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Willard-Grace R, Abigail Cabrera F, Bykhovsky C, Douglas K, Hunter LA, Mnyippembe A, Mgunya KH, McCoy SI, Liu JX. "They call me the 'Great Queen'": implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania. Reprod Health 2024; 21:21. [PMID: 38321482 PMCID: PMC10848389 DOI: 10.1186/s12978-024-01744-x] [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: 09/30/2022] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu ("Queen Club") program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania. METHODS Forty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process. RESULTS The Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program's adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW's need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program. CONCLUSIONS The Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program's future adaptation and scale-up. TRIAL REGISTRATION clinicaltrials.gov #NCT04045912.
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Affiliation(s)
- Rachel Willard-Grace
- Center for Excellence in Primary Care, University of California, San Francisco, San Francisco, CA, USA.
| | - F Abigail Cabrera
- Center for Excellence in Primary Care, University of California, San Francisco, San Francisco, CA, USA
| | - Camilla Bykhovsky
- Center for Excellence in Primary Care, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla Douglas
- Center for Excellence in Primary Care, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren A Hunter
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jenny X Liu
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
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Sharma R, Agarwal P, Jain V, Sagili H, Sarkar S, Panda A, Deliwala K, Shah K. Impact of the Covid-19 Pandemic on the Prevalence of MTP Cases and Their Clinicodemographic Profile in India: A Retrospective Multicentric Study. J Obstet Gynaecol India 2023; 73:477-487. [PMID: 38205114 PMCID: PMC10774516 DOI: 10.1007/s13224-023-01838-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/16/2023] [Indexed: 01/12/2024] Open
Abstract
Background During the Covid-19 pandemic, reproductive health of women was disproportionately affected due to difficult access to safe abortion and contraceptive services. This study aims to assess the impact of the Covid-19 pandemic on the prevalence of MTP cases and to find out the clinicodemographic profiles of women undergoing MTP during three Covid-waves in different hospitals-Government and private sectors in India. Methods This retrospective multicentric cohort study was conducted during three Covid-19 pandemic waves. The records were retrieved from the centers' medical record section and the MTP register from the Department of Obstetrics and Gynaecology. Results On an average, 1.1 women/day underwent MTP during covid waves compared to 1.9 women/day during the pre-covid 2019. The first Covid wave's average MTP/day was very low (0.71) compared to the third (2.88) and second wave (1.12), respectively. These differences were statistically significant (p<0.0001). The most common indication for MTP was contraceptive failure 245(50.9%), followed by eugenic/congenital anomalies 88(18.9%). A total of 244 cases (50.6%) reported for MTP ≤ seven weeks and 114(23.6%) presented between 7 and 12 weeks. More than half (54%) of the women underwent surgical methods for abortion as the unavailability of medical abortion (MA) drugs. IUCD and sterilization were severely affected during the first and second Covid waves. Conclusion Safe abortions are essential services for reproductive-age women. With the uncertainty of future Covid-like an emergency, we should strengthen our telemedicine network so that women can reach out early and MMA can be initiated to reduce the number of surgical abortions and unwanted pregnancies.
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Affiliation(s)
- Richa Sharma
- Department of Obstetrics and Gynaecology, UCMC and GTB Hospital, 110095, New Delhi, India
| | - Pratima Agarwal
- JIPMER Hospital, Dhanvantari Nagar, Puducherry, 605006 India
| | - Vaishali Jain
- Department of Obstetrics and Gynaecology, Vivekanand Institute of Medical Science, B-1/45, Sector-J, Opp-RBI Colony, Aliganj, Lucknow, 226024 India
| | - Haritha Sagili
- Department of Obstetrics and Gynaecology, JIPMER, Puducherry, 605006 India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, JIPMER, Dhanvantari Nagar, Puducherry, 605006 India
| | - Anuradha Panda
- Obstetrics and Gynecology Department, Apollo Hospitals, Jubliee Hills, Villa 37, Aditya Empress Park. Shaikpet, Hyderabad, 500008 India
| | - Kruti Deliwala
- Department of Obstetrics and Gynaecology, Narendra Modi Medical College, 14 Alpakunj Society Hiral Darshan Flats, Bhattha Paldi, Maninagar, Ahmedabad, Gujarat 380007 India
| | - Krupa Shah
- Obstetrics and Gynecology, Melaka Manipal Medical College, MAHE, Manipal. 88, Sai Radha Green Valley, Parampali, Udupi, Manipal, Karnataka 576104 India
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health 2023; 23:357. [PMID: 37403093 DOI: 10.1186/s12905-023-02512-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND AIM By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.
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Affiliation(s)
- Fatemeh Rezaei
- MSc in Midwifery, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- PhD in Midwifery, The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Söderbäck K, Holter H, Salim SA, Elden H, Bogren M. Barriers to using postpartum family planning among women in Zanzibar, Tanzania. BMC Womens Health 2023; 23:182. [PMID: 37069560 PMCID: PMC10111817 DOI: 10.1186/s12905-023-02330-2] [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: 09/26/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. METHODS Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. RESULTS Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. CONCLUSIONS The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.
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Affiliation(s)
| | - Herborg Holter
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Helen Elden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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Lai R. "Every Medicine Is Somewhat Poisonous": Understanding the reluctance to use oral contraceptives among unmarried women seeking abortion in China. Contraception 2023; 119:109917. [PMID: 36473512 DOI: 10.1016/j.contraception.2022.11.008] [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: 03/15/2022] [Revised: 08/11/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In this study, I examined the low uptake of oral contraceptives (OCs) in China and the factors affecting the reluctance among unmarried Chinese women seeking abortion to use OCs to prevent unintended pregnancies. STUDY DESIGN I conducted ethnographic and participant observation in multiple medical facilities and interviewed 62 women who were seeking or had had an abortion between 2013 and 2017 in a coastal city in east China. I analyzed data regarding the women's perceptions and experiences of using OCs through a thematic analysis approach. RESULTS The women reported fear of side effects, including infertility, weight gain, and mental health issues and their view on traditional Chinese medicine further validated their skepticism toward Western medicine. Discouragement from male partners and a lack of sexual and reproductive education also caused their hesitancy and misunderstandings of OCs. CONCLUSIONS This study contributes to a more nuanced understanding of the barriers to OC use in China. It resonates with existing studies that associate the reluctance to use OCs with the fear of side effects and highlights the influence of sociocultural specificities and couple interactions in shaping contraceptive use. IMPLICATIONS Tackling premarital abortions is one of the priorities of the Chinese government in the face of the population crisis. Service providers and educators should understand unmarried women's reluctance to use OCs and provide comprehensive sexuality education and postabortion counseling services to women and men to dispel culturally specific misconceptions.
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Affiliation(s)
- Ruby Lai
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong.
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Bolarinwa OA, Babalola TO, Adebayo OA, Ajayi KV. Health insurance coverage and modern contraceptive use among sexually active women in Nigeria: Further analysis of 2018 Nigeria Demographic Health Survey. Contracept Reprod Med 2022; 7:22. [PMID: 36316721 PMCID: PMC9624092 DOI: 10.1186/s40834-022-00187-8] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background Studies have shown that affordable health insurance can influence healthcare visits and increase the choice of medication uptake in sub-Saharan Africa. However, there is a need to document the influence of health insurance coverage and modern contraceptive use in order to encourage its uptake. Thus, this study examined the influence of health insurance coverage on modern contraceptive use among sexually active women in Nigeria. Methods The secondary dataset utilised in this study were derived from the 2018 Nigeria Demographic and Health Survey (NDHS). Data analyses were restricted to 24,280 women of reproductive age 15–49 years who were sexually active in the survey dataset. Weighted bivariate and multivariable logistic regression models were used to examine the influence of health insurance coverage on modern contraceptive use while controlling for possible confounders. A Significant level of alpha was determined at p < 0.05 using STATA 16.0. Results The prevalence of health insurance coverage and modern contraceptive use among sexually active women in Nigeria were 25.47% and 13.82%, respectively. About 1 out of every 4 sexually active women covered by health insurance were using a modern contraceptive, while 86.50% of the women not covered by health insurance were not using any modern contraceptive method. After adjusting for socio-demographic characteristics, the odds of using any modern contraceptive were significantly higher for sexually active women who were covered by any health insurance [aOR = 1.28; 95% (CI = 1.01–1.62)] compared to sexually active women not covered by health insurance in Nigeria. Conclusion The study demonstrated that health insurance coverage is a significant driver of health service utilization, including modern contraceptive use. Health insurance benefits are recommended to be expanded to cover a broader spectrum of family planning services in Nigeria. More research is required to understand the influence of different health insurance schemes and the use of modern family planning methods in Nigeria.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK ,grid.16463.360000 0001 0723 4123Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Taiwo Oladapo Babalola
- Institute of Governance, Humanities, and Social Sciences [PAUGHSS], PAN African University, Yaoundé, Cameroon
| | | | - Kobi V. Ajayi
- Education, Direction, Empowerment, & Nurturing (EDEN) Foundation, Abuja, Nigeria ,grid.264756.40000 0004 4687 2082Department of Health Behavior, School of Public Health, Texas A&M University, 77843 College Station, TX USA
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da Cunha Pereira P, Monteiro I, Bahamondes L. Natural contraception apps knowledge among Brazilian women and Obstetrics and Gynaecology residents. EUR J CONTRACEP REPR 2022; 27:289-293. [PMID: 35583156 DOI: 10.1080/13625187.2022.2075844] [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
BACKGROUND Our objectives were to determine the knowledge and interest in apps for natural contraception among women and Obstetrics and Gynaecology (OBGYN) residents. STUDY DESIGN An online survey was sent to Brazilian women to gather sociodemographic data, knowledge and interest towards fertility-awareness contraceptive methods and smartphone apps for this purpose. Also, we sent an online survey to OBGYN residents to evaluate the reproductive physiology knowledge of natural contraception and interest in improving it and knowledge and smartphone apps for this purpose. RESULTS A total of 730 women answered the survey, and 638 were included in the study and 94 OBGYN residents answered the survey. Among the respondent women 386 (60.5%) were interested in more information about natural contraception, 226 (35.5%) showed interest in use natural contraception, 85 (13.3%) indicated that they were users of natural contraception, 15 (16.8%) of this group currently uses an app for this purpose and 485 (76%) considers a practical option to have an app for natural contraception. Regarding the respondent residents all answers were included in the study; 62 (65.9%) knew the right definition of 'Natural Contraception', 52 (55.3%) showed interest in information about this topic and 78 (82.9%) considers a practical option to have an app for natural contraception. CONCLUSIONS Less than 15% of the respondent women use natural contraception although about 60% expressed some interest in learning more, and that among OBGYN residents, half showed interest.
