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INTRODUCTION: Although the Government of Nepal has developed strategies to integrate contraceptive services with abortion care to better meet the contraceptive needs of women, data indicate that significant gaps in services remain. This paper assessed post-abortion contraceptive use, trends over 36 -months, and factors influencing usage. METHODS: Data from this paper came from an ongoing cohort study of 1831 women who sought an abortion from one of the sampled 22 government-approved health facilities across Nepal. Women were interviewed eight times over 36 months between April 2019 to Dec 2023. Bivariate and multivariate analysis were used to analyze the data. RESULTS: Results show that after abortion, 59% of women used modern contraception, with injection being the most prevalent method, followed by condoms, pills, implants, and IUD. The hazard model showed that discontinuation of modern contraception was significantly higher among women desiring additional children (aHR 0.62) and lower among literate (aHR - 0.15) and those with existing children (aHR - 0.30). Womens age, ethnicity, cohabitation with husband, households income and autonomy were not associated with continuation. CONCLUSION: After having an abortion, we found that just slightly more than half of women used modern methods of contraception; this percentage did not increase significantly over the course of three years.

Background: Medroxyprogesterone acetate (MPA), a synthetic progestogen, is extensively used for the treatment of various conditions, including contraception, irregular menstruation, functional uterine bleeding, and endometriosis. However, like all pharmaceutical agents, MPA is associated with adverse drug reactions. This study aimed to evaluate the adverse events (AEs) associated with MPA in by analyzing real-world data from the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS). By providing a comprehensive assessment of the safety profile of MPA, this study seeks to support informed clinical decision-making. Methods: Data covering the period from the first quarter of 2004 to the first quarter of 2024 were collected from the FAERS database. Disproportionality analyses were conducted using several statistical methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayesian geometric mean (EBGM). Additionally, time-to-onset (TTO) analysis was employed to quantify the signals of the MPA-associated AEs. Results: A comprehensive dataset comprising 21,035,995 AE reports was compiled. Among these, 3,939 women reported using MPA as a contraceptive method. The reports covered 27 system organ classes (SOCs) and 25 high-frequency AE signals. Notably, significant AEs were identified, some of which were not previously detailed in the medication's prescribing information. Unforeseen significant AEs such as unintended pregnancy (n = 623; ROR, 6.65; ROR025, 6.1; χ2, 2,482.38; PRR, 6.41; EBGM, 5.69; EBGM05, 5.29), bone pain (n = 35; ROR, 13.78; ROR025, 9.4; χ2, 311.2; PRR, 13.75; EBGM, 10.59; EBGM05, 7.69), gait disturbance (n = 34; ROR, 2.82; ROR025, 1.99; χ2, 37.31; PRR, 2.88; EBGM, 2.7; EBGM05, 2.02), dental caries (n = 15; ROR, 23.16; ROR025, 12.32; χ2, 204.26; PRR, 23.14; EBGM, 15.23; EBGM05, 8.98), decrease in blood pressure (n = 15; ROR, 3.88; ROR025, 2.29; χ2, 29.35; PRR, 3.88; EBGM, 3.63; EBGM05, 2.33), and osteonecrosis (n = 9; ROR, 23.44; ROR025, 10.36; χ2, 123.67; PRR, 23.43; EBGM, 15.35; EBGM05, 7.75) were identified as AEs that were not previously outlined in the prescribing information of the medication. Conclusion: Our findings align with clinical observations, highlighting the emergence of previously unreported AE signals associated with MPA and their demographic and TTO characteristics. Further pharmaco-epidemiological studies are required to substantiate these observations. [ABSTRACT FROM AUTHOR]

This study examines an inconsistency between an attitude and a behaviour: non-use of contraception among people who are not trying to get pregnant. More than one in four people in that situation report not using contraception ‘sometimes’ or ‘always’ and consequently face the risk of pregnancy. We test three potential explanations: acceptability of having (further) children; perceived low pregnancy risk; and perceived social pressure. Using 10 waves of the German pairfam panel, we estimate sex-specific between–within models, where each explanation is tested by several indicators. We find evidence for the explanation of a(nother) child being considered acceptable: a positive fertility desire increases contraceptive non-use among women and men, and relationship duration increases it among women. Supporting the explanation of low perceived pregnancy risk, analyses show that perceived infertility, breastfeeding, and age increase the probability of non-use of contraception for women and men. However, there is no strong evidence for perceived social pressure affecting contraceptive non-use. [ABSTRACT FROM AUTHOR]

