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Introduction: Unwanted pregnancy constitutes a huge health issue. Long‐acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women. Material and Methods: This is a secondary analysis of women aged 18–25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow‐ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18–25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357). Results: From September 2017 to May 2019, 770 women aged 18–25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25–10.94), initiation (aOR 4.43, 95% CI 2.32–8.46), and use at 12 months (aOR 2.21, 95% CI 1.31–3.73). The odds of LARC choice at pre‐booked visits were higher and more women received information about extended‐use regimen for short‐acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre‐booked compared to drop‐in visits. Conclusions: Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre‐booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults. [ABSTRACT FROM AUTHOR]

Objective: The goal was to understand how children born of rape in the Democratic Republic of Congo induce parental stress and how parents work together to care for these children. Background: Abundant literature is devoted to children born of rape, but nothing is known about the stress undergone by their parents in the care process. Method: Twenty‐four rape survivor couples and 26 control couples with children aged 6–17 were subjected to Parenting Alliance Inventory (PAI) and Parenting Stress Index (PSI) tests in the east part of the Democratic Republic of Congo. Result s : The parental alliance of the rape survivor couples was comparable to that of the controls. However, for survivor couples, mothers received more support from their husbands for girls than for boys. Parental stress was low among fathers. It was high among mothers of boys and low among fathers of girls. Finally, it was high among mothers of boys compared with fathers. Conclusion: Boys born of rape induce high parental stress compared with girls born of rape, and mothers experience more stress than fathers. Implications: Support programs for families of rape survivors must be gender specific for both parents and children, and preferably a family‐centered approach should be considered. [ABSTRACT FROM AUTHOR]

Indoor temperature trends and the unintended interaction effects In recent years, it has been noticeable that indoor temperatures in residential buildings have followed three trends: decreasing spatial variation, decreasing temporal variation and simultaneously increasing mean levels of indoor temperature. At the same time, architectural design and the construction technologies applied in new buildings and building renovation have undergone a change. In addition, what is considered an appropriate indoor temperature level has changed over time. This is reflected both in quotes from the technical literature and in the requirements set in standards. Research suggests that such changing indoor temperature patterns are associated with unintended interactions in the following main areas: human health and resilience, human indoor climate perception, environmental impacts of buildings, and resilience of buildings in a changing climate. Possible explanations lie in considering the interplay of techno‐cultural factors, techno‐physical building factors, occupant behavioural factors, physiological adaptation factors and psychological factors, rather than considering any one of these factors individually. This leads to the question of whether the established ways of thinking in building planning and operation should remain unchanged in the future. The article concludes with suggestions for adapting these approaches to support such a discussion. [ABSTRACT FROM AUTHOR]

Most studies on the impact of birth intentions on children's well‐being do not separate risks of infant mortality associated with pregnancy intention status from the risks that are associated with sociodemographic characteristics. There is a lack of studies taking a multicountry comparative perspective. We analyzed 60 Demographic and Health Surveys in Asia, the Americas, and Africa to examine the association between birth intentions and infant mortality using sibling fixed‐effects linear probability models accounting for confounding due to time‐invariant maternal characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 41 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in the Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept of birth intentions and in the importance of birth spacing and limiting. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large‐scale, cross‐regional, and cross‐country comparative study to analyze the association between birth intentions and infant mortality using a fixed‐effects approach. [ABSTRACT FROM AUTHOR]

Background: PGF2α is commonly given at the end of embryo flushing (EF) to shorten the interval to the next oestrus and ovulation. Objectives: To determine the effect of repeated EF on plasma progesterone concentration, percentage of mares with endometritis, unwanted pregnancy and subsequent fertility in mares flushed without the use of PGF2α. Study design: Controlled experiments. Methods: Nine mares were inseminated in seven consecutive cycles (n = 63), to either perform an EF (n = 54) 7–9 days after ovulation or left pregnant (n = 9). PGF2α was not used to induce oestrus. Ultrasound examination and blood sampling were performed just before the EF and 72 h later to determine changes in progesterone concentration and signs of endometritis. Results: The overall percentage of positive EF/pregnancy was 55.5% (30/54) and 66.7% (6/9), respectively. The likelihood of pregnancy/positive EF in the first three cycles was 55.5% (15/29). This was not different (p > 0.1) from the fertility of the last four cycles (69.4%, 25/36). In five EF cycles (9.3%), mares had signs of endometritis and early luteolysis (progesterone <2 ng/mL) 72 h after EF. The reduction in progesterone concentration by 72 h after EF was greater (p < 0.05) for Day 9 (−2.3 ± 0.7 ng/mL) than Day 7 (−1.0 ± 0.8 ng/mL) or Day 8 (−1.3 ± 1.1 ng/mL) cycles. The progesterone concentration in non‐flushed mares did not vary significantly during the sampled period (Day 7–12). There were 5 cycles in which the donor mare remained pregnant after the EF, although four were from a single mare. Main limitations: The mare population was limited to barren and maiden mares. The cycle order and operator allocation to each EF were not randomised. Conclusions: EF induces a subtle, but significant reduction in progesterone concentrations compared with non‐EF cycles. However, the percentage of mares with EF‐induced full luteolysis is low (9.3%). The fertility of mares after repeated EF without administration of PGF2α was unaffected; however, there is a considerable risk of unwanted pregnancy (5/27 = 18.5%) in donors from which an embryo was not recovered. [ABSTRACT FROM AUTHOR]

Background: Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. Methods: We conducted a multi‐stage thematic analysis of 33 in‐depth interviews among transgender and gender diverse youth (ages 15–24) living in the southeastern United States on their sexual health education experiences. Results: Our study participants described school‐based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white‐centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment‐free information while holding positive framing around sexuality and gender. Conclusion: There is much work needed to improve the breadth, quality, and relevance of school‐based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community‐based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer‐friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways. [ABSTRACT FROM AUTHOR]