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Affiliation(s)
- Paula da Cunha Pereira
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Ilza Monteiro
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
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Harris ML, Egan N, Forder PM, Bateson D, Sverdlov AL, Murphy VE, Loxton D. Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study. Reprod Health 2022; 19:111. [PMID: 35525995 PMCID: PMC9078003 DOI: 10.1186/s12978-022-01413-x] [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: 10/25/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don't use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women and investigated the influence of chronic disease on contraceptive use over time. METHODS Using data from 15,244 young women from the Australian Longitudinal Study on Women's Health (born 1989-1995), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease. RESULTS Contraceptive use for women with cardiac and autoinflammatory diseases differed to women without chronic disease over the observation period. Compared to women without chronic disease using the pill, women with cardiac disease had double the odds of using 'other' contraception and condoms (OR = 2.20, 95% CI 1.34, 3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR = 1.39, 95% CI 1.03, 1.89). Compared to women without chronic disease who used the pill, women with autoinflammatory disease had increased odds of using LARC and condoms (OR = 1.58, 95% CI 1.04, 2.41), using 'other' contraception and condoms (OR = 1.69, 95% CI 1.11, 2.57), and using the combined oral contraceptive pill and condoms (OR = 1.38, 95% CI 1.09, 1.75). No differences in contraceptive patterns over the observation period were found for women with asthma or diabetes when compared to women without chronic disease. CONCLUSION The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women's contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.
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Affiliation(s)
- Melissa L Harris
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Nicholas Egan
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Peta M Forder
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Deborah Bateson
- Family Planning NSW, Ashfield, NSW, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aaron L Sverdlov
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Cardiovascular Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vanessa E Murphy
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
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Ngacha JK, Ayah R. Assessing the cost-effectiveness of contraceptive methods from a health provider perspective: case study of Kiambu County Hospital, Kenya. Reprod Health 2022; 19:11. [PMID: 35039047 PMCID: PMC8762951 DOI: 10.1186/s12978-021-01308-3] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kenya's contraceptive prevalence rate at 53% is low, with wide disparity among the 47 counties that make up the country (2-76%). Significant financial investment is required to maintain this level of contraceptive use and increase it to levels seen in more developed countries. This is in the context of a growing population, declining donor funding, limited fiscal space and competing health challenges. Studies have shown that long-term contraceptive methods are more cost-effective than short-term methods. However, it is unclear if this applies in Sub-Saharan Africa; with limited financial resources, lower social economic status among users, and publicly managed commodity supply chains, in vertical programs largely dependent on donor funding. This study assessed the cost-effectiveness of contraceptive methods used in Kenya. METHODS A cross-sectional study was undertaken in a county referral hospital in mid-2018. Purposive sampling of 5 family planning clinic providers and systematic sampling of 15 service delivery sessions per method was done. Questionnaire aided interviews were done to determine inputs required to provide services and direct observation to measure time taken to provide each method. Cost per method was determined using activity based costing, effectiveness via couple year protection conversion factors, and cost-effectiveness was expressed as cost per couple year protection. RESULTS The intra-uterine copper device was most cost-effective at 4.87 US dollars per couple year protection followed by the 2-Rod Implant at 6.36, the 1-Rod Implant at 9.50, DMPA at 23.68, while the combined oral contraceptive pills were least cost-effective at 38.60 US dollars per couple year protection. Long-term methods attracted a higher initial cost of service delivery when compared to short-term methods. CONCLUSION Long-term contraceptive methods are more cost-effective. As such, investing in long-term contraceptives would save costs despite higher initial cost of service delivery. It is recommended, therefore, that Sub-Saharan Africa countries allocate more domestic financial resources towards availability of contraceptive services, preferably with multi-year planning and budget commitment. The resources should be invested in a wide range of interventions shown to increase uptake of long-term methods, including reduction of cost barriers for the younger population, thereby increasing contraceptive prevalence rates.
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Affiliation(s)
- James Kiragu Ngacha
- Department of Public & Global Health, University of Nairobi, Nairobi, Kenya.
| | - Richard Ayah
- Department of Public & Global Health, University of Nairobi, Nairobi, Kenya
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Abstract
PURPOSE The aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. METHODS Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse-including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception-by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. RESULTS Girls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference -2.6%, 95% CI -.26%, -4.9%; adjusted prevalence ratio .97, 95% CI .95-1.00, p = .03). CONCLUSIONS We observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.
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Affiliation(s)
- Angela Senders
- Oregon Health & Science University, Institute on Development and Disability, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon
| | - Willi Horner-Johnson
- Oregon Health & Science University, Institute on Development and Disability, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon.
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Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact of Coronavirus Disease 2019 (COVID-19) On Contraception Use in 2020 and up until the end of April 2021 in France. Contraception 2021; 108:50-55. [PMID: 34971603 PMCID: PMC8714238 DOI: 10.1016/j.contraception.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
Objectives To assess the impact of the COVID-19 pandemic on the use of reimbursed contraceptives in France after 15 months of the pandemic, according to age-group and updating previous data only pertaining to the first lockdown (2 months). Study design We conducted a national register-based study by extracting all reimbursements of oral contraceptives (OC), emergency contraception (EC), intrauterine devices (IUD), and implants from the French National Health Insurance database (SNDS), which includes and covers 99.5% of the French population, in 2018, 2019, 2020 and from January 1, 2021 to April30, 2021. We calculated the expected use of contraceptives in 2020 and 2021 in the absence of the pandemic, based on 2018 and 2019 usage and taking annual trends into account. We assessed the difference between observed and expected dispensing rates by contraceptive type and by age-group (≤18 years old, 18< age ≤25, 25< age ≤35, >35). Results Dispensing of all contraceptives decreased compared to expect dispensing numbers: −2.0% for OC, −5.3% for EC, −9.5% for LNG-IUS, −8.6% for C-IUD, and −16.4% for implant. This decrease in the dispensing of contraceptives was observed in all age-groups, but mainly concerned women under the age of 18 years (−22% for OC, −10% for EC, −37.2% for LNG-IUS, −36.4% for C-IUD, −26.4% for implant) and those aged 18 to 25 (−5.1% for OC, −11.9% for EC, −18.1% for LNG-IUS, −15.9% for C-IUD, −17.6% for implants). Conclusions Our study showed that the dispensing of contraceptives in France was markedly impacted by the COVID-19 pandemic. Prescriptions for long-acting contraceptive use and women under the age of 25 years were the most substantially impacted. Ensuring access to contraceptive methods during health emergencies must be a public health policy priority. Implications The COVID-19 pandemic strongly impacted the dispensing of contraceptives in France with varying degrees of decreased dispensing according to the type of contraceptive, the age-group and the level of pandemic-related restrictions. The impact of these restrictions on unintended pregnancy at the population level remains undetermined.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France.
| | - Jérôme Drouin
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare, Diseases of Genital Development, AP.HP University of Paris Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - François Cuenot
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France
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Lee M. The barriers to using modern contraceptive methods among rural young married women in Moshi Rural District, the Kilimanjaro region, Tanzania. Afr J Reprod Health 2021; 25:99-107. [PMID: 37585797 DOI: 10.29063/ajrh2021/v25i4.11] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The relationship between the rate of modern contraception and unintended pregnancy is complicated in Tanzania. Although the contraception rate has been slightly increased; the unintended pregnancy rate has remained at 22~24% since 1999. In addition, married women in rural areas use less modern contraceptive methods than those in urban areas. Young women are at a higher risk of mistimed and unintended pregnancy compared to older females. Various barriers to using contraceptive methods have been reported, including fear of side effects, lack of knowledge, misconception, accessibility of the methods, and limited health workers' skills. This study was aimed to invest the barriers to using modern contraceptive methods among rural young married. A qualitative study was carried out in Moshi rural district in northeast Tanzania between June 2019 and July 2019. 22 in-depth interviews (9 key informants and 13 young married women aged 19-34) were conducted. Thematic analysis was used and data transcripts were coded. As a result, all participants were familiar with modern contraceptive methods and experienced at least one of them. Fear of side effects and prefer inappropriate birth control methods especially superstitious methods were major barriers to use. Also, rumours and misleading concerns have arisen from peers and village members. Condoms were not used among them, and males and the elderly still perceived family planning negatively. Additionally, although long-term modern contraceptive methods have been increased and preferred, IUCD is inaccessible due to the lack of skilled workers and facilities. In conclusion, community-based reproductive education is required to increase awareness of safe and reliable modern contraceptive methods. And frequent outreach services of the field are essential to provide more contraception's benefits to the village members so that barriers to using contraception and unwanted pregnancy could be reduced in rural Tanzania. In order to do that, more interventions, such as NGOs and strengthened government systems of reproductive health, should be enhanced.
