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Bizjak I, Envall N, Emtell Iwarsson K, Kopp Kallner H, Gemzell‐Danielsson K. Contraceptive uptake and compliance after structured contraceptive counseling - secondary outcomes of the LOWE trial. Acta Obstet Gynecol Scand 2024; 103:873-883. [PMID: 38351571 PMCID: PMC11019526 DOI: 10.1111/aogs.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Highly effective long-acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long-term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC. MATERIAL AND METHODS In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self-reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results. RESULTS Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31-2.76) and less likely to be using a short-acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46-0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36-6.75) and youth clinics (aOR 1.81, 95% CI: 1.08-3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96-3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes. CONCLUSIONS The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated.
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Affiliation(s)
- Isabella Bizjak
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Division of Gynecology and Reproductive MedicineKarolinska University HospitalStockholmSweden
| | - Niklas Envall
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Clinical Sciences at Danderyd Hospital, Division of Obstetrics and GynecologyKarolinska InstitutetStockholmSweden
- School of Health and WelfareDalarna UniversityFalunSweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Division of Gynecology and Reproductive MedicineKarolinska University HospitalStockholmSweden
| | - Helena Kopp Kallner
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Clinical Sciences at Danderyd Hospital, Division of Obstetrics and GynecologyKarolinska InstitutetStockholmSweden
- Division of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Kristina Gemzell‐Danielsson
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Division of Gynecology and Reproductive MedicineKarolinska University HospitalStockholmSweden
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J, Kilander H. Women's experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study. BMJ Sex Reprod Health 2024; 50:107-113. [PMID: 38365455 DOI: 10.1136/bmjsrh-2023-202046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but is not routinely practised in Sweden. To improve contraceptive services and facilitate the informed choice of IUD placement at the time of a caesarean section (CS), we performed this study to identify and describe women's experiences of contraceptive services before, during and after an elective CS. METHODS A qualitative design and methodology was used. We interviewed 20 women aged 28-42 years who underwent elective CS in Sweden. Interviews were analysed using reflexive thematic analysis. RESULTS The three main themes found were (1) receptivity to contraceptive counselling in the context of CS, (2) communication and decision-making about postpartum contraception before CS and (3) lack of support and guidance to receive contraceptive services before and after CS. The participants described readiness and interest regarding postpartum contraception. They prefered counselling from around 25 weeks of gestation. Despite this finding, antenatal communication and contraceptive decision-making seemed rare. Participants reported a lack of support and guidance which necessitated a need by women to navigate the contraceptive services themselves in order to receive information about contraception before CS and to receive postpartum support. CONCLUSIONS Antenatal contraceptive counselling including information about IUD placement during CS was appreciated and welcomed by women with elective CS as their birth method. Most of the women whom we interviewed would prefer to receive contraception counselling on postpartum use during the second half of their pregnancy.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology, Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, School of Medical Sciences, Faculty of Health and Medicine, Örebro University, Örebro, Sweden
| | - Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Women's and Children's Health, Karolinska Institute and the WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden
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Armuand G, Grandahl M, Volgsten H, Stern J. Characteristics of good contraceptive counselling - An interview study. Sex Reprod Healthc 2024; 39:100948. [PMID: 38244257 DOI: 10.1016/j.srhc.2024.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective. METHODS A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis. RESULTS One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place. CONCLUSIONS The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.
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Affiliation(s)
- Gabriela Armuand
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Volgsten
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Stern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden.
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Vukomanovic IS, Kocic S, Vukomanovic V, Janicijevic K, Šorak M, Simic V, Djukic S, Djordjevic S, Radevic S. Assessment of Sexual Health and Use of Cervical Cancer Screening among the Female Working Population. Iran J Public Health 2024; 53:198-207. [PMID: 38694863 PMCID: PMC11058389 DOI: 10.18502/ijph.v53i1.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 05/04/2024]
Abstract
Background Cervical cancer occupies a significant place in the overall structure of morbidity and mortality in developing countries. We focused on the sexual health and use of cervical cancer screening among the female working population of reproductive age in Central Serbia. Methods The research was conducted as a cross-sectional study, according to the methodology Stepwise approach to noncommunicable disease risk factor surveillance WHO. The study population consisted of 1182 female working population aged 18-49 years, living on the territory of Central Serbia. The method of simple random sampling was utilized in the research itself. An anonymous standardized questionnaire was used as a research tool. Results During the first sexual intercourse, 38.9% of the participants reported not having used any of the contraceptives, whereas 74.5% of the participants reported not having used them during their last sexual intercourse and 26.1% of the respondents reported not having had a single Pap smear in their lifetime. The multivariate logistic regression analysis singled out the following factors in women who reported not having done a Pap smear in their lifetime as the most significant ones: age - the youngest age group (OR = 3.30, CI = 1.80-6.04), unemployment (OR = 2.87, CI = 0.07-3.40), women who had never been married or had never been in a common-law marriage (OR = 2.55, CI = 1.40-4.66) and individuals with a medium education level (OR = 2.63, CI = 1.67-4.14). Conclusion In Serbia, all the activities should be directed towards increasing the levels of awareness and knowledge on sexual health and cervical cancer screening services.
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Affiliation(s)
- Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Sanja Kocic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Vladimir Vukomanovic
- Department of Nuclear Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marija Šorak
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vera Simic
- Department of Nursing, Secondary Medical School “Beograd”, Belgrade, Serbia
| | - Svetlana Djukic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slavica Djordjevic
- Department of the High School of Health, Academy of Vocational Studies, Belgrade, Serbia
| | - Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
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Envall N, Gemzell Danielsson K, Kopp Kallner H. The use and access to contraception in Sweden during the COVID-19 pandemic period. EUR J CONTRACEP REPR 2023; 28:275-281. [PMID: 37902288 DOI: 10.1080/13625187.2023.2260516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/12/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives. MATERIALS AND METHODS Internet-based e-survey of Swedish women of fertile age, 16-49 years. RESULTS In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services 'as usual'. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001). CONCLUSIONS During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated.SHORT CONDENSATIONThe COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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Kolak M, Löfgren C, Hansson SR, Rubertsson C, Agardh A. Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study. Sex Reprod Health Matters 2022; 30:2111796. [PMID: 36129725 PMCID: PMC9518243 DOI: 10.1080/26410397.2022.2111796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women’s health at both individual and societal levels. This study explored immigrant women’s perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife’s professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.
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Affiliation(s)
- Mia Kolak
- PhD candidate. Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden
| | - Charlotta Löfgren
- Professor, Department of Social Work, Malmö University, Malmö, Sweden
| | - Stefan R. Hansson
- Professor, Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Malmö, Sweden
| | - Christine Rubertsson
- Professor, Department of Obstetrics and Gynecology, Skane University Hospital, Malmö and Lund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anette Agardh
- Professor, Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
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Ferat RM, Haddad LB, Westhoff CL, Hubacher D. Recap of the sixth international symposium on intrauterine devices and systems for women's health. Contraception 2022; 116:14-21. [PMID: 35882359 DOI: 10.1016/j.contraception.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/31/2023]
Abstract
Due to the COVID-19 pandemic, the Sixth International Symposium on Intrauterine Devices and Systems for Women's Health was held as a series of seven 2-hour webinars between May 28, 2020, and June 22, 2021. This Symposium featured 48 different presenters and moderators covering a wide range of topics to highlight new IUD issues and update general IUD knowledge, just as it was done in previous symposia dating back to 1962 [1-5]. A total of 1346 people attended remotely to observe the events live. In this article, we share summaries of the presentations from the sixth symposium. These summaries, provided by the presenters, are meant to archive the symposium. This article gives the reader an overview of the topics and identifies the sessions' moderators and speakers charged with providing the content. Those interested in further detail, references, and information about the speakers can find more information on the conference website: www.iud2020.com. After the summaries, we share ideas for future IUD research and programmatic needs, as provided by Symposium's presenters and organizers. The authors' summaries are personal opinions and do not necessarily reflect the perspectives of the Symposium's organizers or the medical community at large. The Symposium was recorded and the sessions are available for viewing free of charge at the website, www.iud2020.comor on YouTube. As of July 2022, approximately 1700 visitors have viewed the recordings.
