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Though effective reproductive health interventions have been developed for adolescent girls and young women (AGYW) in sub-Saharan Africa, few have explored whether specific components of the interventions are responsible for observed changes in behaviour. Data for this longitudinal mediation analysis come from a quasi-experimental, sexual and reproductive health study conducted among AGYW (age 15-24) in Malawi. We assessed the extent to which the relationship between attending communication-specific small-group sessions and contraceptive use at one-year was mediated by contraceptive communication with partners at six months, using a bootstrapping procedure to estimate indirect effects. Of 358 participants, 44% attended communication-specific small-group sessions, 37% communicated with partners about contraception at six months, and 21% used non-barrier contraception at one-year. Participants who attended communication-specific small-group sessions had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI: 1.07-2.38) and increased non-barrier contraceptive use at one-year (aOR = 3.53, 95% CI: 1.86-6.69). The relationship between attending communication-specific small-group sessions and non-barrier contraceptive use at one-year was partially mediated by contraceptive communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01-0.07). Our results suggest that contraceptive communication with partners is modifiable through interventions and important for AGYW non-barrier contraceptive uptake.

Objective: Medical contraindications to estrogen limit women's contraceptive options. This study assessed the association between selected medical contraindications to estrogen on contraceptive use...

ObjectivesTo improve teen contraceptive use, the SpeakOut intervention combines structured counseling, online resources, and text reminders to encourage teens to share their experiences using intrauterine contraception (IUC) or an implant with peers.Study designTo evaluate the effectiveness of remote delivery of the SpeakOut intervention in increasing teen contraceptive use, we conducted a cluster randomized trial involving female adolescents who were recruited online. Primary participants (n=520) were randomly assigned to receive SpeakOut or an attention control; each primary participant recruited a cluster of up to 5 female peers as secondary participants (n=581). We assessed contraceptive communication, knowledge, and use, at baseline, 3 and 9 months after participants enrolled. We examined differences between study groups, controlling for clustering by primary participant and baseline characteristics.ResultsThe trial's primary outcome, contraceptive use by secondary participants, was similar between groups at both 3 and 9 months postintervention. Compared to controls, primary participants receiving SpeakOut tended to be less likely to discontinue contraception within 9 months (4.8% vs 7.8%, p=0.11 for IUC; 7.8% vs 9.8%, p=0.45 for implants), but this did not reach statistical significance. SpeakOut failed to increase contraceptive communication; regardless of study group, most secondary participants reported peer communication about contraception (86% vs 88%, p=0.57). Most secondary participants were aware of the hormonal IUC (91.4% vs 90.4%, p=0.72), copper IUC (92.9% vs 88.6%, p=0.13), and implant (96.5% vs 96.1%, p=0.83) 3 months after enrolling, regardless of the intervention their primary participant received. However, contraceptive knowledge remained incomplete in all study groups.ConclusionRemote delivery of the SpeakOutintervention did not improve contraceptive communication, knowledge or use among participating teens or their peers.ImplicationsEfforts to support teen-to-teen contraceptive communication and ensure that teens have accurate information about the full range of contraceptive methods, including highly effective reversible contraceptives, require refinement.

Objective To estimate the incidence of ectopic pregnancy (EP) associated with prescription contraceptive use. Study Design We performed a retrospective cohort study of women aged 15 to 44 years at Kaiser Permanente Northern and Southern California during 2010 to 2019. We identified EPs and prescription contraceptive use from diagnosis, procedural, and medication codes, and natural language processing of clinical notes from electronic health records. Contraceptive use categories included combined hormonal contraceptives, intrauterine devices, depot-medroxyprogesterone acetate (DMPA), progestin-only pills (POPs), implants, no method after recent discontinuation of a prescription contraceptive in the last 12 months, and no method after discontinuation of a prescription contraceptive more than 12 months ago or no use of prescription contraceptives during the study period. Contraceptive use was updated as women started, stopped, or changed methods. An EP was attributed to a contraceptive method if it occurred 14 days after starting and up to 42 days after stopping a method. Age-adjusted EP incidence and 95% confidence intervals (CI) were estimated per 10,000 woman-years overall and by contraceptive category. Results There were 11,436 EPs among 3,204,118 women with 11,909,842 woman-years of follow-up for an overall EP incidence of 9.5 per 10,000 woman-years (95%CI 9.3−9.6). The majority of EPs (9662; 84.5%) occurred during no prescription contraceptive use. EP incidence was lowest during DMPA (1.8 per 10,000 woman-years [95%CI 1.2−2.5]) or implant (2.0 per 10,000 woman-years [95%CI 1.2−3.3]) use, and higher during POP use at 15.2 (95%CI 12.2−19.6); however, incidence was highest after recent discontinuation of a prescription contraceptive (20.6 per 10,000 woman-years [95%CI 19.7-21.4]). Conclusions EP incidence is lower with prescription contraceptive use than with nonuse. Implications All prescription contraceptives, including POPs are protective of EP.

The Covid-19 pandemic, besides having an impact on the economy, education and society, also impacts on health, one of which is impact on women's reproductive health services, reproductive health services for women are a form of necessity or cannot be postponed. Many women face several changes as a result of social and physical distancing, including for their reproductive health checks. One of these services is the use of contraceptives. Contraceptive use during The covid-19 pandemic is one of the efforts that must be done in couples of childbearing age (PUS) which are expected to postpone pregnancy before the covid-19 pandemic. health workers continue to monitor the use of contraception for women's reproductive health.