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Affiliation(s)
- Mina Lee
- Independent Health Consultant, Seoul, Republic of Korea and Project officer, National Tuberculosis Association
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Linet T, Lévy-Bachelot L, Farge G, Crespi S, Yang JZ, Robert J, Fabron C. Real-world cost-effectiveness of etonogestrel implants compared to long-term and short term reversible contraceptive methods in France. EUR J CONTRACEP REPR 2021; 26:303-311. [PMID: 33960248 DOI: 10.1080/13625187.2021.1900562] [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: 10/21/2022]
Abstract
BACKGROUND To estimate the cost-effectiveness (CE) of etonogestrel implants compared to other long-term and short-term reversible contraceptive methods available in France. RESEARCH DESIGN AND METHODS A 6-year Markov model compared effectiveness between the implant and six other contraceptive methods in sexually active, not-pregnancy-seeking French females of reproductive age. Contraception efficacy, switch rates and outcomes were based on French current medical practice. Incremental CE ratios (ICERs) were calculated as incremental cost per unintended pregnancy (UP) avoided. Efficiency frontier was plotted to identify cost-effective methods. Uncertainty was explored through sensitivity analyses. RESULTS The implant was on the efficiency frontier along with combined oral contraceptive pill (COC) and copper IUD. Implant avoids between 0.75% and 3.53% additional UP per person-year compared to copper IUD and second generation COC, respectively, with an ICER of €2,221 per UP avoided compared to copper IUD. For the 240,000 French women currently using the implant, up to 8,475 UPs and up to 1,992 abortions may be prevented annually. CONCLUSION With more unintended pregnancies avoided and comparable costs to copper IUD, the implant is a cost-effective option among long-term and short-term reversible contraceptive methods.
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Affiliation(s)
- Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Challans, France
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Abstract
Background The use of contraception in Lao PDR remains inadequate. In 2017, unmet contraception needs among married women aged 15–49 were 14.3% in Lao PDR overall and 18.6% in the province of Savannakhet. Although the government has a goal to reduce gender inequalities, they still persist in many areas. Objective The aim of this research was to understand the extent to which couples’ dynamics and gender attitudes affect contraception use in Savannakhet, Lao PDR. Methods To conduct this research, mixed methods were used. Quantitative methods took the form of a survey filled out by 200 married couples in the province of Savannakhet. Afterwards, focus group discussions were carried out to give meaning to the quantitative data and to obtain a deeper understanding of gender roles and contraceptive use. Results Findings showed that most couples rely on female-dependent contraceptives and that while women hold most of the family planning responsibility, men’s opinions have more weight on the final decision. Additionally, women’s financial autonomy and spousal communication regarding birth control were associated with contraceptive use within the couple. However, this communication usually began after the birth of the third child. Lastly, the hypothesis that egalitarian gender attitudes were associated with contraceptive use could not be confirmed. Conclusion This study clearly demonstrates that contraception use is influenced by couples’ dynamics, more specifically spousal communication, in Lao PDR. The findings have highlighted the need to involve men in all stages of family planning, and to foster both spousal communication and financial autonomy for women. If the findings are implemented, this may foster shared decision making within couples.
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Affiliation(s)
| | | | - Dirk Essink
- Athena Institute, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
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Suárez-López L, de la Vara-Salazar E, Estrada F, Campero L. Lot quality assurance sampling: Information provided to female users of contraceptive methods regarding side effects. Eval Program Plann 2020; 83:101861. [PMID: 32858375 DOI: 10.1016/j.evalprogplan.2020.101861] [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: 03/22/2019] [Revised: 10/25/2019] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Women need to receive accurate information on the proper use of contraceptive methods (CM). The objective of our analysis was to evaluate the quality of CM counseling in health institutions of the public sector using the Lot Quality Assurance Sampling (LQAS) technique. We specifically analyzed whether health-service providers informed CM users of all the side effects they might experience, as specified under the Mexican health-care regulations. Our results demonstrated that, among the four CM analyzed -the intrauterine device, hormonal injection, condom and subdermal implant- only the users of the subdermal implant received complete information on side effects. Our findings thus indicate that the quality of family planning services in the institutions analyzed is deficient. We recommend that service providers be regularly trained in order to improve their performance and that LQAS methodology be adopted as an effective means of regularly monitoring the quality of health services in Mexico.
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Affiliation(s)
- Leticia Suárez-López
- Reproductive Health Division, Center for Population Research, National Institute of Public Health. Mexico, Av. Universidad 655, Col. Santa María Ahuacatitlán, CP 62100, Cuernavaca, Morelos, Mexico
| | - Elvia de la Vara-Salazar
- Reproductive Health Division, Center for Population Research, National Institute of Public Health. Mexico, Av. Universidad 655, Col. Santa María Ahuacatitlán, CP 62100, Cuernavaca, Morelos, Mexico.
| | - Fátima Estrada
- CONACYT - Instituto Nacional de Salud Pública, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI, Tlalpan, C.P. 14080, Ciudad de México, Mexico
| | - Lourdes Campero
- Reproductive Health Division, Center for Population Research, National Institute of Public Health. Mexico, Av. Universidad 655, Col. Santa María Ahuacatitlán, CP 62100, Cuernavaca, Morelos, Mexico
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Cipriani S, Todisco T, Scavello I, Di Stasi V, Maseroli E, Vignozzi L. Obesity and hormonal contraception: an overview and a clinician's practical guide. Eat Weight Disord 2020; 25:1129-40. [PMID: 31515745 DOI: 10.1007/s40519-019-00774-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The growing prevalence of obesity among the fertile female population poses a considerable problem to contraceptive providers. Obese women, who are more at risk for venous thromboembolism and cardiovascular events due to their condition, might be at an even higher risk of developing thromboembolic events when on medical contraception. Combined hormonal contraceptives might be less effective in obese women and may lead to unacceptable metabolic side effects for this population. In addition, the lack of safety data for weight loss drugs and the higher risk for complications during and after pregnancy require a close surveillance of the fertility status of obese patients. OBJECTIVE The aim of this narrative review is to summarize the available medical contraceptive options and to give the readers a practical guidance for a wise contraceptive choice with regards to obesity. METHODS A general literature review of peer-reviewed publications on the topic "obesity and contraception" was performed using the PubMed database. RESULTS Nowadays, there are many useful tools that help clinicians in choosing among the wide range of therapeutic possibilities, such as the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use. Furthermore, the great diversity of hormonal contraceptive formulations (combined hormonal formulations; progestin-only methods) and active substances (different estrogens and progestins) allow physicians to tailor therapies to patients' clinical peculiarities. CONCLUSION Long-acting reversible contraceptives [progestin-only implants, levonorgestrel-intra-uterine devices (IUDs) and copper IUDs] and progestin-only methods in general are excellent options for many categories of patients, including obese ones. LEVEL OF EVIDENCE V, narrative review.
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Huynh ST, Yokomichi H, Akiyama Y, Kojima R, Horiuchi S, Ooka T, Shinohara R, Yamagata Z. Prevalence of and factors associated with unplanned pregnancy among women in Koshu, Japan: cross-sectional evidence from Project Koshu, 2011-2016. BMC Pregnancy Childbirth 2020; 20:397. [PMID: 32646511 PMCID: PMC7346350 DOI: 10.1186/s12884-020-03088-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unplanned pregnancy is a public health issue with adverse consequences for maternal and neonatal health. In Japan, the prevalence of unplanned pregnancy was 46.2% in 2002. However, few studies have investigated this topic, and there is little recent data from Japan. We described and examined the prevalence and determinants of unplanned pregnancy among rural women in Japan from 2011 to 2016. Methods We used cross-sectional data from a community-based cohort study (Project Koshu). Data were collected from 2011 to 2016 via a self-report questionnaire included in the Maternal and Child Health Handbook of Japan. Pregnancy intention was measured as a binary variable (planned or unplanned). Univariate and multivariate logistic regression analyses were performed to examine factors associated with unplanned pregnancy, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). We conducted sensitivity analyses with different definitions of pregnancy intention to assess the robustness of the results. The significance level was set at 5%. Results Of the 932 participants (mean ± standard deviation age at baseline: 31.3 ± 5.2 years), 382 (41%) pregnancies were reported as unplanned. The multivariate analyses showed that maternal age (+ 1 year: OR = 0.94, 95% CI: 0.92–0.97, p < 0.001), ‘other’ family structure (OR = 2.76, 95% CI: 1.12–6.76, p = 0.03), three or more pregnancies (OR = 2.26, 95% CI: 1.66–3.08, p < 0.001), current smoking (OR = 2.60, 95% CI: 1.26–5.35, p = 0.01), balanced diet (OR = 0.62, 95% CI: 0.47–0.83, p < 0.001) and current depression (OR = 1.63, 95% CI: 1.24–2.16, p < 0.001) were strongly associated with unplanned pregnancy. These associations were consistent across definitions of pregnancy intention, supporting the robustness of our results. Conclusions The prevalence of unplanned pregnancy in the study population was high (41%). Risk factors for unplanned pregnancy were age, number of pregnancies, smoking, having a balanced diet and current depression. These results suggest greater efforts are needed to enhance sex education for young people, improve access to family planning services and provide comprehensive health care for high-risk women to help reduce unplanned pregnancies.
