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Background/Introduction: On June 24, 2022, the Supreme Court overturned the 1973 verdict in the Roe v. Wade legal suit that had established the constitutional right to medical abortion [1]. With the right to abortion now being left to the states, many restrictions regarding abortion procedures are being established [2]. We aim to evaluate whether this has led to an increase in the number of birth control prescriptions and sterilisation procedures at Cape Fear Valley Medical Centre in rural North Carolina. Methods: SlicerDicer program within EPIC medical records database was used to retrieve the records of all women that had an obstetrics and gynaecology appointment with Cape Fear Valley Health System between 11/01/21-12/31/2022 for contraception. The data was sorted into race/ethnicity, age, and types of birth control. Principal outcomes measured the trends in birth control prescription or sterilisation procedure appointments before and after the overturn of Roe v. Wade. Results: Contraceptive pill prescriptions decreased from 51.70% to 32.40%. IUD insertions decreased from 39.40% to 11.30%. Injectable birth control remained consistent, at approximately 16%. Nexplanon implantations dropped from 20.60% to 9.70%. Lastly, sterilisation procedures increased from 6.7% to 10.7%. Conclusion: Majority of birth control prescriptions decreased following the overturn of Roe v. Wade, except for sterilisation, which increased by 4.0%. This may indicate that women are now looking for more permanent birth control options after the overturn of Roe v. Wade. Future research should investigate whether similar trends of increasing prevalence of sterilisation procedures is seen throughout the United States. SHORT CONDENSATION: We aim to assess the impact of the Supreme Court overturn regarding the Roe v. Wade legal suit on contraceptive decisions in rural North Carolina. [ABSTRACT FROM AUTHOR]

It is 100 years since the discovery of oestrogen and nearly that since the discovery of progesterone. It is over 50 years since the concept of using intrauterine progesterone. Ten years after its synthesis, the research using levonorgestrel as an intrauterine agent was introduced. The pharmacodynamics and pharmacokinetics of LNG-IUSs and the LNG-IUS 52 mg in particular explain why intrauterine LNG is so highly effective for contraception. When intrauterine LNG is used therapeutically it should ideally be based on clinical monitoring of the pathology being treated rather than a fixed time period While the LNG-IUS 52 mg is probably required for most medical conditions, consideration should be given for using the LNG-IUS 13.5 mg for hyperplasia and endometrial protection during oestrogen therapy and for older women who appear more prone to a low rate of LNG induced breast cancer, although there is not yet an official indication for this. The desire for fertility control, therapy for various genital pathological conditions and reduction of repeated endometrial decidualization and inflammatory breakdown and its consequences, and menopausal problems can be aided by intrauterine LNG. This review explains how a contraceptive also became a WHO listed essential medicine. There are significant differences at many levels in the use of intrauterine levonorgestrel for contraception when compared to using it as a therapeutic. [ABSTRACT FROM AUTHOR]

Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. Education and counselling are deemed crucial and this review aims at comparing published contraceptive guidelines, thus resolving any surrounding misconceptions. Recently published contraception guidelines regarding adolescent pregnancy were retrieved. In particular, guidelines and recommendations from ACOG, RCOG, SOCG, AAP, CPS, NICE, CDC, and WHO were compared and reviewed based on each guideline's method of reporting. Three categories of contraceptive methods are available for adolescents and recommendations on their initiation should be made based on their efficacy, according to all guidelines. Therefore, long acting reversible contraceptives (LARCs) should be highly recommended as the most effective method (typical use failure rate: 0.05%), followed by short-acting hormonal contraceptives (typical use failure rate: 3–9%). The third contraceptive option includes contraceptives used in the moment of intercourse and displays the lowest effectiveness (typical use failure rate: 12–25%), mostly due to its dependence on personal consistency, however offers protection against STI transmission. Adolescents should be encouraged to initiate contraception, with LARCs being the primary choice followed by short-acting hormonal contraception. However, regardless of the chosen effective contraceptive method, the use of condom is necessary for STI prevention. Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. The use of contraceptive methods such as LARCs and short-acting hormonal contraceptives should be encouraged and suggested based on effectiveness with the addition of condom for STI prevention. [ABSTRACT FROM AUTHOR]

Digital fertility awareness-based contraception offers an alternative choice for women who do not wish to use hormonal or invasive methods. The aim of this study was to investigate the key demographics of current users of the Natural Cycles app and assess the contraceptive outcomes of women preventing pregnancy in a UK cohort of women. This was a real world observational prospective observational study. The typical-use effectiveness of the method was calculated using both 13-cycle cumulative probability of pregnancy (life table analysis) and Pearl Index for the entire study cohort. Perfect-use PI was calculated using data from cycles where sexual intercourse during the fertile window was marked as protected and no unprotected sex was recorded on fertile days. 12,247 women were included in the study and contributed an average of 9.9 months of data for a total of 10,066 woman years of exposure. The mean age of the cohort was 30, mean BMI 23.4, the majority were in a stable relationship (83.2%) and had a university degree or higher (83%). The one year typical use, PI was 6.1 (95% CI: 5.6, 6.6) and with perfect-use was 2.0 (95% CI: 1.3, 2.8). 13 cycle pregnancy probability was 7.1%. This is the first study which describes the use of a digital contraceptive by women in the UK. It describes the demographics of users and how they correlate with the apps effectiveness at preventing pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents.Methods: Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only.Results: At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I2 = 99%). Pregnancy during LARC use was rare.Conclusion: LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality.Prospero Registration Number: CRD42017055452. [ABSTRACT FROM AUTHOR]