HIGHLIGHT 1. Relationship between age at menarche, parity, and contraceptive use with histologic type of ovarian cancer was analyzed. 2. A number of patients with ovarian cancer were analytically observed with retrospective cross-sectional approach and the histologic types of the cancer were determined. 3. Age of menarche, parity, and hormonal contraceptive use was found not to have significant correlation with histologic type of ovarian cancer. ABSTRACT Objectives: This study analyzed the relationship between age at menarche, parity, and contraceptive use with histologic type of ovarian cancer. Materials and Methods: This study used an observational analytic with a retrospective cross-sectional approach. The research samples were 128 patients with ovarian cancer at Dr. Saiful Anwar Hospital, Malang, Indonesia, in 2017-2019. All patients underwent primary staging laparotomy. The histologic types of the ovarian cancer consisted of serous type as many as 45, mucinous 45, endometrioid 10, clear cell 20, and others 4. Data analysis used chi-square test. Results: The p value for the relationship between age of menarche and histologic type of ovarian cancer was p=0.500 (p> 0.05), parity p=0.313, and contraceptive use p=0.824. The distribution of clear cell was more common in multiparous, 40% of endometrioid found in nulliparous, while serous were more common in women with hormonal contraceptive use >5 years, whereas mucinous were more common in those with history of use of

Abstarct Objective : To assess an alternative method for estimating demand for postpartum tubal ligation and evaluate reproductive trajectories of low-income women who did not obtain a desired procedure. Study Design : In a two-year cohort study of 1,700 publicly insured women who delivered at eight hospitals in Texas, we identified those who had an unmet demand for tubal ligation prior to discharge from the hospital. We classified unmet demand as explicit or prompted based on survey questions that included a prompt regarding whether the respondent would like to have had a tubal ligation at the time of delivery. We assessed persistence of demand for permanent contraception, contraceptive use, and repeat pregnancies among all study participants who wanted but did not get a postpartum procedure. Results : Some 426 women desired a postpartum tubal ligation; 219 (51%) obtained one prior to discharge. Among the 207 participants with unmet demand, 62 (30%) expressed an explicit preference for the procedure, while 145 (70%) were identified from the prompt. Most with unmet demand still wanted permanent contraception three months after delivery (156/184), but only 23 had obtained interval procedures. By 18 months, the probability of a woman with unmet demand conceiving a pregnancy that she would likely carry to term was 12.5% (95% C.I.: 8.3% - 18.5%). Conclusion : The majority of unmet demand for postpartum tubal ligation among publicly insured women in Texas was uncovered via a prompt and would not have been evident in clinical records or from consent forms. Women unable to obtain a desired procedure had a substantial chance of pregnancy within 18 months after delivery. Implications : Estimates of unmet demand for postpartum tubal ligation based on clinical records and consent forms likely underestimate desire for permanent contraception. Among low-income women in Texas, those with unmet demand for postpartum tubal ligation require improved access to effective contraception.

Background: Weight gain is one of the predominantly problem for women who’s in childbearing age. Weight gain that occurs at women in childbearing age is often associated with contraceptive use. One type of contraception that affects weight gain is the hormonal contraception. Lerning the weight gain from each use of contraception is important as a consideration for the family planning program. Methods: This research method was observational analytic with cross-sectional design. Sample size was 136 respondents and the sampling technique used total sampling. The independent variable is the type of contraception includes 1 month injection contraception, 3 month injection contraception, implant contraception, combined pill contraception, and copper T. IUD contraception. The dependent variable is the weight gain. Data was analyzed with Kruskal Wallis test. Results: The results showed that 120 respondents from 5 contraceptive groups experienced weight gain after using contraception. The results of the Kruskal Wallis test were obtained at value of P

Introduction: In couples, one of whom is diagnosed with HIV, generally the partner is emphasized not to have unprotected sex. This includes the selection of contraceptive methods for women with HIV/AIDS to achieve their reproductive goals. Objective: to analyze the relationship between age, education level, and history of contraceptive use with the choice of contraceptive method in women with HIV/AIDS. Methods: This study uses a descriptive correlative design using Fisher test analysis with a total sample of 20 people who meet the criteria. Results: the relationship between age and current contraceptive use with a p value of 0.241, a history of contraceptive use and current contraceptive use with a p value of 1.00, and the level of knowledge with current contraceptive use with a p value of 0.122. Conclusion: there is no relationship between age, history of contraceptive use, level of knowledge, and current use of contraceptives with p value > 0.005.

BACKGROUND: Poor patient-provider communication, among other reasons, is a notable barrier to contraceptive decision-making among Latinas. Patient-centered approaches to contraceptive counseling that optimize communication align with shared decision-making (SDM) –which is associated with satisfaction and continued contraceptive use among various populations. OBJECTIVE: To examine associations of patient-provider communication and importance of SDM tenets with consistent contraceptive use among a population of Latinas. PATIENT INVOLVEMENT: Formative work for this study included prior qualitative and quantitative research with Latinas who expressed the importance of patient-provider communication during contraceptive counseling and therefore were instrumental in problem definition. METHODS: Cross-sectional surveys were administered to Latinas ages 15–29 years. Patient-provider communication, patient-reported importance of specific SDM tenets, and consistent contraception use were measured and analyzed for associations. RESULTS: 103 Latinas (mean age = 21.4) participated. 33% of participants < 21 years were using contraception consistently vs. 67% for those ≥ 21 (p = 0.003). Among participants ≥ 21, consistent users reported higher communication scores compared to inconsistent users and non-users (p = 0.042). For participants < 21, consistent users were more likely than inconsistent users and non-users to report that 2 SDM tenets (discussion of contraceptive preferences and avoidance of race/ethnic-based judgement) are important (p = 0.052, 0.028, respectively). DISCUSSION: Patient-provider communication was especially important for Latinas ≥ 21 while using an SDM approach during counseling was highly valued by those < 21. Patient-centered approaches to contraceptive counseling provide opportunities to optimize healthcare delivery for this vulnerable population. PRACTICAL VALUE: Results from this research demonstrate that patient-centered communication is highly valued by Latina study participants and is an important consideration in their contraceptive counseling. Clinicians should consider employing techniques such as SDM as they seek to provide patient-centered care during contraceptive counseling for this patient population.