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Affiliation(s)
- Son Trung Huynh
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Hiroshi Yokomichi
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Sayaka Horiuchi
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.,Centre for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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Desalegn M, Belachew A, Gizaw M, Kejela G, Gudeta R. Utilization of long-acting and permanent contraceptive methods and associated factors among married women in Adama town, Central Ethiopia: community based cross-sectional study. Contracept Reprod Med 2019; 4:22. [PMID: 31867118 PMCID: PMC6900854 DOI: 10.1186/s40834-019-0101-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/15/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022] Open
Abstract
Background Long-acting and permanent contraceptive methods have clear advantages over short-acting methods of contraception that benefit both clients and health systems. Despite this importance, studies show that the proportion of women currently using long acting and permanent contraceptive methods are significantly lower than the proportion using short-acting methods. Objective The main aim of the study was to assess the level of utilization of long acting and permanent contraceptive methods and associated factors among married women in Adama town. Methodology Community Based Cross-Sectional Study was conducted in four kebeles of Adama town from April 15–30, 2015. Multistage sampling technique was used to select the study participants. The collected data was cleaned and entered using Epi info 3.5.3 and analyzed using statistical package for social science version 20.0. Factors associated with utilization of long acting and permanent contraceptive methods were identified using logistic regression model. Result In this study, the magnitude of long acting and permanent contraceptive methods was 20.9%. Implant, Intra-Uterine devices (IUDs) and tubal ligation accounted for 16.1, 4.6, and 0.2% respectively. Current use of long acting and permanent contraceptive methods was higher among women who had high knowledge (AOR = 5.26, 95% CI = 1.90–14.69), positive attitude (AOR = 3.25, 95% CI = 1.60–6.58) and women who had 3–4 children (AOR [95%CI] =2.3[1.14–4.63]) compared to those who had no child. Conclusion Current use of long acting and permanent contraceptive methods in Adama town was low. Level of knowledge, attitude about the methods, and number of children were factors affecting utilization of long acting and permanent contraceptive methods. Targeted Information Education Communication Intervention should be intensified to improve the utilization of these methods.
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Affiliation(s)
- Markos Desalegn
- 1Department of Public health, College of medicine and health sciences, Jigjiga University, Jigjiga, Somali region Ethiopia
| | - Ayele Belachew
- 2School of public health, college of health sciences, Addis Ababa University, Addis Abeba, Ethiopia
| | - Muluken Gizaw
- 2School of public health, college of health sciences, Addis Ababa University, Addis Abeba, Ethiopia
| | - Gemechu Kejela
- 3Department of public health, Institute of health sciences, Wollega University, Oromia region, Nekemte, Ethiopia
| | - Robsan Gudeta
- 3Department of public health, Institute of health sciences, Wollega University, Oromia region, Nekemte, Ethiopia
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Yimer AS, Modiba LM. Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey. BMC Womens Health 2019; 19:151. [PMID: 31783844 PMCID: PMC6884853 DOI: 10.1186/s12905-019-0850-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
Background Evidences from various parts of the world reveal that women with disabilities are facing widespread barriers in accessing public services. Service providers and program managers do not grasp the relevance of their work and interventions in addressing the sexual and reproductive health needs of women with disabilities. The present study therefore aimed to assess family planning knowledge and practice among women with sensory disabilities. Methods A mixed method approach using quantitative and qualitative methods was employed to collect the data. The study included 326 blind and deaf women using respondent driven sampling technique and 29 purposely selected key informants. We carried out the study from August 2016–April 2017. The quantitative data were analyzed using SPSS and the qualitative analysis was done using Open code software version 4.02 and triangulated with the quantitative findings. Results The findings showed that nearly two third of the respondents of were sexually active. The majority (97.2%) of study respondents had heard about FP methods, however the level of comprehensive knowledge on modern contraceptive methods was 32.5%. The prevalence of unwanted pregnancy was 67.0% and abortion was 44%. Almost half of sexually active respondents ever used modern contraceptive methods, yet the contraceptive prevalence at the time of survey was 31.1%. Implants were the most commonly used (51%) contraceptive method among current users. Conclusions The use of modern contraceptive methods among women with sensory disabilities was low. Thus, the government and concerned organizations need to address the attitudinal, social, and physical barriers women with sensory disabilities are facing while seeking, accessing to and using family planning services.
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Affiliation(s)
- Awol Seid Yimer
- Ethiopian Public Health Association, P.O.Box: 7117, Addis Ababa, Ethiopia.
| | - Lebitsi Maud Modiba
- Department of Health Studies, University of South Africa, TvW Building 7-160, Pretoria, P.O.Box: 329, South Africa
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Kim S, Choi YS, Kim JS, Kim S, Cho S. Experiences of localization and removal of non-palpable subdermal contraceptive implants with ultrasound. Obstet Gynecol Sci 2019; 62:166-72. [PMID: 31139592 DOI: 10.5468/ogs.2019.62.3.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/28/2018] [Accepted: 10/21/2018] [Indexed: 11/08/2022] Open
Abstract
Objective The aim of this study was to present experiences in localization and removal of non-palpable subdermal contraceptive implants with ultrasonography. Methods Medical records from January 1, 2016, to April 30, 2018, were retrospectively reviewed for 21 patients who were referred to a single institution and had an impalpable implant despite following the removal instruction. In all the cases, more than one attempt was made to remove the implant before referral. The rod was detected using radiography and ultrasonography. In all the cases, localization of the single implant was achieved with ultrasonography. The distal depth of the rod was measured, and skin marking was made following the echogenicity. The implants were subsequently removed under anesthesia. Results In 18 cases, the rods were localized using ultrasonography and successfully removed under local anesthesia. In the other three cases, removal with local anesthesia failed. Although the rod was detected successful with ultrasonography, the implants were removed under general anesthesia in the operating room. The depth from skin to rod, measured with ultrasonography, was >12.0 mm in all the cases and located deep in the muscular layer in the failure cases. The depth of the implants positively correlated with the time spent for removal (r=0.525; P=0.015). Conclusion High frequency ultrasonography is a highly accurate tool for localization and measurement of the skin-to-rod depth. It is also useful for removing non-palpable implants. If the depth of the implant is >12.0 mm, removal of the implant in the operating room under general anesthesia is recommended.
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Dynes MM, Bernstein E, Morof D, Kelly L, Ruiz A, Mongo W, Chaote P, Bujari RN, Serbanescu F. Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April-July 2016. Reprod Health 2018; 15:152. [PMID: 30208913 PMCID: PMC6134585 DOI: 10.1186/s12978-018-0593-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/15/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies. METHODS Cross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April-July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05). RESULTS Clients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40-49 vs 15-19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information. Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts. CONCLUSIONS Strategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality.
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Affiliation(s)
- M M Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
| | - E Bernstein
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - D Morof
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - L Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - A Ruiz
- Centers for Disease Control and Prevention, Division of Reproductive Health (CDCF Contractor), Atlanta, USA
| | - W Mongo
- EngenderHealth, Washington, DC, USA
| | - P Chaote
- Regional Medical Officer, Kigoma, Kigoma Region, Tanzania
| | - R N Bujari
- AMCA Inter Consult, Dar es Salaam, Tanzania
| | - F Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
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Mrwebi KP, Goon DT, Owolabi EO, Adeniyi OV, Seekoe E, Ajayi AI. Reasons for Discontinuation of Implanon among Users in Buffalo City Metropolitan Municipality, South Africa: A Cross-Sectional Study. Afr J Reprod Health 2018; 22:113-119. [PMID: 29777648 DOI: 10.29063/ajrh2018/v22i1.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Early discontinuation of implanon, a long-acting, reversible contraceptive among reproductive age women in South Africa is a serious public health concern. The aim of this study was to examine the reasons for discontinuation of implanon among its previous users. This descriptive cross-sectional study involved 188 consecutively selected participants in two large family planning clinics in Buffalo Metropolitan Municipality, East London, South Africa. Descriptive statistics was conducted using SPSS version 22.0. The mean duration of use was 11.2±7.1 months. Side effects such as heavy bleeding, severe headache and painful arm were the main reasons for discontinuation of implanon (71.3%). Some participants discontinued implanon because they were receiving other medical treatments: 24 participants on the anti-retroviral drugs, one on antipsychotic and antituberculosis drugs, respectively, necessitating removal. Few participants reported wrong positioning (3.2%) and desire for more pregnancies (4.3%) as reasons for discontinuation. The side effects of implanon were the reason for early discontinuation of implanon among women who still needed contraception. Pre-insertion counselling should empower women towards making informed decision on discontinuation and transition to other options.