Induced abortion is an occupational hazard for female sex workers (FSWs). This study aimed to examine the prevalence and factors associated with induced abortion among FSWs in Iran. 1337 FSWs aged ≥18 years who reported selling sex to more than one male client in the past 12 months were recruited in 13 major cities in Iran between January and August 2015. Bivariable and multivariable modified Poisson regression models were constructed to examine the correlates of induced abortion. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported. Lifetime induced abortion was reported by 621 of 1335 participants (46.5%; 95% CI 43.8, 49.2). Older age (APR for ≥ 35 vs. < 25 years, 1.46; 95% CI: 1.03, 2.07), having ever been married (APR 1.58; 95% CI 1.05, 2.39), having ever worked in a brothel (APR 1.19; 95% CI 1.02, 1.38) and a lifetime history of being raped (APR 1.19; 95% CI 1.03, 1.38) were significantly associated with lifetime induced abortion (all p < 0.05). The high prevalence of induced abortion among FSWs in Iran is concerning. Evidence-informed programmes targeting FSWs in Iran would improve their knowledge and encourage contraceptive use as well as promote pregnancy prevention and post-abortion care. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the correlation between obesity and the use of depot medroxyprogesterone (DMPA) with regard to weight gain and changes in bleeding pattern.Methods: A retrospective chart review was conducted of women receiving 150 mg DMPA via intramuscular injection at inpatient and outpatient clinics at the University of Mississippi Medical Centre between 1 June 2012 and 31 December 2016. Body mass indices (BMI) were assessed at baseline and at the time of final injection. Data on race, medical history, age at first DMPA injection, number and timing of injections, reported side effects, indication for DMPA use and reason for discontinuation, if applicable, were collected.Results: Of the 240 women included in the study, 3.3% were underweight, 30.8% were normal weight, 23.3% were overweight, 15% were class I obese, 9.6% were class II obese and 17.9% were class III obese; 87.9% of the population were African American. Women gained 2.40 kg (95% confidence interval 1.34-3.45) while they were on DMPA (p < .01), which after adjusting for confounding variables was inversely associated with age at initial injection (β coefficient -0.13; p = .02). Amenorrhoea was the most commonly reported change in bleeding pattern.Conclusion: Women who started DMPA at an earlier age gained the most weight over time, independently of initial BMI. Similar rates of amenorrhoea were found among all BMI categories. [ABSTRACT FROM AUTHOR]

Objectives: The internet has changed the organisation of sex work. The risk of sexually transmitted infections has frequently been a research focus, but less is known about sex workers' use of contraception for pregnancy prevention. The aim of this research was to gain a better understanding of contraceptive preferences and provider interactions of online sex workers.Methods: Data were obtained from a multi-methods study of sex workers in the UK who advertise on the internet and have sexual contact with clients, particularly in the Birmingham and Solihull areas. The study comprised an online survey among 67 participants and eight qualitative interviews.Results: Reported high rates of condom use with clients led to sex workers considering pregnancy prevention to be a personal rather than an occupational issue. Disclosure of sex working to health professionals is often seen as unnecessary and/or undesirable due to concerns about stigma. A clear distinction between contraceptive needs for commercial and non-commercial partners was evident.Conclusion: Service providers need to take account of both personal and commercial needs during contraceptive consultations and avoid making assumptions based on homogeneous understandings of sex work. Encouraging disclosure of sex work to facilitate appropriate discussions may need new approaches to combat privacy and stigma concerns. [ABSTRACT FROM AUTHOR]

Purpose: We sought to examine whether low-income inner-city expectant women who intend to breastfeed make different contraceptive choices than those who intend to formula feed.Materials and Methods: This cross-sectional pilot study surveyed expectant women age 14 years and older receiving prenatal care at MacDonald Women's Hospital, Cleveland Ohio (01 November 2016-15 January 2017). Questions assessed knowledge and attitudes regarding infant feeding and contraception options, and postpartum feeding and contraceptive intentions.Results: We enrolled 223 expectant women, mean age 25.6 years at a median of 30 weeks gestation; 192 (86.5%) were African-American and 171 (75%) were multiparous. Women intending to breastfeed had 0.44 times the odds of intending to use birth control after delivery (95% CI [0.19-1.05], p = .06), while women intending to feed formula had 2.26 times the odds of intending to use birth control after delivery (95% CI [0.95-5.40]). Contraceptive attitudes significantly impacted intent to use contraception (p = .007), with every point higher on the contraception attitudes scale equating to a 7% increase in odds of postpartum contraception use.Conclusions: Postpartum contraceptive intentions do not differ significantly between women intending to breastfeed and those intending formula feeding. Contraception attitudes do not significantly change this association, but were significantly related to contraceptive intent. Findings highlight the importance of providing comprehensive birth control education to all expectant mothers, regardless of feeding intention. Our study is unique in addressing interactions between maternal contraceptive and feeding intentions among expectant women at high risk for both not breastfeeding and unintended short interval pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to develop a questionnaire to facilitate choice of the most appropriate contraceptive method for individual women.Methods: A literature review was conducted to identify key aspects influencing contraceptive choice and inform development of a questionnaire for online completion. Questionnaire development was overseen by a steering committee consisting of eight gynaecologists from across Europe. The initial draft underwent conceptual validation through cognitive debriefing interviews with six native English-speaking women. A qualitative content analysis was conducted to accurately identify potential issues and areas for questionnaire improvement. A revised version of the questionnaire then underwent face-to-face and online evaluation by 115 international gynaecologists/obstetricians with expertise in contraception, prior to development of a final version.Results: The final conceptually validated Contraception: HeLping for wOmen's choicE (CHLOE) questionnaire takes ≤10 min to complete and includes three sections to elicit general information about the individual, the health conditions that might influence contraceptive choice, and the woman's needs and preferences that might influence contraceptive choice. The questionnaire captures the core aspects of personalisation, efficacy and safety, identified as key attributes influencing contraceptive choice, and consists of 24 closed-ended questions for online completion prior to a health care provider (HCP) consultation. The HCP receives a summary of the responses.Conclusion: The CHLOE questionnaire has been developed to help women choose the contraception that best suits their needs and situation while optimising the HCP's time. [ABSTRACT FROM AUTHOR]

Objectives: Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions.Methods: The article comprises a narrative review of the literature.Results: Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression.Conclusions: For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills. [ABSTRACT FROM AUTHOR]

Case: Second-generation combined oral contraceptives (COCs) are widely used and are believed to be safe for birth control and in the treatment of gynaecological diseases. No randomised controlled study has shown elevations in alanine transaminase (ALT) levels in relation to the use of a second-generation COC. We report a case of drug-induced liver injury (DILI) in a young, moderately obese woman, due to the use of a second-generation COC containing 30 µg ethinylestradiol and 150 µg levonorgestrel. COC use had been initiated 2 years prior to admission to our department. The diagnosis was based on elevated levels of ALT during COC use and was confirmed by re-challenge and a liver biopsy showing signs of former tissue damage after a 3 week break of COC treatment. Conclusions: To our knowledge, this is the first case of biopsy-proven DILI due to COC use in which a re-challenge was performed. [ABSTRACT FROM AUTHOR]

