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Introduction: Medical students play an important role in achieving sexual and reproductive health outcomes, including a greater participation of men in family planning. Objective: To describe the level of knowledge, perception, and acceptance of vasectomy in a sample of Latin American medical students (i.e., whether they would recommend this procedure to their patients, and in the case of male students, whether they would undergo it at some point in their lives) in a sample of Latin American medical students. Materials and methods: Multicenter, cross-sectional, analytical study conducted in November 2020 in 2 676 medical students (1st-7th year) from 8 Latin American countries. Data were collected using a questionnaire validated in each country and completed in Google Forms. The chi-square test of independence was used to determine differences in study variables (knowledge, perception, and acceptance) for each established subgroup, with a significance level of p

Background and Objective: A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population., Material and Methods: Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment., Results: We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected., Conclusions: Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To analyze the perspectives and practices of personnel involved in family planning with women at reproductive risk due to chronic diseases., Method: Qualitative study in which physicians and nurses from primary care centers in a state in central Mexico were interviewed. Interviews were transcribed and analyzed under the Grounded Theory proposal., Results: The perspectives and practices in family planning interventions are unilaterally framed in the biomedical model. Three categories of analysis emerged: "The battle", "Convince by imposing", "Monitor them and catch them"., Conclusion: It is necessary to promote competencies in interculturality, gender perspective and human rights to make the intervention more of a counseling and less of a prescription for life projects.

Background: More than 120 million women worldwide want to avoid pregnancy, but most are not using contraception. This could be because they may not have received clear instructions on how to use the method properly, may not have obtained the most appropriate method for their needs, or may not have been aware of the side effects., Objective: To compare the acceptance of family planning methods (FPM) in women attended for childbirth, caesarean section, and curettage., Material and Methods: Cross-sectional, analytical, prolective study. Women between 18 and 40 years of age in the immediate puerperium attended at a third level hospital were included. A survey which included 5 items with multiple choice answers and 7 with open answers was applied. General data were gathered, included the acceptance or not of some planning method, and the reason for its use or rejection. In addition, it was identified which methods they knew, if they received counseling and the perspective of effectiveness., Results: A total of 648 women were included; 216 women in each group. It was found that there is a higher percentage of acceptance of FPM in women attended by cesarean section, compared to those attended by delivery and curettage (p = 0.0158)., Conclusions: Women attended by cesarean section are more willing to approve FPM, compared to those attended by delivery and curettage. Those patients who receive counseling are the most informed and the ones who approve FPM. Nurses and family physicians are the health workers who offer more counseling., (Licencia CC 4.0 (BY-NC-ND) © 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Introduction: The Andalusian Registry of Pregnancies in patients with multiple sclerosis is the largest Spanish registry on multiple sclerosis (MS) and family planning. For the first time, it includes information on the fertility of men with MS. The influence of the use of a disease-modifying treatment (DMT) on the health of the foetus/newborn and the impact of breastfeeding on MS are also analysed., Subjects and Methods: This is a multicentre, prospective and observational study. Recruitment of patients took place between December 2018 and December 2020. Women were followed up for one year after delivery. Altogether 100 women and 16 men were included, with a total of 103 newborn infants., Results: The annualised relapse rate of the women with MS decreased significantly during pregnancy (from 0.23 to 0.065). A total of 11.2% of patients resorted to assisted reproductive techniques in order to conceive a child. No association was found between the use of a DMT at conception and/or pregnancy and the risk of miscarriage, prematurity or low birth weight. Over half the women with MS (54.2%) chose to breastfeed (26.7% of them while on a DMT)., Conclusions: MS does not affect the fertility of men. Neither does the use of a DMT at the time of conception affect their fertility or their children's health. Assisted reproductive techniques did not have a negative impact on the course of MS. Breastfeeding is a common practice among women with MS and there is no evidence of positive or negative effects on disease progression.

Research conducted to define general knowledge of university students’ attitudes and behaviors about family planning. The sample consisted of 755 Sakarya University students. Data were collected from an open-ended questionnaire form and faceto-face interviews. The data analysis process was conducted using specific software. Most participants (59.7%) were over 22 years old and female, and 1.2 % of the females were married. Women in the study had a positive outlook regarding the positive effects of family planning on sexual health and stated that family planning is important to both society and our economy. The awareness and knowledge regarding family planning was found to be strongest among older participants. The family planning concept was understood correctly by about half of the students. Finally, young people did not have sufficient knowledge about family planning, its methods or where to obtain information on the topic.