Despite growing utilization of family planning in Ethiopia, many pregnancies in rural areas are still unintended and unintended pregnancy remains a major global challenge in public and reproductive health, with devastating impact on women and child health, and the general public. Hence, this study was aimed to determine the prevalence and associated factors of unintended pregnancy in rural women of Ethiopia. This study used a 2016 Ethiopian Demography and Health Survey data. A total weighted samples of 974 reproductive-aged rural women were included in this analysis. Multilevel mixed logistic regression analysis was employed to consider the effect of hierarchal nature of EDHS data using Stata version 14 to determine individual and community level factors. Variables significantly associated with unintended pregnancy were declared at p-value < 0.05 with adjusted odds ratio and 95% confidence interval (CI). The prevalence of unintended pregnancy in rural women was 31.66% (95%CI 28.8%, 34.66%). Never had media exposure (AOR: 2.67, 95%CI 1.48, 4.83), don't have work (AOR: 0.33, 95%CI 0.21, 0.52), being from household size of one to three (AOR: 0.44 95%CI 0.2, 0.96), being primiparous (AOR: 0.41, 95%CI 0.17, 0.99), women from poor families (AOR: 2.4, 95%CI 1.24, 4.56), lacking the intention to use contraceptive (AOR: 0.24, 95%CI 0.14, 0.44) were individual-level factors significantly associated with unintended pregnancy. Women from large central region (AOR: 4.2, 95%CI 1.19, 14.62) and being from poor community wealth status (AOR: 4.3, 95%CI 1.85, 10.22) were community-level factors statistically associated with unintended pregnancy. The present study prevalence of unintended pregnancy in rural women was relatively high. Maternal occupation, household size, media exposure, parity, women wealth, intention to use contraceptive, region and community level wealth were factors statistically associated with unintended pregnancy. Hence, demographer and public health practitioners has to give great emphasis on designing an intervention with implementation strategies to increase accessibility of media for reproductive-age women's and improve women financial capacity, and strengthen maternal health services. These strategies helps to decrease adverse birth outcomes associated with unintended pregnancy in rural areas. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancy is a significant public health concern in Sierra Leone, with far-reaching consequences for both mothers and children. This issue impacts individual well-being, strains healthcare systems, and hinders socioeconomic development. This study examined the prevalence and factors associated with unintended pregnancy in Sierra Leone. Methods: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Provincial variations in the prevalence of unintended pregnancy was presented using a spatial map. A mixed-effect multilevel binary logistic regression models was fitted to examine the factors associated with unintended pregnancy. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intra-cluster correlation coefficients. Results: In Sierra Leone, the national prevalence of unintended pregnancy was 16.4% in 2019. Women aged 20–49 exhibit lower odds of unintended pregnancy compared to those aged 15–19, with the lowest odds found among those aged 30–34. Factors associated with decreased odds include being employed, married or cohabiting, and belonging to the Fullah tribe, while living in various provinces outside the Western area also correlates with lower odds. Conversely, women with secondary education, listened to the radio, those with more children (5+), contraceptive users, larger household sizes (six or more), and those in the middle wealth index had increased odds of unintended pregnancies. Conclusion: The results from Sierra Leone indicate that various socio-economic and demographic factors significantly influence the prevalence of unintended pregnancies, suggesting critical areas for intervention. For women in the 20–49 age group, the lower odds of unintended pregnancies compared to younger women suggest that targeted educational and health initiatives could further enhance their reproductive health outcomes. The protective factors associated with employment, marital status, and tribal affiliation highlight the importance of promoting stable family structures and economic opportunities. Also, women living in the Eastern, Northwestern, Northern, and Southern provinces, the results imply a need for province-specific interventions. These areas may require tailored outreach programs that address cultural and socio-economic barriers to contraceptive use and reproductive health education. The increased odds linked to secondary education, listening to radio, those with more children, contraceptive users, and larger household sizes suggest that educational initiatives should also address family planning and reproductive health. A focused approach that considers the unique needs of these women could lead to more effective strategies in reducing unintended pregnancies in Sierra Leone. [ABSTRACT FROM AUTHOR]

Introduction: Unintended pregnancy is an important public health issue in developing countries like India because of its association with adverse social and health outcomes. Family planning enables women to achieve healthy spacing between births and reduces maternal and child mortality by 10%. Intra Uterine Contraceptive Device (IUCD) is effective immediately after insertion and provides very effective, safe and long-term –yet reversible protection from pregnancy. Postpartum IUCD insertion has a higher rate of retention. Objective: To assess the perception, acceptance and satisfaction regarding postpartum IUCD services among the women delivering in a tertiary care hospital in the coastal district of Karnataka. Materials and Methods: An observational cross-sectional study with a consecutive sampling method was conducted in the coastal district of Karnataka for a period of 2 months with a pretested semi-structured questionnaire by interview technique. Data was compiled in Microsoft Excel, validated and analysed using statistical software: Statistical Package for the Social Sciences (SPSS) version 16.0. Results: 198 women were counselled for PPIUCD insertion, only 38.39% gave consent and 26.76% actually got inserted PPIUCD. The reasons for non-acceptance were fear of complications (11.98%), no familial support (9.15%) and using other contraceptive methods (35.85%). Factors like education status, Socio-Economic Status (SES), parity and previous use were positively correlated with acceptance of PPIUCD. No immediate complications were reported. Conclusion: The PPIUCD has proven to be a useful long-term contraceptive method that is safe, effective, and useful for decreasing family size and spacing out births. Even though they are well aware of PPIUCD, they are hesitant to adopt it. Effective counselling can tackle these issues by clearing all the confusion. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancy at higher risk of perinatal mood disorders; however, concurrent factors such as socioeconomic conditions may be more critical to mental health than pregnancy intention. Mental health risks among individuals undergoing fertility treatment are inconsistent. We investigated mental health risks during pregnancy and parenthood in parents who conceived unintentionally or through fertility treatment compared to those who conceived naturally and intentionally. Methods: We conducted a web-based study with 10,000 adults ≥ 18 years old, either pregnant or with a child aged < 2 years. Male and female respondents weren't couples. We analyzed 1711 men and 7265 women, after filtering out invalid responses. We used a questionnaire including conception methods (e.g., naturally conceived intended/unintended pregnancies, fertility treatment such as scheduled intercourse or ovulation inducers [SI/OI], intrauterine insemination [IUI], and in-vitro fertilization or intracytoplasmic sperm injection [IVF/ICSI]) and mental health risks (e.g., psychological distress, chronic pain, death fantasies). Using a modified Poisson regression, we estimated relative risks (RR [CI]) for mental health risks compared to those with intended pregnancies. Results: Unintended pregnancy showed higher mental health risks during pregnancy in both genders, with women having significantly higher psychological distress, chronic pain, and death fantasies (RR 1.63 [1.05–2.54], RR 1.63 [1.14–2.33], and RR 2.18 [1.50–3.18], respectively). Women's death fantasies risk remained high in parenthood: RR 1.40 (1.17–1.67). In relation to fertility treatments, men using SI/OI during their partner's pregnancy showed higher mental health risks, especially for chronic pain (RR 1.75 [1.01–3.05]). Men who underwent IUI showed higher mental health risks during parenthood, notably death fantasies (RR 2.41 [1.13–5.17]). Pregnant women using SI/OI experienced higher mental health risks, with a significant risk of chronic pain (RR 1.63 [1.14–2.33]). Pregnant women using IVF/ICSI had a significantly lower risk of chronic pain (RR 0.44 [0.22–0.87]), but women who used IVF/ICSI had a significantly higher risk of death fantasies during parenthood (RR 1.40 [1.04–1.88]). Conclusions: Mental health risks vary by parenting stage (pregnancy or early parenthood) and gender, especially for those who conceived unintentionally or through fertility treatment. Both stages require adaptable mental health support for all parents. Trial registration: N/A (non-interventional study). [ABSTRACT FROM AUTHOR]