Objectives: We propose a new, personalised approach of estimating a woman's most fertile days that only requires recording the first day of menses and can use a smartphone to convey this information to the user so that she can plan or prevent pregnancy.Methods: We performed a retrospective analysis of two cohort studies (a North Carolina-based study and the Early Pregnancy Study [EPS]) and a prospective multicentre trial (World Health Organization [WHO] study). The North Carolina study consisted of 68 sexually active women with either an intrauterine device or tubal ligation. The EPS comprised 221 women who planned to become pregnant and had no known fertility problems. The WHO study consisted of 706 women from five geographically and culturally diverse settings. Bayesian statistical methods were used to design our proposed method, Dynamic Optimal Timing (DOT). Simulation studies were used to estimate the cumulative pregnancy risk.Results: For the proposed method, simulation analyses indicated a 4.4% cumulative probability of pregnancy over 13 cycles with correct use. After a calibration window, this method flagged between 11 and 13 days when unprotected intercourse should be avoided per cycle. Eligible women should have cycle lengths between 20 and 40 days with a variability range less than or equal to 9 days.Conclusions: DOT can easily be implemented by computer or smartphone applications, allowing for women to make more informed decisions about their fertility. This approach is already incorporated into a patent-pending system and is available for free download on iPhones and Androids. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to assess the efficacy and tolerability of the monthly vaginal ring (NuvaRing; 15 μg ethinylestradiol [EE] and 120 μg etonogestrel per day) compared with a monophasic (21/7) combined oral contraceptive (COC) containing 30 μg EE and 3 mg drospirenone in healthy Chinese women aged 18-40 years.Methods: This was a phase III, open-label, randomised multicentre trial conducted in China. Participants received NuvaRing or COC for 13 cycles (3 weeks of ring/pill treatment followed by a 1-week ring-free/pill-free period). Contraceptive efficacy was assessed by in-treatment pregnancies and expressed by the Pearl Index (PI; number of pregnancies/100 woman-years of use). Cycle control was assessed by unscheduled (breakthrough) and absence of scheduled (withdrawal) bleeding events. Safety and tolerability were assessed throughout the study.Results: Participants were randomised either to the NuvaRing (n = 732) or to the COC (n = 214); 588 (82.4%) and 182 (78.4%) participants, respectively, completed the study. There were 10 in-treatment pregnancies in the NuvaRing group (PI 1.92; 95% confidence interval [CI] 0.92, 3.53) and five in the COC group (PI 3.12; 95% CI 1.01, 7.29). Breakthrough bleeding/spotting ranged from 18.6% (Cycle 1) to 4.2% (Cycle 11) for NuvaRing and from 21.6% (Cycle 1) to 7.9% (Cycle 11) for COC. Absence of withdrawal bleeding ranged from 8.6% (Cycle 1) to 3.0% (Cycle 11) for NuvaRing and from 14.6% (Cycle 1) to 6.4% (Cycle 5) for COC. For NuvaRing and COC, respectively, 26.6% and 25.0% of participants had treatment-related adverse events, and 7.0% and 9.1% discontinued the study as a result.Conclusions: Once-monthly NuvaRing is efficacious and safe for use in Chinese women. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to retrospectively evaluate the effectiveness of a fertility awareness-based method supported by a mobile-based application to prevent unwanted pregnancies as a method of natural birth control.Methods: In a retrospective analysis, the application's efficiency as a contraceptive method was examined on data from 4054 women who used the application as contraception for a total of 2085 woman-years.Results: The number of identified unplanned pregnancies was 143 during 2053 woman-years, giving a Pearl Index of 7.0 for typical use. Ten of the pregnancies were due to the application falsely attributing a safe day within the fertile window, producing a perfect-use Pearl Index of 0.5. Calculating the cumulative pregnancy probability by life-table analysis resulted in a pregnancy rate of 7.5% per year (95% confidence interval 5.9%, 9.1% per year).Conclusions: The application appears to improve the effectiveness of fertility awareness-based methods and can be used to prevent pregnancies if couples consistently protect themselves on fertile days. [ABSTRACT FROM AUTHOR]

ObjectivesThe aim of the study was to evaluate the ability of a novel web and mobile application to identify a woman's ovulation day and fertile window, in order to use it as a method of natural birth control. MethodsA retrospective study was performed on 1501 cycles of 317 women aged 18 to 39 years. Women entered their basal body temperatures, ovulation test results and date of menstruation into the application. ResultsThe mean delay from the first positive ovulation test to the temperature-based estimation of the ovulation day was 1.9 days; the length of the luteal phase varied on average by 1.25 days per user. Only 0.05% of non-fertile days were falsely attributed and found within the fertile window. ConclusionsThe method is effective at identifying a user's ovulation day and fertile window and can therefore be used as a natural method of birth control. Chinese Abstract 摘要 目的：本研究的目的为评估一个新的网页及移动设备应用鉴别女性排卵日和生育窗的能力，以便将其用于指导自然避孕。 方法：年龄在18至37岁的317名妇女的1501个月经周期被纳入了回顾性研究。受试者将基础体温、排卵测试结果和经期输入至此应用。 结果：首次排卵阳性日至基础体温预计排卵日的平均延迟时间为1.9天；平均每个受试者的黄体期时间变化大约为1.25天。只有0.05%的非生育期被错误地归至生育窗。 结论：此方法可有效识别使用者排卵日及生育窗，因此可应用于自然避孕。 关键词 自然生育控制，生育窗，自然避孕，生育力认知，基础体温，排卵监测 [ABSTRACT FROM PUBLISHER]

Objectives: The aim of this study was to compare the pain-relieving effect of intracervical lidocaine gel with that of lidocaine spray or no local anaesthesia in decreasing pain during insertion of the intrauterine contraceptive device (IUCD).Methods: In a prospective multicentre non-randomised comparative study design, 420 women were divided into three groups of 140 and fitted with the same type of IUCD. Group 1 received cervical lidocaine gel, group 2 received cervical lidocaine spray and group 3 received no topical anaesthesia. A visual analogue scale was used to measure the degree of pain experienced.Results: There were no significant differences between the three groups with regard to baseline characteristics such as age and number of deliveries. Significantly less pain was felt during cervical traction in women using a local anaesthetic. However, there were no significant differences in pain due to IUCD insertion.Conclusions: Application of a local anaesthetic decreased the pain resulting from cervical traction but not that resulting from IUCD insertion. [ABSTRACT FROM AUTHOR]