This study quantifies the cost of unwanted pregnancy in relation to early childhood health in 62 developing countries. The endogeneity problem is dealt with through the household fixed‐effects model that utilizes the variation in the degree of birth wantedness among children within a household. The study uncovers the serious health consequences of children born unwanted. Specifically, children from unwanted births tend to have lower height‐for‐age, weight‐for‐age, and weight‐for‐height by 0.054, 0.065, and 0.04 standard deviations, respectively. We further present suggestive evidence that these health consequences might be ascribed to inadequate prenatal care and unfavorable postpartum behaviors among unintentionally pregnant women. Because poor health in early childhood can lead to long‐term negative ramifications, it is urgent to make contraceptives accessible to reduce unwanted births as well as to implement effective measures to assist women facing unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Context: Women, transgender men, and gender non‐binary individuals facing unwanted pregnancy use online resources for abortion information. We sought to determine the informational and emotional needs that those seeking abortion information on Reddit expressed immediately following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision in the United States. Furthermore, we aimed to understand how the Reddit community addressed these needs. Methods: We collected posts on Reddit in the subreddit r/abortion that expressed informational or emotional needs related to the Dobbs decision created between June 24, 2022 and July 24, 2022. We identified posts using keywords including "roe," "rvw," and "trigger law" and then manually reviewed them to ensure relevance. We analyzed posts and their comments using qualitative descriptive analysis. Results: One hundred and ten posts met inclusion criteria. Original posters expressed needs for legal and medical information. Posters also expressed need for logistical support, including help accessing medication abortion, traveling out of state, and financing abortion care, and emotional support in general and resulting from fear of parental disapproval and shame relating to abortion stigma. Although responders to these comments addressed these needs by offering general support, accurate information, and reliable resources, intersecting and emotional needs sometimes went unaddressed. Conclusion: The Dobbs decision caused confusion and panic among abortion seekers requesting guidance on r/abortion, resulting in informational and emotional needs. While the r/abortion community actively addressed needs, inherent limitations of an online forum prevented some original posters from receiving the multifaceted support they needed. [ABSTRACT FROM AUTHOR]

Stealthing, or non‐consensual condom removal, has become a dark reality for many people, posing risks such as unwanted pregnancy, sexually transmitted diseases, and negative mental health effects. Although stealthing has received prior media coverage, it continues to fly under the legal radar in all but one U.S. jurisdiction. With blogs listing their top 10 tips on stealthing, and memes making light of the issue, it is imperative that the U.S. take action to criminalize stealthing. While the rest of the world amends their laws to include stealthing, the U.S. remains one step behind. Key points for the family court community: An Australian study indicated that roughly 30% of 1189 women respondents had been stealthed.An Australian study indicated that roughly 19% of 1063 men who had sex with men surveyed had been stealthed.A United States study found that 12% of women respondents had experienced stealthing.California is the only American state to enact a civil stealthing law.A study found that among 153 participants, 5.2% reported that they knew what stealthing was. [ABSTRACT FROM AUTHOR]

Context: With abortion no longer deemed a constitutional right in the United States (US), the importance of effective contraceptive methods cannot be overstated. Both male sterilization (vasectomy) and female sterilization (tubal ligation) have the lowest failure rates of available means of contraception. Despite the less invasive and reversible nature of vasectomy compared to tubal ligation procedures and even though some healthcare professionals dissuade certain women, especially those who are white and/or economically advantaged, from undergoing a sterilization procedure, female sterilization is approximately three times more prevalent than male sterilization in the US. Purpose: We suggest that the discrepancy in sterilization rates is attributable to the burdens of pregnancy and birth experienced by women, beliefs that pregnancy prevention is a woman's responsibility, a dearth of sex education that results in lack of knowledge and poor understanding of contraception, perceptions of masculinity in which contraception is viewed as feminizing, and the increase in long‐term singlehood that shapes the desire of individuals to avoid unwanted pregnancy that may result in single parenting. Implications: Recent reports suggest that court rulings restricting abortion access and looming threats to contraceptive legality and accessibility may be prompting a national increase in male sterilization. [ABSTRACT FROM AUTHOR]

There are significant gaps in our understanding of how the experience of an unintended pregnancy affects subsequent contraceptive behavior. Our objective was to explore how three measures of pregnancy preferences—measuring timing‐based intentions, emotional orientation, and planning status—were related to the uptake of postpartum family planning within one year after birth. Additionally, we tested whether the relationship between each measure and postpartum family planning uptake differs by parity, a key determinant of fertility preference. Adjusted hazards regression results show that the timing‐based measure, specifically having a mistimed pregnancy, and the emotional response measure, specifically being unhappy, were associated with contraceptive uptake in the extended postpartum period, while those related to pregnancy planning, as measured by an adapted London Measure of Unplanned Pregnancy, were not. This effect differed by parity; high parity women were consistently the least likely to use contraception in the postpartum period, but the effect of experiencing an unwanted pregnancy or having a mixed reaction to a pregnancy was significantly stronger among high parity compared to low parity women. Greater attention to the entirety of women's responses to unanticipated pregnancies is needed to fully understand the influence of unintended pregnancy on health behaviors and outcomes for women and their children. [ABSTRACT FROM AUTHOR]

Keywords: determinants; magnitude; unsafe abortion; Zambia EN determinants magnitude unsafe abortion Zambia 979 982 4 11/15/22 20221201 NES 221201 Unsafe abortion is a public health problem that is disproportionately higher in sub-Saharan Africa, where approximately 77% of all abortions are unsafe. /td>Reference0.62-1.82Yes184 (64.8)50 (65.8)1.07Aware that abortion is legal in ZambiaYes138 (48.4)17 (22.1)ReferenceReferenceNo147 (51.6)60 (77.9)3.151.99-7.852.881.23-9.77Hospital-level factorsEasy access to abortion services?. [Extracted from the article]

Obstetric anal sphincter injury (OASI) is a common complication of childbirth and can be associated with potential life-changing consequences, the morbidity of which often directly affects maternal wellbeing and mental health. The authors concluded that implementation of this care bundle reduced OASI rates without affecting rates of cesarean section or use of episiotomy. Obstetric anal sphincter injuries (OASIS) include third degree lacerations, which involve the external and/or internal anal sphincter muscle, and fourth degree lacerations, which involves the rectal mucosa in addition to the anal sphincter muscles. [Extracted from the article]