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Affiliation(s)
- Rachel M Ferat
- Columbia University Irving Medical Center, New York, NY, United States.
| | - Lisa B Haddad
- Population Council, Center for Biomedical Research, NY, USA
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- Columbia University Irving Medical Center
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Envall N, Wallström T, Gemzell Danielsson K, Kopp Kallner H. Use of contraception and attitudes towards contraceptive use in Swedish women: an internet-based nationwide survey. EUR J CONTRACEP REPR 2022; 27:409-417. [PMID: 36004625 DOI: 10.1080/13625187.2022.2094911] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Explore contraceptive use, unmet need of and attitudes towards contraceptive use in Sweden. Secondly, to investigate knowledge of contraceptives, prevalence and outcomes of unintended pregnancies. MATERIALS AND METHODS Internet based e-survey of Swedish women aged 16-49. The e-survey contained 49 questions with both spontaneous and multi-choice character on demographics, contraceptive use, knowledge of and attitudes towards contraception, importance of monthly bleeding, and experience of unintended pregnancy. The e-survey was closed when reaching the estimated sample size of 1000 respondents. RESULTS A total of 1016 women participated, whereof 62.4% used contraception, 31.8% did not and 5.8% had stopped in the last 12 months. Unmet need for contraception was estimated at 17.2%. At least one unintended pregnancy was experienced by 19.9%. All women rated effectiveness as the most important characteristic of a contraceptive method. CONCLUSIONS Use of contraception in Swedish women remains low, 62.4%, and the unmet need for contraception has increased to 17.2%. Method effectiveness and health benefits of hormonal contraception should be emphasised during contraceptive counselling, and actions are needed to target groups with low use of effective contraception as well as to reach those who never seek contraception.KEY MESSAGEClose to one third of Swedish women do not use contraception and one fifth have experienced at least one unintended pregnancy. Unmet need for contraception is high despite easy access and subsidies for young women.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, South General Hospital Stockholm, Stockholm, Sweden.,Department of Obstetrics and Gynecology, South General Hospital Stockholm, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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Grandi G, Monari F, Boggio Sola V, Cortesi L, Toss A, Del Savio MC, Melotti C, Centurioni MG, Gustavino C, Varesco L, Facchinetti F, Barra F. BRCA mutation carriers' perception about benefits and risks associated with combined hormonal contraceptives use. EUR J CONTRACEP REPR 2022; 27:439-444. [PMID: 35946412 DOI: 10.1080/13625187.2022.2107199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the actual perceptions about combined hormonal contraceptives (CHCs) use in BRCA mutation carriers in comparison to women from the general population. METHODS This was a cross-sectional, observational study involving two Italian referral centres for hereditary cancers. An identical questionnaire investigating how CHC use could affect the risk of developing some types of cancer, specific diseases, and symptoms was administered to 85 BRCA mutation carriers and 85 healthy women without this genetic mutation (control group). Women's perceptions were evaluated using specific questions and Likert scales (-5 to +5). RESULTS Perceptions about the effects of CHC use on developing specific diseases and symptoms did not differ between BRCA mutation carriers and controls. Conversely, the protective effects of CHC use on colorectal (p = .02), uterine body (p = .01) and ovarian (p = .01) cancers were unknown by BRCA mutation carriers. Moreover, BRCA mutation carriers recognised the association between CHC use and a higher risk of breast (p = .0008) and uterine cervix cancer (p = .007). CONCLUSIONS Investing time and effort in transmitting the correct key messages about oncological risk related to CHC use could potentially increase their use in BRCA mutation carriers.
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Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Monari
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Valentina Boggio Sola
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Toss
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Del Savio
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Chiara Melotti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Grazia Centurioni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Gustavino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Leon-Larios F, Gutiérrez Ales J, Puente Martínez MJ, Correa Rancel M, Lahoz Pascual I, Silva Reus I, Quílez Conde JC. Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020). J Clin Med 2022; 11:jcm11133777. [PMID: 35807063 PMCID: PMC9267860 DOI: 10.3390/jcm11133777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The National Contraception Survey conducted by Sociedad Española de Contracepción intends to know the sexual and contraceptive habits of Spanish women of reproductive age. Methods: A descriptive and cross-sectional study with random sample selection was conducted with women aged from 14 to 49 years old in July and August 2020. Results: A total of 1801 women participated in the study, of which 78.7% used some contraception method during their sexual relationships. The most frequently used methods were condoms (31.3%) and combined oral contraceptives (18.5%) at their last sexual encounter. A total of 25.7% used both condoms and pills, especially younger women and those who had no steady partners (p < 0.001). Use of Long-acting Reversible Contraceptives continues to be low, although a slight increase in their use is observed, and they are recommended for 50% of the users who need contraception. Counselling on contraception was provided to 64.3% of the women, mainly by their gynaecologists. Regarding the decision to use a contraceptive method, the one suggested by health professionals was more influential, although this was not the case for women aged less than 20 years old (p < 0.001). A total of 38.4% of the women have used emergency oral contraception at least once and 66.8% of those who do not make continuous use of contraception methods do so out of personal choice. Conclusions: It is necessary to deepen work on counselling and awareness among the population towards the use of efficient contraceptive methods that prevent unplanned pregnancies.
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Affiliation(s)
| | | | | | - Marta Correa Rancel
- Hospital Universitario de Canarias, 38320 Tenerife, Spain;
- Departamento de Obstetricia-Ginecología, Pediatría, Preventiva, Medicina Legal y Forense, Microbiología, Parasitología, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
| | | | - Isabel Silva Reus
- Centro de Salud Sexual y Reproductiva de Villena, 03400 Alicante, Spain;
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11
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Klint Carlander AK, Thorsell M, Demetry Y, Nikodell S, Kopp Kallner H, Skoglund C. Knowledge, challenges, and standard of care of young women with ADHD at Swedish youth clinics. Sex Reprod Healthc 2022; 32:100727. [PMID: 35461165 DOI: 10.1016/j.srhc.2022.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/13/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Sexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics. METHOD Inductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software. RESULTS Three main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care. CONCLUSIONS Inadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research.
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Affiliation(s)
| | - Malin Thorsell
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Youstina Demetry
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sky Nikodell
- Medical Program, Linköping University, Linköping, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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12
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Kilander H, Weinryb M, Vikström M, Petersson K, Larsson EC. Developing contraceptive services for immigrant women postpartum - a case study of a quality improvement collaborative in Sweden. BMC Health Serv Res 2022; 22:556. [PMID: 35473622 PMCID: PMC9040323 DOI: 10.1186/s12913-022-07965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals’ (HCPs) counselling and a more effective choice of contraceptive methods. Methods The pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018–2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women’s choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year. Results The participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women’s choice of contraceptive methods. Conclusions The QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women’s choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.
