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The Islamic government of Iran recently passed and announced a new law titled "Rejuvenation of the Population and Protection of the Family." This legislation is a noteworthy example of biopolitics-influenced biolaw. In terms of abortion, contraception, prenatal screening, and population control, this law clearly contrasts with women's fundamental rights and freedoms and has significant health-related consequences for different sectors of the population. A historical review of the population policies of the Islamic Republic of Iran shows the occurrence of multiple abrupt and radical changes in such policies over the past four decades. This new law, promoted by religious biopolitics, is the most recent example, and places stringent limits on abortion. According to it, all decisions concerning abortion must be made in courts rather than in health clinics. Such courts are typically presided over by male religious scholars. This law also limits prenatal screening to the degree that will increase the rate of genetic defects, especially in the population's lower socioeconomic strata. By strictly limiting access to contraception, this law will increase the rate of unwanted pregnancies and sexually transmitted diseases. This paper argues that such an influence of biopolitics on biolaw contrasts with the principles of bioethics. Still, Iran's current institution of bioethics cannot address it effectively. Therefore, a new model of interaction between bioethics, biopolitics, and biolaw is needed to prevent the detrimental consequences of such pieces of legislation. Such a paradigm shift is demanded by the current "Woman, Life, Freedom" movement of the Iranian people. [ABSTRACT FROM AUTHOR]

To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. A cross-sectional register-based study including 16,181 women aged 30–49 years participating in the screening programme for cervical cancer in a Swedish County in 2017–2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04–1.41, and aOR 1.41; 95% CI 1.22–1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02–2.06, and aOR 1.56; 95% CI 1.13–2.16, respectively). No significant differences were found in HPV clearance rates. Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception. Women using copper IUD showed no difference in prevalence of HPV or cervical dysplasia compared to women not using contraception in cross-sectional study [ABSTRACT FROM AUTHOR]

Background: Healthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at‐risk cohort. Methods: This paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes. Results: Overall pregnancy outcomes in recipients under the age of 21 are like the adult cohort. Conclusion: It is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate. [ABSTRACT FROM AUTHOR]

The goal of the current study was to examine associations between hormonal contraceptive use and indicators of well-being including body image, eating behavior, sleep and energy level. Drawing on a health protection framework, we expected that individuals who use hormonal contraceptives would be more attuned to health and report more positive health attitudes and behaviors on these dimensions. Undergraduate college women (N = 270; M = 19.39 years, SD = 2.43, range 18–39 years) from diverse racial/ethnic and sexual orientation groups completed a survey online. Measures included hormonal contraception use, body image, weight control behavior, breakfast consumption, sleep behavior, and daytime energy level. Nearly 1/3 (30.9%) of the sample reported current hormonal contraceptive use, with most users reporting use of birth control pills (74.7%). Women who used hormonal contraceptives reported significantly higher appearance orientation and body surveillance, lower average energy, more frequent night awakenings, and more naps. Longer duration of hormonal contraceptive use was significantly related to higher body surveillance, and engaging in more unhealthy weight control behavior. Hormonal contraceptive use is not related to indicators of greater well-being. Rather, hormonal contraceptive use is related to greater attention to appearance, lower daytime energy, and some indicators of poorer sleep quality. Clinicians who prescribe hormonal contraceptives should attend to body image, sleep and energy concerns among users. [ABSTRACT FROM AUTHOR]

Biological sex differences in Cannabis Use Disorder (CUD) progression, cannabis withdrawal severity, and pharmacotherapy response have been reported, suggesting that CUD mechanisms may differ by sex. Drug cue reactivity is an established predictor of drug use behavior, but the literature on sex differences in drug cue reactivity is mixed, including in CUD. One possible moderator of sex differences in drug cue reactivity is hormonal contraceptive (HC) use. The aim of the present study was to test whether sex differences in neural cannabis cue reactivity and craving varied by female HC use in a CUD sample. As part of a larger study, 152 adults reporting frequent cannabis use completed a drug cue reactivity task during electrocenphalogram recording. Late positive potential (LPP) amplitude modulation by cannabis cues was used to measure neural cue reactivity. Craving after the cue reactivity task was also assessed. Males (n = 74) and naturally-cycling females (n = 26), who did not differ from each other, showed significantly greater LPP enhancement to cannabis vs. neutral cues compared to HC-using females (n = 52), an effect mostly driven by neutral cues. Craving was significantly higher in naturally-cycling but not HC-using females compared to males, but only in covariate-unadjusted analyses. Exploratory analyses of HC and menstrual phase characteristics indicate a progesterone-related mechanism may underlie HC effects on cannabis cue reactivity. The present study's results suggest that mixed findings on drug cue reactivity sex differences may be due to variability in HC use, which has implications for sex-specific models of CUD progression and treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate gene expression associated with vaginal bleeding in the 52‐mg hormonal intrauterine device (IUD) users. Materials and Methods: We conducted a prospective study involving 100 women seeking to use the 52‐mg hormonal IUD for contraception. We excluded women with a history or current condition of abnormal uterine bleeding and who were unable to attend a 1‐year follow up. Women who expelled the device, removed it for reasons unrelated to vaginal bleeding, or were lost to follow up were discontinued. We collected endometrial biopsies immediately before IUD placement and assessed 20 selected genes using reverse transcription quantitative polymerase chain reaction. Users maintained a uterine bleeding diary for 12 months following IUD insertion. For statistical analysis, participants were categorized into groups with or without vaginal bleeding at 3 and 12 months. Results: Women with elevated CXCL9 expression had an 8.15‐fold higher likelihood of experiencing vaginal bleeding at 3 months (odds ratio [OR] 8.15, 95% confidence interval [CI] 2.24–29.61, P = 0.001). At 12 months of follow up, women with increased TIMP1 expression had a 2.74‐fold higher chance of experiencing vaginal bleeding (OR 2.74, 95% CI 1.08–6.95, P = 0.033). CXCL9 ≥ 1.5 and IL17A ≥ 0.68 were associated with a higher probability of vaginal bleeding at 3 months, while TIMP1 levels ≥0.943 were linked to an increased risk of bleeding at 12 months. Conclusion: Users of the 52‐mg hormonal IUD with elevated relative CXCL9 expression face an increased risk of vaginal bleeding at 3‐month follow up, whereas those with heightened TIMP1 expression are more likely to experience vaginal bleeding at 12 months. Synopsis: Users of hormonal intrauterine devices with higher expression of CXCL9 and TIMP1 have greater chance of unpredictable bleeding. These results are useful for pre‐use guidance. [ABSTRACT FROM AUTHOR]

