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Background: Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15–49 years in PNG. Methods: Secondary data from the 2016–2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported. Results: The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35–44 years (aOR = 8.54; 95% CI: 1.61–45.26), not working (aOR = 6.17; 95% CI: 2.26–16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60–8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91–16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17–4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61–14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39–8.18 and aOR = 2.54; 95% CI: 1.18–5.45, respectively) more likely to terminate a pregnancy. Conclusion: The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Background: The notion of unmet need for family planning indicates the gap between women's contraceptive practice and their reproductive intention. Although universal access to sexual and reproductive health services including contraceptive methods is a bedrock for sustainable development goals, the unmet need for contraception is high among young women in low-income countries including Ethiopia. The unmet need for contraception is associated with unintended pregnancy which most of the time end in unsafe abortion. Hence, this study aimed to assess the determinants of unmet need for family planning among young married women in Ethiopia using nationally representative data. Method: This study utilized secondary data collected in the 2016 Ethiopia Demographic and Health Survey (EDHS). A two-stage cluster sampling method was used. The analysis included a total of 2444 sexually active married young women (15–24 years). Multilevel logistic regression analysis was conducted to identify individual and community level factors associated with unmet need for contraceptives and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses. Results: In this study, the prevalence of unmet need for contraceptive method among married young women was 18.4% [95% CI: (16.9, 20.0)]. Female head of the household [AOR: 1.62, CI (1.25, 2.11)], primary level of education [AOR: 1.53, CI: (1.16, 2.03)], family size ≥5 [AOR: 1.53, 95%CI: (1.22, 1.93)], undecided to have child [AOR: 2.86, 95%CI: (1.58, 5.20)] and infecund [AOR: 1.54, 95%CI: (1.08, 2.20)] were factors positively associated with unmet need for family planning. Whereas the odds of unmet need for contraceptive method was lower among women-initiated sex between 15–17 years and >17 years [AOR:0.72, 95%CI (0.53, 0.98)] and [AOR: 0.58, 95%CI: (0.40, 0.85)] respectively and community with high proportion of poverty [AOR: 0.68, 95%CI: (0.46, 0.99)]. Conclusion: The prevalence of unmet need for contraceptive methods among young married women was relatively high. Being female household head, age at first sexual intercourse, educational status of the woman, family size, desire for more children, and community poverty were significantly associated with unmet need for family planning. Hence, interventions targeting these special populations at the individual and community level would play a paramount role in meeting the unmet need for contraception among young married women in Ethiopia. [ABSTRACT FROM AUTHOR]

Introduction Sexual and reproductive health is critical for the readiness of the warfighter, as costs of sexually transmitted infections and unintended pregnancy result in added health care costs, lost mission time, and impact on morale. The Multiphase Optimization Strategy (MOST) is an engineering-inspired framework used to optimize biobehavioral interventions. The Military Active-Duty Reproductive and Sexual Health (MARSH) research team applied the MOST framework to develop "Mission Wellness"—an electronic health intervention to promote sexual and reproductive health within the U.S. Military. Materials and Methods From 2017 to 2022, the MARSH team implemented the first and second phases of MOST to develop and optimize "Mission Wellness." All phases received institutional review board approval. The first phase consisted of expert and literature review, qualitative interviews, and beta testing to identify intervention components and the optimization objective and to inform study design. The second phase consisted of a factorial trial. Results Figures 1–4 outline the research program approach, demographics of the sample, and format of the app. Service members who used the application found it to be acceptable and, overall, reported that it would be easier to talk to a sexual partner about risk behaviors and history at the post-intervention assessment compared to baseline. This iterative optimization approach using both local and strategic engagement enhanced program development and set the stage for dissemination and implementation efforts. Conclusions In line with the iterative nature of MOST, the lessons learned during the optimization trial led the MARSH team to return "Mission Wellness" to the preparation phase. The utilization of mixed (i.e. qualitative and quantitative) research methods and engagement with stakeholders at multiple levels of the military enterprise provided the information necessary to further optimize "Mission Wellness." This programmatic approach also provides a blueprint for the development of research design and testing in military health care balancing rigor and agility. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol consumption is associated with unintended pregnancies among teenagers. Its role as a broader determinant of teenage fertility rates remains unclear. We investigate whether adolescent binge drinking affects the number of teenage births. Methods: Binge drinking data from 137,898 females aged 15–16 were collected in the HBSC study (2002–2018, 43 countries/regions) and 267,359 in the ESPAD study (1995–2019, 41 countries/regions). Age‐specific fertility rates were from the Human Fertility Database and the World Health Organization. We examined changes over time in countries' average levels of binge drinking among female pupils aged 15–16 and population‐level fertility rates for the same cohorts when aged 16–19 years. Results: Controlling for differences between countries and survey waves, we found an association between binge drinking and fertility rate, B = 0.019, 95% confidence interval [0.004, 0.034]. When accounting for the countries' time trends, the association was substantially reduced, B = 0.006, 95% confidence interval [−0.0062, 0.0174]. The relationship was not moderated by abortion rates and controlling for contraceptive use had no impact on the findings. Discussion and Conclusions: The association between adolescent binge drinking and fertility rates diminishes when accounting for country‐specific time trends. Given the lack of clear mechanisms linking binge drinking to trends in fertility rates rather than shorter‐term changes, the association likely reflects broader secular trends. Binge drinking may be involved in teen pregnancy and childbirth in individual cases but it does not explain recent developments in teenage fertility rates. [ABSTRACT FROM AUTHOR]