The aim of this study was to identify the care provided by health professionals who work in family planning, in a Family Health Unit in the municipality of Ribeirao Preto, São Paulo. This was a descriptive, cross-sectional and quali-quantitative study. Data were collected through interviews with 11 health professionals. The results revealed that most professionals had not received training in family planning, and that information about contraceptive methods is transmitted in an individual way, having women as the target-public. The contraceptive methods which the professionals suggest and offer more are those considered most effective. These findings indicate that family planning care at the Family Health Unit needs to be adjusted not only to ensure quality of service, but also to ensure sexual and reproductive rights.El objetivo de este estudio fue identificar la asistencia ofrecida por los profesionales de la salud que actúan en la planificación familiar, en una Unidad de Salud de la Familia, en el municipio de Ribeirao Preto, Sao Paulo. Se trata de un estudio descriptivo con corte transversal y abordaje cuali-cuantitativo. Los datos fueron recolectados por medio de entrevista con 11 profesionales de la salud. Los resultados revelaron que la mayoría de los profesionales no recibió capacitación en planificación familiar, siendo que la información sobre los métodos anti-conceptivos es trasmitida de forma individual, teniendo como público objetivo a las mujeres. Los métodos anticonceptivos considerados más eficaces son aquellos sobre los cuales los profesionales más orientan y ofrecen. Los hallazgos apuntan que la asistencia en planificación familiar en la Unidad de Salud de la Familia necesita de adecuaciones, no sólo para asegurar la calidad del servicio prestado, como también para asegurar los derechos sexuales y reproductivos.O objetivo deste estudo foi identificar a assistência oferecida pelos profissionais de saúde que atuam em planejamento familiar, em uma Unidade de Saúde da Família, no município de Ribeirão Preto, São Paulo. Trata-se de estudo descritivo, com corte transversal e abordagem quali-quantitativa. Os dados foram coletados por meio de entrevista com 11 profissionais da saúde. Os resultados revelaram que a maioria dos profissionais não recebeu capacitação em planejamento familiar, sendo que a informação sobre os métodos anticoncepcionais é transmitida de forma individual, tendo como público-alvo as mulheres. Os métodos anticoncepcionais, considerados mais eficazes, são aqueles sobre os quais os profissionais mais orientam e oferecem. Os achados apontam que a assistência em planejamento familiar na Unidade de Saúde da Família necessita de adequações, não só para assegurar a qualidade do serviço prestado como também para assegurar direitos sexuais e reprodutivos.

OBJETIVO: Identificar la influencia de las características reproductivas y el empoderamiento femenino en el uso de servicios de planificación familiar (PF). MATERIAL Y MÉTODOS: Diseño de casos y no casos pareado por controles vecindarios (147 usuarias y 146 no usuarias de servicios de PF de la Secretaría de Salud durante 2003), en dos municipios del estado de Guanajuato, México. Análisis logístico multivariado para identificar diferencias entre usuarias y no usuarias. RESULTADOS: El uso de servicios de PF se asoció positiva y significativamente con poder de decisión de la mujer (alto: RM=3.2; IC95% 1.4-7.4); comunicación con la pareja para el uso de métodos de PF (RM =3.5; IC95% 1.4-9.3), y número de embarazos en su vida (> 6 hijos: RM =4.4; IC95% 1.4-13.8). CONCLUSIONES: El desarrollo de estrategias que involucren a los hombres y que, por otra parte, fomenten y fortalezcan el empoderamiento femenino, puede contribuir a una mayor utilización de servicios de PF.OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95% 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95% 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95% 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

O presente trabalho trata da análise de alguns aspectos do Planejamento Familiar voltados para a contracepção de acordo com o que foi publicado na Revista Brasileira de Enfermagem no período de 1960 a 1997. A questão analisada, considera o discurso da Igreja (católica), do Estado e das Feministas, buscando perceber o posicionamento da Enfermagem . Os registros encontrados revelam que, na década de 60, predominou o discurso da Igreja, sendo que na década de 70 emerge também o discurso do Estado. Na última década analisada, não foi identificado o discurso da Igreja, o do Estado consolida-se e mantém-se o das Feministas. Estes resultados sugerem que a Enfermagem de algum modo reconhece o Planejamento Familiar como pauta de discussão. A metodologia utilizada possibilitou identificar quais os compromissos da Enfermagem em relação ao Planejamento Familiar, enquanto necessidade do ser humano nas suas relações com o Estado e a Sociedade.El presente trabajo trata del análisis de algunos aspectos de la Planificación Familiar referidos a la contracepción en acuerdo con las publicaciones en la Revista Brasileira de Enfermagem en lo periodo de 1960 hasta 1997. La cuestión es analizada desde el discurso de la Iglesia (católica), del Estado y de las Feministas buscando percibir cuál es la posición de la Enfermería. Los registros encontrados reflejan que, en la década de 60, predominó el discurso de la Iglesia, mientras que en la década de 70 emerge también el discurso del Estado. En la década de 80, los tres discursos se hacen presentes en los artículos publicados en la REBEn. En la última década no fue identificado el discurso de la Iglesia, el del Estado se consolida y se mantiene el de las Feministas. Estos resultados sugieren que la producción científica de la Enfermería reconoce la Planificación Familiar como tema de discusión. La metodología utilizada posibilitó identificar cuales fueron los compromisos de la Enfermería en relación a la Planificación Familiar como una necesidad del ser humano en sus relaciones con el Estado y la Sociedad.This work analyses some aspects of family planning policy in Brazil related to contraceptive methods as published in Revista Brasileira de Enfermagem between 1960 and 1997. The subject analysis considers three categories: Catholic church, feminist and official state discourse. According to the records, in the decade of 1960, the Catholic church discourse was predominant. This situation continued in the decade of 1970, accompanied with emerging voice of the official state discourse. In the decade of 1980, the feminist discourse joined. Finally, in the decade of 1990 the feminist discourse continued, the official state discourse was consolidated and that of the Catholic church was not found any more. In conclusion, the journal established family planning on the agenda of Brazilian nursing by the means of scientific production. The methodology used enabled us to identify what are the obligations of nursing with respect to family planning in the context of its relationship with state policies and with the society.