Background Objectives and Methods Results Discussion and conclusions Accurately judging the efficacy of contraceptives is vital for preventing unintended pregnancy. The Pearl index and life table analysis describe female contraceptive performance. However, they are not ideal for quantifying male contraceptive efficacy given differences between male and female methods. In particular, male contraceptives like condoms are used “on demand” rather than long‐term like female contraceptives. Additionally, the number of episodes of sexual intercourse, a key determinant of risk, is not considered. Lastly, men can father concurrent pregnancies in more than one woman. For these reasons, a male‐specific measure may provide a more accurate measure of male contraceptive efficacy.As each episode of heterosexual intercourse within a fertile couple is associated with an approximately 3% risk of pregnancy, the chance of an unintended pregnancy with a given number of episodes of sexual intercourse can be modeled with and without contraceptives of various effectiveness.Such modeling demonstrates that unintended pregnancy is strongly associated with both the number of episodes of sexual intercourse and the efficacy of the method. Based on these models, I propose a novel metric for male contraceptive efficacy called the Probability of Pregnancy100, defined as the percent chance of an unintended pregnancy occurring with 100 episodes of intercourse. Probability of Pregnancy100 should be easy for men to understand and is applicable to men with multiple sexual partners or men using “on‐demand” contraceptives.The prevention of unintended pregnancy by a male contraceptive is strongly influenced by both method efficacy and sexual frequency. Probability of Pregnancy100 may offer a better measure of male contraceptive efficacy compared to the Pearl index and life table analysis as it takes sexual frequency into account; however, Probability of Pregnancy100 will need to be tested prospectively in male contraceptive studies alongside the Pearl index and life table analysis to determine its utility compared to these existing measures of contraceptive efficacy. [ABSTRACT FROM AUTHOR]

Background: Medroxyprogesterone acetate (MPA), a synthetic progestogen, is extensively used for the treatment of various conditions, including contraception, irregular menstruation, functional uterine bleeding, and endometriosis. However, like all pharmaceutical agents, MPA is associated with adverse drug reactions. This study aimed to evaluate the adverse events (AEs) associated with MPA in by analyzing real-world data from the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS). By providing a comprehensive assessment of the safety profile of MPA, this study seeks to support informed clinical decision-making. Methods: Data covering the period from the first quarter of 2004 to the first quarter of 2024 were collected from the FAERS database. Disproportionality analyses were conducted using several statistical methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayesian geometric mean (EBGM). Additionally, time-to-onset (TTO) analysis was employed to quantify the signals of the MPA-associated AEs. Results: A comprehensive dataset comprising 21,035,995 AE reports was compiled. Among these, 3,939 women reported using MPA as a contraceptive method. The reports covered 27 system organ classes (SOCs) and 25 high-frequency AE signals. Notably, significant AEs were identified, some of which were not previously detailed in the medication's prescribing information. Unforeseen significant AEs such as unintended pregnancy (n = 623; ROR, 6.65; ROR025, 6.1; χ2, 2,482.38; PRR, 6.41; EBGM, 5.69; EBGM05, 5.29), bone pain (n = 35; ROR, 13.78; ROR025, 9.4; χ2, 311.2; PRR, 13.75; EBGM, 10.59; EBGM05, 7.69), gait disturbance (n = 34; ROR, 2.82; ROR025, 1.99; χ2, 37.31; PRR, 2.88; EBGM, 2.7; EBGM05, 2.02), dental caries (n = 15; ROR, 23.16; ROR025, 12.32; χ2, 204.26; PRR, 23.14; EBGM, 15.23; EBGM05, 8.98), decrease in blood pressure (n = 15; ROR, 3.88; ROR025, 2.29; χ2, 29.35; PRR, 3.88; EBGM, 3.63; EBGM05, 2.33), and osteonecrosis (n = 9; ROR, 23.44; ROR025, 10.36; χ2, 123.67; PRR, 23.43; EBGM, 15.35; EBGM05, 7.75) were identified as AEs that were not previously outlined in the prescribing information of the medication. Conclusion: Our findings align with clinical observations, highlighting the emergence of previously unreported AE signals associated with MPA and their demographic and TTO characteristics. Further pharmaco-epidemiological studies are required to substantiate these observations. [ABSTRACT FROM AUTHOR]