Using a feminist narrative approach, this article explores how unintended pregnancy can rupture young lives, and how young people respond to and navigate these ruptures. We analyse qualitative data from a longitudinal cohort study in Luwero, Uganda, focusing on narratives of a girl and a boy about their recent experiences of unintended and unwanted pregnancy during COVID-19 school closures. We argue that laws, policies and norms relating to education, sexual and reproductive health, and the family in Uganda position young people in complex and contradictory ways, that create the conditions for unintended pregnancies, and restrict the choices open to them. The analysis traces how pregnancy ruptures their everyday lives, their identities, and relationships. Their narratives reveal gendered ways in which they enact identities to manage the ruptures. Families are sites of contestation, where gender and sexuality are regulated, but are also mobilised by young people to support their efforts to repair the ruptures. Our analysis underscores the importance of working with young people to understand their positionalities, resource environments and social networks as they make and navigate decisions about pregnancy, and of addressing the structural forces that underpin the rupturing effects of pregnancy on teenage lives. [ABSTRACT FROM AUTHOR]

Objective: To examine the uptake of postnatal contraception (PNC) and experiences of PNC care across a geographical region of England. Design: Cross‐sectional online survey. Setting: The North East and North Cumbria Integrated Care System (ICS). Population: Women who had completed a pregnancy in the previous 3 years. Methods: The uptake of PNC by accessed method(s) and the availability of preferred method(s) is described, and adjusted odds ratios are reported for group differences in uptake by characteristics of interest. Main outcome measures: Uptake of medically prescribed/administered contraception and uptake of long‐acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods. Results: Although almost half of respondents (47.1%; n = 1178) reinitiated some form of sexual activity during the postnatal period, only 38.7% (n = 969) of respondents accessed a medically prescribed/administered contraceptive method postnatally, and only 15.5% (n = 389) of respondents accessed a LARC. It is a matter of concern that 18.8% (n = 451) of respondents indicated that they were unable to access their preferred PNC. In multivariate analysis, younger age, lower household income, higher multiparity, operative delivery, unplanned pregnancy and not breastfeeding were significant predictors of higher PNC uptake. Conclusions: The uptake of PNC in this cohort was low, with almost a fifth of women unable to access their preferred method. However, there was some evidence that women belonging to groups perceived to be at risk of rapid repeat pregnancy were more likely to access reliable PNC methods. [ABSTRACT FROM AUTHOR]

Unplanned or unwanted pregnancies and births are linked to adverse maternal outcomes, but the extent to which such relationships hold for all racial/ethnic groups remains unknown. In this paper, I use large-scale data to estimate unadjusted and inverse propensity weighted associations between a five-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. I find substantial racial/ethnic variation. White and Hispanic mothers who reported that their pregnancies were mistimed, unwanted, or that they were unsure how they felt were significantly more likely to experience adverse outcomes than same-race/ethnicity mothers who reported that their pregnancy was intended, but the pattern was much more tenuous for Black mothers. After adjusting for potential confounding variables, relationships between pregnancy intentions and adverse outcomes remain substantial only for white and Hispanic mothers. Significance: What is already known on this subject?: Recent research has found links between unplanned or unwanted pregnancies and adverse maternal outcomes, but the extent to which the relationship varies by race/ethnicity is unknown. What this study adds?: This study estimates unadjusted and inverse propensity weighted associations between a 5-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. Both unadjusted and inverse propensity weighted relationships are considerably stronger among Hispanic and white mothers than among Black mothers. Possible causes of these differences are discussed. [ABSTRACT FROM AUTHOR]

Background: Tubal sterilization is the most commonly used method of contraception in the United States. Because contraceptive effectiveness influences contraceptive selection, we examined typical use failure rates after tubal sterilization in the United States. Methods: We estimated rates of pregnancy after tubal sterilization using data from four waves of the National Survey of Family Growth (NSFG), representative samples of U.S. women aged 15 to 44 years, collected in 2002, 2006 to 2010, 2011 to 2013, and 2013 to 2015. Survey weighting was used in survival analysis to examine time to first pregnancy after tubal sterilization. Data from these participants were censored after a tubal reversal procedure, infertility treatment, hysterectomy, or bilateral oophorectomy. Reported pregnancy rates after tubal sterilization procedures were examined by using Kaplan-Meier curves and then multivariable Cox proportional-hazards models to examine the effects of age at tubal sterilization, race/ethnicity, education, Medicaid funding, and postpartum versus interval procedures. Results: Pregnancy after tubal sterilization was reported by 2.9 to 5.2% of participants across NSFG waves. In the most recent survey wave (2013 to 2015), the estimated percentage of participants with pregnancies within the first 12 months after a tubal sterilization procedure was 2.9%; at 120 months after tubal sterilization, the estimated percentage with a pregnancy was 8.4%. At all the time points examined, pregnancy after tubal sterilization was less common after postpartum procedures than after interval procedures; however, this difference was not evident in multivariable models. In multivariable models, chance of pregnancy decreased with age at time of tubal sterilization. Race/ethnicity, education, and Medicaid funding were not consistently associated with pregnancy after tubal sterilization. Conclusions: These data suggest that there may be nontrivial rates of pregnancy after tubal sterilization. [ABSTRACT FROM AUTHOR]

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Background: Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia. Methodology: This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis. Results: Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers. Conclusion: The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school. [ABSTRACT FROM AUTHOR]

