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Sharif AB, Hasan MT, Naziat MH, Zerin T, Kundu S. Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017-2018 data. BMJ Open 2023; 13:e073469. [PMID: 37451714 PMCID: PMC10351289 DOI: 10.1136/bmjopen-2023-073469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged 15-49 years. DESIGN Cross-sectional study. SETTING We used data from Bangladesh Demographic Health Survey (BDHS) 2017-2018. PARTICIPANTS A total of 9669 Bangladeshi reproductive-aged women who gave information on contraception use were the study participants. A multilevel multinomial logistic regression model was employed where the SARC method was considered as the base category and the cluster was considered as level-2 factor. RESULTS Among the contraceptive users in Bangladeshi women, about 83.48% used the SARC method, while 11.34%, and 5.18% used permanent and LARC methods, respectively. Compared with SARC, women with no formal education and only primary education who were non-Muslims, and had parity of ≥3 had a higher likelihood of using both permanent and LARC methods. Women from the age group of 25-34 years (adjusted relative risk ratio (aRRR): 7.03, 95% CI: 4.17 to 11.85) and 35-49 years (aRRR: 12.53, 95% CI: 7.27 to 21.58) who were employed (aRRR: 1.19, 95% CI: 1.00 to 1.40), had media access (aRRR: 1.24, 95% CI: 1.03 to 1.49), gave birth in last 5 years (aRRR: 1.40, 95% CI: 1.11 to 1.76), whose contraception decision solely made by their husband (aRRR: 7.03, 95% CI: 5.15 to 9.60) and having high decision-making power (aRRR: 2.12, 95% CI: 1.62 to 2.77) were more likely to use permanent contraceptive methods. We observed that women from households with richer (aRRR: 0.65, 95% CI: 0.45 to 0.93) and richest (aRRR: 0.38, 95% CI: 0.23 to 0.63) wealth quintiles were less likely to use LARC methods. CONCLUSIONS This study identified that women with no/less education, non-Muslims, and having parity of ≥3 were more likely to use both permanent and LARC methods than SARC methods. Targeted interventions could be developed and implemented to promote personalised contraceptive use.
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Affiliation(s)
- Azaz Bin Sharif
- Global Health Institute, North South University, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Tamzid Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Habib Naziat
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Tahmina Zerin
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Oral & Maxillofacial Surgery, Marks Medical College Hospital & Dental Unit, Dhaka, Bangladesh
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Uptake of Immediate Postpartum LARCs and Associated Factors among Mothers Who Gave Birth at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Int J Reprod Med 2022; 2022:1422094. [PMID: 35844775 PMCID: PMC9282987 DOI: 10.1155/2022/1422094] [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: 11/12/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Postpartum family planning is an effective strategy for reducing maternal and childhood morbidity and mortality by preventing unintended pregnancy and short interpregnancy intervals. Despite the paramount advantages of long-acting reversible contraceptives (LARC), their uptake remains low in Ethiopia. Therefore, the aim of this study was to assess the uptake of immediate postpartum LARC methods and its associated factors among women who gave birth in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted among 418 eligible mothers who were in the immediate postpartum period. Data were collected using a pretested structured questionnaire before their discharge from the hospital and analyzed by using SPSS version 20. The statistical significance was declared at P value less than 0.05. Results The uptake LARCs among immediate postpartum mothers was 25.4%. The most commonly reported reasons for not using LARC were preference to start contraception after six weeks of delivery (43.3%) and the need to use other methods of contraception (26%). Having unplanned birth (AOR: 1.97; 95% CI: 1.04-3.71) and receiving family planning counselling on LARCs during the postpartum period (AOR: 21.1; 95% CI: 6.49-68.66) were factors significantly associated with immediate postpartum LARC use. Conclusion Low utilization of immediate postpartum LARC uptake was found in the current study setting. There was increased utilization of immediate postpartum LARC among mothers who received family planning counselling during the postpartum period. Therefore, strengthening family planning counselling during the immediate postpartum period is crucial to enhance postpartum LARC use.