In order to capitalise on new opportunities to advance contraceptive and reproductive health choices globally, organisations working in these fields will need to overcome six institutional obstacles. These are: (i) committee management; (ii) over-medicalisation; (iii) fear of risk and controversy; (iv) conferences, meetings, and symposia; (v) obsession with coordination; and (vi) fear of sex. The reproductive health community will require energy, innovative approaches, and a sharp focus on service delivery to address these hurdles that will otherwise slow down and misdirect programmatic momentum. [ABSTRACT FROM AUTHOR]

Objectives To identify factors involved in women's decisions to choose particular contraceptive methods and more specifically, incentives and disincentives to use three long-acting reversible contraceptive (LARC) methods: injectables, implants, and intrauterine devices/systems (IUDs/IUSs). Methods A total of 502 women aged 18 to 30 completed a cross-sectional online questionnaire. Results The three most important factors in choosing a contraceptive method were: high efficacy at preventing pregnancy, protection against sexually transmitted infections, and non-interference with sexual intercourse. The most common incentives for LARC use were the high efficacy and long duration of action. Disincentives included the possibility of irregular bleeding and concerns about effects on fertility; fear of needles and pain was a particular disincentive for IUD/IUS use. Only 93 (18%) of the participants reported ever having used a LARC. Conclusions Reported disincentives to LARC use (e.g., concern about effects on future fertility) indicated that many young women hold inaccurate beliefs about these methods. The relatively high proportions of women who held neutral attitudes about LARCs (21-40%, depending on the method) highlight the importance of education and contraceptive counselling to improve knowledge about the advantages of these methods. Chinese Abstract 摘 要 目的 了解女性选择避孕方法的影响因素和应用三种长效可逆避孕方法（LARC）：注射避孕针、埋植剂和宫内节育器/宫内系统(IUDs / IUSs)的有利和不利因素。 方法 502名18～30岁女性完成了横断面在线问卷调查。 结果 在选择避孕方法的三个最重要的影响因素是：防止妊娠的高效性，预防性传播感染和不干扰性交。LARC使用最常见的有利因素是高效和长效性。不利因素包括不规则出血的可能性和对生育影响的担忧；对针和疼痛的恐惧是选用IUDs / IUSs 的不利因素。只有93（18%）的女性曾经使用过LARC。 结论 应用LARC的不利因素（如对将来生育影响的担忧）表示许多年轻女性对这些方法存在错误的观点。对LARCs持有中立态度的女性占相对较高的比例（21-40%）,提示教育和避孕咨询的重要性，以提高对这些方法优点的认识。 [ABSTRACT FROM AUTHOR]

Objective Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users' profiles at our institution. Methods A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed. Results The number of EC requests, the distribution by age and the demand over the week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p < 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period. Conclusion EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday. Chinese Abstract 摘 要 目的 与西班牙其他自治区相比，在加泰罗尼亚，紧急避孕药（emergency contraception，EC）获取途径的演变有所不同。2004年公共卫生系统批准其免费发放，2009年后将其列为非处方类药物（over-the-counter，OTC）。本研究目的在于评价不同措施对于公众需求的影响。 方法 运用回顾性研究评价紧急避孕药的需求与药物获取途径间的关系。并分析女性的年龄及一周中有需求的天数。 结果 EC免费发放，EC的需求量、使用者年龄分布及一周中有需求的天数均保持稳定。然而，将EC列为OTC后，其需求量显著减少，在小于25岁的女性中分布上升（72% VS 56%， p＜0.001）。整个研究期间还发现周日与周一的需求量始终保持最高。 结论 免费发放EC并不影响其需求量，但转变为非处方药时，其使用量明显减少。本研究中免费获取EC的女性年龄偏小且倾向于在周一使用。 [ABSTRACT FROM AUTHOR]

Objectives Emergency contraceptive pills (ECPs) are underused for preventing unintended pregnancy. Not all women are willing to use them even when at risk of conceiving. This paper examines whether increased knowledge about ECPs may increase the intention to use these products. Methods Factors associated with intention to use emergency contraception (EC) were assessed among 1310 women who participated in the nationally representative Sexual Health in the Netherlands 2009 Survey. Logistic regression models included demographics, prior use of ECPs, and ECP knowledge. Results Seventeen percent of the women did not intend to use EC after unprotected sexual intercourse and a further 27% were unsure whether they would use it. Intention is most strongly related to prior use and not having children. Only two of six knowledge items were related to intention in the multivariate analyses. Being aware that ECPs can be obtained without prescription upgrades intention, whereas knowing that a woman can still get pregnant after having taken the ECP has a negative impact on intention. Conclusions Improving knowledge may contribute to intention to use EC, but its role will be modest. To understand the reasons behind ECP use it is essential to study the contribution of other factors, like attitudes and social norms. Chinese Abstract 摘 要 目的 紧急避孕药（ECPs）可用于非意愿妊娠的预防。即使存在妊娠的风险，并非所有女性都愿意使用紧急避孕药。本文调查研究了增加女性对紧急避孕药的了解是否会增加其使用的意愿情况。 方法 选取参与2009年荷兰全国性健康调查的1310名妇女，评估其采取紧急避孕（EC）意愿的相关因素。Logistic回归模型包含人口统计学情况，既往ECP使用情况及对ECP的知识水平。 结果 17%女性在无保护性行为后不愿意采取EC，而27%女性不确定是否会采取紧急避孕措施。使用意愿与既往使用且未妊娠的经历密切相关。经过多重变量分析，6个认知因素中只有2个因素与使用意愿相关。得知ECP为非处方药物会增加妇女使用ECP的意愿，而得知服用后仍存在妊娠风险会降使用意愿。 结论 提高EC的知识水平虽可增加其使用率，但作用有限。对使用态度和社会规范的进一步研究有助于加深对ECP使用原因的理解。 [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence, socio-demographic and reproductive factors associated with long-acting reversible contraceptive (LARC) use among clients resorting to reversible birth control methods in a tertiary hospital in Ghana. Methods Retrospective review of records of clients who opted for reversible family planning (FP) methods at Komfo Anokye Teaching Hospital, Kumasi, Ghana, from 1 July 2003 to 30 June 2008. We recorded data on their contraceptive history, and socio-demographic- and reproductive characteristics. Categorical variables were compared using the χ2 test and factors associated with LARC uptake examined by binomial regression with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results Of 5946 clients who opted for reversible contraception, 71% chose LARCs, and the remaining 29% chose shorter-acting contraceptives. LARCs were employed mainly by women with more living children ( p trend < 0.001) who had previously used LARCs (adjusted RR: 1.49; 95% CI: 1.39-1.60). Over half of non-contraceptive users started with LARCs while 27% of women switched from shorter-acting contraceptives to LARCs. Conclusion The prevalence of LARC uptake was much higher than the national average. Significant factors associated with current LARC use were the number of surviving children and previous LARC use. [ABSTRACT FROM AUTHOR]