Background: Premarital sexual intercourse has essential implications for the sexual and reproductive health and rights of young women. These include increased sexual pleasure and satisfaction as well as exposure to the risks of unintended pregnancy and sexually transmitted infections, including HIV/AIDS. This study examined the trends, patterns, and associations of premarital sexual intercourse among young women aged 15–24 in Sierra Leone. Methods: Nationally representative cross-sectional data from the 2008, 2013, and 2019 Demographic and Health Surveys in Sierra Leone were used for the study. A weighted sample of 9,675 never-married young women was used to estimate the pooled prevalence of premarital sexual intercourse in Sierra Leone. Percentages were used to present the results of the trends and patterns of premarital sexual intercourse. We employed a multilevel binary logistic regression modelling technique to examine the associations of premarital sexual intercourse. The results were presented using adjusted odds ratio with their respective 95% confidence interval. Results: The pooled prevalence of premarital sexual intercourse among the young women in Sierra Leone was 62.9%. Over the survey years, premarital sexual intercourse increased from 59.8% in 2008 to 65.1% in 2013. However, it declined by 3.5% to 61.6% in 2019. Young women aged 20–24 (aOR = 12.47, 95% CI = 10.54–14.76) had higher odds of engaging in premarital sexual intercourse than those aged 15–19. Young women with higher educational levels (aOR = 1.87, 95% CI = 1.17–2.99), those who were working (aOR = 1.60, 95% CI = 1.44–1.78), those who listened to the radio (aOR = 1.33, 95% CI = 1.29–1.60), and those who lived in the Northwestern (aOR = 2.19, 95% CI = 1.68–2.84), Eastern (aOR = 1.47, 95% CI = 1.23–1.760, Northern (aOR = 1.48, 95% CI = 1.25 -, 1.76), and Southern (aOR = 1.63, 95% CI = 1.36–1.94) regions were more likely to engage in premarital sexual intercourse compared to those with no formal education, those not working, those who did not listen to the radio, and those who lived in the Western region, respectively. Young women in the richest wealth category (aOR = 0.62, 95% CI = 0.49–0.78), and residing in rural areas (aOR = 0.84, 95% CI = 0.72–0.98) had lower odds of engaging in premarital sexual intercourse relative to those from the poorest wealth quintile and those living in urban areas. Conclusion: Our study found a high prevalence of premarital sexual intercourse among young women in Sierra Leone. Premarital sexual intercourse was associated with age, educational level, wealth, employment, and region. This necessitates providing them with comprehensive information regarding sexual and reproductive health behaviours, specifically emphasising the benefits and adverse consequences of engaging in sexual experimentation. Additionally, it is crucial to promote the adoption of abstinence, injections, implants, and condom usage through consistent advocacy for youth-risk communication. [ABSTRACT FROM AUTHOR]

Desired fertility measures are routinely collected and used by researchers and policy makers, but their self-reported nature raises the possibility of reporting bias. In this paper, we test for the presence of such bias by comparing responses to direct survey questions with indirect questions offering a varying, randomized, degree of confidentiality to respondents in a socioeconomically diverse sample of Nigerian women (N = 6,256). We find that women report higher fertility preferences when asked indirectly, but only when their responses afford them complete confidentiality, not when their responses are simply blind to the enumerator. Our results suggest that there may be fewer unintended pregnancies than currently thought and that the effectiveness of family planning policy targeting may be weakened by the bias we uncover. We conclude with suggestions for future work on how to mitigate reporting bias. [ABSTRACT FROM AUTHOR]

Background: Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands' or partners' decision-making power on contraceptive use in Ethiopia. Objective: This study aimed to assess the determinants of low involvement of husbands/partners in women's contraceptive use decision-making processes in Ethiopia. Methods: This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands'/partners' independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as "Yes" or "No". A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance. Results: Husbands'/partners' independent decision-making in women's contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31–59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3–5.4) and over 59 years (AOR = 2.3; CI 1.2–4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9–4.3), secondary education (AOR = 3.9; CI 2.7–4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2–5.4), History of pregnancy termination (AOR = 3.3; CI 2.6–4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7–4.7) and Urban residency (AOR = 3.5; CI 1.6–4.2). Conclusions: In Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency. [ABSTRACT FROM AUTHOR]

This article discusses the need for improved labeling recommendations for medications used during pregnancy and breastfeeding. Currently, there is a lack of data on the safety and efficacy of drugs for these populations, as they are often excluded from drug development programs. The article highlights the value of Model Informed Drug Development (MIDD) in generating data and improving accessibility to safe and effective medicines. Regulatory developments and advancements in nonclinical drug development methodologies and MIDD are expected to enhance the safe use of medicines during pregnancy and breastfeeding. However, challenges remain, including limited experience with MIDD in this context and the uncertainty associated with model predictions. Efforts are being made to improve knowledge through data collection and the development of new methods. European regulators are open to discussions to improve labeling for medicines used during pregnancy and breastfeeding. [Extracted from the article]

Objectives: Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany. Methods: This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18–64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions). Results: Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02–1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17–3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30–2.70). Conclusions: The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted in Austria, Germany, and Switzerland that examined women's knowledge about contraception and reproductive health. The study found that there were gaps in women's knowledge about the female reproductive system, which correlated with unintended pregnancies. Factors such as marital status, age, and income were found to influence the level of knowledge. The study emphasizes the importance of providing women with proper counseling to prevent unintended pregnancies and induced abortions. [Extracted from the article]

Novel male contraceptives have been in development for well over half a century, and despite a robust predicted global market for new methods, funding for research and development has been extremely limited. While the pharmaceutical industry previously supported male contraceptive research and development, industry partners are only spectators in the current space, awaiting a product that has been de‐risked by the public sector before re‐entering the field. Current male contraceptive development efforts are thus primarily funded by nonprofit, non‐governmental, and government agencies who also act as the primary advocates for the field. Specific organizations include the International Consortium on Male Contraception, the Population Council, the Male Contraceptive Initiative, the World Health Organization, and the US National Institutes of Health. The funding provided by these public agencies, alongside their social and policy‐based advocacy efforts such as market research, public education, and calls to action have kept the male contraceptive product development space afloat, resulting in a pipeline of potential products advancing towards market approval. However, as these products mature into more expensive clinical stages of development, they continue to face significant funding challenges, which many programs may not overcome. To fully realize the benefits of novel male contraceptive options, it is incumbent on philanthropic entities, impact investors, venture capital, and/or the pharmaceutical sector to provide significant and timely support for male contraceptive research and development. [ABSTRACT FROM AUTHOR]