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Ferreira PB, Utiyama RY, Tamanaha S, Fukunaga ET. Immediate Postpartum Copper IUD: A Comparative Analysis between Profiles of Women who Accept and who Refuse it. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:154-160. [PMID: 35213913 PMCID: PMC9948272 DOI: 10.1055/s-0041-1741452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the profiles of women who accepted and who refused the insertion of the copper intrauterine device (IUD) postpartum and to learn the motivations related to the refusal of the method. METHODS Cross-sectional study with 299 pregnant women. The women were informed about the possibility of inserting a copper IUD postpartum and were questioned about their interest in adopting or not this contraceptive. All participants answered a questionnaire with information relevant to the proposals of the present study. The sample size was limited to the number of devices available for the present study. RESULTS A total of 560 women were invited to join the present study and 299 accepted. Out of the 299 women included in the present study, 175 accepted the copper IUD and 124 refused. As the number of pregnancies increased, the IUD acceptance rate raised (p = 0.002), especially between the groups with 1 and with ≥ 4 pregnancies (p = 0.013). Regarding the desire to have more children, the women who planned to have more children were more likely to refuse the method than the ones who did not (p < 0,001). CONCLUSION Women with multiple pregnancies and desire to not have more children were more likely to accept the copper IUD. The profile of those who refused was first pregnancy and desire to have more children. Among the three most frequent reasons reported for copper IUD rejection, two responses stood out: no specific justification and desire to have more children.
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Affiliation(s)
| | - Raul Yao Utiyama
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Sonia Tamanaha
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Farah D, de Moraes Andrade TR, Sansone D, Batista Castello Girão MJ, Fonseca MCM. A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System. Am J Prev Med 2022; 62:114-121. [PMID: 34922650 DOI: 10.1016/j.amepre.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of long-acting reversible contraceptives is low among adolescents owing to the high up-front cost. In this study, a 5-year cost-effectiveness model and budget impact analysis were used to compare the use of long-acting reversible contraceptives with the use of combined oral contraceptives among Brazilian adolescents. METHODS A Markov model was developed to mirror the clinical and economic effects of long-acting reversible contraceptives among sexually active Brazilian adolescents in the public health system for a 5-year duration, starting from 2018. The costs were expressed in U.S.$, and a 5% discount rate was applied for both costs and benefits. Model inputs included costs of the contraceptive methods, contraceptive discontinuation and adherence rates, abortion, and birth costs associated with unintended pregnancies. The model outcomes were avoided pregnancies, abortions, and births. Univariate and probabilistic sensitivity analyses were conducted. RESULTS Copper intrauterine device use was dominant 100% of the time for all outcomes, and a budget impact analysis revealed a cost savings of $422,431,269.10 in the 5-year period. Levonorgestrel intrauterine system and subdermal implant use were cost effective for all outcomes. The budget impact analyses revealed costs of $65,645,417.54 for levonorgestrel intrauterine system and $302,852,972.12 for subdermal implant use during the 5-year study period. CONCLUSIONS According to this Brazilian model, copper intrauterine device use is dominant, and levonorgestrel intrauterine systems and subdermal implants are more cost effective than combined oral contraceptives.
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Affiliation(s)
- Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Dayan Sansone
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manoel João Batista Castello Girão
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
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Amutah C, Petsis D, Fields NF, Wood S, Timko A, Akers AY. Effect of Previous Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation. J Pediatr Adolesc Gynecol 2021; 34:732-738. [PMID: 33571659 PMCID: PMC8670013 DOI: 10.1016/j.jpag.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Nonadherence in sexual risk reduction interventions might be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a previous pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation. DESIGN Secondary data analysis from a feasibility study of a health-coaching intervention to improve contraceptive continuation. SETTING Three urban pediatric clinics in Philadelphia. PARTICIPANTS Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method. INTERVENTIONS At baseline, participants completed a sociodemographic questionnaire and semistructured interview, followed by 5 monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content. MAIN OUTCOME MEASURES Intervention completion was defined as the number of completed coaching sessions. Secondary outcomes were qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception. RESULTS Participants with a previous adverse outcome (a previous STI and/or a previous pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs 4; P = .03). Both groups had low HIV/STI knowledge, negative attitudes toward pregnancy, and low HIV/STI risk perception. Those with a previous adverse reproductive outcome held more negative attitudes toward condoms. CONCLUSION Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome might be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize the intervention's reach for vulnerable youth.