Objective: The present study was carried out to describe contraceptive adoption following pregnancy terminations that resulted in outcomes other than live birth. Method: Retrospective calendar data on 31486 women who had experienced a pregnancy loss within the last 60 months prior to the survey date were drawn from a nationally representative dataset. Logistic regression was employed to model the associated factors with contraceptive uptake. Results: Overall, 57.8% reported not adopting any method following the end of the recent pregnancy. There was a significant association between the choice of contraceptive method and timing of adoption. Women with living children were significantly more likely to adopt contraception as compared to women without any child. Conclusion: Contraceptive uptake following a non‐live birth is considerably low in India. Interventions in reproductive health should focus on provision of different contraceptive methods and counseling emphasizing on effectiveness and correct use of the methods at the end of any pregnancy. Synopsis: Contraceptive adoption following a non‐live birth is extremely low in India. The proportion of women opting for more effective methods was found to be considerably low. [ABSTRACT FROM AUTHOR]

Parthenogenesis is a form of asexual reproduction in which a gamete (ovum or sperm) develops without being fertilized. Tomer Jordi Chaffer uses parthenogenesis to challenge Don Marquis' future‐like‐ours (FLO) argument against abortion. According to Marquis, (1) what makes it morally wrong to kill us is that it would deprive us of a possible future that we might come to value—a future "like ours" (FLO) and (2) human fetuses are numerically identical to any adult human organism they may develop into, and thus have a FLO. Chaffer contends that if human ova are capable of parthenogenesis, then they would have a FLO, which contraception may deprive them of, but contends this is absurd. Bruce P. Blackshaw challenges Chaffer, contending sexually fertilized embryos are not identical to unfertilized ovum, but this would yield a more absurd implication, that fertilization deprives an ovum of a FLO! Here I show Marquis' account of identity rules out both Chaffer's and Blackshaw's accounts. [ABSTRACT FROM AUTHOR]

We aimed to evaluate herbal medicine and supplement use patterns among adolescent and young adult women at a clinic focused on family planning. We conducted a cross-sectional survey of patients (age 14-25) at an adolescent Title X clinic. Participants completed an electronic survey that assessed herbal medicine and supplement use, baseline demographic characteristics, and current contraceptive method. We evaluated supplement-drug interactions using the Natural Medicines database Interaction Checker. Quantitative analyses were performed using χ2 and independent medians tests. We enrolled 99 participants with a median age of 20 (15-24) years. Overall, 42.4% of patients reported ever having used supplements or herbal medicines, with 29.9% of patients reporting current supplement or herbal medicine use. Patients with higher education and private insurance were more likely to report a history of and current supplement use (P <.05). The most common herbal supplements reported were green tea (n = 26), cannabidiol (n = 17), and cranberry (n = 16), with 29.6% of participants reporting use to their general health care provider. The most common reasons for use were general health and wellness (29.1%), immune support (23.2%), stress (16.8%), and menstrual irregularities (6.0%). We found 62 moderate risk supplement-drug interactions, with 50 interactions attributed to hormonal contraceptive therapies. The most common interactions were via cytochrome P450 enzyme (CYP3A4 or CYP1A2) inhibition, decreased caffeine clearance, and potential hepatotoxicity. Adolescent and young adult women frequently reported past and current herbal medicine and supplement use, with high rates of moderate-risk supplement-drug interactions. Further research is needed to better elucidate these clinically relevant supplement-contraception interactions. [ABSTRACT FROM AUTHOR]