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Affiliation(s)
- Khungelwa Patricia Mrwebi
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Daniel Ter Goon
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Eyitayo Omolara Owolabi
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Eunice Seekoe
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
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Brito MB, Alves FSS, Souza MQ, Requião SR. Low Level of Knowledge of Contraceptive Methods among Pregnant Teens in Brazil. J Pediatr Adolesc Gynecol 2018; 31:281-284. [PMID: 29294379 DOI: 10.1016/j.jpag.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/25/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To describe knowledge and use of contraceptive methods among pregnant teens in Brazil. DESIGN A cross-sectional survey. SETTING A tertiary care center in Bahia, Brazil. PARTICIPANTS Pregnant teens 10-19 years old. INTERVENTIONS Participants were asked about contraceptive knowledge and previous contraceptive use. MAIN OUTCOME MEASURES Contraceptive knowledge, previous contraceptive use, and contraceptive intentions for after pregnancy. Other survey topics included demographic characteristics, school attendance, and sexual history. RESULTS A total of 90 participants wereincluded in the study, with an average age of 15.4 ± 1.7 years, and a mean age at first sexual intercourse of 13.8 ± 1.2 years. Most participants were unmarried (58/90), of mixed race (57/90), had a household income below minimum wage (59/83), lived with their parents (54/90), and unemployment (81/90). More than 80% were not using contraception or were using it irregularly whenthey became pregnant. Most participants reported knowledge of condoms (82/90), of the combined oral contraceptive pill (75/90) and of injectable contraceptives (68/90). However, less than half reported knowledge oflong-acting reversible contraceptive methods. In terms of contraceptive intentions after pregnancy, the most commonly cited methods were the contraceptive injection (36/90), the intrauterine device (17/90) and the combined pill (9/90). CONCLUSION In this study we found a low level of knowledge of contraceptive methods, and especially of long-acting reversible contraceptive methods, among pregnant teens in Northeast Brazil. Low socioeconomic status and high rates of unplanned pregnancy might be reasons for insufficient sexual and reproductive health counseling in this population.
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Affiliation(s)
- Milena Bastos Brito
- Department of Gynaecologic and Obstetrics, Bahiana School of Medicine and Public Health, Salvador, Brazil.
| | | | - Marlene Quadro Souza
- Department of Gynaecologic and Obstetrics, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Samara Rezende Requião
- Department of Gynaecologic and Obstetrics, Bahiana School of Medicine and Public Health, Salvador, Brazil
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Ajayi AI, Adeniyi OV, Akpan W. Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states. BMC Public Health 2018; 18:604. [PMID: 29739372 PMCID: PMC5941455 DOI: 10.1186/s12889-018-5522-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/27/2018] [Indexed: 11/27/2022] Open
Abstract
Background Contraceptive use has numerous health benefits such as preventing unplanned pregnancies, ensuring optimum spacing between births, reducing maternal and child mortality, and improving the lives of women and children in general. This study examines the level of contraceptive use, its determinants, reasons for non-use of contraception among women in the reproductive age group (18–49 years) in two southwestern Nigerian states. Methods The study adopted an interviewer-administered questionnaire to collect data from 809 participants selected using a 3-stage cluster random sampling technique. We also conducted 46 in-depth interviews. In order to investigate the association between the socio-demographic variables and use of contraceptive methods, we estimated the binary logistic regression models. Results The findings indicated that knowledge of any methods of contraception was almost universal among the participants. The rates of ever use and current use of contraception was 80 and 66.6%, respectively. However, only 43.9% of the participants had ever used any modern contraceptive methods, considered to be more reliable. The fear of side effects of modern contraceptive methods drove women to rely on less effective traditional methods (withdrawal and rhythm methods). Some women employed crude and unproven contraceptive methods to prevent pregnancies. Conclusion Our findings show that the rate of contraceptive use was high in the study setting. However, many women chose less effective traditional contraceptive methods over more effective modern contraceptive methods due to fear of side effects of the latter. Patient education on the various options of modern contraceptives, their side effects and management would be crucial towards expanding the family planning services in the study setting.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200, Eastern Cape, South Africa.
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Cecilia Makiwane Hospital, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200, Eastern Cape, South Africa
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Machiyama K, Huda FA, Ahmmed F, Odwe G, Obare F, Mumah JN, Wamukoya M, Casterline JB, Cleland J. Women's attitudes and beliefs towards specific contraceptive methods in Bangladesh and Kenya. Reprod Health 2018; 15:75. [PMID: 29739429 PMCID: PMC5941610 DOI: 10.1186/s12978-018-0514-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Missing from the huge literature on women's attitudes and beliefs concerning specific contraceptive methods is any detailed quantitative documentation for all major methods in low- and middle-income countries. The objectives are to provide such a documentation for women living in Matlab (rural Bangladesh), Nairobi slums and Homa Bay (rural Kenya) and to compare the opinions and beliefs of current, past and never users towards the three most commonly used methods (oral contraceptives, injectables and implants). METHODS In each site, 2424 to 2812 married women aged 15-39 years were interviewed on reproduction, fertility preferences, contraceptive knowledge and use, attitudes and beliefs towards family planning in general and specific methods. We analysed the data from round one of the prospective cohort study. RESULTS While current users typically expressed satisfaction and held more positive beliefs about their method than past or never users, nevertheless appreciable minorities of current users thought the method might pose serious damage to health, might impair fertility and was unsafe for prolonged use without taking a break. Larger proportions, typically between 25% and 50%, associated their method with unpleasant side effects. Past users of pills and injectables outnumbered current users and their beliefs were similar to those of never users. In all three sites, about half of past injectable users reported satisfaction with the method and the satisfaction of past implant users was lower. CONCLUSIONS High levels of contraceptive use can clearly co-exist with widespread misgivings about methods, even those that are widely used. Serious concerns about damage to health, long term fertility impairment, and dangers of prolonged use without taking a break were particularly common in the Kenyan sites and these beliefs may explain the high levels of discontinuation observed in Kenya and elsewhere in Africa. This documentation of beliefs provides useful guidance for counselling and informational campaigns. The generally negative views of past users imply that programmes may need not only to improve individual counselling but also strengthen community information campaign to change the overall climate of opinion which may have been influenced by dissatisfaction among past users.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | | | | | | | - Joyce N Mumah
- African Population and Health Research Center, Nairobi, Kenya
| | | | - John B Casterline
- Institute for Population Research, Ohio State University, Columbus, USA
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Bornstein M, Carter M, Zapata L, Gavin L, Moskosky S. Access to long-acting reversible contraception among US publicly funded health centers. Contraception 2018; 97:405-410. [PMID: 29253581 PMCID: PMC6750753 DOI: 10.1016/j.contraception.2017.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 07/12/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Access to a full range of contraceptive methods, including long-acting reversible contraception (LARC), is central to providing quality family planning services. We describe health center-related factors associated with LARC availability, including staff training in LARC insertion/removal and approaches to offering LARC, whether onsite or through referral. STUDY DESIGN We analyzed nationally representative survey data collected during 2013-2014 from administrators of publicly funded U.S. health centers that offered family planning. The response rate was 49.3% (n=1615). In addition to descriptive statistics, we used multivariable logistic regression to identify health center characteristics associated with offering both IUDs and implants onsite. RESULTS Two-thirds (64%) of health centers had staff trained in all three LARC types (hormonal IUD, copper IUD, implant); 21% had no staff trained in any of those contraceptive methods. Half of health centers (52%) offered IUDs (any type) and implants onsite. After onsite provision, informal referral arrangements were the most common way LARC methods were offered. In adjusted analyses, Planned Parenthood (AOR=9.49) and hospital-based (AOR=2.35) health centers had increased odds of offering IUDs (any type) and implants onsite, compared to Health Departments, as did Title X-funded (AOR=1.55) compared to non-Title X-funded health centers and centers serving a larger volume of family planning clients. Centers serving mostly rural areas compared to those serving urbans areas had lower odds (AOR 0.60) of offering IUD (any type) and implants. CONCLUSIONS Variation in LARC access remains among publicly funded health centers. In particular, Health Departments and rural health centers have relatively low LARC provision. IMPLICATIONS For more women to be offered a full range of contraceptive methods, additional efforts should be made to increase availability of LARC in publicly-funded health centers, such as addressing provider training gaps, improving referrals mechanisms, and other efforts to strengthen the health care system.
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Affiliation(s)
- Marta Bornstein
- Oak Ridge Institute for Research and Education, Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA.
| | - Marion Carter
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA
| | - Lauren Zapata
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA
| | - Loretta Gavin
- Department of Health and Human Services, Office of Population Affairs, Washington DC
| | - Susan Moskosky
- Department of Health and Human Services, Office of Population Affairs, Washington DC
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Mao L, Bai W, Huo Y, Zhou Y, Yao C, Xi S, Chen X, Sun Y. Cross-sectional study of contraceptive use among Chinese women of reproductive age: results based on a mobile application (APP)-derived data. Arch Gynecol Obstet 2018; 297:1193-1199. [PMID: 29468308 DOI: 10.1007/s00404-018-4687-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/22/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the contraceptive status among Chinese women of reproductive age and factors associated with contraceptive methods. METHODS A cross-sectional study from November 2015 to January 2016 was conducted. We used APP to collect demographics and contraceptive use information of women aged 14-44 years in China. RESULTS A total of 23,669 women completed the study. After data cleaning, 19,768 (83.5%) women were included in the final analysis. The prevalence of contraceptive use was 78.9%; while 21.05% of women did not use any method, condoms (40.10%), rhythm, or withdrawal (31.03%) were the most commonly used methods. When contraceptive methods were divided into four categories-long-acting contraceptives (LAC), short-acting contraceptive (SAC), Others, and "No use"-the prevalence was 6.1% (601/19,678), 40.8% (8022/19,678), 35.1% (6912/19,678), and 21.1% (4143/19,678), respectively. Women with a high level of education, being unmarried, and sexually active women tended to choose SAC; married women were associated with LAC usage. Women with irregular menstrual cycle used a high proportion of emergency contraception. CONCLUSIONS The prevalence of contraceptive use was 78.9%, with condom use being most prominent. Young women of reproductive age have low awareness of contraception. Relevant departments should take necessary measures to improve this situation.