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Affiliation(s)
- Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare Jönköping University, Jönköping, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences and Department of Obstetrics and Gynaecology, Region Jönköping County, Linköping University, Linköping, Sweden
| | - Maja Weinryb
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Malin Vikström
- Maternal Healthcare Unit, Stockholm South General Hospital, The Health and Medical Care Administration, Region Stockholm County, Stockholm, Sweden
| | - Kerstin Petersson
- Maternal Healthcare Unit, Stockholm South General Hospital, The Health and Medical Care Administration, Region Stockholm County, Stockholm, Sweden.,Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden. .,Department of Global Public Health, Karolinska Institutet, Widerströmska huset, floor 3, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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13
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Algren MH, Deen L, Tolstrup JS, Thygesen LC. Associations between health-risk behaviours and non-condom use among 28,620 Danish students: a cross-sectional study. EUR J CONTRACEP REPR 2021; 27:45-52. [PMID: 34907840 DOI: 10.1080/13625187.2021.2005018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Investigations into the associations between health-risk behaviours and non-condom use are important for planning effective preventive interventions targeted sexually transmitted infections. To date, there are no such studies on the Danish general population. The aim of this study was to examine associations between health-risk behaviours (including daily smoking, frequent binge-drinking, cannabis use within the last month and illicit drug use) and non-condom use among Danish students. MATERIAL AND METHOD Cross-sectional data from 28,620 sexually active students aged 15-25 years from the Danish National Youth Study 2014 were analysed using multilevel logistic regression. RESULTS Health-risk behaviours (daily smoking, frequent binge-drinking, cannabis use within the last month and illicit drug use) were significantly associated with higher odds for non-condom use among Danish students, even after adjustment for age, gender, education, religion, and geographical region. The associations remained significant after adjusting for the remaining health-risk behaviours. CONCLUSION Overall, the study showed a clear association between health-risk behaviours and non-condom use among Danish students. The findings of this study have important implications for future planning of more targeted health promotion intervention programmes aimed to increase condom use among young people as a means to reduce sexually transmitted infections.
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Affiliation(s)
- Maria Holst Algren
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Laura Deen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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14
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Stern J, Molin MS, Fernaeus M, Georgsson S, Carlsson T. Contraceptive counseling about adverse reactions of intrauterine contraception: Exploration of narratives found in web-based discussion boards. Midwifery 2021; 104:103166. [PMID: 34717242 DOI: 10.1016/j.midw.2021.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the possibility of experiencing adverse reactions is an important aspect of contraceptive decision-making and information about this topic is highlighted as an essential aspect of contraceptive counseling. The aim of this study was to explore experiences of contraceptive counseling about potential adverse reactions of intrauterine contraception. DESIGN exploratory qualitative study of messages in discussion boards, analyzed with inductive qualitative content analysis. SETTING two large public Swedish web-based discussion boards about sexual and reproductive health. PARTICIPANTS threads related to the aim were identified through searches in the discussion boards during 2019 and 2020, resulting in in 43 included posters who had written 140 messages in total. FINDINGS the themes 'difficulties making an informed decision due to insufficient and untrustworthy information about adverse reactions' and 'feeling dismissed when communicating about experienced adverse reactions' illustrate the results. Posters emphasized the importance of sufficient information about adverse reactions. However, professionals were perceived as overly optimistic regarding intrauterine contraception and focusing on mild or common reactions. The importance of feeling that their adverse reactions were acknowledged was articulated, but posters felt that some professionals dismissed the reactions when being told about it, resulting in frustration and dissatisfaction with care. The discussion boards contained narratives describing a resistance among professionals to send in a formal report about the adverse reaction. KEY CONCLUSIONS according to statements made by posters who have experience of adverse reactions of intrauterine contraception, contraceptive counseling have room for improvement in regard to inclusion of comprehensive information about adverse reactions. The findings illustrate the importance that clients who experience adverse reactions of intrauterine contraception feel they are acknowledged and offered adequate support. IMPLICATIONS FOR PRACTICE echoing guidelines for high-quality contraceptive counseling, the narratives provide further weight that professionals need to have adequate training and resources to offer comprehensive information about adverse reactions of intrauterine contraception. The findings call attention to the importance of follow-up services for clients who experience adverse reactions.
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Affiliation(s)
- Jenny Stern
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden; Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden
| | | | - Maja Fernaeus
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden
| | - Susanne Georgsson
- The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden; Karolinska Institutet, Department of Clinical science, Intervention and technology, SE-171 77 Stockholm, Sweden
| | - Tommy Carlsson
- Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden; The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden.
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15
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Farah D, Girão MJBC, Fonseca MCM. Willingness to pay for short- and long-acting contraceptives among female adolescents and their parents in Brazil:a pilot study. Einstein (Sao Paulo) 2021; 19:eAO6376. [PMID: 34644746 PMCID: PMC8483636 DOI: 10.31744/einstein_journal/2021ao6376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/26/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate willingness to pay for short- and long-acting reversible contraceptive methods among female Brazilian adolescents and their parents, as well as their perspective on using such methods. Methods This is a cross-sectional study of female adolescents aged 13 to 19 years and their parents. We surveyed to estimate their willingness to pay for contraceptive methods. The values are expressed as mean±standard deviation in Brazilian reals (R$). Spearman correlation was employed for socioeconomic status of parents, age of adolescents and their standpoints. The methods types and adolescent and parent perspectives were analyzed by the test χ2. To determine an agreement between pairs and their willingness to pay, we used the Bland-Altman plot. Results A total of 165 surveys were collected. Short-acting method was significantly more acceptable to pay than the long-action method, by both parents and their daughters. Parents and their daughters are willing to pay out-of-pocket R$ 52,25±22,48 and R$ 51,63±21,24 for short-acting reversible contraception method, and R$ 176,83±130,34 and R$ 174,83±143,64, for long-acting method, respectively. Bland-Altman analysis indicated an agreement on both perspectives and the price they are willing to pay for each contraceptive method. Conclusion Parents and adolescent daughters are more willing to pay for short-acting methods. We showed an agreement between the parent and the daughter for the values paid for each method.
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Affiliation(s)
- Daniela Farah
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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16
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Envall N, Emtell Iwarsson K, Bizjak I, Gemzell Danielsson K, Kopp Kallner H. Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial. Acta Obstet Gynecol Scand 2021; 100:2044-2052. [PMID: 34435347 DOI: 10.1111/aogs.14243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intervention trials of structured contraceptive counseling have proved to increase use of long-acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers' and participants' satisfaction with an intervention used in a large trial in Sweden. MATERIAL AND METHODS A cross-sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi-structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. TRIAL REGISTRATION ClinicalTrials.gov (NCT03269357). RESULTS Fourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time-neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package. CONCLUSIONS The intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Isabella Bizjak
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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17
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Harris ML, Egan N, Forder PM, Coombe J, Loxton D. Contraceptive use among women through their later reproductive years: Findings from an Australian prospective cohort study. PLoS One 2021; 16:e0255913. [PMID: 34379661 PMCID: PMC8357106 DOI: 10.1371/journal.pone.0255913] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Examine patterns of contraceptive use and contraceptive transitions over time among an Australian cohort of women through their later reproductive years. Study design Latent Transition Analysis was performed using data on 8,197 women from the Australian Longitudinal Study on Women’s Health’s 1973–78 cohort to identify distinct patterns of contraceptive use across 2006, 2012 and 2018. Women were excluded from the analysis at time points where they were not at risk of an unintended pregnancy. Latent status membership probabilities, item-response probabilities, transitions probabilities and the effect of predictors on latent status membership were estimated and reported. Results Patterns of contraceptive use were relatively consistent over time, particularly for high efficacy contraceptive methods with 71% of women using long-acting reversible contraceptives in 2012 also using long-acting reversible contraceptives in 2018. Multiple contraceptive use was highest in 2006 when women were aged 28–33 years (19.3%) but declined over time to 14.3% in 2018 when women were aged 40–45 years. Overall, contraceptive patterns stabilised as the women moved into their late 30s and early 40s. Conclusions Although fertility declines with age, the stability of contraceptive choice and continued use of short-acting contraception among some women suggests that a contraceptive review may be helpful for women during perimenopause so that they are provided with contraceptive options most appropriate to their specific circumstances.
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Affiliation(s)
- Melissa L. Harris
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- * E-mail:
| | - Nicholas Egan
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Peta M. Forder
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Deborah Loxton
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Saya GK, Premarajan KC, Roy G, Sarkar S, Kar SS, Krishnamoorthy Y, Ulaganeethi R, Olickal JJ. Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India. Health Care Women Int 2021; 45:86-100. [PMID: 34323672 DOI: 10.1080/07399332.2021.1953500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.
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Affiliation(s)
- Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kariyarath Cheriyath Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Yuvraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Farah D, Andrade TRM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis. EUR J CONTRACEP REPR 2021; 25:492-501. [PMID: 33140990 DOI: 10.1080/13625187.2020.1833187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER CRD42017055452.