Introduction: Cervical cancer is the fourth most common form of cancer among women. Smoking tobacco seems to be a risk factor for the development of cervical intra-epithelial neoplasia (CIN) and cervical cancer, but the exact role of smoking in the process of cervical carcinogenesis is not known. The aim of this study is to investigate the relationship between smoking and the development of CIN and cervical cancer. Areas covered: We searched Embase, Medline, Cochrane Central, Web of Science, and Google Scholar for studies on smoking and CIN and cervical cancer, published between 2009 and 2018. The following were the outcomes: CIN3 alone, CIN2 and CIN3 combined, CIN2+, CIN3+, and cervical cancer alone. We included 49 studies in our review and 45 in our meta-analyses. Expert opinion: Based on the available evidence it can be – cautiously – concluded that smoking increases the risk of cervical abnormalities. However, the high risk of bias indicates that for future studies, it will be important to adjust for relevant predictors, to separate CIN from cervical cancer as outcome measures, and to report research methods in detail.

Background Malawi is one of the countries in SSA with the highest TFR. This study aimed to explore factors associated with modern contraceptive use and intention to use contraceptives among women of reproductive ages (15–49 years) in Malawi. Methods The study used secondary data from 2015 to 16 Malawi Demographic and Health Survey (MDHS) dataset. Logistic regression models were used to derive adjusted odd ratios as the measures of association between need, predisposing and enabling factors, and contraceptive use and the intention to use contraceptives among women. The sample constituted 24,562 women who were successfully interviewed during the MDHS. All comparisons are considered statistically significant at 5% level. Results Overall 54.8% of women were currently using contraceptives, while 69.1% had the intention to use contraceptives. The odds of contraceptive use were significantly low among, women aged 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years and 40–44 years compared to women aged 45–49 years; women of Tonga ethnic group (OR = O.60, CI = 0.43 0.84) compared to women of Nyanga ethnic group; women from poor households (OR = 0.78, CI = 0.68–0.90) and middle income households (OR = 0.84, CI = 0.74–0.95) compared to women from rich household. Nonetheless, women with no past experience of terminated pregnancy (OR = 1.50, CI = 1.34–1.68) were more likely to use contraceptives compared to women with past experience of terminated pregnancy. Similarly, Women with primary education (OR = 1.56, CI = 1.16–2.09) and secondary education (OR = 1.39, CI = 1.04–1.85) were more likely to use contraceptives compared to women with higher education. While the odds of intending to use contraceptives were significantly high with age only thus among women aged 15–19 years, (OR = 15.18, CI = 5.94–38.77); 20–24 years (OR = 16.77, CI = 7.46–37.71); 25–29 years (OR = 6.75, CI = 3.16–14.45); 30–34 years (OR = 7.75, CI = 3.61–16.65) and 35–39 years (OR = 5.05, CI = 2.29–11.12) compared to women aged 45–49 years. Conclusion As direct policy measure; information, education and communication programmes on family planning among poor and middle income women, and all women in reproductive ages should be strengthened.

Adolescents face several challenges where ASRH issues are concerned. One of these issues is the low uptake of HIV prevention services especially those in high-density urban townships who are prone to several factors that hinder their access to HIV prevention services. This study sought to highlight the prevalence of HIV prevention methods use among adolescents and factors that determine their accessibility in Dzivarasekwa and Tynwald Districts. A total of 500 questionnaires were administered to adolescents aged 15-19 years to collect quantitative data. The study also conducted 10 Focus group discussions and 20 Key informant interviews to solicit qualitative data. The findings showed that, though a level of prevention was observed, a significant number of adolescents were engaging in sexual activities. Adolescents were aware of most HIV prevention methods: however, their knowledge was not being translated into the utilization of these methods. Recommendations were also offered to serve on how HIV prevention services uptake can be improved amongst adolescents.

Background An aim of this study is to introduce a practitioner-friendly behavior model. Few theories of health behavior explicitly take the effect of social norms on behavior into account. Generally, theories that do take social norms into account assume that the effect of social norms on behavior operates through motivation. We use the Fogg Behavior Model (FBM), a behavior model that is new to public health, to explore whether social norms are associated with modern contraceptive use among Nigerian women, and whether they affect behavior through motivation or through ability. In other words, do social norms that discourage contraception lower women’s motivation to use contraception or do they lower women’s ability to use contraception. Methods This study uses data from a cross-sectional household survey of Nigerian women, ages 14–24. The survey collected data on socio-economic and demographic characteristics of women, whether they were sexually experienced, and whether they used contraception. Modern contraceptive use was the outcome of interest for the study. The survey also collected data on social norms around premarital sex and contraceptive use. Multivariate logistic regression was used for the analysis. Results After adjusting for a range of socio-economic and demographic variables, we found that social norms that discourage contraception had a statistically significant negative association with contraceptive use (aOR = 0.90, p Conclusion These findings suggest that social norms may affect contraceptive use in Nigeria through ability rather than motivation. In terms of programmatic implications, these finding suggest that public health interventions may be able to counter the negative effects of social norms that discourage contraceptive use by increasing women’s ability to practice contraception.