Background: Alcohol use in early pregnancy increases the risk for Fetal Alcohol Spectrum Disorders. Women who engage in heavy drinking and become pregnant when they are not actively trying to conceive are at heightened risk for alcohol-exposed pregnancies. Identifying factors associated with greater risk for alcohol-exposed pregnancies is critical for prevention. Objective: This study explored the odds of contraceptive nonuse and heavy drinking for women trying to conceive or ambivalent about pregnancy as compared to those trying to avoid pregnancy. Methods: Logistic regression analysis was used to examine the role of pregnancy intentions, including ambivalence, on contraceptive nonuse and heavy drinking among a national sample of 583 sexually active heterosexual women of childbearing age conducted online in 2024. Results: Results showed that women who are trying to conceive or are ambivalent about pregnancy have higher odds of contraceptive nonuse than women trying to avoid pregnancy (OR = 13.19, p <.01 and OR = 3.56, p <.001, respectively), but no significant differences in heavy alcohol use by pregnancy intention. Conclusion: Pregnancy intentions are associated with contraceptive nonuse but not heavy alcohol use. Delayed pregnancy recognition among those not actively trying to conceive but also not consistently using an effective form of contraception might place women who are avoiding or ambivalent about pregnancy at heightened risk for an alcohol-exposed pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience. [ABSTRACT FROM AUTHOR]

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18–25 years) and those who were ineligible to benefit (ages 26–33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a −7.4 percentage point reduction (95% CI: −13.5, −1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income). [ABSTRACT FROM AUTHOR]

People who can get pregnant who use drugs face disproportionate harms such as violence, exploitation and trauma and have unmet reproductive health needs as they have the greatest burden of unintended pregnancy (>75%). Recovery community centers (RCCs) provide recovery support services and are primarily staffed with people with lived experience using drugs. RCCs employ recovery coaches who are entrusted with helping participants improve their recovery capital, health, and wellbeing through person-centered strengths-based approaches. Although reproductive health and the prevention of unintended pregnancy can greatly impact all domains of recovery capital, recovery coaches generally do not have training to address this complex issue. We aimed to fill this gap by co-creating and evaluating a bundled model as an intervention tailored for RCCs (training & low-barrier resources including pregnancy tests, prenatal vitamins, and emergency contraception) to promote more equitable outcomes in reproductive health. We described the training and used mixed methods to assess pre-post knowledge, belief, and comfort with the bundled model (n = 20) and further explored perceptions of the model qualitatively to inform future iterations (n = 58). Results included significant gains in all three domains following the training, as well as favorable perceptions that the model will enhance recovery capital. Most were empowered to champion the model, asking for more information about the three resources, perinatal health, and referral information. We seek to begin to expand the theoretical construct of recovery capital by pilot testing an intervention to promote recovery through enhancing reproductive health and justice for people who use drugs (PWUD) who can get pregnant. [ABSTRACT FROM AUTHOR]

Objectives: To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth. Methods: Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support. Results: Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems. Conclusions: Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention. [ABSTRACT FROM AUTHOR]

Background: The maternity continuum of care is a strategy to provide timely and quality maternal and child healthcare through preconception, pregnancy, childbirth, postnatal, and the early childhood periods. The maternity continuum of care effectively reduces global maternal and neonatal deaths. However, several factors are reported to cause low completion of the maternity continuum of care in sub–Saharan Africa. There has been substantial debate in the literature as to whether pregnancy intention influences the completion of the maternity continuum of care. Although several studies have been conducted to determine the influence of pregnancy intention on the completion of the maternity continuum of care, findings are inconsistent and have not been systematically reviewed. Therefore, this review aims to determine the effect of pregnancy intention on the completion of the maternity continuum of care in sub–Saharan African countries. Methods: A systematic search of articles was performed from MEDLINE Complete, CINAHL Complete, PsycINFO, EMBASE, Maternity & Infant Care, Global Health, Scopus, and Web of Science. The identified articles were imported into Covidence and independently screened by two researchers for abstract and title, and then full-text. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The Cochran's Q test and I2 were used for assessing the potential heterogeneity of the studies. Publication bias was assessed using Egger's regression test and inspection of a funnel plot. A fixed-effects meta-analysis model was used to compute the effect of pregnancy intention on the completion of the maternity continuum of care. Results: Ten studies involving 343,932 participants were included in the final analysis. The pooled estimate of the meta-analysis found that women with intended pregnancy had 2.12 times higher odds of completing the maternity continuum of care (pooled odds ratio: 2.12, 95% CI: 1.33, 3.36) as compared to women with unintended pregnancy. Conclusion: Intended pregnancy has a statistically significant positive effect on completing the maternity continuum of care. Policymakers and healthcare providers need to implement strategies to encourage women to plan their pregnancies through the strengthening of pre-conception care and contraceptive counselling to prevent unintended pregnancies. Systematic review registration: PROSPERO CRD42023409134. [ABSTRACT FROM AUTHOR]

Abstract Background Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers’ own experiences and perspectives is necessary to design appropriate interventions. Methods A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022. Findings Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as “infertility caused by FP,” “freedom of sex by promoting FP,” and “cultural taboos on having sex before marriage and talking about sexuality,” were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers’ lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child’s father, and having future perspectives were identified as factors mitigating the negative influences. Conclusions Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary.