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Affiliation(s)
- Daniela Farah
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa Raquel Moraes Andrade
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Manoel João Batista Castello Girão
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
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Gyllenberg F, Tekay A, Saloranta T, Korjamo R, Heikinheimo O. Contraceptive priorities among women seeking family planning services in Finland in 2017-2019. Contraception 2021; 104:394-400. [PMID: 34118269 DOI: 10.1016/j.contraception.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess how women's reproductive history, contraceptive experience and need of abortion care are associated with priorities for contraception. STUDY DESIGN In this cross-sectional survey study, we gathered information on women's history of births and abortions, previous use and satisfaction with contraceptive methods, and features of contraceptive methods they value most. Women were recruited at public family planning and outpatient abortion clinics in the capital region of Helsinki, Finland. RESULTS Of the 1006 women responding, 502 were recruited during visits for abortion care and 504 for contraceptive counseling. Women seeking abortion care more often had a history of abortion than women seeking contraceptive counseling (44% vs 11%), presented with a higher mean number of different contraceptive methods used (69% vs 55% with more than 2 previous methods), and were less often satisfied with the methods used (36% vs 60% satisfied with 2 out of 3 methods), p < 0.001 for all. In addition, women seeking abortion care had lower odds of prioritizing effectiveness (aOR 0.3, 95% CI 0.2-0.5), and higher odds of prioritizing lower hormonal levels or non-hormonal alternatives (aOR 2.0, 95% CI 1.3-3.2). There was no difference between the groups regarding priorities of lesser pelvic pain (aOR 0.7, 95% CI 0.5-1.1), regular period (aOR 01.2, 95% CI 0.8-1.9), or the method being easy to use (aOR 1.2, 95% CI 0.8-1.8). CONCLUSIONS There is a contrast between guidelines emphasizing effectiveness in postabortion contraception, and many women's contraceptive priorities. IMPLICATION STATEMENT Clinicians providing contraceptive counseling must be mindful of each individual's personal contraceptive priorities.
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Emtell Iwarsson K, Envall N, Bizjak I, Bring J, Kopp Kallner H, Gemzell-Danielsson K. Increasing uptake of long-acting reversible contraception with structured contraceptive counselling: cluster randomised controlled trial (the LOWE trial). BJOG 2021; 128:1546-1554. [PMID: 33988917 DOI: 10.1111/1471-0528.16754] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of structured contraceptive counselling on the uptake of long-acting reversible contraceptives (LARCs) and pregnancy rates. DESIGN Cluster randomised trial. SETTING Abortion, youth and maternal health clinics in Stockholm, Sweden. POPULATION Sexually active women aged ≥18 years without a wish for pregnancy seeking abortion and/or contraceptive counselling. METHODS For participants in clinics randomised to intervention, trained healthcare providers implemented a study-specific intervention package designed for structured contraceptive counselling. Participants in the control clinics received routine counselling. MAIN OUTCOME MEASURES The primary outcome was choice of LARCs at first visit. Secondary outcomes were LARC initiation at 3 months and pregnancy rates at 3 and 12 months. We used logistic mixed-effects models with random intercept for clinic to account for clustering. RESULTS From September 2017 to May 2019, 28 randomised clinics enrolled 1364 participants. Analyses including 1338 subjects showed that more participants in the intervention group compared with the control group chose LARCs: 267/658 (40.6%) versus 206/680 (30.3%) (OR 2.77, 95% CI 1.99-3.86). LARC initiation was higher in the intervention group compared with the control group: 213/528 (40.3%) versus 153/531 (28.8%) (OR 1.74, 95% CI 1.22-2.49). At the abortion clinics, the pregnancy rate was significantly lower at 12 months in the intervention group compared with the control group: 13/101 (12.9%) versus 28/103 (27.2%) (OR 0.39, 95% CI 0.18-0.88). CONCLUSIONS Structured contraceptive counselling increased LARC uptake in all clinics and significantly reduced unintended pregnancy rates in abortion clinics at the 12 months follow-up. TWEETABLE ABSTRACT Structured contraceptive counselling increased LARC uptake and reduced pregnancy rates at 12 months.
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Affiliation(s)
- K Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - N Envall
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - I Bizjak
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Bring
- Statisticon Inc., Uppsala, Sweden
| | - H Kopp Kallner
- Division of Obstetrics and Gynaecology, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
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22
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Halane HIM, Hargreave M, Kjaer SK, Christensen J, Mørch LS. Maternal use of hormonal contraception and epilepsy in offspring. Hum Reprod 2021; 36:1674-1681. [PMID: 33580954 DOI: 10.1093/humrep/deab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is maternal use of hormonal contraception associated with the development of epilepsy in the offspring? SUMMARY ANSWER We found that maternal use of hormonal contraception was associated with a slightly increased risk of epilepsy in the offspring. WHAT IS KNOWN ALREADY Foetal exposure to exogenous hormones has been associated with changes in brain development. However, little is known about maternal hormonal contraception use and development of epilepsy in the offspring. STUDY DESIGN, SIZE, DURATION A nationwide cohort of all live born children born in Denmark between 1 January 1998 and 31 December 2014, was followed from day 29 after birth for epilepsy (first diagnosis of epilepsy or first redeemed prescription for anti-epileptic medication) to censoring (emigration, death) or 31 December 2015, whichever occurred first. PARTICIPANTS/MATERIALS, SETTING, METHODS Diagnoses of epilepsy were obtained from the National Patient Registry. The Danish National Prescription Registry supplied information on redeemed prescriptions for hormonal contraception and anti-epileptic medication. Maternal hormonal contraception use was categorized as never use (reference group), previous use (prescriptions redeemed >3 months before pregnancy start) and recent use (prescriptions redeemed ≤3 months before or during pregnancy). MAIN RESULTS AND THE ROLE OF CHANCE The data show that 17 585 children developed epilepsy during a median follow-up of 9.2 years (9 732 635 person-years). The hazard ratio (HR) for epilepsy was 1.07 (95% CI 1.02-1.13) in children of mothers who had used any type of hormonal contraception recently, compared with children of mothers who had not used hormonal contraception. The HR was similar for recent use of oral combined products, while the HRs for recent or previous use of non-oral combined products were 1.32 (95% CI 0.98-1.77) and 1.16 (95% CI 1.02-1.32), respectively. For non-oral progestin-only products, the HRs were 1.19 (95% CI 1.04-1.38) and 1.53 (95% CI 1.31-1.80), respectively, for recent and previous use. LIMITATIONS, REASONS FOR CAUTION There may be some misclassification of maternal hormonal contraception use, as some women may not have used the redeemed prescriptions or used them at a different point in time; potentially leading to an attenuation of the estimates. In addition, although we were able to account for known risk factors for epilepsy, unknown or residual confounding cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS Our findings are based on nationwide population-based data and can therefore be applied to other similar populations. However, as this is the first study in this field, further studies are needed to confirm our findings. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained for this study, which was supported by internal funding at the Unit of Virus, Lifestyle and Genes. All authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- H I M Halane
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen O, Denmark
| | - M Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen O, Denmark
| | - S K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100 Copenhagen O, Denmark.,Department of Gynaecology, Rigshospitalet, 2100 Copenhagen O, Denmark
| | - J Christensen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark.,Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - L S Mørch
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, 2100 Copenhagen O, Denmark
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23
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Bitzer J, Oppelt PG, Deten A. Evaluation of a patient-centred, needs-based approach to support shared decision making in contraceptive counselling: the COCO study. EUR J CONTRACEP REPR 2021; 26:326-333. [PMID: 33871288 DOI: 10.1080/13625187.2021.1908539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Contraceptive Counselling (COCO) study tested whether a structured approach to assessing patient needs and expectations improved method choice and satisfaction with the contraceptive decision-making process. METHODS Physicians and women were invited to complete needs-based contraceptive counselling sessions using a structured questionnaire. Physicians recorded the individual responses online; women evaluated the process using an immediate post-consultation questionnaire and then via a structured online interview 6 months later. RESULTS A total of 92 gynaecologists and 1176 women participated: 951 women completed the immediate post-consultation survey and 145 took part in the 6 month online evaluation. There was a substantial increase in satisfaction with the current contraceptive method: the number of women reporting they were 'very satisfied' with their contraceptive method increased by 30%. This applied to starters and switchers as well as to women continuing with their previous method. Women were highly satisfied with the structured approach; 95% rated the counselling as 'good' or 'very good' and 'comprehensive and detailed'. CONCLUSION Using a structured approach to share information tailored to women's needs can help them choose from a broader range of methods and, in some cases, change to a method more suitable to their individual needs, and ultimately increase satisfaction with their choice.