Objective: To identify characteristics associated with unfulfilled contraceptive preferences, document reasons for these unfulfilled preferences, and examine how these unfulfilled preferences vary across specific method users. Data Sources and Study Setting: We draw on secondary baseline data from 4660 reproductive‐aged contraceptive users in the Arizona, Iowa, New Jersey, and Wisconsin Surveys of Women (SoWs), state‐representative surveys fielded between October 2018 and August 2020 across the four states. Study Design: This is an observational cross‐sectional study, which examined associations between individuals' reproductive health‐related experiences and contraceptive preferences, adjusting for sociodemographic characteristics. Our primary outcome of interest is having an unfulfilled contraceptive preference, and a key independent variable is experience of high‐quality contraceptive care. We also examine specific contraceptive method preferences according to current method used, as well as reasons for not using a preferred method. Data Collection/Extraction Methods: Survey respondents who indicated use of any contraceptive method within the last 3 months prior to the survey were eligible for inclusion in this analysis. Principal Findings: Overall, 23% reported preferring to use a method other than their current method, ranging from 17% in Iowa to 26% in New Jersey. Young age (18–24), using methods not requiring provider involvement, and not receiving quality contraceptive care were key attributes associated with unfulfilled contraceptive preferences. Those using emergency contraception and fertility awareness‐based methods had some of the highest levels of unfulfilled contraceptive preferences, while pills, condoms, partner vasectomy, and IUDs were identified as the most preferred methods. Reasons for not using preferred contraceptive methods fell largely into one of two buckets: system‐level or interpersonal/individual reasons. Conclusions: Our findings highlight that avenues for decreasing the gap between contraceptive methods used and those preferred to be used may lie with healthcare providers and funding streams that support the delivery of contraceptive care. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of Medicaid immediate postpartum long‐acting reversible contraception (IPP LARC) reforms on self‐reported mental health among low‐income mothers aged 18–44 years. Data Sources and Study Setting: We used national secondary data on self‐reported mental health status in the past 30 days from the core component (2014–2019) of the Behavioral Risk Factor Surveillance System (BRFSS). Study Design: We estimated linear probability models for reporting any days of not good mental health in the past 30 days. We adjusted for individual‐level factors, state‐level factors, and state and year fixed effects. Our primary independent variable was an indicator for IPP LARC payment reform. We examined the effect of the Medicaid payment reforms on self‐reported mental health status in the past 30 days using difference‐in‐differences and event‐study designs. Data Collection/Extraction Methods: Not applicable. Principal Findings: State adoption of Medicaid IPP LARC reforms was associated with significant reductions (between 5.7% and 11.5%) in the predicted probability of reporting any days of not good mental health among low‐income mothers. Treatment effects appeared to be driven by respondents reporting two or more children (less than 18 years of age) in the household (ATT = ‐0.028, p = 0.04). Results are robust to a series of sensitivity tests and alternative estimation strategies. Conclusions: Our findings suggest that contemporary efforts to improve access to contraceptive methods may have important benefits beyond reproductive autonomy. These findings have implications for policymakers as the landscape related to family planning services continues to shift. [ABSTRACT FROM AUTHOR]

Background: Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube. Methods: A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis. Findings: The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91). Conclusions: The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform. [ABSTRACT FROM AUTHOR]

Men or mice with homozygous serine/threonine kinase 33 (STK33) mutations are sterile owing to defective sperm morphology and motility. To chemically evaluate STK33 for male contraception with STK33-specific inhibitors, we screened our multibillion-compound collection of DNA-encoded chemical libraries, uncovered potent STK33-specific inhibitors, determined the STK33 kinase domain structure bound with a truncated hit CDD-2211, and generated an optimized hit CDD-2807 that demonstrates nanomolar cellular potency (half-maximal inhibitory concentration = 9.2 nanomolar) and favorable metabolic stability. In mice, CDD-2807 exhibited no toxicity, efficiently crossed the blood-testis barrier, did not accumulate in brain, and induced a reversible contraceptive effect that phenocopied genetic STK33 perturbations without altering testis size. Thus, STK33 is a chemically validated, nonhormonal contraceptive target, and CDD-2807 is an effective tool compound. [ABSTRACT FROM AUTHOR]

Objectives: Controlling population expansion and reducing unintended pregnancies through the use of modern contraceptives is a cost-effective strategy. In recent years, the rate of modern contraceptive use in Bangladesh has been declining. So, this study aimed to investigate the associated factors of the deterioration in modern contraceptive usage. Methods: This study used data from two successive Bangladesh Demographic and Health Surveys (2014 and 2017–18) and applied the Blinder-Oaxaca decomposition analysis to understand the drivers. A popular binary logistic regression model is fitted to determine the factors that influence the use of modern contraceptive methods over the years. Results: This study revealed that highly educated women were more likely to use modern contraception methods, and their use increased by 3 percent over the years. Factors such as women's working status, husband's education, number of living children, and fertility preference were found significantly associated with decreased usage of modern contraception methods over years. The result of the Blinder-Oaxaca (BO) decomposition analysis found a significant decrease between 2014 and 2018. Respondent's age, working status, husband's age, opinion on decision making, region, and media exposure were the most significant contributors to explaining the shift between 2014 and 2018. The two factors that contributed most to narrowing the difference between the two surveys were women's decision on own health (26%), and employment status (35%). Conclusions: The factors that influence modern contraceptive prevalence are important to know for policy implication purposes in Bangladesh. The findings indicate the need for further improvement of factors for balancing the usage of modern contraception methods. [ABSTRACT FROM AUTHOR]