One Health is a collaborative trans‐disciplinary approach to health; integrating human, animal, and environmental health. The focus is often on infection disease transmission and disease risk mitigation. However, One Health also includes the multidisciplinary and comparative approach to disease investigation and health of humans, animals, and the environment. One key aspect of environmental/ecosystem health is conservation, the maintenance of healthy, actively reproducing wildlife populations. Reproduction and reproductive health are an integral part of the One Health approach: the comparative aspects of reproduction can inform conservation policies or breeding strategies (in situ and ex situ) in addition to physiology and disease. Differences in reproductive strategies affect the impact poaching and habitat disruption might have on a given population, as well as ex situ breeding programs and the management of zoo and sanctuary populations. Much is known about chimpanzees, macaques, and marmosets as these are common animal models, but there is much that remains unknown regarding reproduction in many other primates. Examining the similarities and differences between and within taxonomic groups allows reasonable extrapolation for decision‐making when there are knowledge gaps. For example: (1) knowing that a species has very low reproductive rates adds urgency to conservation policy for that region or species; (2) identifying species with short or absent lactation anestrus allows ex situ institutions to better plan contraception options for specific individuals or prepare for the immediate next pregnancy; (3) recognizing that progestin contraceptives are effective contraceptives, but may be associated with endometrial hyperplasia in some species (in Lemuridae but not great apes) better guides empirical contraceptive choice; (4) recognizing the variable endometriosis prevalence across taxa improves preventive medicine programs. A summary of anatomical variation, endocrinology, contraception, pathology, and diagnostics is provided to illustrate these features and aid in routine physical and postmortem examinations as well as primate management. Research Highlights: Comparative studies highlight differences and similarities that can elucidate natural mechanisms of action and causes of infertility and subfertility.Better physiology and pathology data from in situ populations are needed to complement the available knowledge from ex situ populations.Improved knowledge of factors that can negatively impact reproduction supports conservation efforts. [ABSTRACT FROM AUTHOR]

Already in 1912, Sabina Spielrein addressed the transforming and antagonistic movements of life that appear from conception in her work 'Destruction as the cause of coming into being'. Her writings form a bridge between Freud and Jung, as they establish the relationship between biological experiences and archetypes. In 1974 Lloyd deMause examined the intrinsic link between primary relational experiences, brain development and the system of beliefs and values of the Sapiens species. He outlined the parallel between the transformation of child education and cultural evolution. Reflecting this theoretical approach, in child psychotherapy we have the peculiar opportunity of resorting to experiences during pregnancy and birth, to gain a deeper understanding of self-expressions in spontaneous drawings, dreams and sand scenes. [ABSTRACT FROM AUTHOR]

Crisis pregnancy counselling (CPC) is a specific form of crisis counselling, whereby the pregnancy represents a personal crisis for the woman involved. While much research has been undertaken into understanding the antecedents and outcomes of crisis pregnancy, few studies have examined the experience of CPC from the perspective of counsellors. In addition, no studies to date have examined the changes in the experience of CPC following substantial changes in abortion legislation. The current study therefore aimed to describe the experiences of providing CPC within the context of recent legislative changes pertaining to the provision of abortion in Ireland. Seven semi‐structured, in‐depth individual interviews were conducted with counsellors and therapists who had provided CPC in the Irish context. Interviews were recorded, transcribed and analysed using interpretative phenomenological analysis (IPA). Four superordinate themes emerged from the data analysis: (1) tension created by legislative conditions, (2) the impact of societal views and stigma, (3) a new sense of freedom, and (4) finding meaning and motivation in supporting women's choices. Overall, the study highlights that CPC is a complex experience, which differs in important ways from providing counselling in other contexts, including other forms of crisis counselling. Implications for policy and practice are identified. [ABSTRACT FROM AUTHOR]

Limited attention has been paid so far to the impacts of war on proximate determinants of fertility, including childbearing preferences. This study explores the relationship between exposure to local conflict violence and fertility desires in Colombia. I combined nationally representative micro‐level data on the timing, frequency and decisiveness of reproductive preferences from the Demographic and Health Surveys, with geospatial information about local violence from the Uppsala Conflict Data Program from 2000 to 2016. The results show a remarkable stability in women's childbearing desires in relation to conflict during the observation period, robust to multiple respecifications of the study sample, statistical model and conflict measurements. The study indicates that previously reported increases to fertility behaviour cannot be explained by altered preferences, suggesting a surge in unwanted pregnancies. This highlights the need for policy programs to support women in realising their fertility preferences, whatever they may be. [ABSTRACT FROM AUTHOR]

Summary: Macropods play an important ecological role in the Australian environment; however, at high population densities can adversely affect biodiversity and primary production and result in human–wildlife conflicts. While shooting is recognised as the most humane and species‐specific method for controlling macropod populations, in peri‐urban situations fertility control provides an attractive option to replace or reduce lethal interventions. An appropriate fertility control agent for managing overabundant macropods needs to provide long‐lasting infertility following a single treatment, be species‐specific in its action or administration method, and be safe, humane, and cost‐effective. Several contraceptive methods that induce infertility for multiple years have been tested on macropods. These include surgical techniques; hormonal implants containing deslorelin, a gonadotrophin‐releasing hormone (GnRH) agonist, or levonorgestrel, a progestin; and immunocontraceptive vaccines (zona pellucida vaccine and the GnRH‐based vaccine, GonaCon). These methods vary in the complexity of delivery and therefore their potential for adverse welfare impacts. Minimal side effects on behaviour and health have been observed. Despite some recent progress with remote dart delivery of deslorelin implants and GonaCon, efficient deployment of all existing methods is currently restricted to either captive or small, wild populations where individuals can be approached closely enough for safe capture and treatment. Of the currently available methods, levonorgestrel and GonaCon are the most suited to population‐scale management. To date, studies addressing the effect of fertility control on the growth rate of macropod populations have been limited but are essential to enable full evaluation of the efficacy and cost/benefit analysis of the different approaches. Mathematical modelling to identify the level of infertility required to meet population management goals, as well as comparing integrated management strategies, will support planning of large‐scale field trials. Improving dart delivery of existing contraceptive agents and developing new methods, such as an oral contraceptive, would increase the cost‐effectiveness of applying fertility control to free‐ranging macropods and may make treating larger populations feasible. [ABSTRACT FROM AUTHOR]