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Affiliation(s)
- J Bitzer
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - P G Oppelt
- Department of Gynaecology, Erlangen University Hospital, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Deten
- Jenapharm GmbH & Co. KG, Jena, Germany
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24
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Pearson JT, Chelstowska M, Rowland SP, Mcilwaine E, Benhar E, Berglund Scherwitzl E, Walker S, Gemzell Danielsson K, Scherwitzl R. Natural Cycles app: contraceptive outcomes and demographic analysis of UK users. EUR J CONTRACEP REPR 2021; 26:105-110. [PMID: 33539252 DOI: 10.1080/13625187.2020.1867844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Digital fertility awareness-based contraception offers an alternative choice for women who do not wish to use hormonal or invasive methods. The aim of this study was to investigate the key demographics of current users of the Natural Cycles app and assess the contraceptive outcomes of women preventing pregnancy in a UK cohort of women. MATERIALS AND METHODS This was a real world observational prospective observational study. The typical-use effectiveness of the method was calculated using both 13-cycle cumulative probability of pregnancy (life table analysis) and Pearl Index for the entire study cohort. Perfect-use PI was calculated using data from cycles where sexual intercourse during the fertile window was marked as protected and no unprotected sex was recorded on fertile days. RESULTS 12,247 women were included in the study and contributed an average of 9.9 months of data for a total of 10,066 woman years of exposure. The mean age of the cohort was 30, mean BMI 23.4, the majority were in a stable relationship (83.2%) and had a university degree or higher (83%). The one year typical use, PI was 6.1 (95% CI: 5.6, 6.6) and with perfect-use was 2.0 (95% CI: 1.3, 2.8). 13 cycle pregnancy probability was 7.1%. CONCLUSIONS This is the first study which describes the use of a digital contraceptive by women in the UK. It describes the demographics of users and how they correlate with the apps effectiveness at preventing pregnancy.
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Affiliation(s)
| | | | | | | | | | | | - Susan Walker
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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25
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Pearson JT, Chelstowska M, Rowland SP, Benhar E, Kopp-Kallner H, Berglund Scherwitzl E, Acuna J, Gemzell Danielsson K, Scherwitzl R. Contraceptive Effectiveness of an FDA-Cleared Birth Control App: Results from the Natural Cycles U.S. Cohort. J Womens Health (Larchmt) 2020; 30:782-788. [PMID: 33370220 DOI: 10.1089/jwh.2020.8547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Digital fertility awareness-based methods of birth control are an attractive alternative to hormonal or invasive birth control for modern women. They are also popular among women who may be planning a pregnancy over the coming years and wish to learn about their individual menstrual cycle. The aim of this study was to assess the effectiveness of the Natural Cycles app at preventing pregnancy for a cohort of women from the United States and to describe the key demographics of current users of the app in such a cohort. Materials and Methods: This prospective real-world cohort study included users who purchased an annual subscription to prevent pregnancy. Demographics were assessed through answers to in-app questionnaires. Birth control effectiveness estimates for the entire cohort were calculated using 1-year pearl index (PI) and 13-cycle cumulative pregnancy probability (Kaplan-Meier life table analysis). Results: The study included 5879 women who contributed an average of 10.5 months of data for a total of 5125 woman-years of exposure. The average user was 30 years old with a body mass index of 24 and reported being in a stable relationship. With typical use, the app had a 13-cycle cumulative pregnancy probability of 7.2% and a 1-year typical use PI of 6.2. When the app was used under perfect use, the PI was 2.0. Conclusions: The data presented in this study give insights into the cohort of women using this app in the United States, and provide country-specific effectiveness estimates. The contraceptive effectiveness of the app was in line with previously published figures from Natural Cycles (PI of seven for typical use and two for perfect use).
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Affiliation(s)
| | | | | | | | - Helena Kopp-Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Juan Acuna
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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26
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Treister-Goltzman Y, Freud T, Peleg R. Contraception Use among Women of Childbearing Age in Southern Israel: A Comparison Between Two Ethnic Populations. J Racial Ethn Health Disparities 2021; 8:630-7. [PMID: 32700259 DOI: 10.1007/s40615-020-00822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Two populations with different socio-demographic characteristics reside in southern Israel: the traditional Muslim Bedouin population and the Jewish population that leads a western lifestyle. The aim of the study was to assess the rate, pattern, and dynamics of the use of contraception in these two ethnic populations from 2006 to 2016 and to identify factors associated with the practice of effective and safe contraception. METHODS A retrospective study based on a computerized medical database. We recorded actual purchases of different forms of contraception by women of childbearing age (15-49 years) from the two populations in the southern Negev region of Israel. RESULTS Contraceptives were purchased by 7588 Bedouin women and 30,482 Jewish women. The rate of purchase ranged from 5.2 to 9.7% in the Bedouin sector and from 12.9 to 28.2% in the Jewish sector. Oral contraceptives were the most common type. In the Jewish sector, their use remained relatively stable over the years. In the Bedouin sector, in contrast, the rate increased. The only factor that was associated with the use of intrauterine devices was age (OR = 1.063, P < 0.001). Among women who used combined hormonal contraception, Jewish ethnicity (OR = 5.835, P < 0.001), age (OR = 0.926, P < 0.001), and comorbidity (OR = 0.87, P = 0.001) were associated with the use of newer, low-dose estrogen drugs. CONCLUSIONS Our findings, such as the lower rate of contraception practice in the Bedouin sector in general and the use of the new and safer hormonal contraceptives in particular, can help focus the efforts of medical teams in programs for women's health promotion.
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Guleria S, Munk C, Elfström KM, Hansen BT, Sundström K, Liaw K, Nygård M, Kjaer SK. Emergency contraceptive pill use among women in Denmark, Norway and Sweden: Population‐based survey. Acta Obstet Gynecol Scand 2020; 99:1214-1221. [DOI: 10.1111/aogs.13849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/22/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia Guleria
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - Christian Munk
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - K. Miriam Elfström
- Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Bo T. Hansen
- Department of Research Cancer Registry of Norway Oslo Norway
| | - Karin Sundström
- Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Kai‐Li Liaw
- Epidemiology Merck Research Laboratories North Wales PA USA
| | - Mari Nygård
- Department of Research Cancer Registry of Norway Oslo Norway
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
- Department of Gynecology Rigshospitalet University Hospital University of Copenhagen Copenhagen Denmark
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28
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Beckert V, Aqua K, Bechtel C, Cornago S, Kallner HK, Schulze A, Parashar P, Waddington A, Donders G. Insertion experience of women and health care professionals in the Kyleena ® Satisfaction Study. EUR J CONTRACEP REPR 2020; 25:182-189. [PMID: 32223466 DOI: 10.1080/13625187.2020.1736547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The Kyleena® Satisfaction Study (KYSS) is a prospective, observational study conducted to assess satisfaction with LNG-IUS 12 (Kyleena®) in clinical practice and aims to provide adequate information for counselling women on what to expect regarding insertion and satisfaction.Materials and methods: Women deciding to use LNG-IUS 12 during routine counselling were informed of the study and provided informed consent. A baseline analysis was conducted to evaluate demographics, ease of insertion assessed by investigators, pain at insertion rated by women, additional interventions for insertion, and adverse events.Results: 1,110 women (536 parous, 574 nulliparous) had an insertion attempt and were included. Insertion was rated as easy in 494 (92.2%) parous and 516 (89.9%) nulliparous women. Pain was assessed as none or mild by 475 (88.6%) parous and 387 (67.4%) nulliparous women. Additional interventions were not required for most insertions (705; 63.6%). Overall 111 (10.0%) women reported adverse events at the time of baseline analysis.Conclusions: This analysis demonstrates that LNG-IUS 12 insertion is easy and associated with no or mild pain in most women. Additional interventions for insertion are not required in most cases. After 3 months, the number of adverse events is low.Implications: The present baseline analysis of the Kyleena® Satisfaction Study (KYSS) demonstrates that most women rate insertion pain of LNG-IUS 12 as none or mild and clinicians consider insertion easy in the majority of cases.