OBJETIVO: Identificar as representações sobre os métodos contraceptivos que poderiam ser alternativas à esterilização, para um grupo de mulheres esterilizadas, visando a entender os motivos de rejeição a esses métodos. MÉTODOS: Trata-se de trabalho descritivo, qualitativo, cuja população estudada foi constituída por 31 mulheres esterilizadas, aleatoriamente selecionadas da listagem de pacientes atendidas pelo Programa de Planejamento Familiar de um ambulatório de um hospital universitário. As informações foram obtidas das mulheres estudadas por meio de entrevistas semi-estruturadas. As transcrições foram analisadas segundo o método de Análise de Conteúdo. RESULTADOS: A rejeição aos métodos contraceptivos esteve baseada em representações resultantes de informações técnicas recebidas em serviços de saúde, de vivências anteriores com esses métodos ou de informações recebidas do meio social. A rejeição aos métodos hormonais e DIU baseou-se principalmente em representações de baixa inocuidade; os métodos comportamentais (Tabela, Billings) foram rejeitados por representações de baixa eficácia; os métodos de barreira (diafragma e camisinha), por dificuldades no uso desses métodos relacionados a padrões culturais de exercício da sexualidade e representações de baixa eficácia. CONCLUSÕES: A opção pela esterilização feminina pode ser indicativa de rejeição às alternativas contraceptivas oferecidas pelos serviços de saúde. Os profissionais da área de saúde reprodutiva devem aprofundar seu conhecimento sobre os fatores pessoais, socioeconômicos e culturais que podem influenciar as mulheres na procura por um método contraceptivo que assegure maior controle de sua própria fecundidade.OBJECTIVE: To identify the representations of contraceptive methods within a group of sterilized women, aiming at understanding the reasons why they refused those methods. METHODS: A descriptive qualitative study was carried out on 31 sterilized women, randomly selected from a list of patients attending the Family Planning Program of a university hospital. Data was collected through a semi-structured interview. Interview transcription was analyzed according to the Content Analysis method. RESULTS: Refusal to other contraceptive methods was based on representations formed from a mixture of technical information received at health service units, their previous experiences with contraceptive methods and information received in the social environment. Rejection of high efficacy methods (hormonal and IUD) was mostly based on their low innocuousness; refusal to fertility awareness methods (calendar calculation, Billings ovulation method) was due to their low efficacy; and rejection of barrier methods (condom, diaphragm) was due to a culturally patterned sexuality full of interdictions as well as to their low efficacy. CONCLUSIONS: The option for female sterilization may be indicative of the refusal to the contraceptive alternatives offered by health services. Reproductive health professionals should increase in their practice the knowledge about personal, socio-economic and cultural factors that affect women's choice of a contraceptive method that could guarantee a better control over their own reproductive life.

The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.

Introduction: Scientific evidence suggests that mother-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowledge of CAM in women during the first postpartum semester., Methods: An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention consisted of face-to-face counseling about MAC combined with informative brochures and WhatsApp⌖ messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months postpartum. The analysis was performed using R software version 4.0.3., Results: Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC., Discussion: Early postpartum intervention with various communication and information strategies can be useful to choose the MAC that is considered most appropriate for each woman and its correct use.

Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and Methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and STIs were excluded. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to post-procedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother’s health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with complications within the first seven post-VIP days in the studied patients. Prospective studies to assess the safety and cost of the different VIP options are required.