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Affiliation(s)
- Christina Amutah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Naomi F Fields
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman school of medicine, PolicyLab and the Division of Adolescent Medicine
| | - Alix Timko
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, PolicyLab and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Aletha Y Akers
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Adolescent Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Aziz MM, El-Gazzar AF. Intention of pregnant women for the postpartum use of intrauterine devices in Upper Egypt's rural communities. EUR J CONTRACEP REPR 2021; 26:421-428. [PMID: 34126830 DOI: 10.1080/13625187.2021.1934439] [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: 10/21/2022]
Abstract
OBJECTIVES This study aims to assess pregnant women's intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. METHODS The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. RESULTS Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands' disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085-2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108-4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379-0.964), p = 0.03) and perception of IUD related myths (OR (95% CI) = 0.893 (0.836-0.955), p = 0.004) were the negative predictors of the intention to use IUD. CONCLUSION The intention to use IUD is relatively low among pregnant women in rural Upper Egypt. Targeting pregnant women and their husbands with proper counselling regarding IUD use during antenatal care visits would greatly impact increasing their use of the method.
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Affiliation(s)
- Mirette M Aziz
- Public Health & Community Medicine, Assiut University, Assiut, Egypt
| | - Amira F El-Gazzar
- Public Health & Community Medicine, Badr University, Badr City, Egypt
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Buckingham P, Moulton JE, Subasinghe AK, Amos N, Mazza D. Acceptability of immediate postpartum and post-abortion long-acting reversible contraception provision to adolescents: A systematic review. Acta Obstet Gynecol Scand 2021; 100:629-640. [PMID: 33608901 DOI: 10.1111/aogs.14129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC. MATERIAL AND METHODS In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. RESULTS We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. CONCLUSIONS Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.
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Affiliation(s)
- Pip Buckingham
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica E Moulton
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Asvini K Subasinghe
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Natalie Amos
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Monash University, Notting Hill, Victoria, Australia.,Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Drake E, Grush K, Sheeder J, Tocce K. The Association between Immediate Postpartum Etonogestrel Implants and Positive Postpartum Depression Screens in Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2020; 33:550-554. [PMID: 32535218 DOI: 10.1016/j.jpag.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/08/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to compare rates of positive postpartum depression screens at 6 weeks postpartum among adolescents and young adults (AYA) initiating immediate postpartum contraceptive implants and those initiating other methods. DESIGN Through a retrospective observational design, we collected data on demographics, reproductive history, prenatal and postnatal depression, and postpartum contraception. SETTING Patients participating in an AYA prenatal-postnatal program were eligible for inclusion. PARTICIPANTS A total of 497 patients were enrolled between January 2013 and December 2016. The median age was 19 years (range 13-22 years); 86% were primiparous, 50% were Latina, 24% were black, and 16% were white; 34% initiated immediate postpartum implants (n = 169). INTERVENTION Those initiating a contraceptive implant within the first 14 days postpartum were included in the intervention group. MAIN OUTCOME MEASURE We compared rates of positive Edinburgh Postpartum Depression Scales (EDPS) (scores ≥10) in AYA initiating immediate postpartum implants and those initiating other contraceptive methods. RESULTS The AYA initiating immediate postpartum implants were similar to the rest of the cohort in baseline characteristics, aside from an increased rate of preterm births among the intervention group (19.4% vs 12.1%; P = .03). Prenatally, 14% had an elevated Center for Epidemiologic Studies Depression Scale (CES-D) scores (11.5% immediate postpartum implants vs 15.4% comparison, P = .25). At 6 weeks postpartum, 7.6% had a positive postpartum depression screen; this rate was significantly lower for those initiating immediate postpartum implants compared to those choosing other methods (4.1% vs 9.5%, P = .04). CONCLUSIONS Providers should continue to encourage AYA to choose whichever highly effective contraceptive method they prefer for postpartum use.