Published associations between combined oral contraceptive use and uterine fibroid development have lacked prospective imaging with ultrasound to distinguish between incident and prevalent fibroids. The Study of Environment, Lifestyle, and Fibroids prospectively followed fibroid-free, African-American women (the group with the highest disease burden in the U.S.) to identify incident cases. We examined associations between combined oral contraceptive use and the 40-month cumulative risk of fibroids. History of hormonal contraceptive use was collected via telephone interview at enrollment. Fibroid identification was performed using transvaginal ultrasonography at enrollment, and at 20 and 40-months of follow-up. Inverse probability weights for exposures and censoring were used to construct weighted risk ratios (wRR) and weighted risk different (wRD) estimators which control for differences in fibroid risk factors between exposure groups. In addition, unweighted fully adjusted log-binomial regression models (aRR) were run for comparison. Of the 1,308 participants in the analysis sample, 70% had used combined oral contraceptives and 17% developed fibroids by 40 months. We observed an inverse association between ever use of combined oral contraceptives and cumulative fibroid incidence (wRR: 0.78; 95% Confidence Interval (CI): 0.60, 1.00; wRD: -0.05, 95% CI: -0.11, 0; aRR: 0.76, 95% CI: 0.60, 0.98). Fibroid incidence was greater in participants who started using combined oral contraceptives after age 17 years than among younger initiators, though the restriction to ever-users made this estimate less precise (wRR: 1.25; 95% CI: 0.89, 1.76; wRD: 0.04, 95% CI: -0.02, 0.10). No consistent patterns of fibroid incidence were seen among ever-users for duration of, or years since, last combined oral contraceptives use. [ABSTRACT FROM AUTHOR]

Background: Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. Methods: We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021–03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15–17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Results: Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. Conclusions: While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti. [ABSTRACT FROM AUTHOR]

Vasectomy is the most commonly performed urologic procedure in the United States and is a highly effective form of male contraception. The introduction of guidelines by urological societies has standardized vasectomy care. Providers should be awadre of the rationale behind these guidelines, as well as key differences among them. While few major changes to vasectomy technique have been adopted over the past 40 years, new, reversible vasal occlusive technologies may affect delivery of male contraceptive care in the future. Here, we perform a comparative review of vasectomy guidelines from six urological societies worldwide. In addition, we report on the status of several experimental vasal occlusion methods that may be available in the next decade. [ABSTRACT FROM AUTHOR]

Background. Breast cancer ranks as the second most prevalent malignancy among women in Nepal. This cancer has a high likelihood of cure, if detected early. Therefore, it is imperative to emphasize awareness and screening for breast cancer in Nepal. It indeed underscores the importance of clinical breast examination. The study aims to find the disease burden, association of abnormal breast condition with sociodemographic variables, and the need for change in the breast cancer screening protocol. Methods. A cross-sectional study was conducted from July to September 2023 on 100 female participants who were older than 18 years. Data were collected through face-to-face interviews using a structured questionnaire. The chi-square test was used to compare nominal variables while the independent sample t-test and the paired sample t-test were used to compare nominal and continuous variables. Results. The findings of the study showed that 19% of all participants complained about abnormal breast, out of which 31.7% reported lumps, 26.31% reported discharge , another 26.31% reported pain, and the remaining 15.7% reported soreness. The upper outer quadrant and lower inner quadrant each individually accounted for 33.33% of the abnormal findings. The complaints of the participants in our study were significantly correlated with age at marriage, number of pregnancies, and use of contraception. Conclusion. Our study revealed considerable abnormal breast findings. This warrants the need for the change in breast cancer screening protocols which lead to early diagnosis and higher curability. [ABSTRACT FROM AUTHOR]

Introduction: Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. Methods and materials: The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. Results: The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. Conclusion: The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) have a peak incidence between the second and fourth decades of life and can affect women's reproductive life. Objectives: Our study aimed to assess the impact of IBD on the reproductive life of female patients with this condition. Design: Cross-sectional study. Methods: Women with IBD followed at our IBD Unit and a group of healthy controls were enrolled. Data on reproductive life were collected using a dedicated questionnaire. Results: The study included 457 women, of whom 228 had IBD, and 229 age-matched healthy controls. No differences were found in the use of contraceptives, infertility, and endometriosis. The risk of spontaneous and voluntary abortions was significantly higher in IBD patients than in healthy controls [odds ratio (OR) 2 and 3.62, respectively]. The risk of obstetrical complications in the IBD population was more than six times higher in patients who experienced disease reactivations during pregnancy than in those with persistent remission [OR 6.9, 95% confidence interval (CI) 1.51–31.28]. Finally, we found that the chances of breastfeeding were 66% lower in patients with IBD than in controls (OR 0.44, 95% CI 0.22–0.91). Conclusion: Our study underlines the negative impact of IBD on women's reproductive life, supporting the need for proactive preconception counseling. Plain language summary: Reproductive life in IBD women Summarise the established knowledge on this subject Most women with Inflammatory Bowel Diseases are affected during their reproductive years. Women with IBD have fear, uncertainty, and poor knowledge of how the disease can impact their reproductive life. What are the significant and/or new findings of this study? Higher prevalence of abortions in women with IBD. Confirmed adverse pregnancy outcomes in the case of IBD activity. A lower chance of breastfeeding in women with IBD. Pro-active counselling is needed, which start from the moment of conception choice, with correct management of the pathology. [ABSTRACT FROM AUTHOR]