Risky behaviors, such as substance use and unprotected sex, are associated with various physical and mental health problems. Recent genome-wide association studies indicated that variation in the cell adhesion molecule 2 (CADM2) gene plays a role in risky behaviors and self-control. In this phenome-wide scan for risky behavior, it was tested if underlying common vulnerability could be (partly) explained by pleiotropic effects of this gene and how large the effects were. Single nucleotide polymorphism (SNP)-level and gene-level association tests within four samples (25 and Up, Spit for Science, Netherlands Twin Register, and UK Biobank and meta-analyses over all samples (combined sample of 362,018 participants) were conducted to test associations between CADM2, substance- and sex-related risk behaviors, and various measures related to self-control. We found significant associations between the CADM2 gene, various risky behaviors, and different measures of self-control. The largest effect sizes were found for cannabis use, sensation seeking, and disinhibition. Effect sizes ranged from 0.01% to 0.26% for single top SNPs and from 0.07% to 3.02% for independent top SNPs together, with sufficient power observed only in the larger samples and meta-analyses. In the largest cohort, we found indications that risk-taking proneness mediated the association between CADM2 and latent factors for lifetime smoking and regular alcohol use. This study extends earlier findings that CADM2 plays a role in risky behaviors and self-control. It also provides insight into gene-level effect sizes and demonstrates the feasibility of testing mediation. These findings present a good starting point for investigating biological etiological pathways underlying risky behaviors. [ABSTRACT FROM AUTHOR]

Objective: To report the proportion and determinants of repeat induced abortions in China. Methods: Cross‐sectional data were collected of 79 954 women who received an induced abortion from 297 hospitals across 30 Chinese provinces in 2013, using a stratified cluster sampling design. Logistic and Poisson regression models were fitted to identify characteristics associated with repeat abortion. Putative factors included age, household registration (hukou) status, marital status, education, occupation, reproductive history, and current contraceptive practices. Results: Of all abortions, 65.2% were repeat induced abortions. The proportion of repeat abortions varied substantially across provinces, from 36.9% in Qinghai to 85% in Hubei. The strongest factors associated with repeat induced abortion were being older than 40 years (adjusted odds ratio [ORadj] 7.0, 95% confidence interval [CI] 6.2–7.9), divorced or widowed (ORadj 2.1, 95% CI 1.6–2.7), and using oral contraceptives (ORadj 2.1, 95% CI 1.9–2.3). Conclusion: A high proportion of repeat induced abortion was observed across many Chinese provinces, highlighting the need to reduce the incidence of unwanted pregnancy. Several sociodemographic and clinical factors were found to be significantly associated with repeat abortions and should be considered in post‐abortion family planning services. Synopsis: There are substantial differences in repeat abortion rates across provinces in China. Being older, divorced or widowed, and using oral contraceptive pills were the strongest factors associated with repeat abortion. [ABSTRACT FROM AUTHOR]

Objectives: Caesarean section (CS) can be life‐saving for both mother and child, but in Nigeria the CS rate remains low, at 2.7% of births. We aimed to estimate the rate of CS and early neonatal mortality in Nigeria according to obstetric risk and socio‐economic background and to identify factors associated with CS. Methods: We used the 2018 Nigeria Demographic and Health Survey, encompassing 33 924 live births within the last 5 years, to estimate the CS rate and early neonatal mortality rate (ENMR) by obstetric risk group, informed by the Robson classification. The CS rate and ENMR were assessed within each Robson group and stratified by socio‐economic background. Logistic regression analyses were used to explore determinants of CS. Results: Almost three‐quarters (72.4%) of all births were to multiparous women, with a singleton baby of normal birthweight, thus a low‐risk group similar to Robson 3, and with a CS rate of 1.0%. CS rates in the two high‐risk groups (multiple pregnancy and preterm/low birthweight) were low, 7.1% (95% CI: 5.2–9.7) and 1.8 % (95% CI: 1.4–2.4), respectively. The ENMR was particularly high for multiple pregnancy (175 per 1000 live births; 95% CI: 131–230). Greater number of antenatal visits, unwanted pregnancy, multiple pregnancy, household wealth, maternal education, Christians/Others versus Muslims and referral during childbirth were positively associated with CS. Conclusion: Inequitable access to CS is not limited to socio‐economic determinants, but also related to obstetric risk factors, calling for increased efforts to improve access to CS for high‐risk pregnancies. [ABSTRACT FROM AUTHOR]

This study models associations between pregnancy intendedness and prenatal maternal–fetal bonding with postnatal maternal–infant bonding. Unintended pregnancies are associated with disruptions in maternal–infant bonding, which has long‐term adverse implications for maternal and child well‐being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16–38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal–infant bonding postbirth, and higher maternal–fetal bonding scores are associated with higher postnatal maternal–infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy. [ABSTRACT FROM AUTHOR]

Access to abortion care has long been a global challenge, even in jurisdictions where abortion is legal. The COVID‐19 pandemic has exacerbated barriers to access, thereby preventing many women from terminating unwanted pregnancies for an extended period. In this paper, we outline existing and COVID‐specific barriers to abortion care and consider potential solutions, including the use of telemedicine, to overcome barriers to access during the pandemic and beyond. We explore the responses of governments throughout the world to the challenge of abortion access during the pandemic, which are an eclectic mix of progressive, neutral, and regressive policies. Finally, we call on all governments to recognize abortion as essential healthcare and act to ensure that the law does not continue to interfere with providers' ability to adapt to circumstances and to guarantee safe and appropriate care not only during the pandemic, but permanently. COVID‐19 has exacerbated pre‐existing barriers to abortion care globally. This paper highlights how legal and policy responses have protected or hindered equitable access to abortion. [ABSTRACT FROM AUTHOR]