Objective To compare the prevalence of unintended pregnancy measured by the Demographic and Health Survey (DHS) and the London Measure of Unplanned Pregnancy in Bangladesh, and explore the extent of discordance between the measures and the factors associated with the discordance. Methods In 2023, we conducted a cross-sectional survey in four randomly selected districts in Bangladesh: Kurigram, Mymensingh, Pabna and Satkhira. We randomly selected 20 hospitals, five from each district. We collected data from 1200 women who had recently delivered a baby and were visiting the hospitals for postnatal care. We interviewed the women about their pregnancy intention in their last pregnancy using questions in the DHS and the London Measure of Unplanned Pregnancy and examined the discordance in their responses. We used multivariable logistic regression analysis to identify factors associated with discordant responses in reported pregnancy intention. Findings The prevalence of unintended pregnancy was 24.3% (292/1200) using the DHS measure and 31.0% (373/1200) using the London Measure of Unplanned Pregnancy. Discordance in responses to pregnancy intention between the two measures was 27.1% (325/1200). Factors associated with discordance were older age, female sex of the last child born, having more than two children, being in a poorer wealth quintile, living in a rural area and living in Kurigram district. Conclusion The prevalence of unintended pregnancy in Bangladesh measured by the DHS measure may be an underestimate, suggesting that the adverse effects of unintended pregnancy are greater than realized and emphasizing the need to bolster Bangladesh's family planning programme. [ABSTRACT FROM AUTHOR]

Background & Objective: Pregnancy in women diagnosed with Type-1 diabetes mellitus poses a higher risk of experiencing complications related to the health of the fetus, the mother, and the newborn, along with potential obstetric issues. The objective of this study was to examine the maternal and fetal outcomes, as well as complications faced by pregnant women with type-1 diabetes, and to identify potential preventable factors. Methods: This retrospective cohort study, conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan (January 2022 - January 2023), focused on registered pregnancies of women with Type-1 diabetes. A predesigned questionnaire recorded demographic information, diabetes and obstetric history, clinical details, treatment specifics, maternal, perinatal, and neonatal outcomes. Results: This study included 100 women with pre-existing Type-1 diabetes (mean age: 15.11 ± 5.64 years at diabetes diagnosis). Of these, 72% reported unplanned pregnancies, with a mean HbA1C at conception 8.29%. Median gestational age at delivery was 32.15 ± 10.82 weeks. Delivery outcomes included 40% normal vaginal deliveries and 60% C-sections (9% emergency, 51% elective). Stillbirths occurred in 14 cases, while 16 women experienced one miscarriage, seven had two, and 10 had three miscarriages. Glycemic targets (fasting) were achieved in 55 women, and post-meal targets only in 29, whereas, neonatal complications included hypoglycemia in 13 and low birth weight in 12 neonates. Conclusion: The high frequency of unplanned pregnancies and cesarean sections along with poor management of prepregnancy care and poor glycemic control results in compromised maternal and perinatal outcomes in this high-risk group. [ABSTRACT FROM AUTHOR]

The United States faces troubling fertility trends that include high percentages of unintended pregnancies, as well as record-low fertility rates and individuals having fewer offspring than they desire. To address these problems, scholars and public health advocates have argued for the implementation of fertility information into existing sex-education curricula. In this study, we draw from 32 semi-structured interviews with secondary school sex educators to gain insight into their experiences on this front. They contended that one of the greatest barriers to their successfully teaching fertility related material was that students do not find fertility information relevant. Participants described three appeals that they employ to communicate fertility information as persistently relevant to the adolescents in their classes. Our interviews revealed that all three of these relevance appeals employ targeted invitations for students to tailor fertility information in ways that fit them personally. These findings suggest a need to re-conceptualize targeting and tailoring research in ways that connect with the goals of in situ, relevance-oriented communication, and they indicate how a focus on teaching health educators to establish fertility as relevant would help to situate future generations for better sexual and reproductive health over a lifetime. [ABSTRACT FROM AUTHOR]

The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. Repeated cross-sectional study. Women aged 16–49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. A total of 38,288 women were included with a median age of 25 (interquartile range: 22–29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%–56.1%; P trend <0.001) and oral contraception (27.2%–20.5%; P trend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%–6.0%; P trend = 0.002) and intrauterine device (2.8%–11.8%; P trend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (P trend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56–0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48–0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07–1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22–1.87) had higher odds of using moderate-high-efficacy contraception. Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes. [ABSTRACT FROM AUTHOR]

Objective: Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. Methods: We conducted a cross‐sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006–2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%–4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. Results: Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03–1.57) to aRR = 1.66 for low education (95% CI: 1.30–2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88–2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29–2.24) and in polytherapy (aRR 2.65; 95% CI 1.66–4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08–1.26) to 1.26 (not married or cohabiting; 95% CI 1.17–1.36). Significance: Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care. [ABSTRACT FROM AUTHOR]

Emergency contraception reduces the risk of unintended pregnancy, after unprotected sexual intercourse or contraceptive failure. In Belgium, emergency contraception is available without a prescription and pharmacists play therefore a crucial role in dispensing emergency contraception. This study assesses the dispensing practices of emergency contraception by pharmacists in two regions of Belgium. Simulated patient study, using a predefined scenario, evaluating a request for emergency contraception. The scenario involves a 25-year-old woman not using contraception, who had unprotected sexual intercourse 84 h (3.5 days) ago. Her last menstrual period was 10 days ago. 260 pharmacies were randomly selected. Principal outcome: proportion of pharmacists who deliver the adequate emergency contraception. We considered the following responses as adequate: Prescribing ulipristal acetate or redirecting to another pharmacy, in case of unavailability, or referring for a copper IUD We analysed the data obtained in 216 pharmacies (216/260 = 83.1%). In 64% of cases, adequate dispensing of emergency contraception (dispensing of ulipristal acetate or referral for intrauterine device insertion) occurred. There was an association between correct dispensing and asking appropriate questions, such as the date of the last menstrual period and the date of the risky sexual intercourse. More than one-third of visited pharmacies did not distribute appropriate emergency contraception, underlining the need for improvement. We hypothesise that this may be achieved with appropriate training, use a dispensing checklist. We assesses the dispensing of emergency contraception by pharmacists using a simulated patient. More than one-third of visited pharmacies did not distribute appropriate emergency contraception, underlining the need for improvement. [ABSTRACT FROM AUTHOR]