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Affiliation(s)
| | - Keith Aqua
- Virtus Research Consultants, Wellington, Florida, USA
| | | | | | - Helena Kopp Kallner
- Dept of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Sweden
| | | | | | | | - Gilbert Donders
- Femicare VZW, Tienen, Belgium.,University Hospital Antwerp, Antwerp, Belgium
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29
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Nordström F, McTaggart J, Melander E, Altman D, Kopp Kallner H. Contraceptive use at the time of and after an ectopic pregnancy: a retrospective cohort study. EUR J CONTRACEP REPR 2020; 25:147-150. [PMID: 32118492 DOI: 10.1080/13625187.2020.1726887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Approximately, 1-2% of all pregnancies are ectopic; 25% of unintended pregnancies are conceived despite the use of contraception. The primary objective of our study was to explore the proportion of ectopic pregnancies (EPs) that were conceived during contraceptive use among women in Stockholm County. Secondary objectives were to establish the prevalence of contraceptive methods used at the time of EP and the intended contraceptive method after treatment completion.Methods: We performed a retrospective cohort study of 1180 women diagnosed with and treated for EP between 1 December 2013 and 30 April 2017 at all hospitals in Stockholm County. Demographic variables and contraceptive use before and after treatment were noted. Exclusion criteria were uncertainty about the diagnosis of EP in the patient records and planned treatment/follow-up outside Stockholm County.Results: A total of 222/1180 (18.8%) EPs were conceived during known contraceptive use. A total of 112/222 (50.5%) women with known use of contraception at the time of conception discontinued contraceptive use and 81/857 (9.5%) women with no prior use of contraception initiated contraceptive use. Among the 857 women, 520 (60.7%) expressed a desire to conceive. Results were compared using the Mann-Whitney U test or Fisher's exact test as appropriate.Conclusion: EP occurring during use of contraception is an unexplored problem. Contraceptive use decreased in women who were using contraception at the time of EP conception, leaving these women at risk of a subsequent unintended pregnancy. There should be more focus on contraceptive use after treatment for EP, in order to preserve fertility.
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Affiliation(s)
- Fanny Nordström
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Julia McTaggart
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Emma Melander
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Altman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Stockholm Urogyn, Solna, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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30
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Tatla MK, Faber MT, Hansen BT, Arnheim-Dahlström L, Munk C, Nygård M, Kjær SK. Factors associated with condom use during sexual intercourse with a new partner among Scandinavian women. Prev Med 2020; 131:105944. [PMID: 31811868 DOI: 10.1016/j.ypmed.2019.105944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/15/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
In this population-based, cross-sectional questionnaire study among 18-45-year-old women from Denmark, Sweden, and Norway conducted during 2011-2012 we examine factors associated with using condoms with a new partner. Condom use with a new partner was assessed among 6202 women having had a new partner in the recent six months. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the associations between sociodemographic and lifestyle factors, and sexual behavior, respectively, and condom use with a new partner using a logistic regression model. Always/almost always ("always") condom use served as the reference category in all analyses and was compared with sometimes/rarely ("sometimes") and never use in two separate analyses. Overall, respectively 36.3%, 26%, and 37.7% reported always, sometimes, or never condom use with a new partner. Married/cohabiting were more likely than single women to never (OR = 2.50, 95% CI: 2.07-3.02) or sometimes (OR = 1.30; 95% CI 1.04-1.62) use condoms with recent new partners. Increasing number of new partners in the recent six months was also associated with condom use with a new partner (never: OR for ≥3 partners = 0.56; 95% CI: 0.47-0.67; sometimes: OR for ≥3 partners = 1.64; 95% CI: 1.38-1.94). Furthermore, women reporting early age at first sexual intercourse, no contraception at first intercourse, or not being vaccinated against human papillomavirus used condoms with new partners less frequently. These findings may suggest that continued awareness about the risk of contracting sexually transmitted infections when practicing condomless sex is important.
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Affiliation(s)
- Manrinder Kaur Tatla
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
| | - Mette Tuxen Faber
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway.
| | - Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway.
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Böttcher B, Abu-El-Noor M, Abu-El-Noor N. Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers. BMC Womens Health 2019; 19:165. [PMID: 31856794 PMCID: PMC6923918 DOI: 10.1186/s12905-019-0869-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. METHODS A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data. RESULTS Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods. CONCLUSION Women's contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women's choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.
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Affiliation(s)
- Bettina Böttcher
- Faculty of Medicine, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine.
| | - Mysoon Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine
| | - Nasser Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza, Gaza Strip, Palestine
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Eriksson C, Skinstad M, Georgsson S, Carlsson T. Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study. Reprod Health 2019; 16:172. [PMID: 31775765 PMCID: PMC6882246 DOI: 10.1186/s12978-019-0835-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality. Objective The overarching aim was to investigate the quality of websites about long-acting reversible contraception. Methods Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index. Results The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29–55) indicating moderate to difficult readability levels, corresponding to a grade level of 9. Conclusions The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.
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Affiliation(s)
| | | | - Susanne Georgsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical science, Intervention and technology, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Carlsson
- Sophiahemmet University, Stockholm, Sweden. .,The Swedish Red Cross University College, Huddinge, Sweden. .,Department of Women's and Children's Health, Uppsala university, MTC-huset, Dag Hammarskjölds väg 14B, 1 tr, SE-75237, Uppsala, Sweden.
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Nur U, El Reda D, Hashim D, Weiderpass E. A prospective investigation of oral contraceptive use and breast cancer mortality: findings from the Swedish women's lifestyle and health cohort. BMC Cancer 2019; 19:807. [PMID: 31412822 PMCID: PMC6694621 DOI: 10.1186/s12885-019-5985-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The association between oral contraceptive (OC) use and long-term mortality remains uncertain and previous studies have reported conflicting findings. We aim to assess the long-term impact of OC use on all-cause and cancer-specific mortality. METHODS Out of 49,259 participants, we analysed data on 2120 (4.3%) women diagnosed with first primary breast cancer between 1993 and 2012, in the Swedish Women's Lifestyle and Health Study. Kaplan-Meier plots were used to graph the hazard of mortality in association with oral contraceptives use, stage of disease and hormone receptors status at diagnosis. Cox proportional hazard model were used to estimate hazard ratios (HR) between OC use and all-cause mortality. The same association was studied for breast cancer-specific mortality by modelling the log cumulative mortality risk, adjusting for clinical stage at diagnosis, hormone receptor status, body mass index and smoking. RESULTS Among 2120 women with breast cancer, 1268 (84%) reported ever use of OC and 254 died within 10 years of diagnosis. The risk of death for OC ever-users relative to never-users was: HR = 1.13 (95% CI: 0.66-1.94) for all-cause mortality and HR = 1.29 (95% CI: 0.53-3.18) for breast cancer-specific mortality. A high percentage of women (42.9%) were diagnosed at early stage disease (stage I). CONCLUSIONS Among women with primary breast cancer, OC ever-users compared to never- users did not have a higher all-cause or breast cancer specific-mortality, after the adjustment of risk factors.