Los oferentes del servicio de vasectomía en la Clínica del Hombre, en Bogotá, construyen sus representaciones sobre este método anticonceptivo con base en un discurso biomédico, en su interacción con el usuario y en sus propias experiencias de vida. En la oferta del servicio, los orientadores tienen el mayor contacto con los usuarios. Son los encargados de indagar los motivos para solicitar el servicio y dar información que permita tomar una decisión con tranquilidad y certeza. Adicionalmente, son quienes, de manera directa, filtran la demanda del servicio a partir de sus experiencias, conocimientos y destrezas. Esto, conforme a una permanente negociación que realizan entre los criterios institucionales (número y espaciamiento de los hijos, edad del cliente, estabilidad de la pareja y grado de seguridad en la decisión), y su percepción y valoración del usuario. Las representaciones de los orientadores estudiados sobre la toma de decisión de la vasectomía muestran que es presentada, por una parte, como un método fácil e inofensivo y, por otra, como una opción de planificación liberadora.Vasectomy service providers at the Clínica del Hombre (Men's Clinic) in Bogotá, Colombia, construct their representations concerning male sterilization on the basis of biomedical discourse, their interaction with clinic users, and their own life experiences. During provision of such services, the counselors are the health professionals who have the closest contact with these clients of the clinic. Counselors are in charge of exploring their motivations in requesting the service, in addition to providing information allowing them to take a calm, sound decision. They also directly filter demand based on their experience, knowledge, and skills, in permanent negotiation between institutional criteria (number of children and gap between them, client's age, steadiness of couple's relationship, and conviction concerning the decision), and their perception and assessment of the client. An analysis of the counselors' representations of decision-making as pertaining to vasectomy indicates that it is a relatively simple and harmless procedure as well as a liberating option in terms of family planning.

Objective: In Spain, a total of 95,149 voluntary terminations of pregnancy (VTP) took place only in the year 2019, 90% of them requested by the woman, 53% of whom had at least one child. This situation highlights the relevance of postpartum family planning (PFP) and the work of the professionals in charge of its promotion. The aim of this study was to establish whether midwives and the rest of the nursing professionals regard PFP as an activity to perform within their professional role and how they implement it, as well as to identify their knowledge on it., Methods: Study performed through an ad-hoc questionnaire between March 2017 and June 2019 in three groups of Nursing professionals dedicated to woman care (n=153) made up of: 1) Nurses specialized in Obstetrics and Gynecology Nursing (Midwifery) of the Delivery suite Department; 2) midwives in Primary Care; 3) Nurses in Postpartum Unit from 3 different hospitals and 37 associated health centers. Analysis by labor group and the comparison of the different professional activities were performed through Pearson chi-squared test or a likelihood ratio, depending on sample size in qualitative variables, and in quantitative variables, by Kruskal-Wallis' test., Results: Not all professionals regard PFP as an activity within their professional role, and there is no consensus regarding its implementation (P<0.001). Concerning their level of knowledge, there are differences among professionals regarding the timeframe when the woman should receive the information on PFP (P=0.002), only 13% of them know that PFP should be started from day 21 of postpartum, and although 95% of them know about the incompatibility of breastfeeding with some contraceptive methods, this knowledge is higher among midwives than among general nurses (P=0.012)., Conclusions: Although midwives are the most aware and knowledgeable professionals on PFP, the responsibility of informing women on postpartum contraception does not always fall on them, and this situation could have an effect on the woman's health and reduce the incidence of unwanted pregnancies., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The main purpose of this paper is to understand the relationship existing between Gender-Based Violence (GVB) and the Use of Reproductive Health and Family Planning services. To carry out this task, we use multivariate logit regression models to explore the direction and strength of the relationship, using a population-based sample for Bolivian women during 2003-2004. Results show a strong, negative and significant relationship between GVB and use of RH/FP services at the population-level, after adjusting for respondent’s and partner’s individual and household characteristics. That is, GBV is strongly and significantly associated with the use of RH/FP services, in a way that women experiencing domestic violence are less likely to use those services.

Objective: to analyze the correlation between child development and pregnancy planning and other associated aspects., Method: a cross-sectional study conducted with 125 mother-child dyads, the children aged from 11 to 23 months old and attending daycare centers located in socially disadvantaged areas. Child development according to domains was assessed using the Ages & Stages Questionnaire-BR and pregnancy planning was evaluated through the London Measure of Unplanned Pregnancy. The mothers were interviewed at their homes and non-parametric tests were used for data analysis., Results: 17.6% of the pregnancies were unplanned, 24.8% were planned and 57.6% were ambivalent. Inadequate development in the different domains ranged from 21% to 40% and was not associated with pregnancy planning. However, the "communication" domain was associated with Bolsa Família and the "personal/social" and "communication" domains, with gender; while "personal/social", "broad motor coordination" and "fine motor coordination" were domains related to the child's age., Conclusion: no correlation between pregnancy planning and child development was observed; however, the low frequency of planned pregnancies and the high percentages of inadequate child development show the need to invest in the training of health professionals, both for contraceptive care and preconception health and for the promotion of child development, especially in socioeconomically disadvantaged contexts.