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Background: A nationwide study on the contribution of abortion to maternal mortality in Ethiopia was 6%−9%. To bring Ethiopia's legal system into compliance with the country's new constitution, a new criminal code was created in 2005. In the new penal code, after 2005, abortion was permitted under broad circumstances; in the case of rape, incest, or fetal impairment; if pregnancy continuation or birth would endanger the health or life of the woman or fetus; if the woman has physical or mental disabilities; and if the woman is a minor who is physically or mentally unprepared for childbirth. Objectives: To determine the status of women's perception toward the current Ethiopian abortion law among reproductive‐aged women. Method: A community‐based study was conducted from June 10 to October 30, 2023. Chi‐square test and multivariable logistic regression methods were employed using SPSS 23. The strength of associations and the significance level was examined using p‐value and odds ratio at 95% CI, respectively. Result: The prevalence of women's positive perception toward Ethiopian abortion law among reproductive‐aged women is 21.18%. The age group of between 18 and 24, educational status of being unable to read and write, living solely, history of unplanned pregnancy, and age of marriage under 18 were associated with women's perception to the current abortion law of Ethiopia. Conclusion: The finding of this study is unexpectedly low, which needs exhaustive intervention. [ABSTRACT FROM AUTHOR]

Background: The human immune virus or acquired immune deficiency syndrome, is a major threat to the health of millions of people worldwide. In Ethiopia, there were more than a million people living with HIV/AIDS. The continuous and appropriate use of condoms, particularly among those who have HIV-positive clients, is essential to a comprehensive and long-term approach to avoiding HIV and other STIs as well as unintended pregnancy. But irregular condom use is regularly reported. There is inconsistent reports of the prevalence and correlates of frequent condom use in Ethiopia. This study's goal is to provide an overview of the most recent research on magnitude condom use among people living with HIV in Ethiopia. Methods: Four databases of PubMed, Science Direct, Scopus, and Google Scholar were used. Finally, 10 studies that satisfied the eligibility criteria were included in the systematic review and meta-analysis. The data were collected using a methodical checklist for data extraction, and STATA 14 was utilized for the analysis. The consistent condom use was reported as use of condom in every sexual encounter preceding the study. The prevalence of consistent condom usage among HIV/AIDS patients was calculated by dividing the total number of patients who regularly used condoms by the total number of HIV/AIDS patients and multiplying that result by 100. The factors associated with a consistent use of condom were described using the pooled odds ratio (OR) and calculated based on binary outcomes from the included primary studies. The statistical significance was determined based on the correlation factor as their confidence level should not include 1. Subgroup analyses by region and publication years were carried out by using a random-effects model. The STATA commands of metan magnitude semagnitude, random xlab(.1,5,10) lcols (authors) by (variables)texts(120) xsize(18) ysize (14) were used to carried out the subgroup analysis. To assess the presence of publication bias, funnel plot, Egger test and Begg's test at 5% significant level were computed. The asymmetry of funnel plot and the Egger test and Begg's test P value of 0 >0.5 showed the absence of publication bias. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. Result: The pooled magnitude of consistent condom use was 50.56% (95%CI: 38.09–63.02). The predictors of consistent condom use includes urban residence (AOR = 3.46; 95% CI: 2.24–5.35), marital status (AOR = 0.33; 95% CI: 0.18–0.61), and HIV disclosure status (AOR = 5.61;95%CI: 2.29–13.73). Conclusion: Half of the HIV/AIDS patients in our study regularly used condoms. According to this study, urban residency, disclosure status, and marital status were all associated with consistent condom use among HIV/AIDS patients. Therefore, health education about condom use should be provided to married couples and people living in rural regions. In addition, disclosing HIV status and the necessity of constant condom usage would be crucial for consistent condom use. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. Methods: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. Results: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71–4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74–7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14–0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10–0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. Conclusions: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW. Plain English summary: Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited. To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy. Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week. The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW. [ABSTRACT FROM AUTHOR]

Background: The management of systemic lupus erythematosus (SLE) during pregnancy remains a challenge currently. Identifying early predictors of adverse pregnancy outcomes in SLE patients can help to develop treatment plan and improve prognosis. The aim of this study is to explore the clinical and laboratory variables in the early pregnancy that can predict adverse neonatal and maternal outcomes, thereby facilitating the grading management of SLE. Methods: A retrospective analysis was conducted on 126 pregnant women with SLE who were admitted to Zhongnan Hospital of Wuhan University between January 2017 and December 2022. All enrolled patients were diagnosed (including newly diagnosed and previously diagnosed) during first trimester of pregnancy and their clinical records, laboratory results and pregnancy outcomes were reviewed. The association between the clinical and laboratory characteristics of patients at 12 gestational age and the adverse neonatal (ANOs) as well as maternal outcomes (AMOs) were analyzed. Results: A total of 117 live births (92.8%) were recorded in the study. ANOs occurred in 59 (46.8%) cases, including fetal loss in 9 cases (7.1%), preterm birth in 40 cases (31.7%), small for gestational (SGA) in 15 cases (11.9%), and complete heart block in 2 cases (1.5%). Univariate analysis showed that disease activity index (P < 0.0001), lupus nephritis (P = 0.0195), anti-SSB positivity (P = 0.0074) and hypocomplementemia (P = 0.0466) were related to ANOs. However, multivariate analysis showed that only disease activity during early pregnancy was an independent predictor for ANOs (OR = 7.053, 95% CI: 1.882 to 26.291, P = 0.004). In addition, 48 patients experienced AMOs during subsequent trimester, including 24 (19.0%) patients with disease flare and 23 (18.3%) patients with pre-eclampsia. Unplanned pregnancy (P = 0.010), active disease (P = 0.0004), new onset SLE (P = 0.0044) and lupus nephritis (P = 0.0009) were associated with AMOs in univariate analysis, while disease activity was identified as an independent risk factor for AMOs (OR = 2.553, 95% CI: 1.012–6.440, P = 0.047). Conclusion: Active disease in early pregnancy is associated with adverse pregnancy outcomes. For patients with high risk factor for ANOs and AMOs, more intensive treatment and follow-up should be a wise measure. Especially for those who suffer from active disease, they should be fully informed and given the option to terminate or continue their pregnancy. [ABSTRACT FROM AUTHOR]