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Affiliation(s)
- Ula Nur
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, P.O. Box, 2713, Doha, Qatar
| | - Darline El Reda
- Michigan Medical Advantage Group, Ann Arbor, MI USA
- College of Human Medicine, Division of Public Health, Michigan State University, East Lansing, MI USA
| | - Dana Hashim
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Malmborg A, Brynhildsen J, Hammar M. A survey of young women's perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire. Sex Reprod Healthc 2019; 21:75-80. [PMID: 31395237 DOI: 10.1016/j.srhc.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Few studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. STUDY DESIGN A secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. MAIN OUTCOME MEASURES Were self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. RESULTS A negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p < 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8-13.8). The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1-11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2-6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). CONCLUSIONS The women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.
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Affiliation(s)
- Agota Malmborg
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
| | - Mats Hammar
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
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Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Ups J Med Sci 2019; 124:203-212. [PMID: 31495254 PMCID: PMC6758707 DOI: 10.1080/03009734.2019.1653407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
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Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- CONTACT Yvonne Skogsdal Maternal Health Care Unit, Region Örebro County, Box 1613, SE-701 16, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala, Sweden
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Sundell M, Ginstman C, Månsson A, Forslund I, Brynhildsen J. Patterns of prescription and discontinuation of contraceptives for Swedish women with obesity and normal-weight women. EUR J CONTRACEP REPR 2019; 24:192-197. [PMID: 31112059 DOI: 10.1080/13625187.2019.1610873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: This study aimed to explore the prescription of different contraceptive methods to Swedish women with obesity and to compare the pattern of prescription and adherence to treatment between this group and normal-weight women. Materials and methods: This study included 371 women with obesity and 744 matched normal-weight women, aged 18-40. Medical records were scrutinised for the period 1 January 2010 to 31 December 2014. The retrieved variables included: background characteristics, prescribed contraceptive methods, adverse effects, duration of treatment, reason for discontinuation and bleeding pattern. Result: Progestin-only pills were mainly prescribed to women with obesity (44% vs. 20%, p = 0.001) whereas combined hormonal contraception was mainly prescribed to normal-weight women (60% vs. 21%, p < 0.0001). Thirty-three percent vs. 25% (p = 0.003) discontinued their contraceptive method within 1 year. The most commonly declared reason for discontinuation was bleeding disturbance (14.7% vs. 9.6%, p = 0.008). Conclusion: The most commonly prescribed contraceptive method in women with obesity was progestin-only pills, but surprisingly many women with obesity were prescribed combined hormonal contraception despite current Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within the first year of the study period, compared with incident normal-weight users.
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Affiliation(s)
- Micaela Sundell
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Charlotte Ginstman
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Agnes Månsson
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Ingrid Forslund
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Jan Brynhildsen
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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Guleria S, Thomsen LT, Munk C, Nygård M, Hansen BT, Elfström KM, Arnheim-Dahlström L, Liaw KL, Frederiksen K, Kjær SK. Contraceptive use at first intercourse is associated with subsequent sexual behaviors. Contraception 2019; 99:217-221. [DOI: 10.1016/j.contraception.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/28/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
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Hellström A, Gemzell Danielsson K, Kopp Kallner H. Trends in use and attitudes towards contraception in Sweden: results of a nationwide survey. EUR J CONTRACEP REPR 2019; 24:154-160. [DOI: 10.1080/13625187.2019.1581163] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anna Hellström
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
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Emtell Iwarsson K, Larsson EC, Gemzell-Danielsson K, Essén B, Klingberg-Allvin M. Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200171. [PMID: 30665889 DOI: 10.1136/bmjsrh-2018-200171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women. METHODS The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015. RESULTS The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception. CONCLUSIONS Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.
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Affiliation(s)
- Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Women's and Children's Health/International Maternal and Child Health (IMCH), Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/International Maternal and Child Health (IMCH), Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Höglund B, Larsson M. Midwives' work and attitudes towards contraceptive counselling and contraception among women with intellectual disability: focus group interviews in Sweden. EUR J CONTRACEP REPR 2019; 24:39-44. [PMID: 30633574 DOI: 10.1080/13625187.2018.1555640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Family planning counselling is an essential part of sexual and reproductive health care; however, health care professionals often fail to offer sexual and reproductive health services to women with intellectual disability (ID), based on a misconception of inactive sexuality. The aims of this study were to gain a deeper understanding of midwives' perceptions of sexual health and contraceptive use of women with ID, and of midwives' practices in providing contraceptive counselling to women with ID. METHODS Five focus group interviews were conducted with 19 midwives at five antenatal/family planning clinics in central Sweden between December 2016 and February 2017. RESULTS The findings are presented in a paradigm model comprising the following components: context, causal conditions for women with ID needing contraception, intervening conditions, action and interaction strategies based on the midwives' approach and performance during the consultation, and finally consequences. Midwives strived to enhance informed choice, whenever possible, and tried to maintain a neutral attitude during counselling. They wanted to provide the most suitable contraceptive method balanced against any risk of long-term use and possible side effects. Midwives raised the need for teamwork and inter-professional support to improve health care, security and access to other related services for women with ID. CONCLUSIONS Few women with ID request contraceptive counselling, which limits midwives' knowledge, experience and competence. Midwives, therefore, plan consultations carefully and strive to enable women with ID to make informed contraceptive choices. Increased teamwork could be a way to strengthen the role of midwives and thereby improve counselling.
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Affiliation(s)
- Berit Höglund
- a Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Margareta Larsson
- a Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
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Abstract
OBJECTIVES To describe women's self-reported use of non-medical contraceptive methods (including barrier methods, fertility awareness-based methods and withdrawal), explore reasons for and satisfaction with choice of contraceptive methods and examine women's fertility awareness. METHODS A cross-sectional survey was conducted among women consulting at primary healthcare clinics not using medical contraceptives. RESULTS Most of the 648 participants (67%) reported using a mix of condom use, withdrawal and a calendar method, while 23% used only condoms. Eleven percent reported using the Billings ovulation method, diaphragm/cap or fertility monitor and found these methods highly satisfactory. A majority of the women who primarily used condoms also reported being satisfied. Most women actively chose non-medical contraception because it was perceived as without adverse effects, uncomplicated and effective. Fertility awareness was generally poor. CONCLUSION Frequent use of withdrawal and a calendar method, as well as poor fertility awareness, suggests a need for improved counselling at contraceptive clinics on fertility awareness and more effective non-medical contraceptive methods to assist women in making an informed contraceptive choice.
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Affiliation(s)
- Anette Nilsson
- a Youth Clinic Hisingen, City of Gothenburg , Gothenburg , Sweden.,b The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences , Gothenburg , Sweden
| | - Tone Ahlborg
- b The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences , Gothenburg , Sweden
| | - Susanne Bernhardsson
- c Närhälsan Research and Development Primary Health Care , Region Västra Götaland , Gothenburg , Sweden.,d Department of Health and Rehabilitation, Unit of Physiotherapy , The Sahlgrenska Academy at University of Gothenburg, Institute of Neuroscience and Physiology , Gothenburg , Sweden
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Gass JD, Semrau K, Sana F, Mankar A, Singh VP, Fisher-Bowman J, Neal BJ, Tuller DE, Kumar B, Lipsitz S, Sharma N, Kodkany B, Kumar V, Gawande A, Hirschhorn LR. Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India. PLoS One 2018; 13:e0207987. [PMID: 30481209 PMCID: PMC6258538 DOI: 10.1371/journal.pone.0207987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal outcomes in the immediate post-delivery period are critical indicators of quality of care. Data on childbirth outcomes in low-income settings usually require home visits, which can be constrained by cost and access. We report on the use of a call center to measure post-discharge outcomes within a multi-site improvement study of facility-based childbirth in Uttar Pradesh, India. Methods Of women delivering at study sites eligible for inclusion, 97.9% (n = 157,689) consented to follow-up. All consenting women delivering at study facilities were eligible to receive a phone call between days eight and 42 post-partum to obtain outcomes for the seven-day period after birth. Women unable to be contacted via phone were visited at home. Outcomes, including maternal and early neonatal mortality and maternal morbidity, were ascertained using a standardized script developed from validated survey questions. Data Quality Assurance (DQA) included accuracy (double coding of calls) and validity (consistency between two calls to the same household). Regression models were used to identify factors associated with inconsistency. Findings Over 23 months, outcomes were obtained by the call center for 98.0% (154,494/157,689) consenting women and their neonates. 87.9% of call center-obtained outcomes were captured by phone call alone and 12.1% required the assistance of a field worker. An additional 1.7% were obtained only by a field worker, 0.3% were lost-to-follow-up, and only 0.1% retracted consent. The call center captured outcomes with a median of 1 call (IQR 1–2). DQA found 98.0% accuracy; data validation demonstrated 93.7% consistency between the first and second call. In a regression model, significant predictors of inconsistency included cases with adverse outcomes (p<0.001), and different respondents on the first and validation call (p<0.001). Conclusions In areas with widespread mobile cell phone access and coverage, a call center is a viable and efficient approach for measurement of post-discharge childbirth outcomes.