Background: Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia. Objective: To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia. Methods: We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model. Results: In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts. Conclusion: In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women. [ABSTRACT FROM AUTHOR]

To evaluate gene expression associated with unfavorable vaginal bleeding in users of the Etonogestrel (ENG) contraceptive implant. Prospective study involving 100 women who intended to use the ENG implant. Exclusion criteria included abnormal uterine bleeding, inability to attend a 1-year follow-up, and implant removal for reasons unrelated to vaginal bleeding or loss of follow-up. We obtained endometrial biopsies before implant placement and assessed the expression of 20 selected genes. Users maintained a uterine bleeding diary for 12 months post-implant placement. For statistical analysis, we categorized women into those with or without favorable vaginal bleeding at 3 and 12 months. Women with lower CXCL1 expression had a 6.8-fold increased risk of unfavorable vaginal bleeding at 3 months (OR 6.8, 95% CI 2.21–20.79, p < 0.001), while those with higher BCL6 and BMP6 expression had 6- and 5.1-fold increased risks, respectively. By the 12-month follow-up, women with lower CXCL1 expression had a 5.37-fold increased risk of unfavorable vaginal bleeding (OR 5.37, 95% CI 1.63–17.73, p = 0.006). Women with CXCL1 expression < 0.0675, BCL6 > 0.65, and BMP6 > 3.4 had a higher likelihood of experiencing unfavorable vaginal bleeding at 3 months, and CXCL1 < 0.158 at 12 months. Users of ENG contraceptive implants with elevated BCL6 and BMP6 expression exhibited a higher risk of breakthrough bleeding at the 3-month follow-up. Conversely, reduced CXCL1 expression was associated with an elevated risk of bleeding at both the 3 and 12-month follow-ups. [ABSTRACT FROM AUTHOR]

Introduction: Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. Methods: We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. Results: The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. Conclusion: While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem. [ABSTRACT FROM AUTHOR]

Background: Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments. Methods: This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression. Results: We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the '>' and '<' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively. Conclusions: These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well. [ABSTRACT FROM AUTHOR]

Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low‐resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low‐cost behavioral interventions to mitigate reproductive cancer risks. [ABSTRACT FROM AUTHOR]

Background: In this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours. Methods: Using the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women). Results: Higher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method. Discussion: The fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies. Conclusion: The results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women's contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way. [ABSTRACT FROM AUTHOR]

Background: Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. Methods: Cross-sectional survey with married women (15–49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. Results: Only 16% of the respondents were involved—either autonomously or jointly with their spouse—in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06–1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. Conclusion: Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming). [ABSTRACT FROM AUTHOR]

Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal. We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal. Eighty-seven appeals addressed an endometriosis-related issue. Three themes—evidence, treatment, and time—were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences. Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis. [ABSTRACT FROM AUTHOR]

Introduction: Unintended pregnancy remains a major challenge to the reproductive health of women especially in the developing countries. It is a major reason for unsafe abortion, a major contributor to maternal mortality. Emergency contraception (EC) is use of drug or device to prevent pregnancy after unprotected sexual intercourse. Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. Aims & Objectives: This study was designed with an aim to assess the knowledge, awareness and practice of emergency contraception among medical undergraduates. Objectives • To assess the gap between knowledge, perception and practice of emergency contraception among medical undergraduates • To educate the young medical undergraduate to implement the knowledge into practice. Material and Method: After approval from IEC, a questionnaire based cross sectional observational study was conducted in the Department of Obstetrics & Gynecology, Index Medical College Hospital & Research Center, Indore to evaluate the knowledge, awareness and practice of emergency contraception among 400 medical undergraduate students from 1st to 4th year and internship; enrolled in various medical courses (MBBS & BDS) in the university were selected in this study which was conducted over a period of six months from October 2023 to March 2024. Participants qualifying the inclusion criteria were enrolled and interviewed using pretested semi structured questionnaire to assess their knowledge, awareness and practice with emergency contraception. Data was analysed using SPSS version 20.0 software (SPSS, Chicago, IL, USA). Data were presented as percentages and tables. Association between variables was tested using the χ2 test. Results: A response rate of 73% was observed with majority of participants being females (53.55). About 18.5% of the participants had knowledge about using oral contraceptive pills (OCP) and intrauterine contraceptive devices (IUCD) as EC. 70% were aware that only OCP is used as an EC, while 18.5% said both OCP and IUCD can be used. 62.5% knew the timing of EC use within 72 hours of intercourse. 88% knew all situations under which an EC can be taken. The batch-wise difference in knowledge and attitude component was statistically significant, but not for attitude. Five participants had a sexual experience, and three out of them had used an EC. Conclusion: The study revealed that there is a gap in knowledge, attitude and practices about emergency contraception in young college going students, leading to incorrect practices and unintended pregnancies ending up in abortions. The medical teaching system should address the lack of comprehensive knowledge about EC among future healthcare professionals, as EC is crucial for preventing pregnancy after unprotected sex or contraceptive accidents. [ABSTRACT FROM AUTHOR]

Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15–49 years from fifth round of National Family Health Survey (2019–2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion. [ABSTRACT FROM AUTHOR]

Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia. [ABSTRACT FROM AUTHOR]