Background: Multipurpose prevention technologies (MPTs) are products capable of simultaneously addressing multiple sexual and reproductive health needs such as unwanted pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs are urgently needed to address the double burden of unplanned pregnancy and HIV. While condoms are currently the only accessible MPTs, they are not solely under a woman's control, and female condoms face limitations due to poor acceptability and high cost. Methods: We conducted a sub-analysis of qualitative data from 39 couples participating in the MTN 045 study to examine the perception of couples on choice and acceptability of a "2 in 1" MPT that combines HIV and pregnancy prevention. Results: Couples recognized the benefits of MPTs for HIV and pregnancy prevention but perceptions tied to each indication and a novel prevention technology tool raised important concerns relevant to use of future MPTs. In the study, participants' perceptions of MPT use were influenced by pregnancy planning. When the timing was less critical, they prioritized HIV prevention. Misinformation about family planning methods, including MPTs, affected decision-making with potential to hinder uptake of future MPTs. Concerns about side effects, such as weight gain and hormonal imbalances, influenced willingness to use MPTs. Conclusion: Addressing the myths and misconceptions surrounding the use of contraceptives is crucial in promoting their acceptance and ultimate use. Strategies for addressing the drawbacks women might experience while using a particular product should be in place as new MPTs progress through the development pipeline and approach roll-out. [ABSTRACT FROM AUTHOR]

Objective: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. Methods: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. Results: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. Conclusion: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences. [ABSTRACT FROM AUTHOR]

Adolescents face a higher risk for HIV, STIs, and unintended pregnancy than any other age group in sub–Saharan Africa, and have unique health care needs as they navigate this period of growth and developmental milestones. We conducted the Youth Friendly Services study among adolescents in Rustenburg, South Africa to address some of these concerns. Participants aged 12–19 were followed quarterly for 12 months, asked at baseline about demographics, their sexual behavior, and tested for HIV, STIs, and pregnancy (girls). Report of sexual activity was not a requirement for enrollment. Assent and parental consent were obtained for participants under 18. Some follow up visits fell during COVID-mandated shutdowns, and we worked with participants to reschedule and extend follow up as appropriate. Here we present data on reported behaviors, participant attrition, risk of HIV, other STI, and pregnancy. From May 2018 to August 2019, we enrolled 223 HIV-negative, non-pregnant adolescents (64% girls). The median age was 17 (IQR: 14–18). Among the 119 (53%) participants who reported being sexually active at baseline, the median age at first sex was 16 years (IQR: 15–17). During follow-up, an additional 16 (7%) participants reported having their first sexual encounter. Among the sexually active participants, the incidence of HIV was 1.5 cases / 100 person-years at risk (PYAR, 95% CI: 0.4–6.0), the incidence of chlamydia was 15.7 cases (95% CI: 10.1–24.4), gonorrhea was 4.7 cases (95% CI: 2.1–10.5), and HSV was 6.3 cases (95% CI: 3.1–12.6); we observed no cases of incident syphilis. The incidence of pregnancy among sexually active girls was 15.0 pregnancies / 100 PYAR (95% CI: 8.5–26.5). Despite small numbers, the incidence of most STIs was significantly higher in females compared to males. We also observed two pregnancies and 5 incident STIs among participants who reported never having had sex, these tended to be younger participants. From March to September 2020, the clinic was shut down for COVID-19, and 53 study visits were postponed. Follow up was concluded in November 2020, a total of 19 participants were lost to follow up, however only one participant dropped off-study during COVID-19 shutdowns. Retention at the final visit was 91.5%. We successfully completed a prospective study of adolescents to learn more about the risks they face as they navigate sexual debut in the context of a program of youth-friendly counseling and services. Among self-reported sexually active participants, we observed a high rate of HIV, STI and pregnancy, however we also observed pregnancy and STIs among those who reported no sexual activity. [ABSTRACT FROM AUTHOR]

Introduction: South African women bear an intersecting burden of HIV, sexually transmitted infections (STIs) and unintended pregnancy. Multipurpose prevention technologies (MPTs) are a class of products that address multiple needs and have the potential to improve uptake and use of prevention products. Methods: Analysing survey data from 703 HIV-negative women 18--40 years in three provinces in South Africa, collected between July and November 2022, this study explores their preferences for prevention methods and factors influencing choice of hypothetical prevention methods, including MPTs. Descriptive statistics and multinomial regression analyses were conducted to determine prevention method preferences and factors associated with choosing a pill, injectable or MPT-implant type prevention method. Results: Most women wanted to prevent HIV, STIs and pregnancy. The most important factors when choosing a prevention product were whether it provided dual and long-term protection and if side effects were manageable. If choosing only one method, half of women would choose any MPT-implant and a quarter each would choose a pill or an injectable method, with method choices differing by population group. Discussion: Prevention method choices were influenced by sexual-behavioural factors and current and prior contraceptive method use. Providing a choice of prevention methods and a population specific approach to new method development and introduction with access to accurate information could enhance their ability to fill a gap in prevention needs. [ABSTRACT FROM AUTHOR]