Purpose: To audit hormonal contraceptive use and associated symptomology in elite women’s soccer in England. Methods: Seventy-five elite women’s soccer players from the Women’s Super League (WSL) completed a questionnaire to assess: hormonal contraceptive (HC) use or non-use, reasons for initiation and discontinuation and the symptoms experienced by HC and non-HC users. Results: Twenty-eight per cent reported current HC use, with 43% having used HCs previously. Combined HCs accounted for 62% of total usage, with progestin-only HCs making up the remainder. Eighty-six per cent pre-empted negative symptoms before commencing HCs, with 38% experiencing adverse symptoms. Negative symptoms were most common in progestin-only HC users (63%). Eighty-six per cent reported benefits associated with HC usage include pain management and the ability to predict or control their cycles. Six non-HC users reported amenorrhea, with one medically diagnosed. Negative MC-related symptoms were reported by 74%, with 4% unable to train due to these symptoms. Unfavorable symptoms typically occurred during the first days of menstruation (59%). Conclusion: Most WSL players do not currently use HCs (72%). Most HC users reported benefits of HC usage, whilst most non-HC users reported negative symptoms especially around menstruation. Practitioners should track players' MCs to help minimise discomfort and maximise performance.

Riechman, SE and Lee, CW. Oral contraceptive use impairs muscle gains in young women. J Strength Cond Res XX(X): 000-000, 2021-Many active young women use oral contraceptives (OCs), yet their effects on the body composition and exercise performance have not been thoroughly studied. We examined the effects of OCs on muscle responses to a standardized resistance exercise training (RET) program. Two groups of young healthy women (18-29 years old, non-OC: n = 38, OC: n = 34) underwent 10 weeks of whole-body RET (3 days·wk-1, 3 sets, 6-10 repetitions, at 75% of maximum strength, 13 exercises). Body composition was determined using hydrostatic weighing, and blood samples were taken before and after training to measure dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), IGF-1, and cortisol levels. There were significant differences in lean mass gains between the groups (non-OC: 3.5 ± 0.4% vs. OC: 2.1 ± 0.5% and non-OC: 1.6 ± 0.2 kg vs. OC: 1.0 ± 0.2 kg, p < 0.05). Plasma concentrations of DHEA, DHEAS, and IGF-1 were significantly lower, and cortisol levels were higher in the OC group before and after training (p < 0.05). In addition, there were significant differences in lean mass gains depending on the androgenicity of progestin between the non-OC and medium-high groups (non-OC: 1.6 ± 0.2 kg, Low = 1.1 ± 0.2 kg, med-high = 0.3 ± 0.5 kg, p < 0.05). Oral contraceptive use impaired lean mass gains in young women after RET and was associated with lower DHEA, DHEAS, and IGF-1 and higher cortisol. The diminished lean mass gain may be related to the effect of OCs on anabolic and catabolic hormone levels or the androgenicity of progestin that may bind to androgen receptors and inhibit its function.

Since 2014, Indonesia has initiated to implement a national health insurance system, which included both of short- (SARC) and long-acting reversible contraceptive (LARC) into the benefit package. The aim of this study was to analyze the cost-effectiveness of contraceptive use in Indonesia after the implementation of the national health insurance in 2014-2017. A decision tree model was developed to analyze the cost-effectiveness of contraceptive use in Indonesia in 2014-2017 by comparing two strategies of pregnancy prevention: contraceptive and non-contraceptive. For contraceptive strategy, we took into account SARC and LARC. In a comparison with non-contraceptive, we calculated that the incremental cost-effectiveness ratio (ICER) of SARC would be $5.18, $4.80 and $3.76 per pregnancy averted for injection, condom, and pill, respectively. For LARC, we calculated that the ICER would be $1.67 and $0.84 for implant and intrauterine device (IUD), respectively, compared with non-contraceptive. In general, the cost-effectiveness value of LARC ($1.25) was much better than SARC ($4.58). The cost of contraceptive was considered to be the most influential parameter affecting both the ICER of SARC and LARC. In conclusion, the use of LARC in Indonesia was considered to be more cost-effective than SARC since the implementation of national health insurance system. In particular, IUD yielded the greatest cost-effectiveness value, compared with other methods.

U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

Studies have shown a relationship betweendrinking and ineffective contraception and condom use. The rate of binge drinking and ineffective contraception or ineffective condom use among college women was proved to be high. This article examined the influence of addictive behavior on utilization of contraceptives among undergraduate students. Addictive factors that were compared with utilization included attending club and parties, alcohol consumption, and smoking. The data used in analysis was based on stratified probability sample of 453 respondents interviewed in 2017 from Masinde Muliro University of Science and Technology (MMUST). Quantitative and qualitative data was analyzed using descriptive statistics. The study revealed that there was a statistical significant relationship between respondent who frequently attended clubs and parties and contraceptives utilization (OR=0.48 95%CI 0.27-0.84, p=0.01). However, patronizing clubs and parties frequently reduced the probability of using contraceptives by 48% compared to those who did not frequent clubs or parties. Also, alcohol consumption was significantly associated with contraceptives utilization (OR=0.33: 95%CI 0.18-0.59, p=0.00). This result also revealed that respondents who consumed alcohol were 0.33 times less likely to use contraceptives than those who did not indulge in alcohol. Smoking was not statistically significantly associate with contraceptive utilization (p=0.85). The article recommends that HIV and AIDS peer educators should be tasked with educating on sexual and reproductive health and the importance of implementing specific programs in institutions of higher learning to limit the risks of addiction and partying, not only in terms of alcohol abuse, but also addictive behavior such as smoking.

A gravidez ectópica (GE) ocorre em local extrauterino, por diversas causas, caracterizando os maiores índices de mortalidade materna no primeiro trimestre gestacional e em muitos casos, necessita de tratamento cirúrgico e/ou emergencial. O presente estudo reflete acerca de sua ocorrência após o uso do contraceptivo oral de emergência. Evidenciou-se a importância da adesão ao planejamento familiar, diagnóstico precoce, maior conhecimento por parte das usuárias e parceiros, além de atenção por parte dos profissionais da saúde para promoção de orientações e assistência mais eficazes.