Objectives To investigate satisfaction with abortion care among women and their male partners, and to identify factors associated with high overall contentment with the care received. Methods A multi-centre cross-sectional questionnaire survey conducted in 2009 among 798 Swedish abortion-seeking women and 590 male partners was analysed with logistic regression. Results Overall care satisfaction was rated high by two-thirds (74%) of the women and half (52%) of the men. For women, factors associated with high overall satisfaction with care were: to be well treated by the health care staff (Odds Ratio [OR] = 11.78), sufficient pain relief (OR = 3.87), adequate information about the gynaecological examination (OR = 2.25), suitable contraceptive counselling (OR = 2.23), and ease of access to the clinic by phone (OR = 1.91). For men, the factors were to be well treated by the health care staff (OR = 5.32), and adequate information about the abortion procedure (OR = 2.64). Conclusion Most women and half of the men were pleased with the attention they had received, but one in four women and half the men were not, or not completely, suggesting improvement is needed, especially with regard to men. For both women and men the human aspect of the care, namely, the consideration showed by the attending staff, appears to be the most important factor associated with satisfaction regarding abortion care. [ABSTRACT FROM AUTHOR]

Background The hormonal control of spermatogenesis was unravelled decennia before the recent advances in genetics and molecular biology. This explains why hormonally active agents, with the potential of suppressing pituitary gonadotropins, have been used in attempts to develop clinically applicable contraceptives for men. Male hormonal contraception Earlier studies indicated that high-normal or supraphysiological levels of androgens are needed to achieve an acceptable suppression of spermatogenesis, especially in some Caucasian men. Therefore, non-androgenic agents have been used instead to induce hypogonadism and suppression of spermatogenesis, the resultant hypoandrogenism being counteracted by exogenous testosterone supplementation. In spite of the considerable progress made in male hormonal contraception, further improvements, pertaining to different aspects, are still needed. The most promising regimen to date is a combination of testosterone and a progestin. Conclusions and perspectives Now that male hormonal contraception is technically possible, its refinement and wide implementation depend solely on the willingness of the pharmaceutical industry to invest in the further development of this method. For the time being, condoms and vasectomy remain the only widely available methods for male contraception. [ABSTRACT FROM AUTHOR]

The article reflects on the sustainable supply of reproductive-health commodities in developing countries. It mentions that sustainable supply of commodities can prevent unintended pregnancies and unsafe abortions, averting tens of thousands of maternal deaths annually. It informs that Reaching Millennium Development Goal (MDG) Five for maternal health will require sharp acceleration of progress in order to approach the targets.

In this article the author discusses the effectiveness of diaphragm as a female contraceptive, and the development of a new SILCS diaphragm whose reliability is same as the Ortho diaphragm. It mentions how the selection of a contraceptive method that meets a woman's expectation can improve her compliance and enhance her satisfaction with the method. It also mentions a survey that examines the type of women who would choose a diaphragm and urges contraception providers to promote this method.

Objectives To analyse the acceptability and patterns of use of the levonorgestrel releasing-intrauterine system (LNG-IUS) and the etonogestrel releasing-subdermal implant (ENG implant) among young European women. Methods A total of 454 women aged 20-35 years opting to switch their method of contraception from oral contraception to the LNG-IUS or ENG implant, were recruited in an observational study in four different European countries (France, Ireland, Slovakia and the United Kingdom). The present paper reports the interim results of the study at 12 months of observation. Results Data from 311 subjects (211 using the LNG-IUS and 100 using the ENG implant), with at least one follow-up visit after insertion, were analysed. The cumulative continuation rates at 12 months for the LNG-IUS and ENG implant were 93% and 86%, respectively. Most women were satisfied with their method of contraception after one year of follow-up (80% in the LNG-IUS group and 66% in the ENG implant group). Conclusions Both the LNG-IUS and the ENG implant are highly acceptable contraceptive options among women with previous experience of oral contraceptive use. The highest continuation and satisfaction rates were observed with the LNG-IUS. [ABSTRACT FROM AUTHOR]

Female sterilisation is a safe and effective form of permanent birth control. In the United States (US), it is still the second most commonly used form of contraception overall and is the most frequently used method among married women and among women over 30 years of age. Although several European countries have noted a sharp decline in the number of women electing tubal sterilisation in recent years, such trends have not been as obvious in the US. While female sterilisation remains popular, there are considerable system-level barriers to getting the procedure for certain segments of the population as well as emerging concerns about appropriate utilisation of this contraceptive method in light of newer, reversible options and the knowledge that regret after permanent contraception is high. Given the complexity of this decision-making process, it is critical that providers ensure at the very least that women are aware of the potential disadvantages of tubal occlusion and are knowledgeable of other highly effective contraceptive methods that are available but vastly underutilised in the US, namely, vasectomy, intrauterine contraceptives, and implants. [ABSTRACT FROM AUTHOR]

Objectives This pilot study aimed at identifying counselling topics relevant to young women, at comparing their perceived and actual knowledge about combined oral contraceptives (COCs), and at determining the appropriate scope of counselling material about benefits and risks of COCs. Method Thirty women aged 18--24 completed an online questionnaire assessing information needs and knowledge about 25 medical conditions under consideration as potential counselling items (benefits, risks and myths) and preferences about counselling material. Results Respondents were unable to identify non-contraceptive benefits of COCs or potential severe health risks and had some misconceptions. They rated their knowledge of specific COC effects significantly lower than their corresponding interest in the effect. In contrast, the assessment of how well participants felt they were informed about benefits and risks was rated predominantly as ''rather well''. Eleven items were identified as relevant to patients, the most relevant being cancer-related effects of COCs whereas there was less interest in thrombotic risk. Participants preferred detailed counselling materials and considered gynaecologists, patient information leaflets and the internet as their major sources of information. Conclusion While most women were confident of being knowledgeable about COCs, many were unaware of their knowledge gap. Healthcare professionals should proactively educate about items relevant to their patients. Counselling materials provided by the gynaecologist seem to be an appropriate communication channel. Additional efforts are needed to improve knowledge of the thrombotic and other risk associated with COCs. [ABSTRACT FROM AUTHOR]