Background The aim of the current study was to examine the prevalence and predictors of unmet need for contraception among women in sexual unions in Benin. Methods Data for the study was extracted from the recent 2017–2018 Benin Demographic and Health Survey. A weighted sample of 9513 women of reproductive age was included in the study. We used multivariable multilevel binary logistic regression analysis to examine the factors associated with unmet need for contraception. Results The prevalence of unmet need for contraception was 38.0% (36.7, 39.2). The odds of unmet need for contraception was higher among women with ≥4 births compared with those with no births, and among those who reported that someone else or others usually made decisions regarding their healthcare compared with those who make their own healthcare decisions. Wealth index was associated with a higher likelihood of unmet need for contraception. Also, the region of residence was associated with unmet need for contraception, with the highest odds being among women from the Mono region (adjusted odds ratio [aOR]=2.18, 95% CI 1.33 to 3.58). Conclusions Our study shows that the unmet need for contraception among women in Benin is relatively high. Our findings call on relevant stakeholders, including government and non-governmental organisations, to enhance women's empowerment as part of interventions that seek to prioritise contraceptive services for women. [ABSTRACT FROM AUTHOR]

Background/Obectives Methods Results Conclusions Oral retinoids are teratogenic, and pregnancy avoidance is an important part of retinoid prescribing. Australia does not have a standardised pregnancy prevention programme for women using oral retinoids, and the contraception strategies for women who use oral retinoids are not well understood.The objectives were to determine trends in the use of prescription retinoids among Australian reproductive‐aged women and whether women dispensed oral retinoids used contraception concomitantly.This was a population‐based study using Australian Pharmaceutical Benefits (PBS) dispensing claims for a random 10% sample of 15‐44‐year‐old Australian women, 2013 ‐ 2021. We described rates and annual trends in dispensing claims for PBS‐listed retinoids and contraceptives. We also estimated concomitant oral retinoid and contraceptive use on the day of each retinoid dispensing and determined if there was a period of contraceptive treatment that overlapped. Estimates were then extrapolated to the national level.There were 1,545,800 retinoid dispensings to reproductive‐aged women; 57.1% were oral retinoids. The rate of retinoid dispensing to reproductive‐aged women increased annually, from 28 dispensings per 1000 population in 2013 to 41 per 1000 in 2021. The rate of oral retinoid dispensing doubled over the study period, from 14 dispensings per 1000 population in 2013 to 28 per 1000 in 2021, while topical retinoid dispensing did not change. Only 25% of oral retinoid dispensings had evidence of concomitant contraceptive use in 2021.Rates of oral retinoid dispensing have doubled among reproductive‐aged women over the past decade. A large percentage of oral retinoid use does not appear to have concomitant contraception use, posing a risk of teratogenic effects in pregnancies. [ABSTRACT FROM AUTHOR]

Objective To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. Study Design This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic—Clinic for Acceptance Recovery and Empowerment (CARE)—between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. Results A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05–1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76–1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36–1.84). Conclusion In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. Key Points Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic. Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic. Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to examine the relationship between body mass index (BMI) and complications for patients undergoing postpartum permanent contraception. Study Design Retrospective cohort study of patients aged 18 or older who had a vaginal delivery at an academic hospital between 2011 and 2016 and underwent a postpartum tubal ligation during the delivery admission. There were three comparative groups: nonobese (BMI ≤ 29 kg/m 2), obese (BMI 30–39 kg/m 2), and morbidly obese BMI (≥40 kg/m 2). The outcome of interest was composite operative complications which included any occurrence of an intraoperative, postoperative, or anesthesia complication. Results A total of 921 patients were included for analysis. Average operative time was statistically longer for patients in the morbidly obese group (33 minutes) vs. the nonobese (25 minutes) and obese (29 minutes) groups (p < 0.0001). Composite complications were greater for the obese groups, but not statistically significant (5.1 vs. 6 vs. 16%, p = 0.06). Wound complications were significantly greater for the obese groups (0.8 vs. 1.5 vs. 5.5%, p = 0.01). A logistic regression model demonstrated that only operative time was predictive of operative complications. Conclusion Overall complications of postpartum tubal complications are low; however, our study did demonstrate significantly longer operative time and wound complications for patients with obesity. The findings of our study indicate that postpartum permanent contraception can remain as an option for these patients. Further studies may help identify the best practices to decrease operative time and subsequent wound complications. This study contributes to the limited data regarding obesity and postpartum permanent contraception. We found increased operative time and wound complications for obese patients. Additional studies may identity best practices to decrease these complications. Given our findings of overall low operative complications, postpartum permanent contraception can remain an option for obese patients. [ABSTRACT FROM AUTHOR]

Introduction: Highly effective long‐acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long‐term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC. Material and methods: In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self‐reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results. Results: Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31–2.76) and less likely to be using a short‐acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46–0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36–6.75) and youth clinics (aOR 1.81, 95% CI: 1.08–3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96–3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes. Conclusions: The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated. [ABSTRACT FROM AUTHOR]

