Rural and urban Midwestern United States contraception practices

Contraceptive use in Cambodia: does household decision-making power matter?

In Cambodia, the growth of family planning services and socio-economic development have resulted in a spectacular rise in contraceptive prevalence rate and an equally remarkable reduction in contraceptive use differentials. With rising educational levels and increased participation in the modern labour market, Cambodian women are playing an increasingly pivotal role in household decision-making. This study used data from three rounds of Cambodia Demographic and Health Surveys to elucidate trends and patterns of contraceptive use. It then examined the determinants of contraceptive use through the use of logistic regression. The central hypothesis to be tested was whether or not women's involvement in household decision-making affected contraceptive use. Multivariate analysis showed that apart from the number of living children, women's work status and education of both men and women had a more significant impact on contraceptive use, as compared to women's power in household decision-making. More effort is needed to empower women in all aspects in order to reduce the socio-economic differentials in contraceptive use and improve their reproductive health, in line with the goal of the global agenda of the sustainable development goals (SDGs) to leave no one behind.

Higher uptake of long-acting reversible and permanent methods of contraception by Australian women living in rural and remote areas

OBJECTIVES

To examine factors associated with the uptake of i) long-acting reversible, ii) permanent and iii) traditional contraceptive methods among Australian women.

METHODS

Participants in the Australian Longitudinal Study on Women's Health born in 1973-78 reported on their contraceptive use at three surveys: 2003, 2006 and 2009. The participants were 5,849 women aged 25-30 in 2003 randomly sampled from Medicare. The main outcome measure was current contraceptive method at age 28-33 years categorised as long-acting reversible methods (implant, IUD, injection), permanent (tubal ligation, vasectomy), and traditional methods (oral contraceptive pills, condoms, withdrawal, safe period).

RESULTS

Compared to women living in major cities, women in inner regional areas were more likely to use long-acting (OR=1.26, 95%CI 1.03-1.55) or permanent methods (OR=1.43, 95%CI 1.17-1.76). Women living in outer regional/remote areas were more likely than women living in cities to use long-acting (OR=1.65, 95%CI 1.31-2.08) or permanent methods (OR=1.69, 95%CI 1.43-2.14).

CONCLUSIONS

Location of residence is an important factor in women's choices about long-acting and permanent contraception in addition to the number and age of their children.

IMPLICATIONS

Further research is needed to understand the role of geographical location in women's access to contraceptive options in Australia.

Sterilization of rural and urban women in the United States

OBJECTIVE

To examine the prevalence of sterilization among women aged 20-34 years in rural and urban areas in the United States.

METHODS

Data were obtained from the 2006-2010 National Survey of Family Growth, a cross-sectional survey conducted by the Centers for Disease Control and Prevention. The study population included the 4,685 female respondents who did not want to become pregnant at the time of the survey. Women who were not sexually active with men or were infertile for reasons other than contraception were excluded. We performed bivariate and stratified analysis and multivariable logistic regression modeling to determine the associations between place of residence and sterilization after considering other demographic characteristics.

RESULTS

Rural women were at increased odds of undergoing sterilization compared with urban and suburban women (22.75% compared with 12.69%, respectively; crude odds ratio [OR] 2.03, 95% confidence interval [CI] 1.44-2.86; risk difference 0.10, 95% CI 0.05-0.16). Education level was found to be a significant effect modifier of the relationship between location of residence and sterilization. In adjusted analysis, controlling for age, parity, race and ethnicity, income, insurance status, history of unintended pregnancy, and relationship status, rural women without a high school degree were more likely to have undergone sterilization compared with urban and rural women with greater than a high school education (OR 8.34, 95% CI 4.45-15.61).

CONCLUSIONS

Rural women with low education levels have a high prevalence of sterilization. Future studies need to address the reasons for this interaction between education and geography and its influence on contraceptive method choice.

LEVEL OF EVIDENCE

II.

Contraceptive counseling in Turkey after induced abortion

OBJECTIVE

To determine the effectiveness of post-abortion contraceptive counseling to women with unwanted pregnancy and to investigate use of modern contraceptive methods among Turkish women.

METHODS

A prospective case-control study was conducted at 3 Turkish centers between March 23, 2008, and January 10, 2011. A total of 333 women enrolled in the study were divided into 2 groups. Women in group 1 (n=140) presented with unwanted pregnancy requiring induced abortion whereas women in group 2 (n=193) had requested contraception counseling.

RESULTS

The use of coitus interruptus or condoms was significantly more frequent in group 1 than in group 2 (P<0.001). No statistically significant differences were detected between the 2 groups in their use of oral contraceptives, intrauterine devices, injection methods, calendar methods, and other methods. The education level attained by women in group 1 was lower than that of women in group 2 (P=0.041).

CONCLUSION

Increased effort is required to ensure that sufficient education about family planning is provided to Turkish women for the prevention of unwanted pregnancies and induced abortions.

The use of effective contraception among young Hispanic women: the role of acculturation

PURPOSE

Culture may play an important role in contraceptive preference among young Hispanic women. We examined whether acculturation predicted the use of different contraceptives, grouped by level of efficacy in preventing pregnancy.

METHODS

1017 sexually active Hispanic women between the ages of 16 and 24 (mean age 20.69 ± 2.42 years) responded to a self-administered questionnaire. Data were analyzed using multinomial logistic regression.

RESULTS

Women low in acculturation (OR 1.79, CI 1.06-3.02) and bicultural (OR 2.66, CI 1.52-4.64) were more likely than women high in acculturation to have used no method of contraception than long-acting reversible contraception (LARC). Bicultural women were more likely to have used condoms than LARC (OR 2.51, CI 1.40-4.49) compared to women high in acculturation. Finally, women in low in acculturation (OR 1.98, CI 1.11-3.50) and bicultural (OR 1.88, CI 1.01-3.51) were more likely to have used cyclic hormonal contraception than LARC compared to women high in acculturation.

CONCLUSIONS

Educational efforts should focus on young Hispanic women who are bicultural and low in acculturation in order to increase their use of more effective contraceptive methods and reduce the number of unplanned pregnancies among this population.

Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

Background

Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1) Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2) Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them.

Methods

Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models.

Results

Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were < age 35, white, single (never married and no partner), Catholic, and had private medical insurance. Participant's recent or current usage of a particular cancer screening or contraceptive method varied by type of method: Pap smear within the past year (69.1%), breast self-exam within the past month (45.5%), mammogram within the past year (65.7% for women age 45–55), condom usage during every episode of sexual intercourse (15.4%), current usage of birth control pills (17.8%), and ever use of emergency contraception (9.3%). The participants correctly answered 87.9% of all survey questions about condoms, 82.5% about birth control pills, 78.5% about breast self-exams, 52.9% about Pap smears, 35.4% about mammograms, and 25.0% about emergency contraception. In multivariable logistic regression models, survey participants who had private medical insurance and those who recently or currently used a given screening or contraceptive method had a greater odds of correctly answering all questions about each cancer screening or contraceptive method.

Conclusion

Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria

The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.