Objective To explore key factors influencing young women when choosing between two methods of emergency contraception (EC). Methods We interviewed 26 young women who accessed community sexual and reproductive health services for emergency contraception after they had chosen an EC. Results Most women had an unrealistically high expectation about efficacy of the emergency contraceptive pill (ECP) and lacked knowledge of the intrauterine device (IUD) as an alternative method of EC. Previous use, easy accessibility, ease of use, and advice from peers, influenced women to choose the ECP, whereas past experience of abortion, firm motivation to avoid pregnancy, presentation after 72 hours, and considering that an IUD may provide long-term contraception as well, inclined women to choose the IUD. When participants were shown the IUD, many found it to be smaller and less frightening than they had imagined. Conclusions Women need better information and education about the IUD as a highly effective method of EC. Health professionals must provide such information at every opportunity. Showing the IUD during counselling might help correct misconceptions and would improve acceptability. Wider availability of expertise concerning EC-IUDs is essential to assist more women in making informed decisions when choosing a method for EC. [ABSTRACT FROM AUTHOR]

Objectives To analyse changes in contraceptive practice among Czech women, during the last two decades, and to evaluate the associated demographic impacts. Methods Recent trends in fertility and abortion are presented and compared with earlier survey data on contraceptive use. Data from four Czech surveys carried out as part of international projects in 1993, 1997, 2005, and 2008 were used to document changes in contraceptive practice among Czech women. Results Greater availability and greater acceptance of new birth control methods have resulted in increased contraceptive use and in the replacement of traditional methods with more effective alternatives. While only 42%% of women in union (married and cohabiting) used condoms, the pill or an intrauterine contraceptive in 1993, 75%% of all women with a partner currently use effective contraceptives. The fertility transition towards delayed childbearing has not resulted in additional requirements in terms of family planning as no increase in the abortion rate among young women is observed. Conclusion The shaping of a new reproduction pattern in the Czech Republic has been accompanied by significant improvements in contraceptive practice. Despite the fact that the Czech population cannot be considered to perform outstandingly in terms of use of contraception, any remaining unmet need for modern contraception is marginal. [ABSTRACT FROM AUTHOR]

Objectives To explore young men's perceptions of (i) the risk for themselves and their partners in connection with unprotected intercourse, and (ii) the main barriers to practising safe sex. Methods Qualitative latent content analysis of interviews involving 22 Swedish males aged 16--20, who requested a Chlamydia test. Results The main categories identified were: (1) Low perceived threat regarding sexual risk-taking - personal consequences in focus. Threats could be both immediate and distant with varying preventative strategies. The young men worried more about their personal consequences than about the consequences for their partner. They were confident that an unintended pregnancy would be terminated, leading to decreased motivation for sharing pregnancy-preventing practices with their partner. (2) Perceived barriers to practising safe sex. Main barriers to condom use were interference with spontaneity, pleasure reduction, fear of loosing one's erection, and embarrassment or distrust. Other obstacles were the girl's use of hormonal contraception, and difficulties in communicating about safe sex. Conclusion The young men did not seem to worry about risks when having unprotected sex. To protect men's -- and women's -- sexual and reproductive health, efforts are needed to increase the former's contraceptive responsibilities and awareness of consequences related to unprotected sex. [ABSTRACT FROM AUTHOR]

Background Considerable sexual and reproductive health (SRH) challenges have been reported among rural-to-urban migrants in China. Predictors thereof are urgently needed to develop targeted interventions. Study design A cross-sectional study assessed determinants of unmet need for contraception using semi-structured interviews in two cities in China: Guangzhou and Qingdao. Results Between July and September 2008, 4867 female rural-to-urban migrants aged 18-29 years participated in the study. Of these, 2264 were married or cohabiting. Among sexually-active women ( n = 2513), unmet need for contraception was reported by 36.8% and 51.2% of respondents in Qingdao and Guangzhou, respectively; it was associated with being unmarried, having no children, less schooling, poor SRH knowledge, working in non-food industry, and not being covered by health insurance. A substantial proportion of unmarried migrants reported they had sexual intercourse (16.6 % in Qingdao and 21.4% in Guangzhou) contrary to current sexual standards in China. Conclusion The study emphasises the importance of improving the response to the needs of rural-to-urban migrants and recommends strategies to address the unmet need for contraception. These should enhance open communication on sexuality, increase the availability of condoms, and improve health insurance coverage. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between reproductive health practices/outcomes and exposure to intimate partner violence (IPV) among women in Nigeria. More specifically, the association between IPV and use of contraception; miscarriages,induced abortions, stillbirths, and infant mortality; and having many children, was assessed. Methods Data on studied variables were retrieved from the Demographic and Health Surveys of Nigeria 2008, a nationally representative sample of 33,385 women of reproductive age. IPV was defined as exposure to physical, sexual or emotional abuse. The association between contraception use, pregnancy outcomes and infant mortality, and exposure to IPV was assessed using the chi-square test for unadjusted analyses. To control for potential confounding, socio-demographic variables were adjusted for using multiple logistic regression. Results Compared with women not exposed to IPV, those who were, exhibited a higher likelihood of using modern forms of contraception; having a history of miscarriages, induced abortions, stillbirths, or infant mortality; and having many children. The aforementioned observations still stood after adjustment for potential confounders (e.g., demographic and socioeconomic factors). Conclusion Though causal inference cannot be drawn due to the cross-sectional design, the study has important implications for incorporation of IPV detection and management in initiatives aimed at improving women's reproductive health. [ABSTRACT FROM AUTHOR]

Objectives In Hungary, the one-dose levonorgestrel-only emergency contraception pill (ECP) is available only with prescription. There is a perceived need among both doctors and women to introduce ECP over-the-counter (OTC). The aim of this study was to gain information - which, as in most geographical areas, was lacking so far - on the knowledge and attitude of pharmacists relating to OTC use of ECP in South-Eastern Hungary. Methods A questionnaire survey with 22 questions was conducted among the members of the Chamber of Pharmacists in the three-county area. Results Completed questionnaires were returned by 108 pharmacists. The vast majority (97%) of the respondents were aware of the dosing schedule of the available ECP. Nearly three quarters (73.4%) of the pharmacists estimated the effectiveness of ECP to be 80%. However, the knowledge around side effects, mode of action and effect on the menstrual cycle varied. Fifty-five per cent of the pharmacists would prefer OTC distribution of ECP. Conclusions This is the first study in Hungary about knowledge and awareness of pharmacists regarding ECP. Most respondents were reasonably informed but further training courses for pharmacists are recommended before introducing OTC access to ECP in Hungary. [ABSTRACT FROM AUTHOR]