Objective: To determine the incidence of low libido in women using the levonorgestrel (LNG) subdermal implant for contraception after 12 months and to identify other adverse effects. Materials and methods: Cohort study that included women over the age of 18, with no children or prior gestations and in a stable relationship, with an LNG implant inserted at least three months before in a private teaching hospital in Armenia (Quindío), Colombia, between 2014 and 2019. Women with a history of sexual dysfunction, sexually transmitted infections in the past six months, weighing more than 89 kg and difficult to follow were excluded. Consecutive sampling was used. The characteristics of the study population were described, the cumulative incidence of low libido and the adverse effects related to the LNG subdermal implant after 12 months of follow-up were estimated. The tool used was the Female Sexual Dysfunction Index (FSFI). Descriptive statistics were applied. Results: The participants were 238 women with a mean age of 24.69 (SD ± 5.82) years. An 18.82% incidence of low libido was found. In 60.25% of the women were diagnosed with low libido in the first 6 months of follow-up. Adverse effects manifested as early as 3 months after the insertion of the implant, the most frequent being irregular bleeding (62.34%), followed by amenorrhea (38.91%) and weight gain (33.89%). Conclusions: It is important for practitioners and users to become aware of the presence of low libido disorder and the adverse events that may occur with the use of the levonorgestrel subdermal implant. Future research is required to confirm these findings and the underlying physiological cause.

Los oferentes del servicio de vasectomía en la Clínica del Hombre, en Bogotá, construyen sus representaciones sobre este método anticonceptivo con base en un discurso biomédico, en su interacción con el usuario y en sus propias experiencias de vida. En la oferta del servicio, los orientadores tienen el mayor contacto con los usuarios. Son los encargados de indagar los motivos para solicitar el servicio y dar información que permita tomar una decisión con tranquilidad y certeza. Adicionalmente, son quienes, de manera directa, filtran la demanda del servicio a partir de sus experiencias, conocimientos y destrezas. Esto, conforme a una permanente negociación que realizan entre los criterios institucionales (número y espaciamiento de los hijos, edad del cliente, estabilidad de la pareja y grado de seguridad en la decisión), y su percepción y valoración del usuario. Las representaciones de los orientadores estudiados sobre la toma de decisión de la vasectomía muestran que es presentada, por una parte, como un método fácil e inofensivo y, por otra, como una opción de planificación liberadora.

Objetive: Analyze the perception of adolescent pregnancy in the Department of North Santander., Method: A descriptive cross-sectional study was conducted with 406 adolescent mothers between 10 and 19 years old in 6 sub-regions of the department. We used a structured survey and the Statistical Package for the Social Sciences (SPSS; Version No. 23) was employed for the data tabulation., Results: 69 % of adolescents believe that unplanned pregnancy is associated with the lack of sexual education. 66 % say that it is preventable with the use of contraceptive methods. It is known that unwanted pregnancies are the main cause of school dropouts for 62 % of adolescents., Discussion: Ensuring greater access to sex education and facilitating the free and easy access to contraception can reduce the problem of teen pregnancy.