Abstract Background Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India. Methods We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran’s I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts. Results The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran’s I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p

Abstract Background Despite the progress made in improving maternal and child health in Ethiopia, it still has one of the highest maternal and neonatal mortality rates in the world. This is largely due to inadequate healthcare infrastructure and a lack of comprehensive evidence-based maternal and reproductive health services. To achieve the Sustainable Development Goal targets related to maternal and child health, it is essential to conduct culturally sensitive and policy-relevant research to identify areas for improvement. Methods To address these issues, through The University of Newcastle’s increased global focus and investment into funding international research higher degrees, we developed a program on the Worldwide Wellness of Mothers and Babies (WWOMB) and trained Doctor of Philosophy students who conducted cross-cutting research across the reproductive life course. Importantly, the program aimed to bridge the inequality gaps in maternal and child health whilst cultivating a new generation of research leaders in low- and middle-income countries such as Ethiopia. Results The WWOMB program has successfully generated a substantial body of epidemiological research in Ethiopia, covering five major themes: family planning and contraception, maternal and child health service utilisation, maternal and child health outcomes, maternal and child nutrition, and health economics. The key findings of the studies conducted in Ethiopia have demonstrated geographical disparities in the use of modern contraception and maternal health service utilisation, high incidence of severe maternal outcomes and neonatal near misses, high prevalence of intimate partner violence during pregnancy and its significant impact on adverse pregnancy outcomes, and the presence of economic disparities in maternal and child health, particularly around service delivery and availability. Conclusions Investment in healthcare infrastructure and services, coupled with efforts to reduce economic inequalities, can contribute to improved maternal and child health in Ethiopia. The WWOMB project has focused on delivering evidence-based recommendations for policy and practice that could accelerate the country’s progress towards achieving Sustainable Development Goal targets related to maternal and child health.

Abstract Background The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. Methods We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle–Ottawa Scale to assess the quality of the included studies. The Cochran’s Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. Results Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. Conclusion Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women’s opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. Systematic review registration PROSPERO registration number CRD42023409148.

Background: The intention of pregnancy is considered one of the major factors contributing to the foetal or maternal outcome. An exploration of the magnitude of this problem and its related factors can lead to improved foetal or maternal health. Objective: The objective of this study was to assess pregnancy intention and its related factors among females attending antenatal clinics of tertiary care hospitals. Methods: It is a cross-sectional (analytical) study conducted at the antenatal clinic, Jinnah Hospital Lahore, within the duration of January-April 2022. Two hundred and fifty(250) pregnant women aged 20 to 39 years were enrolled using non-probability convenience sampling. All the information was noted in a structured questionnaire based on study variables. The collected data was analysed using SPSS version 27.0 and frequency tables were generated. Appropriate test of significance was applied and p-value < 0.05 was taken as statistically significant. Results: Among 250 pregnant females, about 195(78%) of the females reported the current pregnancy to be intentional while 55(22%) were unintentional. It was also seen that age and parity were significantly related to the intention of pregnancy p-value

Abstract 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.

Background: Despite the progress made in improving maternal and child health in Ethiopia, it still has one of the highest maternal and neonatal mortality rates in the world. This is largely due to inadequate healthcare infrastructure and a lack of comprehensive evidence-based maternal and reproductive health services. To achieve the Sustainable Development Goal targets related to maternal and child health, it is essential to conduct culturally sensitive and policy-relevant research to identify areas for improvement. Methods: To address these issues, through The University of Newcastle's increased global focus and investment into funding international research higher degrees, we developed a program on the Worldwide Wellness of Mothers and Babies (WWOMB) and trained Doctor of Philosophy students who conducted cross-cutting research across the reproductive life course. Importantly, the program aimed to bridge the inequality gaps in maternal and child health whilst cultivating a new generation of research leaders in low- and middle-income countries such as Ethiopia. Results: The WWOMB program has successfully generated a substantial body of epidemiological research in Ethiopia, covering five major themes: family planning and contraception, maternal and child health service utilisation, maternal and child health outcomes, maternal and child nutrition, and health economics. The key findings of the studies conducted in Ethiopia have demonstrated geographical disparities in the use of modern contraception and maternal health service utilisation, high incidence of severe maternal outcomes and neonatal near misses, high prevalence of intimate partner violence during pregnancy and its significant impact on adverse pregnancy outcomes, and the presence of economic disparities in maternal and child health, particularly around service delivery and availability. Conclusions: Investment in healthcare infrastructure and services, coupled with efforts to reduce economic inequalities, can contribute to improved maternal and child health in Ethiopia. The WWOMB project has focused on delivering evidence-based recommendations for policy and practice that could accelerate the country's progress towards achieving Sustainable Development Goal targets related to maternal and child health. [ABSTRACT FROM AUTHOR]

