide, and are often selected due to convenience, ease of use and lack of side effects. A variety of tubal occlusion techniques are available for female permanent contraception, and procedures can be performed using a transcervical or transabdominal approach. This article reviews currently available techniques for female permanent contraception and discusses considerations when helping patients choose a contraceptive method and tubal occlusion technique.
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Affiliation(s)
- Elizabeth A Micks
- Department of Obstetrics & Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA 98195-6460, USA
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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Champaloux SW, Tepper NK, Curtis KM, Zapata LB, Whiteman MK, Marchbanks PA, Jamieson DJ. Contraceptive Use Among Women With Medical Conditions in a Nationwide Privately Insured Population. Obstet Gynecol 2015; 126:1151-1159. [PMID: 26551183 PMCID: PMC11022835 DOI: 10.1097/aog.0000000000001134] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine contraceptive use among women with selected medical conditions. METHODS We used a nationwide health care claims database to identify women aged 15-44 years continuously enrolled in private insurance during 2004-2011 with and without selected medical conditions. We assessed current permanent and reversible prescription contraceptive use during October 1, 2010, to September 30, 2011, with diagnosis, procedure, and pharmacy codes and calculated prevalence by age and condition. We used polytomous logistic regression to calculate odds of female sterilization or reversible prescription methods compared with neither. Among users of reversible methods, we used logistic regression to calculate odds of using long-acting reversible contraceptives compared with shorter acting methods. RESULTS A low proportion of women with medical conditions were using sterilization or reversible prescription methods (45% and 30% of women aged 15-34 and 35-44 years, respectively), and this proportion was consistently lower among the older age group across all medical conditions. Across both age groups, sterilization and long-acting reversible contraceptives were used less frequently than shorter acting methods (injectable, pill, patch, or ring). The odds of sterilization were higher among women with any compared with no condition for women aged 15-34 years (odds ratio [OR] 4.9, 95% confidence interval [CI], 4.5-5.3) and 35-44 years (OR 1.2, 95% CI, 1.1-1.2). Among women using reversible prescription methods, the odds of using long-acting reversible contraceptives were increased among those with any compared with no condition for women aged 15-34 years (OR 2.2, 95% CI, 2.1-2.5) and 35-44 years (OR 1.1, 95% CI, 1.1-1.2). CONCLUSION Despite the potential for serious maternal and fetal pregnancy-associated risks, contraceptive use was not optimal among women with medical conditions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Steven W Champaloux
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Canadian Contraception Consensus Chapter 6 Permanent Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(16)39377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Ralston SJ, Farrell RM. The Ethics of Access: Who Is Offered a Cesarean Delivery, and Why? Hastings Cent Rep 2015. [PMID: 26215717 DOI: 10.1002/hast.476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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