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Affiliation(s)
- Erin Drake
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kira Grush
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO
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Bhide S, Ascha M, Wilkinson B, Verbus E, Montague M, Morris J, Arora KS. Variation in effectiveness of planned postpartum contraception at two time points from prenatal to postpartum care. Contraception 2020; 102:246-250. [PMID: 32540241 DOI: 10.1016/j.contraception.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify characteristics of women who have consistent plans in terms of contraceptive effectiveness from antepartum to postpartum care. STUDY DESIGN This is a secondary analysis of a retrospective chart review of women who delivered at a single tertiary care center from 2012 to 2014. Preferred postpartum contraceptive plan was abstracted at three time points (prenatal care, hospital discharge, and outpatient postpartum care) and categorized into three tiers of effectiveness. We then examined consistency between the first two time points for the effectiveness in postpartum contraceptive method planned. RESULTS Of the 8,394 women in the study cohort, 2,642 (31.5%) had a consistent postpartum contraceptive plan. Women who had a consistent plan were more likely to have higher parity (aOR 2.36, 95% CI 2.06-2.70 for parity 2+), choose highly effective methods of contraception (p < 0.001), achieve their contraception plan (adjusted odds ratio [aOR] 2.16, 95% confidence interval [95% CI] 1.85-2.52), but not more likely to have a subsequent pregnancy within 365 days of delivery (aOR 0.92, 95% CI 0.81-1.05). CONCLUSION Better understanding contraceptive decision-making as a journey and removing external barriers during that process is a necessary component of pregnancy care. IMPLICATIONS Counseling and documentation of contraceptive preferences throughout antepartum and postpartum care can help improve contraceptive outcomes.
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Affiliation(s)
- Sayuli Bhide
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States.
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Thiel de Bocanegra H, Kenny J, Sayler K, Turocy M, Ladella S. Experiences with Prenatal and Postpartum Contraceptive Services among Women with a Preterm Birth. Womens Health Issues 2019; 30:184-190. [PMID: 31859188 DOI: 10.1016/j.whi.2019.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/30/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Providing postpartum contraception can help to achieve recommended interpregnancy intervals (≥18 months from birth to next pregnancy), decrease the risk of preterm birth, and thus improve maternal and infant health outcomes of future pregnancies. However, the experiences of women with preterm birth regarding contraceptive services have not been documented. We sought to better understand contraceptive counseling experiences and postpartum contraception of women with a preterm birth. METHODS We interviewed 35 women, ages 18-42 years, with a recent preterm birth in California. The transcribed interviews were analyzed using ATLAS.ti v.8. RESULTS Women had public (n = 15), private (n = 16), or no insurance (n = 4) at the time of the interview. Women were mainly Latina (n = 14), Caucasian (n = 9), or African American (n = 6); 15 women were foreign born. Women's experiences ranged from spontaneous preterm births to births with severe medical complications. We identified five themes that were associated with women's engagement in the contraceptive method choice and understanding of birth spacing: 1) timing and frequency of contraceptive counseling; 2) quality of patient-provider interaction and ability to follow up on questions; 3) women's personal experiences with contraceptive use and experiences of other women; 4) context in which contraceptive counseling was framed; and 5) system barriers to contraceptive use. CONCLUSIONS Postpartum contraceptive counseling should address women's preterm birth experience, medical conditions, age, contraceptive preference, and childbearing plans. Having a preterm birth intensifies gaps in hospital and outpatient clinic coordination and provider-patient communication that can lead to use of less effective or no contraceptive methods and risk of early subsequent unplanned pregnancies.
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Affiliation(s)
- Heike Thiel de Bocanegra
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Department of Obstetrics and Gynecology, University of California Irvine, Orange, California.
| | - Jazmine Kenny
- School of Social Sciences, Humanities, and Arts, Department of Public Health, University of California, Merced, California
| | - Kristina Sayler
- Department of Human Ecology, University of California, Davis, Davis, California
| | - Mary Turocy
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Subhashini Ladella
- Department of Obstetrics and Gynecology, Fresno Medical Education Program, University of California San Francisco, Fresno, California
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Ragmanauskaite L, Kahn B, Ly B, Yeung H. Acne and the Lesbian, Gay, Bisexual, or Transgender Teenager. Dermatol Clin 2019; 38:219-226. [PMID: 32115131 DOI: 10.1016/j.det.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although most teenagers experience acne, for sexual and gender minority teenagers, acne could be more challenging and require specific psychosocial considerations. Acne may be more strongly associated with mental health issues in sexual and gender minority adolescents. Acne development during puberty may trigger gender dysphoria in transgender patients. Transgender and gender nonbinary patients receiving testosterone therapy may experience new or worsening acne. Comprehensive care for moderate to severe acne in sexual and gender minority adolescents should include culturally competent discussions about sexual behaviors, contraception, and/or gender-affirmation treatment plans.