Background: Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India. Methods: We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran's I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts. Results: The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran's I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level. Conclusion: Our analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the country. [ABSTRACT FROM AUTHOR]

Background: Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers' own experiences and perspectives is necessary to design appropriate interventions. Methods: A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022. Findings: Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as "infertility caused by FP," "freedom of sex by promoting FP," and "cultural taboos on having sex before marriage and talking about sexuality," were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. Conclusions: Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary. Plain English summary: Teenage girls becoming pregnant unexpectedly face higher health and socio-economic risks, which can affect both the lives of teenage mothers and newborns. In Kenya, the government has targeted ending teenage pregnancies by 2030, but the decrease has been limited. Although understanding teenage mothers' experiences and perspectives is important for designing appropriate interventions, only a few studies have been conducted. This study focused on 19 teenage mothers and other key participants to gain a deeper understanding of their backgrounds. Four major reasons were identified for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about birth control methods, (3) financial challenges, and (4) low access to birth control methods. At the study site, cultural norms and stereotypes were observed as barriers in promoting the use of birth control methods to teenagers. In addition, teenagers from poor backgrounds were found to be more vulnerable because they can be easily taken advantage of by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. In this study, unintended teenage pregnancies negatively influenced most participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. [ABSTRACT FROM AUTHOR]

Introduction: Condoms 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. Objective: To assess the cost-effectiveness of LNG-IUS 52 mg (Mirena®) versus other LARC for contraception in Spain. Materials and Methods: 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. Results: 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. Conclusions: 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. SHORT CONDENSATION: 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]

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]

Background: Currently, approximately half of all pregnancies worldwide are unintended. Contraceptive use significantly reduces the risk of unintended pregnancy; however, options for men are particularly limited. Consequently, efforts are underway to develop novel, safe, and effective male contraceptives. Results: This review discusses research into emerging male contraceptive methods that either inhibit sperm production or impair sperm function. It focuses on those in the preclinical or early clinical stages of development. [ABSTRACT FROM AUTHOR]

Introduction: Efforts to develop reversible male contraceptives analogous to female oral contraceptives are underway and may be introduced in the next decade. The advent of novel male contraceptives provides an opportunity for an ethical reformulation of the contraceptive paradigm given the relational, rather than individual, nature of sexual relationships, and family planning. For individuals in any sexual relationship that could result in pregnancy, issues of reproductive autonomy, freedom, equality in reproductive decision‐making and risks—both of side effects and of unintended pregnancies—are significant. Historically, however, women have been attributed the greatest responsibilities simultaneously with the most restrictions on their freedom of choice and access to reproductive care. Objectives: In this paper, we extend our prior "shared risk" model of male contraception to one of "shared risk and responsibility" to ethically inform this discourse. Conclusions: This updated framework more fully captures the complexity of this novel technology and may be of use to regulatory and legal agencies grappling with an intervention that poses medical risks to the member of the relationship who does not face risks of becoming pregnant. [ABSTRACT FROM AUTHOR]

Long-acting contraception (LARC) is the utmost effective form of reversible birth control methods and there are to main types which include the intrauterine device (IUD) and the birth control implant. The objectives of this paper was to investigate the knowledge, attitude and age factors of long acting reversible contraceptives (LARC) among postgraduate students at a tertiary institution in greater machester, England, UK using an online participatory survey, opned to the general public through internal email and social media (Twitter, WhatsApp, Facebook). Targeting 322 female postgraduate students between 21-50 years. However, only 50 participants took part in the survey due to the limitations posed by COVID-19 pandemic. The results showed that there were more participants between 31-40 years (42.9%), more married women (49.0%), more Christians (59.2%), and an equal number of White and black Africans (44.9%). The percentages of women who have heard about LARC include; implants (87.8%), injectables (85.7%), Intrauterine devices (72.9%), and hormonal intrauterine system (58.3%). Some of the participants showed positive attitudes towards LARC, while majority of the participants would not use LARC because of the side effects. Most of those who have used implants and injectables were women between 21-30 years, and older women have used intrauterine devices more than the younger age group. Some barriers to the use of LARC include; Side effects of LARC (63.8%), Interference with the body's processes(63%), and lack of knowledge about different methods available(54.3%), having a foreign object in their bodies (59.1% for injectables) and (53.2% for implants). [ABSTRACT FROM AUTHOR]

Many female military service members choose to use hormonal contraception to prevent pregnancy and/or to control or suppress menses. Hormonal contraception, which comes in many different forms based on dose, estrogen/progestin type, and route of administration (oral, vaginal, transdermal, implant, intrauterine device, injectable), may cause side effects, some of which can influence military medical readiness, or the health status necessary to perform assigned missions. This expert review summarizes the evidence around common military-relevant side effects of hormonal contraception that could impact readiness, including effects on weight and body composition, bone health, psychological health, and physical performance, and serves as a tool for uniformed and civilian clinicians counseling female service members about hormonal contraception. Current evidence suggests some hormonal contraception can lead to weight and fat gain, may modulate susceptibility to mood or mental health disorders, and could impact bone mineral density and stress fracture risk; more research is needed on physical performance effects. Clinicians must be familiar with readiness considerations of each type of hormonal contraception to provide comprehensive patient education and allow for optimal shared decision-making about hormonal contraception use among female Service members. Considering the relative lack of data on the effects of nonoral hormonal contraception routes on readiness outcomes and the growing interest in long-acting reversible contraceptives among female service members, future research should continue to investigate effects of all hormonal contraception methods available to service members. [ABSTRACT FROM AUTHOR]