Introduction: Concerns about safety and side effects from contraceptives are widespread and related to reluctance to use them. Measuring these concerns is an essential component of understanding contraceptive decision-making and guiding contraceptive and interpregnancy clinical care. Methods: We used qualitative research and item response theory to develop and test a psychometric instrument to measure contraceptive concerns and beliefs. We developed 55 candidate scale items and tested them among 572 adolescents and adults across nine California healthcare facilities in 2019–2020. We derived a 6-item scale and assessed differences by age and social determinants of health with multivariable regression. Results: In qualitative data, participants voiced both concerns and positive beliefs about contraception. Quantitative survey respondents were aged 21 years on average, and 24% were parous. Over half (54%) worried contraception has dangerous side effects, and 39% worried it is unnatural. The mean Contraceptive Concerns score, increasing with higher concerns, was 1.85 (SD: 1.00, range 0–4, α = 0.81). Items fit a partial credit item response model and met prespecified criteria for internal structure validity. Contraceptive use declined with increasing Concerns score (adjusted prevalence ratio [aPR] = 0.81 [0.72–0.92]). Scores were elevated among Black (mean: 2.06; aβ = 0.34 [0.09, 0.59]) and Multiracial or other race (2.11; aβ = 0.34 [0.02, 0.66]) respondents vs. White (1.66), but not Latinx respondents (1.81; aβ = 0.11 [− 0.11, 0.33]). Scores were also elevated among participants with lower maternal education (high school/Associate's 1.89 versus college 1.60; aβ = 0.28 [0.04, 0.53]). Discussion: The psychometrically robust Concerns instrument can be used in research to measure autonomous contraceptive decision-making and to design person-centered care. Significance: What is already known on this subject?: Concerns about safety and side effects from contraceptives are prevalent and must be considered when designing and evaluating contraceptive care, including in the interpregnancy period. However, to date no rigorously developed instrument has existed. What this study adds?: The six-item Contraceptive Concerns instrument is psychometrically robust and can be used in research to measure and understand autonomous contraceptive decision-making and to design equitable person-centered contraceptive care. [ABSTRACT FROM AUTHOR]

Oestrogen is considered by many to be a major cause of breast cancer, and yet hormonal contraception and menopausal hormonal therapy have a paradoxically small effect on breast cancer risk. Also, in the oestrogen‐only arm of the Women's Health Initiative, subjects given oestrogen had a reduced risk of breast cancer compared to controls. Initiation of breast cancer likely begins early in life, in the long‐lived ER−PR− breast stem cell. The main mitogen of ER+PR+ breast cancers is oestrogen derived from local breast fat and the tumour itself, rather than circulating oestrogens. Progesterone is relatively breast neutral, but progestins in the laboratory have been shown to expand malignant breast stem cell number. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusion\nSHORT CONDENSATIONTo evaluate the influence of the personal experience of female obstetricians and gynaecologists (Obst/Gyns) who utilise contraceptive methods on the provision of these methods.An anonymous online web-based survey was carried out with female Obst/Gyns. The instrument contained questions about their current and previous contraceptive methods use, factors that influenced the choice and satisfaction with the ongoing method, as well as the occurrence of adverse events. They were also asked whether the experience of any adverse events influenced their decision in prescribing any particular contraceptive method.476/9000 (5.3%) female Obst/Gyns answered the survey. The most common contraceptive in use was the 52-mg levonorgestrel-intrauterine device (52-mg LNG-IUD) (34%), followed by non-Long-Acting Reversible Contraception hormonal methods (21.2%). More than half of the respondents (57.6%) reported having some adverse effects and 18.7% reported that the personal experience of an adverse effect with the use of a contraceptive method influenced the prescription of that method.Half of female Obst/Gyns encountered adverse events linked to contraceptive usage. Additionally, almost one-fifth believe that their own encounter with adverse effects from a contraceptive method impacts their decision to prescribe the same method.Almost one-fifth of the female obstetrics and gynaecologists that answered the online survey reported that the personal experience of an adverse effect with the use of a contraceptive method influenced the prescription of that method. [ABSTRACT FROM AUTHOR]

Background: Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. Methods and materials: A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15–24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. Results: Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09–0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01–0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01–0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24–0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60–7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05–0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02–5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. Conclusion: The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Pandemics have affected many people's social and emotional lives. Conception planning, contraceptive usage, and pregnancy intentions are activities with minimal research. This study is the first to evaluate how the COVID‐19 pandemic influenced reproductive plans and contraceptive use among women during the pandemic in Jeddah, Saudi Arabia, in 2022.A cross‐sectional survey was conducted by sending an online questionnaire to married women from Jeddah, Saudi Arabia. The questionnaire included demographics, personal obstetrics information, changes in pregnancy intentions owing to the COVID‐19 pandemic, and questions about contraceptive usage. Qualitative data were presented as frequencies, and a χ2 test was performed to determine the relationships among the variables.A total of 639 women enrolled in the study; most participants were 25–34 years old, and most indicated they changed their reproductive intentions during the pandemic (49%). Family planning accounted for 25.8% of participants who changed their reproductive intentions. Only 17.5% changed their choices because of fear of the COVID‐19 impact. The percentage of women using contraception was significantly reduced during the lockdown, to 36.8%. Oral contraceptive pills were the most frequently used method during the curfew period (17.5%).The COVID‐19 lockdown affected the reproductive intentions of most women in Jeddah, and it significantly reduced contraceptive use. [ABSTRACT FROM AUTHOR]