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Affiliation(s)
- Laura Ragmanauskaite
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - Benjamin Kahn
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - BaoChau Ly
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road Northeast Suite 100, Atlanta, GA 30322, USA.
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Johnson NA, Fuell Wysong E, Tossone K, Furman L. Associations Between Prenatal Intention and Postpartum Choice: Infant Feeding and Contraception Decisions Among Inner-City Women. Breastfeed Med 2019; 14:456-464. [PMID: 31166698 DOI: 10.1089/bfm.2018.0248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose: We sought to understand how women's prenatal infant feeding and contraception intentions were related to postpartum choices. Materials and Methods: Expectant women ≥14 years of age receiving care at MacDonald Women's Hospital, Cleveland Ohio were previously surveyed regarding feeding and contraceptive intentions. Here, we asked: (1) What were postpartum feeding choices, and did prenatal intention predict postpartum choice?, (2) What were postpartum contraceptive choices, and did prenatal intention predict postpartum choice?, and (3) What was the relationship of postpartum contraceptive choice to postpartum feeding choice? Results: Of 223 women interviewed prenatally, 214 (96%) were followed to postpartum in-hospital, and 119 out of 214 (56%) were followed to the postpartum visit. The mean age was 25 years, 185 out of 206 (89.8%) were African American, and 149 out of 200 (75.0%) were multiparous. Prenatal feeding and contraceptive intent were significantly associated with postpartum feeding and contraceptive choices, respectively (both p < 0.0001). More women who initiated breastfeeding chose no contraception (54.5% for any breastfeeding versus 32.2% for exclusive formula feeding) versus long-acting reversible contraception (LARC), tubal ligation, or other contraceptive types (χ2 = 9.28, p = 0.03). After adjusting for known confounders, only receipt of other contraceptive types (not LARC, not tubal ligation) was significantly associated with decreased odds of any breastfeeding (p = 0.02). Conclusions: Among low-income predominantly African American inner-city women, prenatal intentions were significantly associated with postnatal choices for infant feeding and contraception. After controlling for confounders, women receiving less effective types of contraception (not LARC and not tubal ligation) had reduced odds of any breastfeeding (p = 0.02).
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Affiliation(s)
| | - Elena Fuell Wysong
- Wright State University Affiliated Hospitals Integrated Obstetrics and Gynecology Residency Program, Dayton, Ohio
| | - Krystel Tossone
- Case Western Reserve University Mandel School of Applied Social Sciences, Cleveland, Ohio
| | - Lydia Furman
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
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Gallagher B, Cameron ST, Craig A, Gallimore A, Lakha F. Antenatal contraception counselling and provision of contraception after delivery for first-time young mothers enrolled with a Family Nurse Partnership programme. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200214. [PMID: 31391215 DOI: 10.1136/bmjsrh-2018-200214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate antenatal contraceptive counselling and provision of postpartum contraception on contraceptive choices of first-time teenage mothers enrolled with a Family Nurse Partnership (FNP) programme. DESIGN Health service research evaluation. POPULATION Cohort of FNP clients (n=195), Scotland, UK. METHODS Antenatal contraceptive counselling and provision of chosen method from the hospital. Evaluation consisted of (i) self-administered questionnaires of FNP clients and (ii) interviews with FNP clients and FNP nurses. MAIN OUTCOME MEASURES FNP client views on intervention. Secondary outcomes included: contraceptive choice antenatally, at day 10 postpartum, 3 and 12 months after delivery, and views of FNP nurses on the intervention. RESULTS Antenatal questionnaires were completed by 118/195 (61%) clients. 96/118 (81%) agreed that it was very or quite helpful to receive antenatal contraceptive counselling and 80/118 (68%) were planning to use a long-acting reversible method of contraception (LARC). 97/121 (80%) wished to receive contraception before leaving the hospital. 104/195 (53%) completed a questionnaire at day 10 postpartum, of which 33 (32%) indicated that they had received contraception from the hospital. FNP nurses expressed frustration when contraception was not provided; this was usually attributed to the busy workload of the maternity department. CONCLUSIONS Antenatal contraceptive counselling was appreciated by FNP clients and they expressed a preference for contraception provision following delivery. Over two-thirds planned to use a LARC method but many did not receive this from the hospital. Further interventions are required to ensure that the provision of postpartum contraception is prioritised for this group of young women.