Introduction: People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. Method: This study used data (N = 9803) from a Dutch nationally representative registry of people with low‐risk pregnancies receiving primary midwife‐led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. Results: Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 –2.59), preterm birth (OR, 1.27; 95% CI, 1.02‐1.58), small for gestational age (OR, 1.19; 95% CI, 1.00‐1.41), and induction of labor (OR, 1.14; 95% CI, 1.01‐1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71‐0.97). The timing of prenatal care initiation did not mediate any of these associations. Discussion: Our findings suggest that people in primary midwifery‐led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities. [ABSTRACT FROM AUTHOR]

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]

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]

BackgroundMedroxyprogesterone acetate (MPA), a synthetic progestogen, is extensively used for the treatment of various conditions, including contraception, irregular menstruation, functional uterine bleeding, and endometriosis. However, like all pharmaceutical agents, MPA is associated with adverse drug reactions. This study aimed to evaluate the adverse events (AEs) associated with MPA in by analyzing real-world data from the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS). By providing a comprehensive assessment of the safety profile of MPA, this study seeks to support informed clinical decision-making.MethodsData covering the period from the first quarter of 2004 to the first quarter of 2024 were collected from the FAERS database. Disproportionality analyses were conducted using several statistical methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayesian geometric mean (EBGM). Additionally, time-to-onset (TTO) analysis was employed to quantify the signals of the MPA-associated AEs.ResultsA comprehensive dataset comprising 21,035,995 AE reports was compiled. Among these, 3,939 women reported using MPA as a contraceptive method. The reports covered 27 system organ classes (SOCs) and 25 high-frequency AE signals. Notably, significant AEs were identified, some of which were not previously detailed in the medication’s prescribing information. Unforeseen significant AEs such as unintended pregnancy (n = 623; ROR, 6.65; ROR025, 6.1; χ2, 2,482.38; PRR, 6.41; EBGM, 5.69; EBGM05, 5.29), bone pain (n = 35; ROR, 13.78; ROR025, 9.4; χ2, 311.2; PRR, 13.75; EBGM, 10.59; EBGM05, 7.69), gait disturbance (n = 34; ROR, 2.82; ROR025, 1.99; χ2, 37.31; PRR, 2.88; EBGM, 2.7; EBGM05, 2.02), dental caries (n = 15; ROR, 23.16; ROR025, 12.32; χ2, 204.26; PRR, 23.14; EBGM, 15.23; EBGM05, 8.98), decrease in blood pressure (n = 15; ROR, 3.88; ROR025, 2.29; χ2, 29.35; PRR, 3.88; EBGM, 3.63; EBGM05, 2.33), and osteonecrosis (n = 9; ROR, 23.44; ROR025, 10.36; χ2, 123.67; PRR, 23.43; EBGM, 15.35; EBGM05, 7.75) were identified as AEs that were not previously outlined in the prescribing information of the medication.ConclusionOur findings align with clinical observations, highlighting the emergence of previously unreported AE signals associated with MPA and their demographic and TTO characteristics. Further pharmaco-epidemiological studies are required to substantiate these observations.

Introduction: Unintended pregnancies constitute one of the major public health problems of important concern in Nigeria, where sex refusal in marriage might be impossible. This descriptive, household-based study, investigated the prevalence and predictors of unintended pregnancy in the past two years among married women aged 35-49 years in Ibadan, South West, Nigeria. Methods: A three-stage sampling technique was used to recruit 425 respondents across three local government areas. Data were collected and analyzed using a structured interviewer-administered questionnaire. The dependent variable, “Unintended pregnancy,” was defined as an unplanned, unwanted, or mistimed pregnancy. Data were summarized using descriptive statistics. Bivariate chi-square tests were used to determine the factors associated with unintended pregnancy, while binary logistic regression was used to determine the predictors of unintended pregnancy (α0.05). Results: The mean age of the women was 41.1 ± 4.2 years, 149 (35.1%) had high autonomy, while 233 (54.8%) had medium autonomy. Further, 177 (41.6%) were poor, while 106 (25.0%) were rich. In all, 108 (25.4%) women have had an unintended pregnancy. Women with low autonomy (AOR=3.41, 95%C.I.=1.70-6.82, p=0.001) and medium autonomy (AOR=2.41, C.I.=1.29-4.49, p=0.006) had higher odds of unintended pregnancy. The likelihood of unintended pregnancy was higher among women living in poor households (AOR=2.04, 95%C.I.=1.13-3.68, p=0.017). Conclusions: The level of unintended pregnancy was high among older women of reproductive age in Ibadan. Social interventions that focus on empowerment of such women should be undertaken by governmental agencies, non-governmental agencies, and community-based organizations to increase women’s autonomy and reduce unintended pregnancy among them.

Abstract 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.