IntroductionUnintended pregnancies in Europe have been estimated to constitute 43% of all pregnancies, with the proportion in Sweden being unknown. In striving for equitable healthcare, increased knowledge about unintended pregnancies among women born outside Europe is needed. We aimed to estimate the proportion of unintended pregnancies in women born in Sweden compared with women born outside Europe in an unselected population seeking gynaecological emergency care in early pregnancy. Our secondary aim was to compare contraceptive use at the time of conception in unplanned pregnancies between women born in Sweden and women born outside Europe.MethodsPregnant women seeking gynaecological emergency care in early pregnancy at a tertiary hospital were asked to fill out a questionnaire in their native language. The questionnaire contained questions from the London Measure of Unplanned Pregnancy (LMUP) and questions regarding sociodemographic data, gynaecological health and previous contraception.ResultsOf 180 pregnancies, 66 were unintended (36.7%) according to the LMUP. Among patients born in Sweden, 49/129 (38.0%) of the pregnancies were unintended compared with 17/51 (33.3%) among patients born outside Europe (p=0.56). 86% of participants with unintended pregnancy did not use any form of contraception during the month of conception, with no difference between women born in Sweden and those born outside Europe.ConclusionsAmong women seeking gynaecological emergency care in early pregnancy, unintended pregnancies are common. Women with unintended pregnancies had low use of preconception contraceptives, which highlights a need for further interventions aimed at avoiding unintended pregnancies.

Background: While low perceived susceptibility (PS) to pregnancy is a common risk factor for having sex without contraception among women susceptible to unintended pregnancy, little research has examined the correlates of low PS, and none have investigated whether low PS predisposes women to later pregnancy discovery and prenatal care initiation among women with unintended births. Methods: We use data from the 2004‒2011 Pregnancy Risk Assessment Monitoring System and limit our sample to women in the United States with unintended births who were not using contraception at the time of the index pregnancy (n = 55,940). Women were classified as having low PS if they indicated they could not get pregnant at the time the index pregnancy occurred or they or their partner were sterile. We use logistic regression to identify correlates of low PS and determine whether low PS is associated with timing of pregnancy recognition and prenatal care initiation. Results: Over one-third of women with unintended births cited low PS as a reason for contraceptive nonuse. Maternal age and disadvantage are correlated with low PS. Among women with unintended births, those with low PS had lower odds of early pregnancy recognition (adjOR = 0.88; 95% CI: 0.82, 0.94) and prenatal care initiation (adjOR = 0.86; 95% CI: 0.79, 0.94) compared to those who did not hold these beliefs. Contribution: Although research remains focused on other barriers to contraceptive use, low perceived susceptibility to pregnancy is critical to understanding the high rates of unintended pregnancies and births in the United States and may affect prenatal health.

The Affordable Care Act (ACA) mandated that private health plans cover contraceptives without out-of-pocket expenses for patients. Previously, long-acting reversible contraceptives (LARCs) were sub...

Modern contraceptive use prevents the risk of unplanned pregnancies, unsafe abortions and STIs. Yet little is known about the use of modern contraceptives by female students in tertiary institutions given that available studies have been using women in the reproductive age as the unit of analysis. The study was conducted at the University of Zimbabwe and the Chinhoyi University of Technology. The study triangulated quantitative and qualitative research methods. A survey with 770 female students, 537 from the University of Zimbabwe and 233 from the Chinhoyi University of Technology, to assess the magnitude of modern contraceptive use among female students and explore the facilitating and inhibiting factors underlying contraceptive use. Qualitative data were collected from eight face-to-face in-depth interviews, eight face-to-face focus group discussions and four face-to-face key informant interviews. Modern contraceptive use was high, 98%, however an insignificant variation was noted, 98% at UZ and 97% at CUT. Male condoms were commonly used by students throughout their sexual activities with marginal variations noted- 98% at UZ and 97% at CUT. Female students accessed contraceptives from the SAYWHAT resource centre although the prevalence was high among students at CUT, 95%, when compared to UZ students, 87%. Therefore the study recommends that the preferred modern contraceptives should be available and accessible to students. Information of safe sex practices should be disseminated to students to ensure consistency in contraceptive use. Contraceptive distribution points should be accessible to students to increase contraceptive uptake.

In 2010, the Centers for Disease Control and Prevention (CDC) released the U.S. Medical Eligibility Criteria for Contraceptive Use, providing recommendations for health care providers on safe use of contraception for people with certain characteristics or medical conditions. Adapted from World Health Organization guidance, the goal of the recommendations is to remove unnecessary medical barriers to contraception. Over the past decade, CDC has updated recommendations based on new evidence, collaborated with national partners to disseminate and implement the guidelines, and conducted provider surveys to assess changes in attitudes and practices around contraception safety and provision. CDC remains committed to supporting evidence-based guidelines for safe use of contraception, as the basis for improving access to contraception and high-quality family planning services, reducing unintended pregnancy, and improving reproductive health in the United States.