Objective: To analyze the reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome (AIDS)., Method: Cross-sectional and descriptive study carried out from January to December, 2015, in the outpatient care of infectious disease unit in a hospital located in Fortaleza, Ceará. Data were collected through a form applied by interview in a private setting., Results: 102 women participated in the study. Most were aware that they were serologically positive with human immunodeficiency virus (HIV) during prenatal care (96.1%) and did not intend to have more children (63.7%). Women who were less than 39 years of age, had a higher educational level, and a shorter time of antiretroviral therapy had better chances of having children (p≤0.05). Having a steady partner increased the chance of desiring to have children, while tubal ligation was higher among women that did not receive counseling on family planning. Knowledge of family planning was limited because of lack of assistance provided by health professionals., Objetivo: Analisar aspectos reprodutivos e conhecimento sobre planejamento familiar de mulheres com síndrome da imunodeficiência adquirida (Aids)., Método: Estudo transversal, descritivo, realizado de janeiro a dezembro de 2015, no ambulatório de infectologia de um hospital em Fortaleza, Ceará. Os dados foram coletados por meio de formulário, aplicado por entrevista em ambiente privativo., Resultados: Participaram do estudo 102 mulheres. A maioria delas teve conhecimento da sorologia positiva para vírus da imunodeficiência humana (HIV) durante o pré-natal (96,1%), e estas não pretendiam mais ter filhos (63,7%). Mulheres com idade menor que 39 anos, maior escolaridade e menor tempo de terapia antirretroviral tiveram maiores chances de ter filhos (p≤0,05). Mulheres com idade menor que 39 anos e maior escolaridade tiveram maiores chances de ter informações corretas sobre ter filhos na vigência do HIV (p≤0,05). Ter parceiro fixo aumentou a chance de desejar ter filhos, enquanto a laqueadura tubária foi maior em mulheres que não receberam orientações sobre planejamento familiar., Conclusão: A maioria das mulheres com Aids não pretendem mais ter filhos. O conhecimento sobre o planejamento familiar foi limitado por falta de orientações pelos profissionais de saúde., Objetivo: Analizar aspectos reproductivos y el conocimiento acerca de planificación familiar de las mujeres con síndrome de inmunodeficiencia adquirida (SIDA)., Método: Estudio transversal, descriptivo realizado de enero a diciembre de 2015, en la sala de enfermedades infecciosas de un hospital de Fortaleza, Ceará. Los datos fueron recolectados a través de una entrevista semiestructurada de forma de cuestionario en un ámbito privado., Resultados: El estudio incluyó a 102 mujeres. La mayoría de ellos tenían conocimiento de ser seropositivas para el virus de la inmunodeficiencia humana (VIH) durante la atención prenatal (96,1%), y que no tenía intención de tener más hijos (63,7%). Mujeres menores de 39 años, con educación superior y terapia antirretroviral más corta eran más propensas a tener hijos (p=0,05). Mujeres con edades de menos de 39 años y más educación tenían más probabilidades de tener la información correcta acerca de tener hijos en presencia del VIH (p=0,05). Tener pareja estable aumentó la posibilidad de desear tener hijos, mientras que la ligadura de trompas fue mayor en las mujeres que no han recibido orientación sobre la planificación familiar., Conclusión: La mayoría de las mujeres con SIDA no tienen intención de tener hijos. El conocimiento acerca de la planificación familiar se vio limitada por la falta de orientación por los profesionales de la salud.

Nearly 38% of unplanned pregnancies occur because of unmet contraceptive needs. In HIV-positive women, these figures triple, a phenomenon explained by social determinants such as poverty, access to health services, violence, and forced displacement, all of which are frequent elements in the lives of these women. Unplanned pregnancies represent a psychological burden related to women's fear of transmitting the infection to their children, orphanhood, and assuming risks during pregnancy, in addition to family and social consequences that are expressed in lack of prenatal care, neglect of their health, and an increased likelihood of vertical transmission. Technical assistance for differentiated contraception counseling integrated into HIV care and control services is basic to achieving short- and medium-term elimination of vertical transmission of HIV. These women's characteristics are different from those of the general population, as expressed in their reproductive lives, desires, and intentions regarding motherhood; and their unplanned pregnancies represent a greater psychological, social, and economic burden than that of other women. Recognizing this would allow contraception counseling to be provided by HIV care and follow-up programs, in the same place and time, with trained personnel, capable of understanding and meeting their reproductive needs within a rights-based framework, ensuring that health systems, based on the responsibility they have to society, would be capable of offering quality reproductive care counseling, aimed at meeting the specific needs of HIV-positive women.

Objective: To evaluate the effectiveness of a contraceptive counselling intervention among adolescents by sex and origin., Methods: A pre-post study with a 3-month follow-up was conducted in adolescents from three disadvantaged neighbourhoods. Participants received a counselling session at a community centre. Contraception use at last intercourse and knowledge, beliefs and self-efficacy before and after the intervention were compared with χ(2) and McNemar tests, stratified by sex and origin (autochthonous or immigrant)., Results: A total of 138 (76%) participants completed the follow-up. Fifty-five percent of the participants were girls, 85% were aged 16-19 years and 71% were immigrants. Knowledge and several self-efficacies increased after the intervention. Condom use increased by 5.4% and the proportion not using any method declined by 7.7%., Conclusions: Contraceptive counselling in the community setting increased the use of contraception and improved psychosocial determinants, especially in immigrant adolescents., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: The absence of IUD visible threads in the cervix is a complication of the intrauterine device. The IUD withdrawal in these cases was performed with Novak cannula or curettage instrumented under anesthesia and surgery. Its extraction with Mathew clip is an alternative., Objective: To demostrate the effectiveness of the Mathew's clip as an alternatively for removal of intrauterine devices not visible threads., Material and Methods: A cross-sectional, retrospective, descriptive study was conducted in from February 2012 to July 2014 at the Family Planning Service of Gynecology and Obstetrics of the General Hospital of Mexico "Dr. Eduardo Liceaga "., Results: 106 patients (54%) had no visible threads; in 84 patients (81.5 %) it was removed with Novak, cannula; in 19 patients (18.4%) in which it was not possible, the removal was done with a Mathew's clip., Discussion: Mathew' clip is an alternative in cases where it was not possible to remove the IUD with Novak cannula, 19 IUDs no visible threads were removed. CONCLUSIONS. Mathew clip for removal of intrauterine devices with no visible threads means less risk to the patient and a decrease in institutional costs.