Objective To gain knowledge about the male partner's experience of being present during an induced home abortion. Methods Twenty-three couples, whose male partner had been present when the woman aborted at home, were interviewed one to two weeks post-abortion. Results Each of the men supported his partner in her decision to have a home abortion, as this gave him the possibility of being near and of caring for her needs on the expulsion day. All the men were present and all their partners confirmed that they had been supportive. Half the men had been anxious prior to the expulsion, but most considered that their experiences during the expulsion had been ‘easier than expected’ and their dominant feeling was one of relief. Conclusions Abortion is an important life event. When taking place at home, it increases the possibility for the couple to share the experience. Sharing an abortion may have a positive impact on those men who lack a sense of responsibility regarding reproductive issues, such as contraceptive use. This could facilitate society's efforts to involve men as a target group in this field. Designing an abortion policy that caters for the needs of both partners is a challenge. [ABSTRACT FROM AUTHOR]

Background and objective After the fall of state socialism in Poland in 1989, a Catholic-nationalist government assumed power. The new political power of the Catholic Church resulted in severe restrictions on family planning (FP) services. Yet, Poland's fertility rate declined sharply, suggesting that women are controlling their fertility despite restrictions. This study examined the Church's influence on women's contraceptive decisions, and how women reconcile religious teachings with their contraceptive use. Methods We conducted a mixed-methods study, including a cross-sectional survey and qualitative interviews, in Gdańsk, Poland with sexually active women aged 18–40. The quantitative sample included 418 respondents; the qualitative sample included 49 respondents. Results Despite restrictions on FP services, modern contraceptive use among our sample was 56%, up from 19% in 1991. Catholicism played a relatively small role in respondents' contraceptive decisions; though 94.2% of respondents were Catholic, 79% reported that the Church had little or no influence on reproductive decisions. Women's explanations for how they reconcile their reproductive practices with Catholicism included using elements of religion to support contraceptive use, prioritising responsibility for family and financial considerations over the Church's prohibitions, and challenging the Church's credibility in FP matters. Conclusions Our findings underscore women's struggles under post-socialist reproductive policies that limit FP access. Despite religious, political, and economic obstacles, contraceptive use has increased dramatically, indicating that FP is a high priority for women in Poland. Policies should respond to women's needs. Comprehensive, state-sponsored FP and sex education are urgently needed and the state should legitimise such services. [ABSTRACT FROM AUTHOR]

Mechanical barriers, specifically male condoms, command renewed interest and are used today by more people. The worldwide prevalence rate of male condoms was about 6% in 2007 corresponding to 65 million cohabiting couples. The prevalence of female barrier methods, including diaphragms, cervical caps and female condoms has declined to less than 1% of women in North America and in north-west Europe. Even smaller percentages use female barriers elsewhere. First-year life table pregnancy probabilities of mechanical barrier methods range from 4 to 19 per hundred in clinical trials. The male condom is the only proved preventive tool against several sexually transmitted infections (STIs), especially HIV. The effectiveness of the diaphragm and cervical caps in this regard appears limited. Further research is needed to measure the efficacy of female condoms in disease prevention. Sponges are not known to protect against STIs. Because of their ease of use and availability, low short-term costs, relative freedom from side effects, and usefulness in combating STIs, mechanical barrier methods, especially condoms, will continue to be used on a large scale. For our literature search we used personal files, search engines such as Popline, Medline, PubMed and Google, and data bases of WHO, FHI and Cochrane Library. [ABSTRACT FROM AUTHOR]

A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the ‘no-scalpel technique’. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30–60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure. [ABSTRACT FROM AUTHOR]

Chemical contraceptives mainly known as spermicides are one of the oldest types of contraceptives. The industrial revolution facilitated new developments, and they became a leading and widespread method. However, their use declined in the second half of the 20th century, and came under focus again only with the upsurge of sexually transmitted infections (STIs). The effectiveness of spermicides depends on the users' compliance and pregnancy rates vary widely: from 6/100 woman-year (with perfect use) to 26/100 woman-year (with typical use). Preparations consist of two components: an excipient (foam, cream, jelly, soluble film, suppository or tablet); and a chemical agent with spermicidal properties (acidic compound, microbicidal agent, detergent). The most widely used active agent has been the surface active (detergent) nonoxynol-9 (N-9). Based on their mode of action (surfactant effect of detergents, enzymatic action of microbicides on cell metabolism) spermicides were thought to provide protection against STIs including HIV. Recent studies have, however, shown that detergents may actually increase the risk. Because of this, there is an urgent need for a suitable non-detergent spermicide, and research should focus on developing new compounds to replace N-9 and other agents having similar undesired effects. This paper reviews the latest studies reporting results on these recent developments. [ABSTRACT FROM AUTHOR]

Despite the popularity of ‘modern’ contraceptives, natural family planning (NFP), including fertility awareness-based (FAB) methods and withdrawal, are practised in most countries. Worldwide FAB methods and withdrawal are used, respectively, by about 3.6% and 2.9% of all couples of reproductive age. This article describes the underpinnings of the different NFP methods, their rationales, histories, rules for use, efficacy and in broad categories their prevalence. Pregnancy rates of FAB methods with perfect use have ranged between 0.3 and 5.0 per 100 users per year, but typical use rates rises into the teens or higher. Withdrawal requires the male partner to be aware of his impending climax and to pull out of the vagina before ejaculation. Perfect use and typical pregnancy rates for withdrawal are estimated to be 4 and 27 per 100 per year, respectively. Many couples find NFP in accord with their own beliefs, satisfactory in its effectiveness and useful in planning a desired pregnancy. Many prize their self-control in practising NFP or withdrawal. In our research we used Medline, Popline and the Cochrane Library search engines in English, local institutional libraries, our own files in our native languages, the literature references contained therein, and source recommendations from colleagues. [ABSTRACT FROM AUTHOR]