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Affiliation(s)
| | - Sharon T Cameron
- Chalmers Centre, Edinburgh, UK
- Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Fatim Lakha
- Honorary Consultant in Public Health, NHS Lothian, Edinburgh, UK
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14
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Guzzo KB, Eickmeyer K, Hayford SR. Does Postpartum Contraceptive Use Vary By Birth Intendedness? PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:129-138. [PMID: 30040189 PMCID: PMC6135704 DOI: 10.1363/psrh.12074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Women with an unintended birth have an elevated risk of subsequent unintended pregnancy, and multiple unintended pregnancies could exacerbate any negative consequences of such births. It is therefore important to understand whether postpartum contraceptive use differs by birth intendedness. METHODS Data on 2,769 births reported in the 2011-2015 cycles of the National Survey of Family Growth were used to examine postpartum contraceptive use. Life-table estimates were employed to assess differences by birth intendedness in timing of postpartum contraceptive use, and multinomial logistic event history methods were used to model initial contraceptive uptake and efficacy by birth intendedness. RESULTS Compared with postpartum women whose births were on time or too late, those with seriously mistimed and those with unwanted births were more likely to first adopt a highly effective method (e.g., implant or IUD), rather than no method (relative risk ratios, 1.9 and 1.7, respectively); mothers with unwanted births were also more likely to first use least effective methods (e.g., condoms or withdrawal) instead of no method (1.5). Mothers with seriously mistimed births had a reduced likelihood of using either effective methods (e.g., the pill or injectable) or least effective methods, rather than highly effective ones (0.5 for each). CONCLUSION The elevated risk of repeat unintended fertility does not seem to be due to mothers' initial postpartum contraceptive behavior. Whether mothers with unintended births use contraceptives less consistently, discontinue use sooner or switch methods more often than those with intended births remains to be seen.
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Affiliation(s)
- Karen Benjamin Guzzo
- Associate Professor, Department of Sociology, Bowling Green State University, Bowling Green, OH
| | - Kasey Eickmeyer
- Ph.D. Candidate, Department of Sociology, Bowling Green State University, Bowling Green, OH
| | - Sarah R Hayford
- Associate Professor, Department of Sociology, Ohio State University, Columbus
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Pritt NM, Norris AH, Berlan ED. Barriers and Facilitators to Adolescents' Use of Long-Acting Reversible Contraceptives. J Pediatr Adolesc Gynecol 2017; 30:18-22. [PMID: 27477904 DOI: 10.1016/j.jpag.2016.07.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022]
Abstract
Most pregnancies among teenagers are unintended and many can be attributed to contraception misuse or nonuse. The etonogestrel implant and intrauterine devices, referred to as long-acting reversible contraceptives, or LARCs, are the most effective reversible contraceptive methods. These methods are safe for use by adolescents, yet the number of LARC users remains low among adolescents in the United States. In this review we examine recent literature about barriers and facilitators to LARC use among adolescent women. Factors that influence decision-making and provision are organized into 4 categories: (1) cost and clinical operations; (2) adolescent awareness and attitudes; (3) confidentiality, consent, and parental attitudes; and (4) health care provider knowledge, attitudes, and counseling. Knowledge deficits and misconceptions among adolescents and their health care providers are key barriers to adolescent LARC use.
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Affiliation(s)
- Nicole M Pritt
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Alison H Norris
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio; Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio
| | - Elise D Berlan
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
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Conroy KN. Promoting Uptake of Long-Acting Reversible Contraception Among Teen Mothers. J Adolesc Health 2016; 58:598-9. [PMID: 27210008 DOI: 10.1016/j.jadohealth.2016.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Kathleen N Conroy
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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