A 6‐year‐old Hereford embryo donor cow was referred to Auburn University College of Veterinary Medicine for a mass in the tip of her left uterine horn. The cow had recently undergone an embryo collection which yielded unfertilized, degenerated ova. Transrectal palpation and ultrasound revealed a multi‐locular mass enveloped by two separate compartments that resembled an amniotic and allantoic cavity within the uterus. Tissue was collected via a uterine flush and submitted for histopathology. The tissue was determined to be placenta, confirming the diagnosis of a molar pregnancy. Following treatment, the cow was able to produce numerous viable embryos. Molar pregnancies are rare and characterized by abnormal growth of trophoblastic cells leading to formation of intrauterine cystic masses. It is important to routinely perform an ultrasonographic examination of the cow's reproductive tract approximately 30 days following non‐surgical in vivo embryo collections to detect and treat unwanted conditions such as pregnancy and cystic conditions. [ABSTRACT FROM AUTHOR]

Cactoblastis cactorum's unintended arrival to Florida and its expansion in North America represent a threat to Opuntia‐based agriculture and natural ecosystems in the United States and Mexico. Apanteles opuntiarum attacks C. cactorum and is a potential biocontrol agent due to its specificity, wide distribution and occurrence. Laboratory rearing methods using excised cladodes for C. cactorum as host larvae of A. opuntiarum were developed, but require a continuous supply of cactus with a risk of microorganisms compromising the rearing. Host cues —including odour of host metabolic subproducts like faeces and chemicals emitted by the attacked plant— are the most important signals that help a parasitoid locate a host. Little attention has been paid to behavioural differences of parasitoids in the presence of hosts reared on artificial diet. Thus, the aims of the present work were to determine the effect of meridic diet for C. cactorum on parasitoid behaviour and to determine whether prior experience (previous exposure to stimuli) influences the response of A. opuntiarum towards hosts. Parasitism rates were assessed using cladodes or meridic diet as larvae food source. Behavioural experiments also evaluated the effect of prior experience (larvae or frass from larvae fed on cactus or diet) on host searching, encounter and attack of different stimulus (larvae or frass from larvae fed on cactus or diet). Parasitism behaviour of A. opuntiarum was negatively affected by the use of meridic diet to feed host larvae. Presenting parasitoids with larvae rather than their frass influenced excitatory behavioural responses in terms of contact, probing and stinging in A. opuntiarum females, whereas the effect of prior experience on the behaviours was not quite consistent. For laboratory mass‐rearing procedures of A. opuntiarum, we recommend previous contact of females with frass from cactus‐fed larvae and a piece of cactus, which showed enhanced parasitism rates. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: It is estimated that 25% of pregnancies worldwide end in induced abortion. In Romania, the abortion situation shows a specific pattern. Following the fall of the communist regime, first‐trimester abortions were legalized, and between 1990 and 1992, the country's abortion rate was the highest in the world, with 182 abortions per 1000 women of reproductive age. However, there are currently no statistically reliable data, as some abortions are not reported. The purpose of this study was to identify the main circumstances that determine the choice to undergo abortion with all related potential risks, rather than using contraception. Method: We conducted a prospective type 1 cohort study based on a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement that included women who presented at Bucur Maternity, Saint John Hospital, Bucharest, for abortion during the first trimester, between July and December 2018. The patients were asked to complete a 21‐item questionnaire based on psychosocial data. Results: The study included 119 patients, with a mean age of 29.57 years. Their educational level was average (ie, 51.3%, 4.2%, and 8.4% had completed high school, elementary school, and college or university, respectively). Most women were married (46.2%), and 47.9% were unemployed. The main reason for deciding to undergo an abortion was poverty (P =.014), and guilt was correlated with this decision (P =.004). Conclusion: The profiles of the women who chose to undergo an abortion as a family planning method were as follows: in the third decade of life, resident of urban areas, married, unemployed, and with a low family income. The main reasons for abortion were financial status, advanced maternal age, incompatibility of pregnancy with future plans, and the desire to postpone conception. [ABSTRACT FROM AUTHOR]

CONTEXT: Measurement of pregnancy intentions typically relies on retrospective reporting, an approach that may misrepresent the extent of unintended pregnancy. However, the degree of possible misreporting is unclear, as little research has compared prospective and retrospective reports of intention for the same pregnancies. METHODS: Longitudinal data collected between 2010 and 2015 on 174 pregnancies were used to analyze the magnitude and direction of changes in intendedness (intended, ambivalent or unintended) between prospective and retrospective measurements of intendedness using versions of the London Measure of Unplanned Pregnancy (LMUP). Changes were assessed both continuously and categorically. Differences in the degree of change—by pregnancy outcome and participant characteristics—were examined using mixed‐effects linear and logistic regression models. RESULTS: Over two and one‐half years of follow‐up, 143 participants reported 174 pregnancies. Approximately half showed changes in intention between the prospective and retrospective assessments, with 38% of participants reporting increased intendedness and 10% decreased intendedness. Reported intendedness increased more among those who gave birth (mean change in continuous LMUP score, 2.2) than among those who obtained an abortion (0.7), as well as among individuals with a college degree (4.1) than among those with a high school diploma (1.2). Participants who reported recent depression or anxiety symptoms showed more stable intentions (0.02) than those who did not (2.1). CONCLUSIONS: Retrospective measurement of pregnancy intentions may underestimate the frequency of unintended pregnancy, with such underestimation being greater among certain subgroups. Estimates based on retrospective reports thus may produce inaccurate impressions of intentionality. Further efforts to refine the measurement of pregnancy preferences are needed. [ABSTRACT FROM AUTHOR]