Objectives To investigate the causes of the persistently high abortion rate in Serbia. Methods We analysed the legal aspect of abortion, related health care regulations and policies, and social environment, as primary factors, and knowledge, attitudes and practice of health care providers and clients, as secondary determinants of the large number of induced abortions. Results A complex array of factors accounted for the high abortion prevalence. The main ones are easy access to induced abortion coupled with substantial obstacles to efficient use of contraception, insufficient relevant knowledge about and a resistance to modern contraceptives among women and men in need and health care providers, a firm social basis for traditional birth control, and limitations in the family planning programme. Conclusions The persistence of a high abortion rate in Serbia appears to be due to many underlying causes, which have changed little over time. The future of this issue will depend on the introduction of a modern concept of family planning at the political, educational and health care level. [ABSTRACT FROM AUTHOR]

Objective To assess knowledge and attitudes towards abortion among women and obstetricians/gynaecologists in Armenia, in order to facilitate the introduction of medical abortion. Methods Ninety-nine doctors and 400 women in three cities in Armenia were purposively selected to participate in face-to-face interviews using structured survey instruments. Results Most women knew that abortion is legal under any (31%) or certain (50%) circumstances. The majority of women had heard of medical abortion, but had superficial or incorrect knowledge of the method. Thirty percent of women expressed a preference for medical abortion over surgical abortion. Despite the fact that the medications are not readily available in Armenia, nearly one out of three doctors reported having experience in using misoprostol or mifepristone + misoprostol to terminate pregnancies. Doctors not providing medical abortion cited concerns about the method's efficacy and safety, or felt that they did not have enough information. One-third of doctors were very interested in receiving training on medical abortion methods. Conclusions Both doctors and women in Armenia are interested in medical abortion as an alternative to surgical abortion. Efforts should focus on informing women about the legality of abortion and the details of the medical abortion procedure, and on training doctors in this new method. [ABSTRACT FROM AUTHOR]

In this article the author presents his opinion on how to make induced abortion safe and legal, worldwide. He claims that induced abortion has beneficial effects on public health but access to safe induced abortion is a controversial issue in some countries. He talks about human rights and abortion laws and says that woman should have a right to plan their family. He infers that abortion-related mortality and morbidity should be prevented by giving women, affordable, safe and legal abortion.

Objectives To assess the efficacy and acceptability of two misoprostol regimens (400 μg oral or sublingual) following mifepristone for medical abortion. Methods Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 μg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. Results Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85-1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. Conclusions This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women. [ABSTRACT FROM AUTHOR]

Objectives To assess the profile of long-acting reversible contraceptives (LARCs) users in Europe. Methods A random sample of women aged 15-49 years in 14 European countries (Germany, France, UK, Spain, Italy, Russian Federation, Estonia, Latvia, Lithuania, Austria, Czech Republic, Denmark, Norway, and Sweden) underwent web-based or computer-aided face-to-face interviews in June 2006. In this paper data pertaining to a subgroup of women using LARCs are presented. Results A total of 11,490 women participated in the full study. Of these, 1,188 (10%) women were LARC (hormonal implant, injectables, levonorgestrel-releasing intrauterine system [LNG-IUS], copper intrauterine device [Cu-IUD]) users. The age of the LARC users exceeded 30 years for 57-91% of them. Furthermore, more than half of them found convenience an extremely important factor when selecting the LARC as a contraceptive method. As compared to those wearing a Cu-IUD, women using hormonal LARCs experienced fewer physical and emotional symptoms that appeared or worsened during menstruation. Conclusions LARCs have their place in the contraceptive market in Europe. The most popular LARCs among European women were the LNG-IUS and the Cu-IUD; both were mainly used by women who had children and had no wish to have more in the future. [ABSTRACT FROM AUTHOR]

Objectives To compare two post-abortion family planning (FP) service packages on contraceptive use and repeat abortion rate among young women in three cities in China. Methods In this cluster-randomized trial, one FP service package included provision of limited information and referral to existing FP services, and the other, more comprehensive, package consisted - in addition to the above simple package - of individual counselling, free provision of contraceptive materials, and involvement of the male partner. Eight matched pairs of hospitals were certified by centralized randomization. Women undergoing abortion were followed up for six months, and data were collected in two rounds, before and after the intervention. Results We followed a total of 2336 women younger than 25 years (555 before and 555 after the simple intervention package; 634 before and 592 after the comprehensive intervention package). Both packages increased use of any contraceptive method, but the comprehensive approach also increased use of more effective methods. Odds ratios for consistent and correct use of condoms were 2.32 (95% confidence interval 1.55-3.46) and 2.78 (1.81-4.26), respectively, compared with the simple package. The rates of unwanted pregnancies and repeat abortions were somewhat reduced for both packages, with no significant statistical difference between them. Conclusion Couples who received the comprehensive post-abortion FP service appear to use more effective contraceptive methods and show better compliance. [ABSTRACT FROM AUTHOR]

Background In Australia just over half of all women of reproductive age have experienced an unplanned pregnancy, many of which could have been avoided by use of emergency contraception. A dedicated emergency contraceptive pill (ECP) pack became available on prescription in Australia in 2002, and over the counter in 2004. Objectives To determine if availability of a dedicated over the counter ECP pack in Australia increased knowledge and use of emergency contraception (EC). Material and methods Women attending three free-standing abortion clinics in Sydney answered an anonymous questionnaire on their knowledge and use of the ECP. Group 1 (208 women) was recruited prior to a dedicated ECP pack being available, group 2 (308) after it was available on prescription, and group 3 (202) after it became available over the counter. Results Women who had heard about EC were significantly younger (p < 0.005). The mean age of women who had never heard about EC was 29.8 years compared to 26.3 for women who had heard about EC. More women expressed awareness of the ECP after it became available over the counter. Women in group 2 attained a higher educational level than women in the other groups (p < 0.005). There was a significant trend to increased use of the ECP in women of higher educational level (p < 0.005). The use of EC did not increase significantly with improved availability and access. Conclusions Among women seeking termination of pregnancy wider availability of the ECP has increased women's awareness of EC but not use. [ABSTRACT FROM AUTHOR]

Objectives To compare the efficacy of repeated doses of 100 μg vs. 200 μg misoprostol given sublingually for induction of second trimester abortion. Methods One hundred and sixty-two women at 15-22 weeks' gestation were randomized to receive every 2 h either 100 μg (group 1; n = 81) or 200 μg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen. Results There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4-1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37-3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 ± 592 μg [7 ± 3 doses] vs. 614 ± 432 μg [6 ± 4 doses], respectively; p = 0.000). Conclusions Sublingual administration of repeated doses of 100 μg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 μg. [ABSTRACT FROM AUTHOR]