AbstractIntroductionObjectiveMaterials and MethodsResultsConclusions\nSHORT CONDENSATIONCondoms and combined oral contraceptive pills are widely used in Spain with high failure rates. Long-Acting Reversible Contraceptive (LARC) methods offer better efficacy and adherence and reduce unintended pregnancies (UP) compared with short-acting reversible contraceptive (SARC) methods.To assess the cost-effectiveness of LNG-IUS 52 mg (Mirena®) versus other LARC for contraception in Spain.A Markov model with annual cycles and an eight-year time horizon was developed from the Spanish national healthcare system (NHS) perspective, considering costs for contraceptive method acquisition, health care resources (HCR) and UP. Effectiveness was based on failure and discontinuation rates. Sensitivity analyses were performed to test the model’s robustness.LNG-IUS 52 mg (Mirena®) resulted in lower costs and fewer UP versus LNG-IUS 13.5 mg (Jaydess®), Implant (Implanon®) and Copper IUD. LNG-IUS 52 mg (Levosert®) prevented the same UP events at a higher cost. LNG-IUS 19.5 mg (Kyleena®) was the most effective option, due to a lower discontinuation rate.LNG-IUS 52 mg (Mirena®) is the least costly LARC, driven by lower acquisition costs and reduced HCR utilisation. Increasing LNG-IUS 52 mg (Mirena®) uptake in contraception could generate further cost savings for the Spanish NHS and reduce economic burden of UP.Levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena®) is an effective and cost-saving long-acting reversible contraceptive (LARC) method compared with other similar methods in Spain over an eight-year time horizon, and Kyleena® was the most effective option. [ABSTRACT FROM AUTHOR]

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice. [ABSTRACT FROM AUTHOR]

Background Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. Purpose To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. Methods In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. Results Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. Conclusions Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. Clinical Trials Registration # NCT05177783 , ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783 [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancy is a global public health issue with significant adverse effects which include health and economic consequences. Globally, there were 121 million unintended pregnancies annually between 2015 and 2019 among women of reproductive age between 15 and 49 mainly due to the non-uptake of modern contraceptives, harmful norms, stigma and lack of sexual and reproductive health care and information. Methods: We extracted information from the Nigeria Demographic Health Survey conducted in 2008, 2013, and 2018 to assess the trends and factors associated with unintended pregnancies among women of reproductive-aged 15–49. The descriptive summaries were presented using percentages and binomial logistic regressions for the inferential analysis. All analyses were computed using Stata 15.0 at a 5% level of significance and accounted for the complex survey nature as well as the population size. Results: The study included a total of 63,040 women of reproductive age. The prevalence of unintended pregnancy was highest among adolescents aged 15–19 years (15.1%, 95% CI: 13.9–16.5) and decreased with increasing age. The pooled adjusted model revealed that women had 11% lower odds of reporting unintended pregnancies in 2013 compared to 2008. Adolescent girls (aOR 2.48; 95%CI: 2.14–2.89) and young adults (aOR 1.86; 95%CI: 1.69–2.04) have higher odds of reporting unintended pregnancies compared to older women. Also, unmarried women had 9.8 times higher odds of reporting unintended pregnancies compared to ever-married women. Conclusions: The findings from this study highlight the need for further family planning educational programs and initiatives that support the uptake of effective contraceptive methods to reduce the likelihood of unintended pregnancy and improve women's sexual and reproductive health while considering regional variations within the country to ensure tailored interventions that address specific needs within each region. [ABSTRACT FROM AUTHOR]

Background: Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders. Methods: Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes "Shadow of the past," reflecting past experiences, and "Shadow of the future," reflecting future imaginaries, building upon the existing "Narrative Framework." Results: The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The "Shadow of the present" was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future. Conclusions: This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders. Plain English Summary: Recent studies show that women with psychiatric disorders are more likely to experience unintended pregnancies. However, the underlying reasons are not fully understood. Understanding those reasons is important to provide better healthcare. Our study explored how women with psychiatric disorders make decisions about family planning. We had conversations with different groups of women—women with unintended pregnancies, women without children, and women with intended pregnancies—through focus group discussions. We partnered with the Dutch mental health organization MIND to capture diverse opinions. Key themes and categories in the discussions were identified and organized. We found four main themes: "Shadow of the past" showed how past events, trauma, and lack of knowledge about parenting affect family planning. "Shadow of the present" revealed different feelings about family planning, the importance of the awareness of psychiatric disorders, and uncertainty about decisions. "Shadow of the future" included thoughts about becoming a mother, the impact of social influences, and concerns about passing on psychiatric disorders. "Reflections on the decision" showed how psychiatric disorders, experiences with motherhood, and feelings of regret, grief and relief had an influence on family planning decisions. In conclusion, our study highlighted the complexity of family planning decisions for women with psychiatric disorders. Past experiences and societal influences, like stigma, play a big role. These insights show the need for personalized family planning support for women with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology Background: Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy that can result in severe maternal morbidity and mortality. Medical, surgical, and minimally invasive therapies alone or in combination have been described in the literature, but the optimal treatment modality of cesarean scar ectopic pregnancies is unknown. Limited information exists on the course of cesarean scar ectopic pregnancy following treatment with cytotoxic agents. Case Report: We present a case of a woman with a history of multiple cesarean births that was provided with medical abortion for an unintended pregnancy. However, upon follow-up, the patient was found to have a cesarean scar ectopic pregnancy. Following the diagnosis, she was treated by multi-dose systemic methotrexate-leucovorin and with ultrasound-guided intra-gestational sac injection of potassium chloride. After resolution of beta human gonadotropin levels, ultrasound follow-up revealed persistence of residual tissue in the cesarean scar. The patient elected for resection of the residual tissue with operative hysteroscopy. We report a novel hysteroscopic finding after medical treatment of a cesarean scar ectopic pregnancy with intra-gestational sac injection of potassium chloride. Conclusions: Direct visualization of the intra-abdominal cavity and intra-uterine cavity showed that combined medical management with systemic methotrexate and local potassium chloride injection is an effective treatment modality for live cesarean scar ectopic pregnancies, with minimal anatomical harm. Hysteroscopic resection offers a safe and effective approach for removal of persistence of residual tissue. [ABSTRACT FROM AUTHOR]