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Affiliation(s)
- Lele Mao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. .,Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Yuliang Huo
- Department of Medical Statistics Office, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Yingfang Zhou
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Chen Yao
- Department of Medical Statistics Office, Peking University First Hospital, Beijing, China
| | - Sisi Xi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xing Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Stifani BM, MacCarthy S, Nunn A, Benfield N, Dourado I. From Pill to Condom, or Nothing at all: HIV Diagnosis and Discontinuation of Highly Effective Contraceptives Among Women in Northeast Brazil. AIDS Behav 2018; 22:663-670. [PMID: 28688030 PMCID: PMC9982654 DOI: 10.1007/s10461-017-1846-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 01/12/2023]
Abstract
This is a cross-sectional study examining highly effective contraceptive (HEC) use among HIV-positive women in Salvador, Brazil. We used multivariate logistic regression to look for predictors of alternative contraceptive choices among women who discontinued HEC after HIV diagnosis. Of 914 participants surveyed, 38.5% of participants used HEC before but not after diagnosis. Of these, 65.9% used condoms alone; 19.3% used no protection; and 14.8% reported abstinence. Use of condoms alone was associated with a history of other sexually transmitted infections (AOR 2.18, 95% CI 1.09-4.66, p = 0.029). Abstinence was associated with recent diagnosis (AOR 8.48, 95% CI 2.20-32.64, p = 0.002). Using no method was associated with age below 25 (AOR 5.13, 95% CI 1.46-18.00, p = 0.011); income below minimum wage (AOR 2.54, 95% CI 1.31-4.92, p = 0.006); HIV-positive partner status (AOR 2.69, 95% CI 1.03-7.02, p = 0.043); and unknown partner status (AOR 2.90, 95% CI 1.04-8.05, p = 0.042). Improved contraceptive counseling is needed after HIV diagnosis. Continuation of HEC should be encouraged for women wishing to prevent pregnancy, and may increase contraceptive coverage among HIV-positive women.
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Affiliation(s)
- Bianca M Stifani
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Sarah MacCarthy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Amy Nunn
- School of Public Health of Brown University, 121 South Main Street, Suite 810, Providence, RI, 02912, USA
| | - Nerys Benfield
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Rua Basílio da Gama, s/n - Campus Universitário Canela, Salvador, Bahia, 40110-040, Brazil
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Fuzzell L, Shields CG, Alexander SC, Fortenberry JD. Physicians Talking About Sex, Sexuality, and Protection With Adolescents. J Adolesc Health 2017; 61:6-23. [PMID: 28391967 DOI: 10.1016/j.jadohealth.2017.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/12/2016] [Accepted: 01/29/2017] [Indexed: 11/29/2022]
Abstract
Adolescent-physician communication about sexual behaviors, sexuality, and protective behaviors is vital for the support of sexual minorities and the prevention of sexually transmitted infections and unintended pregnancies. The objective of this review is to identify sexual topics that physicians and adolescents discuss during medical encounters and examine the quantity and quality of that communication. We performed a systematic literature review of major databases through May 2016. We identified 33 papers that focused on adolescent-physician communication about three major sexual health topics: coital or noncoital sexual behaviors, sexual orientation or attractions, and sexually protective or preventative behaviors. Communication between adolescents and physicians about these sexual topics is infrequent and coincides with calls for improvement in clinical sex communication. Communication about sexual attractions, sexual orientation, and noncoital sexual behaviors were the rarest in practice, whereas mentions of contraception were more frequent. The review also highlights substantial limitations with this body of research, and more advanced research designs are warranted. Associations between clinical sexual communication and sexual health outcomes (e.g., contraceptive use and sexually transmitted infection occurrence) would improve knowledge of the effectiveness of communication in practice.
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Affiliation(s)
- Lindsay Fuzzell
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana.
| | - Cleveland G Shields
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana
| | | | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Habib MA, Raynes-Greenow C, Nausheen S, Soofi SB, Sajid M, Bhutta ZA, Black KI. Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan. BMC Pregnancy Childbirth 2017; 17:156. [PMID: 28558671 PMCID: PMC5450067 DOI: 10.1186/s12884-017-1339-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 02/29/2016] [Accepted: 05/22/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). METHODS We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. RESULTS Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age < 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = < 12 months (AOR 1.7 1.4-2.2), having a parity of >2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85. CONCLUSIONS This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan.
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Affiliation(s)
- Muhammad Atif Habib
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, 2006, Australia.
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
| | | | - Sidrah Nausheen
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Sajid
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Kirsten I Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, 2006, Australia
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Yared A, Sahile Z, Mekuria M. Sexual and reproductive health experience, knowledge and problems among university students in Ambo, central Ethiopia. Reprod Health 2017; 14:41. [PMID: 28292296 PMCID: PMC5351050 DOI: 10.1186/s12978-017-0302-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Youths in universities are at high risk of STIs and SRH problems in Ethiopia. However, students did not perceive themselves at risk of STI/HIV infection though reports showed they were sexually active, had multiple sexual partners and reported symptoms of STIs. Having recognized the threat posed by SRH problems, this study aimed to assess the SRH experiences, knowledge, and problems among university students at Ambo University in Ethiopia. Methods A cross-sectional study was conducted in Ambo University main campus from January to February 2015 using mixed approach of quantitative (survey) and qualitative (in-depth interview) methods. Proportionate stratified sampling technique was used to select 400 survey respondents and purposive sampling was employed to identify 10 in-depth interviewees. The quantitative data was coded, entered to SPSS and descriptively analyzed, while the qualitative data was categorically organized, repeatedly reviewed and thematically analyzed. Results Mean age during first sex of 17.29 ± SD 2.21 and mean number of past 12 months regular sexual partners of 1.36 ± SD 0.505 were recorded. Only 21.1% of survey respondents perceived themselves to be at risk of HIV. Almost all survey respondents ever heard of STIs (94.5%) and HIV/AIDS (98%), and 89.4% knew modern contraceptives such as pills (64.8%) and condoms (56.8%). Despite awareness of STIs including HIV/AIDS, more than one fifth (22.8%) had any of the STIs in the past one year. Although the quantitative data showed unwanted pregnancy (5%) and abortion (2.5%) existed in the campus minimally, high rates of unwanted pregnancy and unsafe abortion were reported in the qualitative data. Conclusions SRH/STIs were problems among students of the university. Although students knew about STIs, the STI infection rate in the past year was quite high, and was almost as high as the percentage of students who reported sexual activity in the past year. Though reported by a minority of students, unwanted pregnancy and unsafe abortion may also be a problem. The university thus needs to launch a program directed towards STIs and SRH problems, particularly among female students.
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Affiliation(s)
- Abenezer Yared
- College of Social Sciences and Humanities, Ambo University, Ambo, Ethiopia.
| | - Zekariyas Sahile
- Department of Public Health Officer, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Mulugeta Mekuria
- Department of Public Health Officer, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Carter MW, Gavin L, Zapata LB, Bornstein M, Mautone-Smith N, Moskosky SB. Four aspects of the scope and quality of family planning services in US publicly funded health centers: Results from a survey of health center administrators. Contraception 2016; 94:340-7. [PMID: 27125894 DOI: 10.1016/j.contraception.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/28/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aims to describe aspects of the scope and quality of family planning services provided by US publicly funded health centers before the release of relevant federal recommendations. STUDY DESIGN Using nationally representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each. RESULTS Half of the sample received Title X funding and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past 3 months. Service provision to males was substantially lower except for STD screening. A total of 63% and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all five recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients and being a Planned Parenthood clinic were associated with higher scores on most indices. CONCLUSION Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types. IMPLICATIONS STATEMENT As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess change as implementation of recent family planning service recommendations continues.
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Affiliation(s)
- Marion W Carter
- Centers for Disease Control and Prevention, Division of STD Prevention, 1600 Clifton Road, MS-E-80, Atlanta, GA, 30329, USA.
| | - Loretta Gavin
- Office of the Assistant Secretary of Health, Office of Population Affairs, 1101 Wootton Parkway, Suite 700, Rockville, MD 20852, USA
| | - Lauren B Zapata
- Centers for Disease Control and Prevention, Division of Reproductive Health, 4770 Buford Highway NE, Mailstop F-74, Chamblee, GA 30341-3717, USA
| | - Marta Bornstein
- Oak Ridge Institute for Science and Education, based at the Centers for Disease Control and Prevention, Division of STD Prevention, 1600 Clifton Road, MS-E-80, Atlanta, GA 30329, USA
| | - Nancy Mautone-Smith
- Office of the Assistant Secretary of Health, Office of Population Affairs, 1101 Wootton Parkway, Suite 700, Rockville, MD 20852, USA
| | - Susan B Moskosky
- Office of the Assistant Secretary of Health, Office of Population Affairs, 1101 Wootton Parkway, Suite 700, Rockville, MD 20852, USA
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Vural F, Vural B, Cakiroglu Y. The Effect of Combined Antenatal and Postnatal Counselling on Postpartum Modern Contraceptive Use: Prospective Case-Control Study in Kocaeli, Turkey. J Clin Diagn Res 2016; 10:QC04-7. [PMID: 27190896 DOI: 10.7860/jcdr/2016/16931.7641] [Citation(s) in RCA: 4] [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] [Received: 09/21/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The integration of family planning education into obstetric care has been suggested to increase postpartum contraception use. However, ideal time and type of counseling is controversial. There is no prospective study about combining prenatal and postnatal education on the postpartum modern contraceptive use (PPMC). AIM This study was aimed to explore the effects of the addition of postpartum contraceptive counselling to antenatal education on PPMC. MATERIALS AND METHODS Family planning counselling was given to all participating patients throughout antenatal care (ANC) via brief communications. After delivery, the women were categorised into two age-matched groups with a 1:1 allocation ratio in the order of the birth date. No further intervention was performed for Group I (n: 98). Women in Group II (n: 102) received further contraceptive education at six weeks after hospital discharge. Six months after delivery, PPMC was compared between the two groups. RESULTS PPMC was similar between Group I and II (p>0.05). Previous contraceptive experiences, obstetric care service intensity and partner's support were the factors related to postnatal contraceptive use. Logistic regression analysis showed that PPMC was independent of confounding factors in each group. CONCLUSION The addition of postnatal counseling to antenatal one did not further increase PPMC. The results of this study suggested that family planning counseling should be provided antenatally.