Objective: Determine the impact of informed contraceptive counseling on choice of contraceptive method., Methods: Multicenter descriptive study using before-and-after evaluation in nine cities in Colombia. Women considering use of self-administered combined hormonal methods at the time of consultation were invited to participate. They were asked about contraceptive method use and preference, following signing of informed consent. Later, they were given standardized medical advice on contraception and then asked again about contraceptive preference and reasons for their choice., Results: The study enrolled 858 women. At the beginning of the study, 538 (62.7%) women were using the combined pill and 281 (32.8%) were not using any contraceptive method. Before receiving counseling, women showed a preference for the pill (62.7%), followed by the intravaginal ring (28.4%), and transdermal patch (14%). After counseling, preferences were as follows: pill (40.8%), intravaginal ring (31.5%), and transdermal patch (11.3%). After counseling, 32.5%, 26.8%, and 7.5% of those considering the pill, patch, and ring, respectively, changed their intended choice. Region of origin, employment status, desire to conceive a child in the future, and having a stable relationship showed a statistical relationship to choice of method. However, age, number of children, and level of education were not determining factors., Conclusions: Medical advice has an impact on choice of self-administered combined hormonal contraceptives, which helps women to use the method of their choice and improves adherence to the method in accordance with its particular conditions.

INTRODUCTION. Multiple sclerosis (MS) is a disabling disease occurring mainly in women of childbearing age. MS may interfere with family planning and motherhood decision. AIM. To study the influence of MS diagnosis and course of the disease on motherhood decision. PATIENTS AND METHODS. The cohort of 35 to 45-year-old female patients diagnosed with MS for at least ten years was selected from six Portuguese MS centers. A structured questionnaire was applied to all patients in consecutive consultation days. Clinical records were reviewed to characterize and collect information about the disease and pregnancies. RESULTS. One hundred women were included; mean age at MS diagnosis was 26.3 ± 5.0 years; 90% of the participants presented with a relapsing-remitting MS; 57% had no pregnancies after the diagnosis. MS type and number of relapses were not significantly different between women with or without pregnancies after the diagnosis (p = 0.39 and p = 0.50, respectively). Seventy-seven percent of the patients did not have the intended number of pregnancies. Main reasons given were fear of future disability and the possibility of having relapses. Forty-three women considered that pregnancy might worsen MS. CONCLUSION. In our population, motherhood choice was unrelated to the MS type and the number of relapses. However, a relevant number of women had fewer pregnancies than those intended before MS diagnosis and believed that pregnancy could worsen the disease. An effort to better inform the patients should be made to minimize the impact of MS diagnosis on motherhood decision.

Objective: To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health., Methods: We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis., Results: The discourses were grouped into four categories related to participants' perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact., Conclusions: The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

The risk of pregnancy in breastfeeding should be a concern of women. Family planning programs in the postnatal period contraceptive choices offer high efficiency. Breastfeeding is a natural contraception method (LAM) as a contraceptive shield has 98 % efficiency. Women should consider using an alternate contraceptive method when feeding requirements for this method to be effective are not met. Some of contraceptive alternatives in lactation include hormonal methods. According to the Medical Eligibility Criteria for Contraceptive Use WHO combined hormonal methods are contraindicated during breast feeding, hormonal progestogen only method are considered only in Group 3 and Group 1 immediate postpartum after 6 weeks postpartum. There are modifications to these criteria by the CDC and the UK for the use of these hormones in early in lactation.

The objective of this study is to analyze adolescents' knowledge and perceptions of Chile's Family Planning Program. A cross-sectional study using both quantitative (semi-structured surveys) and qualitative (focus group technique and individual surveys) research methods was conducted with a sample of 277 adolescents aged 15-19 years who were users of the Hospital de El Carmen, in the year 2010. The study results showed that 12% of the participants had initiated sexual activity (of this group, 42% of males and 22% of females had done so before the age of 15). Although all participants recognized that both partners should take responsibility, women consulted the program more frequently than men (13.5% of males and 40% of females had consulted the program). Women also acknowledged receiving more information on birth control methods before initiating sexual activity than their male peers. Adolescents of both sexes continue to have misconceptions about birth control. Therefore, it is necessary to enhance activities aimed at heightening awareness of the program among adolescents.