Background: Previous Women's Ischemia Syndrome Evaluation (WISE) work demonstrated prior oral contraceptive (OC) use was associated with lower coronary artery disease (CAD) in women with suspected ischemia. The association of prior OC use with longer term all-cause and cardiovascular disease (CVD) mortality is unclear. Materials and Methods: WISE women undergoing coronary angiography for suspected ischemia (enrolled 1996–2001) with prior OC use history and 10-year follow-up data were analyzed. A blinded core laboratory assessed atherosclerotic CAD severity. Kaplan–Meier analyses evaluated prior OC use relative to all-cause and CVD mortality. Cox regression analyses adjusted for baseline differences. Mediation, interaction, and multicollinearity were analyzed. Results: Our 686 women had a mean age 62.5 ± 9.6 years, multiple cardiac risk factors, and 39% previously used OC. Prior OC users were younger, with less lipid-lowering medication use and lower atherosclerotic CAD severity scores (all p

One of the most dangerous diseases for Indonesian women is cervical cancer. Hormonal contraceptive use is one of the risk factors for cervical cancer, especially in prolonged use for more than five years. This study evaluates the correlation between hormonal contraceptive use with cervical cancer incidence in Surabaya Wisnuwardhana Cancer Foundation. In this research, the authors used the analytical design with the cross-sectional approach. There were 30 respondents selected with the purposive sampling technique. The independent variable was hormonal contraceptive use, and the dependent variable was cervical cancer incidence. The instruments utilized questionnaires and medical records. Data analysis applied the Rank-spearman test with the significance level of α = 0.05. The results showed that most of the respondents (63,3%) used hormonal contraception. Almost half of them (46.7%) are categorized in class 2 of pap smear classification (mild infection). Hormonal contraceptive use correlated with cervical cancer incidence (p=0.005). The prolonged hormonal contraceptive use, the greater cervical cancer incidence in women.

Background: Combined oral contraceptive use is associated with a decreased risk of invasive epithelial ovarian cancer (ovarian cancer). There is suggestive evidence of an inverse association between progestin-only contraceptive use and ovarian cancer risk, but previous studies have been underpowered. Methods: The current study used primary data from 7,977 women with ovarian cancer and 11,820 control women in seven case–control studies from the Ovarian Cancer Association Consortium to evaluate the association between use of depot-medroxyprogesterone acetate (DMPA), an injectable progestin-only contraceptive, and ovarian cancer risk. Logistic models were fit to determine the association between ever use of DMPA and ovarian cancer risk overall and by histotype. A systematic review of the association between DMPA use and ovarian cancer risk was conducted. Results: Ever use of DMPA was associated with a 35% decreased risk of ovarian cancer overall (OR, 0.65; 95% confidence interval, 0.50–0.85). There was a statistically significant trend of decreasing risk with increasing duration of use (Ptrend < 0.001). The systematic review yielded six studies, four of which showed an inverse association and two showed increased risk. Conclusions: DMPA use appears to be associated with a decreased risk of ovarian cancer in a duration-dependent manner based on the preponderance of evidence. Further study of the mechanism through which DMPA use is associated with ovarian cancer is warranted. Impact: The results of this study are of particular interest given the rise in popularity of progestin-releasing intrauterine devices that have a substantially lower progestin dose than that in DMPA, but may have a stronger local effect.

We used a nationally representative survey of 2186 Mexican Catholic parents to assess two outcomes: support for adolescent access to modern contraception and whether adolescents unaccompanied by an adult should have access to contraceptive methods. A majority (85%) of Mexican Catholic parents support adolescent access to modern contraceptive methods, but there was less support (28%) for access to contraception unaccompanied. Further, our results show strong support (92%) for sex education in schools. Parents who believe that good Catholics can use contraception had higher odds of support for adolescent access and unaccompanied access to modern contraception. Mexican Catholic parents support adolescent access to modern contraception, but support for unaccompanied access to contraception is lower. This may reflect an interest in being involved, and not necessarily opposition to contraceptive use. Measures of Catholicism that focus on behaviors may better explain opinions about adolescent access to contraception.

Unintended pregnancies due to low prevalence of contraceptive use in Pakistan leads to a huge burden of induced abortions. These abortions are a major cause of concern, as a majority of these abortions are performed in an unhygienic environment by untrained providers, leading to maternal morbidities and mortalities. Some of the contributing factors of unsafe abortions are lack of availability of quality services, financial barriers, stigma associated with abortion and lack of awareness about abortion law. Therefore, there is an urgent need to invest on family planning and post-abortion care services through health system strengthening approach. The proposed comprehensive strategy for actions at the individual, facility, community and policy levels can address the issue of unsafe abortion in the country.

Desalew Zelalem,1 Alemayehu Worku,2 Tadese Alemayehu,1 Yadeta Dessie1 1School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Desalew ZelalemSchool of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, EthiopiaEmail desalewzelalemayele@yahoo.comBackground: Spousal family planning communication plays an important role in making better reproductive health decisions and in increasing the use of modern contraceptive methods. The objective of the current study is to examine the association of spousal family planning communication in its broader context with current modern contraceptive use among couples.Methods: A community based cross-sectional survey was conducted in twelve kebeles of Harar Urban Health and Demographic Surveillance System. A total of 2700 currently married couples of whose wives were in the reproductive age participated in the study. The selection of the study participants was made using simple random sampling and data were collected using an interviewer administered structured questionnaire and analyzed using Stata version 12.Results: The level of current modern contraceptive use was 57.1% (95% CI: 0.53, 3.39). Effective spousal family planning communication was significantly associated with current modern contraceptive use even after controlling for socio-economic and demographic variables. Socio-economic and demographic variables such as religion of couples, number of couples’ living children, household monthly income, couples’ family planning approval and women’s counseling about family planning by health workers were significantly associated with current modern contraceptive use.Conclusion: Policies and programs aimed at increasing contraceptive prevalence should properly address the importance of spousal communication about family planning and integrate men into family planning programs to facilitate and enhance couples communication skills.Keywords: effective communication, Poisson regression, Harar Urban HDSS, current contraceptive use