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Affiliation(s)
- Fisun Vural
- Specialist, Obstetrics and Gynecology Clinic, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Birol Vural
- Professor, Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine , Kocaeli, Turkey
| | - Yigit Cakiroglu
- Assistant Professor, Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine , Kocaeli, Turkey
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Manigart Y, Béliard A, Rozenberg S, Gilles C. [State of contraception in 2016]. Rev Med Brux 2016; 37:253-260. [PMID: 28525223] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The Pill and other forms of hormonal contraception, if taken correctly, are very effective and safe for millions of women, but since a few years, due to the debates and controversies about the third- and fourth-generation pills, other options have gained in popularity. OBJECTIVES to provide a review of oestroprogestative contraception (OP), progesta-tive contraception, IUDs with a focus on their advantages and side-effects according to the specific needs of women. METHODS literature review and lessons learned from clinical practice. RESULTS The importance of family and individual history, the life-style and socio-economic conditions are critical factors for advising women on the 15 contraceptive choices available to them. The risk/benefit ratio of OP contraception needs a yearly follow-up. The progestative contraception is the preferred option for women who have contraindication for oestrogen, are older than forty, and/or have risk factors such as a history of venous thromboembolism, overweight and smoking. The IUD usually is well tolerated and causes few side effects. Among the other contraceptive methods, sterilization and diaphragms are briefly discussed. CONCLUSION Among the many safe and effective contraceptive methods, it is important for general practitioners to know the advantages and the side effects of each method, as well as the specific conditions of the woman, to propose the best options available. In case of difficulties of follow up or adherence to daily uptake, in particular among adolescents, long-acting methods such as IDU or implants are preferable.
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Affiliation(s)
- Y Manigart
- C.H.U. Saint-Pierre, Service de Gynécologie-Obstétrique, Rue Haute 322, Bruxelles, Belgium
| | - A Béliard
- C.H. du Bois de l'Abbaye et de Hesbaye, ULg, Service de Gynécologie-Obstétrique, Belgium
| | - S Rozenberg
- C.H.U. Saint-Pierre, Service de Gynécologie-Obstétrique, Rue Haute 322, Bruxelles, Belgium
| | - C Gilles
- C.H.U. Saint-Pierre, Service de Gynécologie-Obstétrique, Rue Haute 322, Bruxelles, Belgium
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Agadjanian V, Hayford SR, Luz L, Yao J. Bridging user and provider perspectives: family planning access and utilization in rural Mozambique. Int J Gynaecol Obstet 2015; 130 Suppl 3:E47-51. [PMID: 26082266 PMCID: PMC4609646 DOI: 10.1016/j.ijgo.2015.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine how the contraceptive behavior of women in rural southern Mozambique is shaped by their individual and household characteristics; community characteristics; access to family planning services; and characteristics of health facilities. METHODS Quantitative and qualitative data were collected mostly between January 20 and December 15, 2011, in rural areas of four districts in Gaza Province, Mozambique. The data included: a retrospective household-based survey of women of reproductive age (the analytical sample consisted of 1554 non-pregnant women in marital union); qualitative interviews with a subsample of surveyed women; a survey of communities where the women resided (n=56); and a survey of all health facilities in the study area (n=56). Binomial and multinomial logistic models were fitted to predict current use of modern contraceptive methods. Statistical analyses were complemented by insights from qualitative data. RESULTS Positive associations were detected between contraceptive use and education, household wealth, and perceived HIV infection status. Distance to the clinic was negatively associated with contraceptive use. These effects were additive, with some varying by type of contraceptive method. Examination of qualitative data highlighted frequent cognitive dissonance between service providers and users. CONCLUSION A simultaneous consideration of user-level and provider-level perspectives on contraceptive use improves our understanding of contraceptive dynamics and can usefully inform policy.
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Affiliation(s)
- Victor Agadjanian
- T. Denny Sanford School of Social and Family Dynamics, Center for Population Dynamics, Arizona State University, Tempe, USA.
| | - Sarah R Hayford
- Department of Sociology and Institute for Population Research, Ohio State University, Columbus, USA
| | - Luciana Luz
- Cedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jing Yao
- Urban Big Data Centre, School of Social and Political Sciences, University of Glasgow, Glasgow, UK
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Melhado-Kimura V, Alegre SM, Pavin EJ, dos Santos PDNS, Bahamondes L, Fernandes A. High prevalence of insulin resistance assessed by the glucose clamp technique in hormonal and non-hormonal contraceptive users. EUR J CONTRACEP REPR 2014; 20:110-8. [PMID: 25328007 DOI: 10.3109/13625187.2014.961599] [Citation(s) in RCA: 3] [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: 11/13/2022]
Abstract
OBJECTIVE To assess the prevalence of insulin resistance (IR) and associated factors in contraceptive users. METHODS A total of 47 women 18 to 40 years of age with a body mass index (kg/m(2)) < 30, fasting glucose levels < 100 mg/dl and 2-hour glucose level < 140 mg/dl after a 75-g oral glucose load were submitted to a hyperinsulinemic-euglycemic clamp. The women were distributed in tertiles regarding M-values. The analysed variables were use of combined hormonal/non-hormonal contraception, duration of use, body composition, lipid profile, glucose levels and blood pressure. RESULTS IR was detected in 19% of the participants. The women with low M-values presented significantly higher body fat mass, waist-to-hip ratio, fasting insulin, HOMA-IR and were nulligravida, showed > 1 year of contraceptive use and higher triglyceride levels. IR was more frequent among combined oral contraceptive users, however no association was observed after regression analysis. CONCLUSIONS The prevalence of IR was high among healthy women attending a family planning clinic independent of the contraceptive method used with possible long-term negative consequences regarding their metabolic and cardiovascular health. Although an association between hormonal contraception and IR could not be found this needs further research. Family planning professionals should be proactive counselling healthy women about the importance of healthy habits.
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Affiliation(s)
- Vaneska Melhado-Kimura
- * Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP) , Campinas, SP , Brazil
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Tsitsika A, Andrie E, Deligeoroglou E, Tzavara C, Sakou I, Greydanus D, Papaevangelou V, Tsolia M, Creatsas G, Bakoula C. Experiencing sexuality in youth living in Greece: contraceptive practices, risk taking, and psychosocial status. J Pediatr Adolesc Gynecol 2014; 27:232-9. [PMID: 25016561 DOI: 10.1016/j.jpag.2013.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 09/02/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To assess initiation of sexual activity and contraception methods used among Greek adolescents. To determine the association of adolescents' emotional and behavioral status with their sexual activity. DESIGN A descriptive cross-sectional survey was conducted. SETTING, PARTICIPANTS The population (N = 1074, age 14-16) consisted of a random sample, stratified according to locality and population density, of 20 public junior high and high schools located in the urban district of Athens, Greece. INTERVENTIONS Anonymous self-reported questionnaires were used to assess sexual activity choices and contraception methods. The Youth Self-Report questionnaire was used to evaluate the psychosocial competencies and difficulties of Greek adolescents. MEASURES Analyses included frequencies with chi-square tests and multivariate logistic regression analysis. MAIN OUTCOME Factors that may influence sexual engagement of Greek adolescents were assessed. RESULTS Of the adolescents who completed the questionnaire 21.8% reported having experienced sexual intercourse. The male/female ratio was 3/1 (P < .001) and the mean age of sexual debut was 14.5 ± 0.9 years. Condoms were the most preferred contraceptive method (79.9%), followed by withdrawal (38.9%). Emergency contraception was used by 9.6% of participants. Adolescents with separated, divorced or with a deceased parent, and non-Greek nationality have higher possibility of being sexually active. Adolescents who reported sexual intercourse had significantly higher score of thought problems (β = 1.07, SE = 0.35, P = .002), attention difficulties (β = 0.67, SE = 0.29, P = .022), delinquent behavior problems (β = 2.37, SE = 0.34, P < .001), aggressive behavior (β = 1.97, SE = 0.48, P < .001), and externalizing problems (β = 4.18, SE = 0.78, P < .001). CONCLUSIONS Engagement in sexual activities was significantly associated with psychosocial difficulties among adolescents living in Greece.