The family planning (FP) concept has traditionally been, and is closely related to, sexual and reproductive health. At the International Conference on Population and Development held in Cairo in 1994, FP is recognized as a health strategy that, properly applied, can contribute to the development of nations. Over the past years we have found that the benefits are not only aimed at preventing unwanted pregnancies, there by preventing induced abortions and maternal death, but it also improves child health, facilitating access to education for children in the world, it promotes the empowerment of women not only in the workplace but also in other areas such as politics and thus, the concept of gender; it helps to reduce poverty by stimulating economic development and increasing the standard of living of people . This means that it not only contributes to one but to the eight Millennium Development Goals by 2015. Despite the evidence of its benefits, there are still social, cultural, political or religious barriers that cause an unmet need in Family Planning, which does not respect the right of individuals to choose and decide the number of children they want, and prevent the experience of a healthy sexuality.

Objectives: To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old., Method: We performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results., Results: The adolescent's sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy., Conclusions: The family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.

Objective: To describe women's perception of health care after they decided to have a voluntary termination of pregnancy and their referral to the abortion clinic., Design: Qualitative method, using semi-structured interviews carried out between April and June 2005., Setting: Primary Health Care District of Seville, Spain., Participants: Women living in the city of Seville and attending subsidized abortion clinics., Main Measurements: Thirty-six women of varying ages and educational level were interviewed. The interview studied the assessment and information given by health professionals, and accessibility and use of family planning services. The results were analysed and triangulated with other studies and experts in the field., Main Results: Most of the women interviewed were satisfied with the health care provided. Occasionally they perceived a bureaucratic attitude from physicians, who transmitted their disapproval and lack of support for an abortion decision. There were important differences in the way they were referred to abortion clinics, and in the information given to the women. Older women opted for private care, because this accelerated procedures and protected their privacy. Most women did not use family planning services before the abortion decision, except for requesting contraception., Conclusions: The study found there is a need to reduce the variety of patterns of care for women requesting an abortion, to speed up the proceedings and to train family doctors in assessment and information delivered to women during the process.

Objectives: This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning)., Methods: The study had quantitative (cross-sectional study) and qualitative components., Population: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed., Results: 26,199 women were treated for incomplete abortion during the study period. 40 % were treated using Manual Vacuum Aspiration (MVA) and 60 % using sharp curettage (SC). Family planning counselling was provided for 99,8 % of MVA cases; however, only 57,3 % of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 % of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 % of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well., Conclusions: MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.

Objective: To contribute to a better understanding of the problems of pregnancy among adolescent women, including proximate and socioeconomic determining factors, in two large, culturally different cities in Colombia: Santa Fe de Bogotá and Cali., Methods: This longitudinal study combined quantitative and qualitative research methods, using information generated by a survey of adolescents conducted in 2003. The survey included 550 adolescents in Bogotá and 550 adolescents in Cali, from all socioeconomic strata. To analyze the determinants, discrete-time proportional hazards models were used. For the qualitative study, 72 in-depth interviews and four focus groups were done. With the information organized by subjects and categories that were defined in relation to the purposes of the study, categories were identified that arose from the patterns and recurrences in the data, in order to see sociocultural trends by sex, stratum, and city., Results: The patterns of sexual activity, union (married or unmarried relationship), and maternity differ considerably among the socioeconomic strata, in both of the cities. The adolescent women in the low stratum begin having sexual relations, form unions, and become mothers earlier in life and with greater frequency than do adolescent women in the medium or high strata. The main determinant of the reproductive behavior of adolescent women is the set of contextual and socioeconomic factors in the home, mainly the family context (environment and supervision) and the educational climate (the average number of years of formal education of the family members over the age of 15)., Conclusions: Sex education has been provided in the schools in Colombia since 1993, but our results clearly indicate that it has had only a limited impact on the reproductive behavior of adolescent women.

Objective: To determine the causes of non postpartum contraceptive use among adolescent mothers., Patients and Methods: We conducted a cross-section descriptive study. We included women who asked for attention of an obstetric event in 2002, we identified those were in immediate postpartum period, and we selected those that did not began a birth-control method. Data were collected directly with an interview and revision of the file, later on they were coded and processed manually; the causes of non contraceptive use were classified in: attributable causes to patient: personal, religious, moral, familiar, cultural, etc. Reasons, when they received information and advice or when they did not assist to educational actions; attributable causes to hospital: technique administrative factors, insufficient educational communication activities by service provider; and attributable causes to medical indication: presence of risk factors for health women. The statistical analysis was carried out using frequencies and percentages., Results: We found 261 women, we identified 160 (61%) in immediate postpartum period, 52 (32%) they did not began contraceptive use., Conclusion: The causes of non postpartum contraceptive use among adolescent mothers were attributable to themselves in 75%, in 21% to the medical unit, and 4% to medical indication.