Estimated use of emergency contraception (EC) remains low, and one reason is measurement challenges. The study aims to compare EC use estimates using five approaches. Data come from Performance Monitoring and Accountability 2020 surveys from 10 countries, representative sample surveys of women aged 15 to 49 years. We explore EC use employing the five definitions and calculate absolute differences between a reference definition (percentage of women currently using EC as the most effective method) and each of the subsequent four, including the most inclusive (percentage of women having used EC in the past year). Across the 17 geographies, estimated use varies greatly by definition and EC use employing the most inclusive definition is statistically significantly higher than the reference estimate. Impact of using various definitions is most pronounced among unmarried sexually active women. The conventional definition of EC use likely underestimates the magnitude of EC use, which has unique programmatic implications. [ABSTRACT FROM AUTHOR]

This study analyses the psychological, clinical and criminal characteristics of neonaticide focusing on court verdicts with the aim of formulating recommendations for judicial guidelines. This study was register based, comprising all known neonaticides in Austria and Finland between 1995 and 2005. The cases (n = 28) were obtained by screening death certificates from coroner departments and analysing them alongside all further reports available. Five out of 21 convicted offenders were imprisoned with an average sentence of 1.65 years. A mental disorder, at the time of the offence, was diagnosed in half of the offenders (9/18) who underwent forensic examination. Of the total offenders, 14 were deemed responsible for the crime, one was deemed to have had diminished responsibility and three were considered not responsible for the crime. The main motive, determined by court evaluation, was an 'unwanted child', followed by 'no motive', 'fear of abandonment or a negative response from others' and 'mental overload'. The rate of repeated neonaticide was 13 per cent. Considering the rate of mental illness within the neonaticide offenders, we would recommend a treatment detention order instead of imprisonment or non‐prosecution, as well as state‐of‐the‐art guidelines for the court. 'Analyses the psychological, clinical and criminal characteristics of neonaticide focusing on court verdicts' Key Practitioner Messages: Autopsies should be conducted for all suspected neonaticides.Forensic examinations should be performed by experts with knowledge and experience of neonaticide.There should be standardised forensic examinations using structured psychiatric and psychological methods by two independent experts.Neonaticide cases should be tried in specialised courts.A psychiatric treatment order should be made for all neonaticide offenders as a preventive measure to reduce reoffending and address the high psychological burden. [ABSTRACT FROM AUTHOR]

This paper addresses two key controversial questions to do with the concept of archetypes - do they operate autonomously without connection to an individual's personal life experience? Does their biological base mean they are genetically determined, innate and thus a priori inherited psychic structures? These questions are addressed through the case of a person who began life as an unwanted pregnancy, was adopted at birth and as an adult, experienced profound waking visions. An emergent/developmental model of archetype is outlined which stresses developmental start-points through this infant's engagement via response and reaction to the affective and material world of the infant/birth mother matrix and from which emergence later occurs by way of participation in a socio-cultural and material context. The emergentism aspect of this model rescues it from being reductionist since it allows for cultural and socialisation inputs. The model's explanatory power is vastly enlarged by combining this with the developmental component. Critically, once developmentally produced mind/brain (image schema) structures are in place, they have the capacity to generate psychological life. Imagery can then appear as if it is innately derived when that is not the case. The contemporary neuroscience which supports this model is both outlined and related back to the case example. [ABSTRACT FROM AUTHOR]

CONTEXT: Researchers have developed various measures of pregnancy ambivalence in an effort to capture the nuance overlooked by conventional, binary measures of pregnancy intention. However, the conceptualization and operationalization of the concept of ambivalence vary widely and may miss the complexity inherent in pregnancy intentions, particularly for young people, among whom unintended pregnancy rates are highest. METHODS: To investigate the utility and accuracy of current measures of pregnancy ambivalence, a mixed‐methods study was conducted with 50 young women and their male partners in northern California in 2015–2016. Survey data were used to descriptively analyze six existing pregnancy ambivalence measures; in‐depth interviews addressing pregnancy desires and plans were deductively coded and thematically analyzed to understand why some participants appeared to be ambivalent from the survey data when their interview responses suggested otherwise. RESULTS: Eighty participants would be considered ambivalent by at least one measure. After assessment of the interview data, however, these measures were deemed to have misclassified almost all (78) participants. Qualitative analysis revealed several themes regarding misclassification: conflation of current pregnancy desires with expected postconception emotional responses; acceptability of an undesired pregnancy; tempering of survey responses to account for partners' desires; perceived lack of control regarding pregnancy; and, among participants with medical conditions perceived to impact fertility, subjugation of pregnancy desires in the interest of self‐protection. CONCLUSIONS: Current approaches to measuring pregnancy ambivalence may fail to capture the intricacies of pregnancy intentions and may be ineffective if they do not account for young people's experiences, especially when used to inform clinical practice, programs and policy. [ABSTRACT FROM AUTHOR]

Over the last half century, United States debates about abortion focused at first on the question whether the fetus is a person with rights and later on whether involuntary conception—for instance, as a consequence of sexual assault—might mitigate a woman's responsibilities toward the fetus she carries. This article argues that, whatever one's position on these two questions, a third, morally salient dimension of most US women's experiences of unwanted pregnancy deserves more attention: both abortion and birth burden women with their inevitable moral failure to fulfill their responsibilities to persons who frequently have de facto last‐resort and unavoidable claims on them. Using Lisa Tessman's work on moral failure and Pope Francis's interventions on abortion and mercy, I argue that this moral anguish is not a simple emotional remainder. Structural evil, not necessity, is the primary driver of forced pregnancy choices that injure women and their children both materially and morally. Consequently, whether they abort or carry to term, women with unwanted pregnancies need mercy or forgiveness. But they also need compassionate solidarity: prophetic, active efforts to transform the social structures that make material harm and moral failure, and consequent moral anguish and moral injury, inevitable for many pregnant women. [ABSTRACT FROM AUTHOR]

Obstetric anal sphincter injuries (OASIS) include third degree lacerations, which involve the external and/or internal anal sphincter muscle, and fourth degree lacerations, which involves the rectal mucosa in addition to the anal sphincter muscles. Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped-wedge design. Obstetric anal sphincter injury (OASI) is a common complication of childbirth and can be associated with potential life-changing consequences, the morbidity of which often directly affects maternal wellbeing and mental health. [Extracted from the article]