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Affiliation(s)
- Artemis Tsitsika
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
| | - Elisabeth Andrie
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Efthymios Deligeoroglou
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Chara Tzavara
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Irene Sakou
- Adolescent Health Unit, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Donald Greydanus
- Department of Pediatrics School of Medicine, Western Michigan University, Kalamazoo, MI
| | - Vassiliki Papaevangelou
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Mariza Tsolia
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Creatsas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Chryssa Bakoula
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Donadiki EM, Jimenez-Garcıa R, Velonakis EG, Hernandez-Barrera V, Sourtzi P, Lopez de Andres A, Jimenez-Trujillo I, Pino CG, Carrasco-Garrido P. Factors related to contraceptive methods among female higher education students in Greece. J Pediatr Adolesc Gynecol 2013; 26:334-9. [PMID: 24075084 DOI: 10.1016/j.jpag.2013.06.011] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE We aimed to determine the prevalence of contraceptive methods and identify factors associated with the use of contraception by Greek female higher education students. DESIGN Cross-sectional epidemiologic survey on the factors determining the use of contraception among higher educational students. SUBJECT 3,624 female students between 18 and 26 years of age. MAIN OUTCOME MEASURES We used primary individualized data drawn from a survey carried among female college students in Greece. The dependent dichotomous variables were the responses "YES" or "NO" to the question: "During the last 12 months, what contraceptive method have you generally used in your sexual intercourses?" The methods were male condoms, oral contraceptive use (OCs) and emergency contraception (EC). The independent variables which were analysed in this survey were socio-demographic characteristics, variables related to lifestyle and variables associated with sexual habits. RESULTS Condom was the most widely used (53.87%). The variables associated independently and significantly with a greater likelihood of the use of condoms were condom use at first sexual intercourse, occupational status and higher educational level of parents. As for OCs, those who had relationship, had more than 2 sexual lifetime partners and had ever visited gynecologist (OR 6.40; 95%CI 2.80-9.40) was more likely to use. For the use of EC, those who were older, had relationship, were smokers and had more than 2 sexual lifetime partners (OR 2.15; 95%CI 1.75-2.64), was more likely to use this method. CONCLUSIONS Condom is the most used contraceptive method among female higher educational students in Greece, followed by EC. The variable most strongly associated with use of the OCs was a gynecologist visit. The factors associated with use of EC were having more than 2 sexual partners, smoking, and having a stable sexual partner.
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Affiliation(s)
- Elisavet M Donadiki
- Department of Public Health, University of Athens, Faculty of Nursing, Athens, Greece
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Stidham Hall K, Moreau C, Trussell J, Barber J. Young women's consistency of contraceptive use--does depression or stress matter? Contraception 2013; 88:641-9. [PMID: 23850075 PMCID: PMC3796023 DOI: 10.1016/j.contraception.2013.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 02/18/2013] [Revised: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND We prospectively examined the influence of young women's depression and stress symptoms on their weekly consistency of contraceptive method use. STUDY DESIGN Women ages 18-20 years (n = 689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n = 8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression. RESULTS Consistent contraceptive use (72% of weeks) was 10-15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p < .001). Controlling for covariates, women with depression and stress symptoms had 47% and 69% reduced odds of contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31-0.91 and OR 0.31, CI 0.18-0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12-0.58), condoms (OR 0.40, CI 0.23-0.69) and withdrawal (OR 0.12, CI 0.03-0.50). CONCLUSION Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods. IMPLICATIONS Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women's psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women's dynamic mental health symptoms impact family planning behaviors and outcomes over time.
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Affiliation(s)
- Kelli Stidham Hall
- Department of Obstetrics and Gynecology, Institute for Social Research, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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Wood S, Beeson T, Bruen B, Goldberg DG, Mead H, Shin P, Rosenbaum S. Scope of family planning services available in Federally Qualified Health Centers. Contraception 2013; 89:85-90. [PMID: 24176250 DOI: 10.1016/j.contraception.2013.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 04/29/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Federally Qualified Health Centers (FQHCs) are a major and growing source of primary care for low-income women of reproductive age; however, only limited knowledge exists on the scope of family planning care they provide and the mechanisms for delivery of these essential reproductive health services, including family planning. In this paper, we report on the scope of services provided at FQHCs including on-site provision, prescription only and referral options for the range of contraceptive methods. STUDY DESIGN An original survey of 423 FQHC organizations was fielded in 2011. RESULTS Virtually all FQHCs reported that they provide at least one contraceptive method (99.8%) at one or more clinical sites. A large majority (87%) of FQHCs report that their largest primary care site prescribes oral contraceptives plus one additional method category of contraception, with oral contraception and injectables being the most commonly available methods. Substantial variation is seen among other methods such as intrauterine devices (IUDs), contraceptive implants, the patch, vaginal ring and barrier methods. For all method categories, Title-X-funded sites are more likely to provide the method, though, even in these sites, IUDs and implants are much less likely to be provided than other methods. CONCLUSION There is clearly wide variability in the delivery of family planning services at FQHCs in terms of methods available, level of counseling, and provision of services on-site or through prescription or referral. Barriers to provision likely include cost to patients and/or additional training to providers for some methods, such as IUDs and implants, but these barriers should not limit on-site availability of inexpensive methods such as oral contraceptives. IMPLICATIONS With the expansion of contraceptive coverage under private insurance as part of preventive health services for women, along with expanded coverage for the currently uninsured, and the growth of FQHCs as the source of care for women of reproductive age, it is critical that women seeking family planning services at FQHCs have access to a wide range of contraceptive options. Our study both highlights the essential role of FQHCs in providing family planning services and also identifies remaining gaps in the provision of contraception in FQHC settings.
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Affiliation(s)
- Susan Wood
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA.
| | - Tishra Beeson
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
| | - Brian Bruen
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
| | - Debora Goetz Goldberg
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
| | - Holly Mead
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
| | - Peter Shin
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
| | - Sara Rosenbaum
- Department of Health Policy, The George Washington University School of Public Health and Health Service, Washington, DC 2006, USA
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Hall KS, Moreau C, Trussell J, Barber J. Role of young women's depression and stress symptoms in their weekly use and nonuse of contraceptive methods. J Adolesc Health 2013; 53:241-8. [PMID: 23582524 PMCID: PMC3713141 DOI: 10.1016/j.jadohealth.2013.02.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE We prospectively examined the influence of young women's depression and psychological stress symptoms on their weekly contraceptive method use. METHODS We examined data from 689 women ages 18-20 years participating in a longitudinal cohort study. Women completed 8,877 weekly journals over the first year, which assessed reproductive, relationship, and health information. We focused on baseline depression (Center for Epidemiologic Studies-Depression Scale) and stress (Perceived Stress Scale) symptoms and weekly contraceptive method use. Analyses used multivariate random effects and multinomial logistic regression. RESULTS Approximately one quarter of women exhibited moderate/severe depression (27%) and stress (25%) symptoms at baseline. Contraception was not used in 10% of weekly journals, whereas coital and noncoital methods were used in 42% and 48% of weeks, respectively. In adjusted models, women with moderate/severe stress symptoms had more than twice the odds of contraception nonuse than women without stress (odds ratio [OR] 2.23, confidence interval [CI] 1.02-4.89, p = .04). Additionally, women with moderate/severe depression (RR .52, CI .40-.68, p < .001) and stress (relative risk [RR] .75, CI .58-.96, p = .02) symptoms had lower relative risks of using long-acting methods than oral contraceptives (OCs; reference category). Women with stress symptoms also had higher relative risks of using condoms (RR 1.17, CI 1.00-1.34, p = .02) and withdrawal (RR 1.29, CI 1.10-1.51, p = .001) than OCs. The relative risk of dual versus single method use was also lower for women with stress symptoms. CONCLUSION Women's psychological symptoms predicted their weekly contraceptive nonuse and use of less effective methods. Further research can determine the influence of dynamic psychological symptoms on contraceptive choices and failures over time.
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Affiliation(s)
- Kelli Stidham Hall
- Department of Obstetrics and Gynecology, Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-0445, USA.
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Ehsanpour S, Aghaii A, Kheirabadi GR. The association of contraceptive methods and depression. Iran J Nurs Midwifery Res 2012; 17:234-8. [PMID: 23833619 PMCID: PMC3696218] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND None of the contraceptive methods are fully side-effect free. One of the side effects that commonly causes discontinuation is mood changes and depression. The present study aimed to compare the depression between contraceptive methods including low-dose estrogen (LD) combined pills, condom and intrauterine devices (IUD). MATERIALS AND METHODS In a cross-sectional study, 216 women were selected through systematic random sampling from 10 health care center sin Isfahan in 2011. Beck Depression Inventory II was used and individual productivity characteristics were asked. Validity and reliability of Beck depression inventory have been repeatedly confirmed in Iran. Content validity the productivity characteristics questionnaire was confirmed and its reliability was measured through Cronbach's alpha correlation coefficient (calculated as 0.71). ANOVA, covariance analysis and logistic regression were used to analyze the data. FINDINGS Depression was observed in 47.8% of participants; however, there was no difference between mean score of depression in the users of three contraceptive methods. CONCLUSIONS The findings of this study showed that depression is not correlated with family planning type and fear of depression should not be an obstacle to choose between these methods. Depression is a multifactor issue. This study showed that type of family planning method in itself cannot be the cause of depression and family planners and consultants should consider this.
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Affiliation(s)
- Soheila Ehsanpour
- Department of Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezo Aghaii
- MSc Student, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Kheirabadi
- Assistant Professor of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Gholam Reza Kheirabadi, Assistant Professor of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Abstract
Emergency contraception is often misunderstood by the general public and nurses alike. This article outlines information about methods of post-coital contraception that all nurses need to provide appropriate health advice to women in any nursing setting. This article first appeared in Nursing Standard. 14, 7, 38-43. Readers who successfully completed a written 'practice profile assessment' on that occasion may not do so again.
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Affiliation(s)
- S Quinn
- Sheila Quinn RN, BSc(Hons), MSc (Social Research), is Senior Lecturer, School of Health, Biological and Environmental Sciences, Middlesex University. She is also Family Planning Sister, Margaret Pyke Centre, London
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