Background: Contraceptive use reduces the need for abortion by preventing unwanted pregnancies, and the causes of maternal death worldwide. Contraceptive use helps women to plan their pregnancies and contributes for population growth. This study aims to analyze the attitudes and knowledge of the women attending Van Norma Clinic for the use of contraceptive methods. Methods: A cross-sectional study was used to analyze the information. A convenience sampling method has been used to select the 100 women who attended Van Norman Clinic in Family planning service in the period of the study of four months (April to July, 2020). A self-administered questionnaire with four parameters addressing importance of using contraceptive methods, the factors affecting the women’s attitudes for not using contraceptive methods, types of contraceptive methods currently used, advantages and disadvantages of using contraceptive methods was used to collect data. Results: Research findings show that the majority of respondents knew the importance of using contraceptive methods like preventing unwanted pregnancies (97%), spacing pregnancies (96%), planning pregnancies (92%), and getting well (70%). Two factors affecting women for not using contraceptive methods had been identified such as religion (73%) and fear (70%). In addition, the women attending Van Norman Clinic prefer using implants (99%) and injectable (99%). It is clear that women do not know the consequences related to the nonuse of contraceptive methods. Some recommendations have been made to the health care facilities, parents, women themselves, churches’ leaders and government in general. Conclusion: Factors which influence women’s attitudes for not using contraceptive methods were notified in our study such as religion (73.0%) and fear (70.0%) which was explained by the fact that in Burundi most people are catholic which is the most religion prohibiting the use of contraceptive methods. However, the participants’ knowledge was significantly good as their score was more than 50% for all variables.

Changes in health insurance coverage, or insurance churn, is common in the months surrounding pregnancy, but there has been limited study of how churn affects women's experiences with reproductive health care. We conducted in-depth interviews with women seeking abortion care in Mississippi in 2016. We coded interview transcripts relating to experiences accessing reproductive health care before pregnancy and organized the codes into themes. Of the 38 women interviewed, one-third were uninsured and half described recent changes in their health insurance. This contributed to inconsistent care, as women shifted from private clinicians while insured to health department clinics while uninsured. For several women, these shifts created barriers to contraceptive use and were closely related to their unintended pregnancy. Insurance churn and associated disruptions in contraceptive use were common among Mississippi women seeking abortion in this study. Policies should support women's reproductive autonomy by facilitating consistent coverage and reliable access to contraception.

Introduction Intrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized. Methods A cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test. Results Most of the 299 women who participated were 18–29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant. Conclusion The intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.

Background Contraceptive nonuse has diverse effects on women, such as unintended pregnancies and births that result in high fertility and poor maternal health outcomes. In Uganda, knowledge on contraceptive use is high, amidst undesirably high contraceptive nonuse and scarce literature on predictors of contraceptive nonuse across regions. This study assessed factors associated with contraceptive nonuse among women of reproductive age across regions in Uganda. Method This study used data from a cross-sectional 2016 Uganda demographic and health survey that had 18,506 women of reproductive age. The relationship between contraceptive nonuse and socio-economic and demographic factors across regions were assessed using a binary multivariable logistic regression model. Results In Uganda, contraceptive nonuse is estimated at 40%. Northern region (55%) had the highest prevalence of contraceptive nonuse compared to Central region (35%) with the lowest. Across regions, wealth index, number of living children, educational level, and children born in the last 5 years prior to the demographic survey differently predicted contraceptive nonuse. Conversely, age, religion, age at first marriage, sexual autonomy, age at first birth, desire for children, listening to radio, and employment status were only predictors of contraceptive nonuse in particular regions amidst variations. Residence, perception of distance to health facility, watching television, and reading newspapers or magazines did not predict contraceptive nonuse. Conclusions The study findings propose the need to appreciate regional-variations in effect of contraceptive nonuse predictors and therefore, efforts should be directed towards addressing regional-variations so as to attain high contraceptive usage across regions, and thus reduce on unwanted pregnancies and births.

Background: Emergency contraceptive methods offer women safe means of preventing unwanted pregnancies. Providing women with knowledge about EC will improve their understanding and cooperation which in turn can affect their attitude towards EC and hence increase their utilization of these methods. Aim of the study: to assess the effect of an educational guidelines on childbearing women’s knowledge, attitude and their intention regarding emergency contraceptive use. Subjects and Method: A Quazi experimental research design was used in this study. This study was implemented at the family planning clinic in the New General Mansoura hospital. A convenient sample of 87 women at the childbearing age were recruited according to inclusion criteria. Two tools of data collection were used: Tool (1): Sociodemographic and reproductive history interview schedule and tool (II): An attitudinal assessment scale. Results: There was a highly statistical significant increase in the total knowledge score immediately after intervention and during the follow up, where P

Background: The World health organization’s recommendations aim to provide comprehensive post-abortion care for all women coming for abortion services. Different investigations have been conducted in Ethiopia reporting the prevalence and the determinant factors of post-abortion contraception, but they lack consistency and are characterized by discrepancies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and associated factors of family planning utilization among women receiving abortion services in Ethiopia. Methods: A systematic review and meta-analysis of published and grey literature were conducted . The protocol was registered on PROSPERO at CRD42020162969. PubMed, Google Scholar, Science Direct, HINARI and Cochrane Library and Google were used to review studies starting from January 14, 2020 to March 11, 2020. STATA 14 software was used for analysis. JBI approach was used for critical appraisal, study selection, and data extraction. The possible risk of publication bias was examined using the Funnel plot, Begg’s and Egger’s test. Statistical heterogeneity was quantified using Cochran’s Q and the I2 test statistic. A random effect model was used as a method of analysis. Result: A total of 8236 women were involved using sixteen studies having 7 to 9 quality scores. The pooled prevalence of family planning utilization among women receiving abortion services in Ethiopia was 69.73% (95% CI: 63.67,75.79) .In addition, subgroup analysis showed the highest prevalence of post-abortion contraception on Addis Ababa city Administration,79.38(95%- CI;66.87,91.89). Counseling for contraceptive: (OR=3.48,95% CI: 1.94,6.25), and history of contraceptive use: (OR=7.62, 95% CI: 3.28:17.69) have shown a positive association with post-abortion family planning utilization in Ethiopia. Conclusion: Family planning utilization among women receiving abortion services is shown to be less than the WHO and national recommendation. Counseling and history of contraceptive use were found to be significantly associated with post-abortion family planning utilization in Ethiopia.