Women still die from abortion complications despite the fact that each single death from abortion is potentially preventable. On the 100th anniversary of I Acta Obstetricia et Gynecologica Scandinavica i ( I AOGS i ), we are proudly presenting this special themed issue on women's global sexual and reproductive health to our readers. Celebrating 100 years of AOGS with a focus on global health. [Extracted from the article]

Both many critics of abortion and many defenders of abortion have suggested that artificial wombs could end the abortion debate. If the fetus is removed from the uterus, women have an end to an unwanted pregnancy. If the living fetus is then put in an artificial uterus for ectogenesis, there is no termination of the life of the fetus. Joona Räsänen challenges this view in his article, Ectogenesis, abortion and a right to the death of the fetus. Räsänen provides three arguments for a right to secure the death of the human being in utero, namely the 'right not to become a biological parent argument', the 'right to genetic privacy argument', and the 'right to property argument'. This article critiques these three arguments for a right to the death of the fetus. [ABSTRACT FROM AUTHOR]

In the postpartum period women are vulnerable to unintended pregnancy, which may lead to legal or illegal abortion and impact on maternal and neonatal morbidity and mortality. Although several postpartum family planning options are available, lack of access to and availability of family planning services and trained staff pose serious challenges. Peripheral centers may not have a doctor; however, they will have nursing staff that can be trained to offer family planning counselling and services. The present study demonstrates how task sharing with nurses to provide postpartum intrauterine device (PPIUD) services worked to give women a convenient and safe contraceptive method. PPIUD insertion provides women the additional advantage of leaving hospital with appropriate long‐term contraception after institutional delivery, and also decreases the costs borne by patients and the government. This approach also impacts maternal and newborn health by avoiding unwanted pregnancy. Task sharing using nurses to provide postpartum intrauterine device services is critical to reduce maternal mortality and gives women a convenient and safe contraceptive method. [ABSTRACT FROM AUTHOR]

Despite an extensive evidence base on contraceptive method choice, it remains uncertain which factors are most influential in predisposing women toward certain methods and against others. This paper addresses this gap in knowledge by making use of rarely-measured perceptions about specific methods, perceived social network experience of methods, and women's own past experiences using specific methods. We draw on baseline data from the project, "Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning." Using conditional logit analysis, we ascertain which perceived method-specific attributes, including past experience of methods by women themselves and by their friends, predict preferred future contraceptive method among 317 women living in Nairobi slums who are using no method but intend to start in the next 12 months. Results show that satisfaction with past use, positive experience of use by a woman's social network, husband/partner's approval, lack of interference with menses, and perception of safety for long term use were all associated with choice of a future method. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi‐purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost‐effectiveness of combinations of candidate multi‐purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). Methods: We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost‐effectiveness of five candidate co‐formulated or co‐provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end‐users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability‐adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. Results: At central incidence rates, all single‐ and multi‐purpose scenarios modelled were cost‐effective among FSWs and women aged 16–24, at a governmental willingness‐to‐pay threshold of $1175/DALY averted (range: $214–$810/DALY averted among non‐dominant scenarios), however, none were cost‐effective among women aged 25–49 (minimum $1706/DALY averted). The cost‐effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. Conclusions: To the best of our knowledge, this is the first study to estimate the cost‐effectiveness of a range of potential MPTs; suggesting that MPTs will be cost‐effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively. [ABSTRACT FROM AUTHOR]

Abstract: Public health nurses (PHNs) often work with adolescent populations at risk for unplanned pregnancies who do not have access to comprehensive sexual health education (CSHE). Evidence‐based CSHE can have a significant protective effect on adolescent sexual behaviors. This article applies critical caring theory to public health nursing advocacy for CSHE. Critical caring theory defines the social justice work of PHNs as an expression of their caring as nurses. The lack of CSHE in schools for adolescents is a social justice issue, and PHNs can be important advocates. The purpose of this article is to explore how critical caring theory can inform public health nursing practice regarding the importance of CSHE advocacy with the goal of creating equitable access to CSHE for all adolescents. [ABSTRACT FROM AUTHOR]

Emergency contraception (EC) is a method to be used in the case of unprotected sexual intercourse, failure of a regular contraceptive method, or after rape to try to prevent an unintended pregnancy. Oral EC remains surrounded by controversy, much due to myths and misconceptions among the public, policy makers and healthcare providers. This has resulted in restrictions on its availability in many parts of the world and restrictions on women's access to it. The aim of this article is to provide an evidence-based view on some of these common controversial issues surrounding oral EC in clinical practice.Tweetable Abstract: Controversy about emergency contraception restricts access for women. [ABSTRACT FROM AUTHOR]

Objective: To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers.Data: We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers in 24 states, 11 of which implemented prescription contraception coverage mandates between 2000 and 2008.Study Design: Individual-level difference-in-differences models compare the probability of unintended birth among privately insured recent mothers in state-years with mandates to those in state-years without mandates. Additional models use aggregate data to estimate the effect of mandates on states' number of unintended births.Principal Findings: State mandates are associated with decreased probability of unintended birth (1.58 percentage points) among privately insured women in the second year of implementation, driven by decreased probability of mistimed birth (1.37 percentage points or 614 births per state-year) in the second year of implementation. We find no effects in the first year of implementation or on the probability of unwanted birth. Unexpectedly, recent mothers without private insurance experienced declines in unintended birth, but among unwanted, rather than mistimed, births.Conclusions: State prescription contraception insurance mandates are associated with reduced probability of unintended and mistimed births among privately insured women. [ABSTRACT FROM AUTHOR]