Background. Intrauterine contraceptive devices (IUCDs) are considered to be an effective way of preventing unwanted pregnancies. However, one significant complication associated with IUCDs is uterine perforation especially at the time of insertion and could reach the peritoneal cavity and the viscus of the adjacent organs. Intravesical migration is extremely rare. Case Presentation. We report a 41-year-old woman who was diagnosed with IUCD intravesical migration after she presented to our hospital complaining of persistent lower urinary tract symptoms. Laparoscopic removal was done after the failure of cystoscopic extraction. Conclusion. The IUCD must be monitored continuously by the gynaecologist, and suspicions of intravesical migration must be considered in those presenting with persistent, unexplained lower urinary tract symptoms. [ABSTRACT FROM AUTHOR]

Background: Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. Methods: Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15–49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. Results: The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992–1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. Conclusion: Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to estimate hospital charges (HC) and length of stay (LOS) for pregnancy and 6 weeks postpartum and to characterize the outliers who utilize a disproportionate share of health care resources. Study Design We performed a cross-sectional study of 500 subjects at a tertiary center between 2012 and 2014. Subjects were included who had inpatient status and an ICD-9 code for pregnancy; those with an ICD-9 code for ectopic pregnancy were excluded. Data were collected 266 days prior to the estimated date of delivery (EDD) and up to 42 days post-delivery. Medical diagnoses, obstetrical details, demographics, HC, and LOS were collected. Super-utilizers (SUs) were selected as patients with total HC exceeding $75,000, those who incurred $75,000 or less were assigned to the typical utilizer (TU) group. Results HC was positively skewed, with median's (interquartile range) of $151,143 (97,707–198,732) and $28,186 (19,292–38,943) among SUs and TUs, respectively. Despite the low proportion of SU patients (7%, n = 36), they accounted for 30% of charges. Similarly, SUs had longer LOS (16 vs. 3 days, p <0.05). They had earlier deliveries (34.5 vs. 38.5 weeks, p <0.05), higher cesarean section rates (69 vs. 35%, p <0.05), and more hysterectomies (8.3 vs. 0%, p <0.05). The most common complications in SUs were preterm labor (33.3 vs. 5.4%, p <0.05) and preterm premature rupture of membranes (25 vs. 3.9%, p < 0.05). The most common pre-existing condition in SUs was chronic hypertension (11.1 vs. 3%, p < 0.05). Conclusion Although SUs comprise only 7% of the obstetrical population, they account for almost a third of the total HCs; in turn, SUs are at risk of adverse outcomes. Targeting this population can guide efforts to improve maternal health through prevention, research, and personalized care. SUs may have clustering at hospitals with higher levels of care and this topic warrants further investigation with state and national level data. Key Points Just 7% of pregnant patients accounted for 30% of hospital charges. Super-utilizers had higher rates of preterm delivery, cesarean section, and hysterectomy. The most common pre-existing medical condition in super-utilizers was chronic hypertension. [ABSTRACT FROM AUTHOR]

AbstractVasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18–72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25–56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice. [ABSTRACT FROM AUTHOR]

Background: Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. Methods: Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. Findings: The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. Conclusions: This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Plain English summary: Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs. [ABSTRACT FROM AUTHOR]

Background: Uttar Pradesh (UP) is the most populous state in India, with a historically lower level of family planning coverage than the national average. In recent decades, family planning coverage in UP has significantly increased, yet there are considerable geographic and socio-economic inequalities. Methods: The data used for the study is derived from a cross-sectional quantitative survey of 12,200 currently married women conducted during December 2020–February 2021 in UP by the Technical Support Unit. Univariate and bivariate analyses were performed and equiplots were used to make visualizing inequalities easy. Results: The findings of the study reveal significant variation in family planning coverage indicators amongst currently married women in reproductive ages by administrative divisions in UP. For instance, in the Jhansi division, it was 72.4%, while in Faizabad, it was 39.3%. Jhansi division experienced the highest modern contraceptive coverage with the lowest inequity compared to other divisions. However, the range of coverage within the division by Accredited Social Health Activist (ASHA) areas is 25% to 75%. In fact, for some ASHA areas in the Jhansi division, the family planning demand satisfied for modern contraception ranged from more than 85% to less than 22%. On the other hand, the Gonda division with the lowest coverage and lowest inequity for demand satisfied for modern contraception has some ASHA areas with less than 5% and some with more than 36%. The study also revealed intersectionality of education, wealth, place of residence and geographic divisions in identifying inequity patterns. For instance, in case of Mirzapur and Varanasi, the demand satisfied among the illiterates was 69% and the corresponding percentage for literates was 49%. With respect to place of residence, Basti division, where the coverage for modern contraception is extremely low, demand satisfied for modern contraceptive methods is 16.3% among rural residents compared to 57.9% in the case of urban residents. Conclusions: The findings showed inequality in the modern family planning methods coverage in UP in both best and worst performing divisions. The inequalities exist even in extremely small geographies such as ASHA areas. Within the geographies as well, the socio-economic inequalities persisted. These inequalities at multiple levels are important to consider for effective resource allocation and utilization. [ABSTRACT FROM AUTHOR]

Background: Early childbearing disrupts girls' otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing. Method: This study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20–24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs). Results: Many women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04–1.11) than those from the General caste. Conclusion: To decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women's reproductive rights. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. Methods: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15–49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. Results: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women’s age, area of residence, mother tongue of household head, age of husband, and number of children ever born. Conclusion: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women. [ABSTRACT FROM AUTHOR]