Objective: To identify the prevalence of hormonal contraceptive (HC) use, menstrual cycle disturbances, and self-perceived physical and emotional symptoms related to the menstrual cycle/pill cycle in elite female athletes. Methods: One hundred eighty-six Danish elite female athletes completed an online questionnaire to assess menstrual status and history, use of HCs, and self-perceived physical and emotional symptoms related to the menstrual cycle or HC use. Results: Fifty-seven percent of elite female athletes in Denmark use HC, with 74% using combined HCs and 26% using progestin only. Sixty percent of oral contraceptive users reported having manipulated their menstrual cycle by continuous oral contraceptive use. Forty-nine percent of non-HC users had a regular menstrual cycle, while 51% experienced menstrual disturbances, with 1 athlete being primary amenorrheic and 13 athletes having secondary amenorrhea. Menstrual disturbances were experienced by a larger proportion of endurance athletes (69%) compared with athletes performing power and technical disciplines. In endurance athletes amenorrhea was associated with a higher cardiovascular training volume (P P Conclusion: HC use is common among elite athletes, and continuation of HC is used to manipulate the menstrual cycle in relation to sport competitions. HC use does not abolish dysmenorrhea, but it may reduce emotional-related side effects. Menstrual disturbances are frequent in endurance athletes and are associated with cardiovascular training volume.

The purpose of this literature review was to further explore gynecological care and contraceptive use in women with cerebral palsy. We address barriers to pelvic examinations for cervical cancer screenings and current contraceptive methods in severely debilitated patients with cerebral palsy.

BACKGROUND: Rates of unintended pregnancy among women receiving medication treatment for opioid use disorder (mOUD) are high, likely due in part to low rates of contraceptive use. Lack of knowledge about contraception may be contributing to inadequate contraceptive use. OBJECTIVES: To compare contraceptive knowledge among women and men receiving mOUD relative to a comparison group seeking primary care. METHODS: We surveyed 332 reproductive-age women and men receiving mOUD or primary care with the recently validated 25-item Contraceptive Knowledge Assessment. We examined overall differences between patient groups and between females and males using two-way analyses of variance; individual item differences were tested using logistic regression. RESULTS: The mean percent of total correct responses was lower among individuals receiving mOUD (n=167) relative to the comparison group (n=165), 47.7% vs. 53.8%, respectively (p

Introduction and purpose: Ovarian cancer (OC) takes the 7th place among most common female malignancies worldwide. There are almost 240 thousand of new cases diagnosed each year and the number is constantly growing. Defining risk factors of OC is essential to provide good education among women and predict this malignancy better. The aim of this review is to analyze the current data on risk factors of OC concentrating on family history, obesity andoral contraceptives use. Material and method: This review was based on articles from 2010 to 2020 collected in PubMed and concerning the impact of several risk factors on developing OC. Results: The best described risk factor of OC is genetics and family history. 75% or hereditary OCs are associated to BRCA genes mutations, especially BRCA1. Other mutations increasing the risk of OC are MSH2 and MLH1 genes mutations. Diverse risk factors correlate with different histological subtypes of OC. Obesity increases the levels of estrogens, androgens and leptin, which may promote the proliferation of ovarian epithelial cells. Using oral contraceptives is related to 20% decreased risk of OC for each 5 years of use. Conclusions: BRCA1/2, MSH2 and MLH1 mutations and obesity are well-defined risk factors of ovarian cancer. The first-choice risk-reducing procedure among BRCA carriers is bilateral salpingo-oophorectomy. On the contrary, using oral contraceptives results in decreased risk of OC. Promoting knowledge about OC risk factors among women and healthcare professionals is crucial in order to reduce the number of ovarian cancer.

Injectable contraception (Cyclofem) is a hormonal contraceptive method containing only progesterone, an injection of medroxyprogesterone acetate and an estrogen component that works in 4 weeks and is available as a contraceptive for women. The results of an interview study on 10 acceptors at Bidan Praktik Mandiri "IW" using cyclofem injectable contraception with 5 people resulted from irregular menstrual disorder, 4 menstruating men, and 1 person weight gain. Objective to know the Old Relation of Contraceptive Use Cyclofem Injection With Menstrual Disorder On Acceptor. Quantitative descriptive research type with correlation study method. In this study describes the relationship of variables about the Old Use of Cyclofem Injectable Contraception with Menstrual Disorders on Acceptors. Data collection with documentation and questionnaires, the number of respondents as many as 26 people. The result of analysis that have been done by using Chi Square formula is got p-value value (Asymp Sig. (2 sided)) at Pearson Chi Square value is 0.000, so χ2

Contraception in women with severe medical conditions is a potential measure to reduce maternal mortality. We sought to determine the contraceptive use in women with medical conditions at the University Hospital of the West Indies (UHWI) in Jamaica to determine if there is room for improvement in contraceptive use. Participants were identified from the medical out-patient departments and questionnaires administered. Two hundred and sixty females between 18 and 44 years with varied chronic medical conditions were included. Those included were systemic lupus erythematosus (SLE), diabetes, hypertension (HTN), thyroid disease, cardiac and renal disease. The total current use of contraception was 58.4%, while 41.6% were not on contraceptives. The use of barrier methods and long-acting reversible contraceptives (LARCs) was 71% and 10%, respectively. The current use of contraception in patients with sickle cell disease (SCD) was 84% (