Emergency contraception ( EC) has the potential to reduce unintended pregnancy and abortion rates. This review provides an overview of the three main methods of EC available in Australia, including the copper intrauterine device and oral ECs, levonorgestrel and ulipristal acetate, and brings together evidence from several guidelines to assist pharmacists' practices. The relative efficacy and safety of each method are discussed, together with practical recommendations regarding special considerations, including ongoing contraception, women with an elevated body mass index, drug interactions and breastfeeding. An evidence-based treatment algorithm is provided to assist in decision-making regarding EC use, with ulipristal acetate now likely to be the first-line oral EC given its superior efficacy relative to levonorgestrel, irrespective of time taken following unprotected sexual intercourse, but there are special considerations regarding its use. Pharmacists must be aware of key differences in available methods of EC and be prepared to counsel women on such to facilitate shared decision-making. [ABSTRACT FROM AUTHOR]

Objective: To determine the safety and effectiveness of female sterilisation in the Finnish population.Design: A national register-based study using record linkage.Setting: National data from Finland.Sample: A total of 16 272 female sterilisations performed in 2009-2014.Methods: The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method.Main Outcome Measures: Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs).Results: There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients.Conclusions: Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation.Tweetable Abstract: Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe. [ABSTRACT FROM AUTHOR]

CONTEXT Many sexual minority women, regardless of sexual identity, engage in heterosexual behavior across the life course, which provides them opportunities to experience an unintended pregnancy. In addition, sexual minority women are more likely than others to report characteristics that may make them vulnerable to unintended pregnancy. Little research, however, has examined whether the risk of unintended pregnancy is elevated among these women. METHODS Using data from the 2006-2010 National Survey of Family Growth, logistic regression models were fitted to examine sexual orientation disparities in mistimed and unwanted pregnancies among 9,807 women aged 20-45; mixed-effects hazard models assessed disparities in the intention status of 5,238 pregnancies among these women by maternal sexual orientation. RESULTS Compared with heterosexual women reporting only male partners, heterosexual women who have sex with women had higher odds of reporting a mistimed pregnancy (odds ratio, 1.4), and bisexual women had higher odds of reporting an unwanted pregnancy (1.8). When compared with pregnancies reported by heterosexual women with only male partners, those reported by heterosexual women who have sex with women were more likely to be mistimed (hazard ratio, 1.7), and those reported by bisexual and lesbian women were more likely to be unwanted (1.7-4.4). CONCLUSIONS Compared with heterosexuals who have sex with men only, adult sexual minority women are at equal or greater risk of reporting an unintended pregnancy. More research addressing the reproductive health care needs of sexual minority women is needed to develop strategies to improve family planning for this population. [ABSTRACT FROM AUTHOR]

Unintended pregnancies disproportionately occur among teenage women, yet little is known about the determinants of pregnancy desire among this group. The authors use a comprehensive baseline survey and data on pregnancy desires to investigate which unmarried 18- to 20-year-old women want a pregnancy, want to avoid pregnancy, and report consistent pregnancy desire and disinclination. Variables that positively predict pregnancy desire generally negatively predict desire to avoid pregnancy. Although most young women have no desire and strong disinclination in most weeks, childhood public assistance is a strong predictor of wanting pregnancy and not wanting to avoid it. Comparing nested models suggests that the effects of childhood disadvantage operate through social environments where early pregnancy is less stigmatized. Young women in serious relationships, who are depressed, and who are not pursuing postsecondary education have more desire for pregnancy and less disinclination, but little of childhood disadvantage is mediated by these factors. [ABSTRACT FROM AUTHOR]

Using data from the Relationship Dynamics and Social Life Study, this study examines the role of perceived norms in predicting unintended pregnancy among young women aged 18 to 22 years. First, it compares the relative influence of the content (injunctive [approval] versus descriptive [prevalence]) and referent (parents versus friends) of fertility-related norms. Second, in identifying entrance into motherhood as an important life course event, particularly during the transition to adulthood, it explores how these influences vary by parity. Third, it tests two potential mechanisms: conformity via internalization and superficial conformity. Findings support injunctive norms: Nonmothers' risk of unintended pregnancy is largely influenced by friends' approval, whereas parents' approval best predicts that of young mothers'. The effects are independent of respondents' own attitudes, suggesting superficial conformity. The study sheds light on how young women's perceptions of what is 'normal' among important others influence a consequential early-life event: becoming a parent. [ABSTRACT FROM AUTHOR]

Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client-centered care. This article builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research. Unintended pregnancy and HIV are intrinsically interrelated SRH issues, however broadening the constellation of services, scaling up, and mainstreaming integration continue to be challenging. Overcoming stigma, reducing gender-based violence, and meeting key populations' SRH needs are critical. Health systems research using SRH as the entry point for integrated services and interaction with communities and clients is needed to realize universal health coverage. [ABSTRACT FROM AUTHOR]

Background Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low. Aim To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers. Method A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use. Results Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required. Conclusions Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate. [ABSTRACT FROM AUTHOR]

Background Fetal alcohol spectrum disorders ( FASD) comprise a continuum of lifelong outcomes in those born prenatally exposed to alcohol. Although studies have shown no differences in rates by race, FASD is of particular concern for American Indian communities. One tribally run prevention program is the Oglala Sioux Tribe ( OST) CHOICES Program, which is modeled after the evidence-based CHOICES program that was focused on preconceptional prevention of alcohol-exposed pregnancy ( AEP) by reducing risky drinking in women at risk for pregnancy and/or preventing unintended pregnancy. Methods The OST CHOICES Program was made culturally appropriate for American Indian women and implemented with 3 communities, 2 on the reservation and 1 off. Data on drinking, sexual activity, and contraception use were collected at baseline and 3 and 6 months postintervention. Data were analyzed using descriptive statistics, 1-way analysis of variance, and a random intercept generalized estimating equation model. Results A total of 193 nonpregnant American Indian women enrolled in the OST CHOICES Program, and all were at risk for AEP because of binge drinking and being at risk for an unintended pregnancy. Fifty-one percent of participants completed both 3- and 6-month follow-ups. Models showed a significant decrease in AEP risk from baseline at both 3- and 6-month follow-ups, indicating the significant impact of the OST CHOICES intervention. Women in the OST CHOICES Program were more likely to reduce their risk for AEP by utilizing contraception, rather than decreasing binge drinking. Conclusions Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations. [ABSTRACT FROM AUTHOR]