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Affiliation(s)
- Jonathon D. Gass
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Katherine Semrau
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fatima Sana
- Population Services International- India, New Delhi, India
| | - Anup Mankar
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Jennifer Fisher-Bowman
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Brandon J. Neal
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle E. Tuller
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Bharath Kumar
- Population Services International- India, New Delhi, India
| | - Stuart Lipsitz
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Bhala Kodkany
- Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Atul Gawande
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Skogsdal YRE, Karlsson JÅ, Cao Y, Fadl HE, Tydén TA. Contraceptive use and reproductive intentions among women requesting contraceptive counseling. Acta Obstet Gynecol Scand 2018; 97:1349-1357. [PMID: 30007091 PMCID: PMC6175138 DOI: 10.1111/aogs.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
Abstract
Introduction Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish‐speaking women requesting contraceptive counseling. MATERIAL AND METHODS A cross‐sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future. Results In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short‐acting reversible contraception, 22.8% (n = 443) used long‐acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse. Conclusions Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.
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Affiliation(s)
| | - Jan Åke Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Yang Cao
- School of Medical Sciences, Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.,Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Elisabeth Fadl
- Faculty of Medicine and Health, Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Tanja Adele Tydén
- Department of Women's and Children's Health, Academic Hospital, Uppsala, Sweden
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Engstrand S, Kopp Kallner H. Cost of unintended pregnancy in Sweden — a possibility to lower costs by increasing LARC usage. Contraception 2018; 97:445-450. [DOI: 10.1016/j.contraception.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/14/2017] [Accepted: 01/17/2018] [Indexed: 11/15/2022]
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Baird DT, Bajos N, Cleland J, Glasier A, La Vecchia C, Leridon H, Milsom I, Benagiano G, Bhattacharya S, Bhattacharya S, Crosignani PG, Evers JLH, Negri E, Volpe A. Why after 50 years of effective contraception do we still have unintended pregnancy? A European perspective. Hum Reprod 2018; 33:777-783. [DOI: 10.1093/humrep/dey089] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/26/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - D T Baird
- Centre for Reproductive Biology, University of Edinburgh, UK
| | | | - J Cleland
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Glasier
- Simpson Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - H Leridon
- Directeur de recherche émérite, INED, / French Institute for Demographic Studies, Paris cedex, France
| | - I Milsom
- Department of Obstetrics and Gynaecologist, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - G Benagiano
- London School of Hygiene & Tropical Medicine, London, UK
| | - S Bhattacharya
- Gynaecology, Obstetrics and Urology, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - S Bhattacharya
- Professor of Reproductive Medicine, Head of Division of Applied Health Sciences and Director Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK
| | - P G Crosignani
- IRCCS Ca’ Granda Foundation, Maggiore Policlinico Hospital, Milano, Italy
| | - J L H Evers
- Maastricht University and Academisch ziekenhuis Maastricht, Dept. Obstetrics & Gynaecology, Maastricht, The Netherlands
| | - E Negri
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - A Volpe
- Dipartimento Integrato Materno Infantile, Università di Modena, Modena, Italy
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Hognert H, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Milsom I, Lidegaard Ø, Lindh I. High birth rates despite easy access to contraception and abortion: a cross-sectional study. Acta Obstet Gynecol Scand 2017; 96:1414-1422. [DOI: 10.1111/aogs.13232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Helena Hognert
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Finn E. Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics & Gynecology; Faculty of Health Sciences; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Ingela Lindh
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
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Arousell J, Carlbom A, Johnsdotter S, Larsson EC, Essén B. Unintended Consequences of Gender Equality Promotion in Swedish Multicultural Contraceptive Counseling: A Discourse Analysis. Qual Health Res 2017; 27:1518-1528. [PMID: 28728532 DOI: 10.1177/1049732317697099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers' ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women's possibilities to obtain adequate support. At the end of the article, we suggest how health care providers' reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu.
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Kolak M, Jensen C, Johansson M. Midwives’ experiences of providing contraception counselling to immigrant women. Sexual & Reproductive Healthcare 2017; 12:100-106. [DOI: 10.1016/j.srhc.2017.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
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49
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Nieto-Andrade B, Fidel E, Simmons R, Sievers D, Fedorova A, Bell S, Weidert K, Prata N. Women's Limited Choice and Availability of Modern Contraception at Retail Outlets and Public-Sector Facilities in Luanda, Angola, 2012-2015. Glob Health Sci Pract 2017; 5:75-89. [PMID: 28193721 PMCID: PMC5493452 DOI: 10.9745/ghsp-d-16-00304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022]
Abstract
In Angola, many women want to use family planning but lack access to affordable and preferred methods. This article assesses the link between women's choice and availability of contraceptive methods in Luanda, Angola, drawing on data from 3 surveys: a 2012 survey among women ages 15-49 and 2 retail surveys conducted in 2014 and 2015 among outlets and facilities offering contraceptive methods. Descriptive statistics for women's contraceptive knowledge, use, and preferred methods were stratified by age group. We report the percentage of establishments offering different methods and brands of modern contraception, and the mean price, volume of units sold, and value (Angolan Kwanzas) for each brand. Data from the 2 retail surveys are compared to measure changes in availability over time. Results show that 51% of women reported having an unwanted pregnancy. Less than 40% of women knew about long-acting reversible contraceptives (LARCs). Overall, the method most commonly used was male condoms (32.1%), with a substantial proportion (17.3%) of women not using their preferred contraceptive. Trends in contraceptive use mirror availability: in 2015, condoms were available in 73.6% of outlets/facilities, while LARC methods were available in less than 10%. The availability of different methods also dropped significantly between 2014 and 2015-by up to 15 percentage points-with a subsequent price increase in many brands. To meet women's needs for contraception and make informed choice possible, Angola should reinforce demand creation and contraceptive supply in both the public and private sectors through behavior change programs aimed at both women and providers, improved quality of services, training of health personnel on method options and delivery, and improved supply chain distribution of contraceptives. This will allow women to find the methods and brands that best suit their needs, preferences, and ability to pay.
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Affiliation(s)
| | - Eva Fidel
- Population Services International/Angola, Luanda, Angola
| | - Rebecca Simmons
- Institute for Reproductive Health at Georgetown University, Washington, DC, USA
| | - Dana Sievers
- Population Services International, Washington, DC, USA
| | - Anya Fedorova
- Population Services International/Angola, Luanda, Angola
| | - Suzanne Bell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Weidert
- Bixby Center for Population, Health, and Sustainability, University of California, Berkeley, Berkeley, CA, USA
| | - Ndola Prata
- Bixby Center for Population, Health, and Sustainability, University of California, Berkeley, Berkeley, CA, USA
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50
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Lindh I, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Hognert H, Milsom I, Lidegaard Ø. Contraceptive use in the Nordic countries. Acta Obstet Gynecol Scand 2016; 96:19-28. [DOI: 10.1111/aogs.13055] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Finn E. Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Insitute and Karolinska University Hospital; Stockholm Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Helena Hognert
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology; Faculty of Health Sciences; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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