Objective: To explore factors related to the use of contraceptive methods in young Chilean women with higher education. Methods: Using the 9th Chilean National Youth Survey, multinomial models were conducted to predict contraceptive methods used during the last intercourse among sexually initiated female college students aged 17–29 years who had already completed high school (n = 1828). Results: The results indicate that using contraceptive methods at onset sexual activity was positively associated with the use of all contraceptive methods (relative risk ratio [RRR]immediate = 3.97, RRRdaily = 2.95, RRRlong‐term = 1.82, P < 0.05). Having a previous unintended pregnancy increased the odds of using long‐term contraceptive methods (RRR = 2.13, P < 0.05). Increased age of sexual initiation was associated with increased odds of using immediate contraception methods (RRRadolescence = 2.57, RRRyoung adulthood = 3.75, P < 0.05). Substance use was not associated with contraception methods used. Medium socioeconomic status, compared with high, decreased the odds of using immediate and daily contraceptive methods (RRR = 0.26, P < 0.05 for both). Low socioeconomic status was associated with decreased odds of using daily contraception (RRR = 0.39, P < 0.05). Finally, incomplete (RRR = 2.21, P < 0.05) or complete (RRR = 2.38, P < 0.05) professional education increased the odds of immediate contraceptive methods. Conclusions: To generate family planning policies aimed at university students, individual factors related to sexual behavior should be addressed in accordance with the local reality and with a gender focus. Synopsis: Using contraception at onset of sexual activity increased the likelihood of contraceptive use. Unintended pregnancy was linked to long‐term methods, while later sexual initiation was correlated with immediate contraception. [ABSTRACT FROM AUTHOR]

Mediation analysis with contemporaneously observed multiple mediators is a significant area of causal inference. Recent approaches for multiple mediators are often based on parametric models and thus may suffer from model misspecification. Also, much of the existing literature either only allow estimation of the joint mediation effect or estimate the joint mediation effect just as the sum of individual mediator effects, ignoring the interaction among the mediators. In this article, we propose a novel Bayesian nonparametric method that overcomes the two aforementioned drawbacks. We model the joint distribution of the observed data (outcome, mediators, treatment, and confounders) flexibly using an enriched Dirichlet process mixture with three levels. We use standardization (g-computation) to compute all possible mediation effects, including pairwise and all other possible interaction among the mediators. We thoroughly explore our method via simulations and apply our method to a mental health data from Wisconsin Longitudinal Study, where we estimate how the effect of births from unintended pregnancies on later life mental depression (CES-D) among the mothers is mediated through lack of self-acceptance and autonomy, employment instability, lack of social participation, and increased family stress. Our method identified significant individual mediators, along with some significant pairwise effects. [ABSTRACT FROM AUTHOR]

Although teen pregnancy and birth rates have declined over the decades, all adolescentpopulations are at risk. Disparities among adolescent pregnancies still exist, including increased risk and rates of unplanned pregnancy among vulnerable adolescents, including those with a mental health diagnosis.Adolescent girls with mental health disorders are notably at higher risk and are three timesmore likely to become pregnant than those without a mental illness. Adolescents who have experienced trauma and have a mental health diagnosis are much more likely to engage in high-risk sexual activity, to not participate in contraceptive use, and to become pregnant than their counterparts.Using Trauma Informed Care (TIC) to assess mental health diagnoses, high-risk sexual behaviors, and risk for unplanned pregnancy among adolescent populations can be an effective approach for primary prevention. There is increased expectation for clinicians to practice TIC and to establish relationships with patients while understanding how mental health diagnoses can impact health behaviors. The focus of this paper is to examine the effects of adolescent unplanned pregnancy, identify the increased risk for adolescents with mental health disorders, and discuss general methods for TIC in clinical practice. [ABSTRACT FROM AUTHOR]

The sexual and reproductive health of cisgender women with HIV is essential for overall health and well-being. Nationally representative estimates of sexual and reproductive health outcomes among women with HIV were assessed in this study. Data from the Centers for Disease Control and Prevention's Medical Monitoring Project—including data on sexual and reproductive health—were collected during June 2018–May 2021 through interviews and medical record abstraction among women with HIV and analyzed in 2023. Among women with HIV aged 18–44 years (n =855), weighted percentages were reported, and absolute differences were assessed between groups, highlighting differences ≥|5%| with CIs that did not cross the null. Overall, 86.4% of women with HIV reported receiving a cervical Pap smear in the past 3 years; 38.5% of sexually active women with HIV had documented gonorrhea, chlamydia, and syphilis testing in the past year; 88.9% of women with HIV who had vaginal sex used ≥1 form of contraception in the past year; and 53.4% had ≥1 pregnancy since their HIV diagnosis—of whom 81.5% had ≥1 unintended pregnancy, 24.6% had ≥1 miscarriage or stillbirth, and 9.8% had ≥1 induced abortion. Some sexual and reproductive health outcomes were worse among women with certain social determinants of health, including women with HIV living in households <100% of the federal poverty level compared with women with HIV in households ≥139% of the federal poverty level. Many women with HIV did not receive important sexual and reproductive health services, and many experienced unintended pregnancies, miscarriages/stillbirths, or induced abortions. Disparities in some sexual and reproductive health outcomes were observed by certain social determinants of health. Improving sexual and reproductive health outcomes and reducing disparities among women with HIV could be addressed through a multipronged approach that includes expansion of safety net programs that provide sexual and reproductive health service coverage. [ABSTRACT FROM AUTHOR]

Background: Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. Objective: The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. Methods: Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. Results: Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). Conclusion: Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs. [ABSTRACT FROM AUTHOR]