Abstract Background Unintended pregnancies and abortions among unmarried adolescents in Nigeria are outcomes of the interplay of multifaceted factors. Abortion, a global public health and social issue, impacts both developed and developing countries. This scoping review explored the literature and mapped the risk factors for unintended pregnancies and abortions among unmarried female adolescents in Nigeria. Methods A scoping literature search was conducted across databases, including PubMed, Science Direct, Web of Science, EBSCOhost, JSTOR, African Index Medicus, and Scopus. Inclusion criteria encompassed peer-reviewed articles and reports in English, focusing on unmarried female adolescents. The range of interest included the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among this demographic. Studies categorized as grey literature were excluded to ensure the reliability and validity of the synthesized information. Results A total of 560 articles, 553 identified through databases and 7 through hand search, were subjected to a comprehensive full-text review, resulting in the inclusion of 22 studies that met the criteria for the final review. The scoping review shed light on the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among unmarried adolescents in Nigeria. The range of incidence for having sex varied from 57.2% to 82.7%, with the prevalence of unintended pregnancies ranging from 23.4% to 92.7%. Contraceptive use was notably low, with 21.5% reporting low usage, contributing to the high incidence of abortions, ranging from 20.2% to 51.0%. Factors influencing unintended pregnancies included a lack of awareness of modern contraceptives and limited access to sexual and reproductive health information. For induced abortions, factors such as the impact on educational career, childbearing outside wedlock and fear of expulsion from school were identified. Conclusion This scoping review, through a systematic examination of existing literature, contributes to a more robust understanding of the factors influencing unintended pregnancies and abortions among unmarried adolescents in Nigeria. The findings inform future research directions and guide the development of targeted interventions to improve reproductive health outcomes for this vulnerable population.

Background and purpose: An unintended pregnancy denotes a conception that occurs without prior planning or intention by the couple involved. The repercussions of such pregnancies can be substantial for both the mother and the child, potentially resulting in inadvertent neglect of fetal health and influencing the quality of caregiving behaviors. These factors may contribute to adverse outcomes, such as low birth weight. This research aims to assess the impact of unintended pregnancy on newborn anthropometric parameters within the marginal neighborhoods of Bandar Abbas. Materials and methods: This study is a component of a prospective cohort project involving pregnant women residing in marginalized areas of Bandar Abbas City in 2015. A total of 1351 participants were enrolled in the cohort project, with 825 individuals included in this investigation. Among these, 132 were categorized into the exposure group representing unintended pregnancies, while 693 comprised the non-exposure (control) group, based on the proportion of unintended pregnancies in the original dataset. Our study delineates the associations between birth weight, height, head circumference, and the primary exposure variable of maternal unintended pregnancy. Data collection on unintended pregnancy and potential confounding factors was conducted through questionnaires and face-to-face interviews during the initial cohort visit, coinciding with the women's pregnancies. Confounding variables pertinent to each outcome were rigorously evaluated utilizing a causal analysis approach, facilitated by the dagitty software, with data management performed using SPSS version 24. Univariate analysis involved the utilization of Pearson's correlation coefficient, independent t-tests, and one-way analysis of variance to explore the relationships between anthropometric indices and individual characteristics. Meanwhile, multivariate analysis entailed the application of multiple linear regression techniques. Results: Among the total of 1351 pregnancies investigated, 219 (16.2%) were identified as unintended. The mean age of mothers experiencing unintended pregnancies was 29.23±6.49 years, compared to 26.98±5.31 years for those with intended pregnancies. For unintended pregnancies, the mean and standard deviation of birth weight, height, and head circumference were calculated as 3059.24±501.11 grams, 48.52±3.11 cm, and 33.80±2.22 cm, respectively. Conversely, for intended pregnancies, these measures were 3080±17.17 grams, 48.63±2.65 cm, and 33.82±1.92 cm, respectively. Statistically significant positive correlations were observed between birth weight and maternal age (P=0.041, r=0.056), paternal age (P=0.008, r=0.073), and maternal BMI (P

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]

To examine the impact of About Us , an innovative healthy relationships intervention that promotes positive adolescent romantic relationships and the use of effective contraceptives, on improving behavior, attitudes, and intentions related to sexual intercourse, relationship communication, and conflict resolution at 3- and 9-month follow-up, compared to services as usual. This was a multi-site, two-group, parallel, randomized-controlled trial with an intervention/comparison allocation ratio of 3:2 conducted at seven high schools in California between February 2018 and May 2021. Overall, our study did not find statistically significant evidence of improved behavior, attitudes, and intentions related to sexual intercourse, relationship communication, and conflict resolution among participants (14–18 years old) randomized to the intervention group (n = 316) compared to services as usual (n = 217) during follow-up (group x time; p >.05). Exploratory within group analyses showed that, compared to baseline, at the 3-month follow-up, the prevalence of reporting having had sex increased in the control group relative to intervention group (+19% vs. +9%, p <.01). Our sub-group analyses showed that changes in condom use intentions scores differed across school sites (group x time x school; p <.01); mixed (positive and negative) trends were observed for intervention effect, and schools with positive intervention effect trends tended to have greater program participation. About Us did not show statistically significant positive impacts on primary or secondary outcomes as anticipated. Our exploratory findings show evidence of some promising trends of intervention effects at the school-level, suggesting a need for better tailored intervention components and/or delivery to address the unique environmental contexts of participants. Overall, the context of study implementation was negatively affected by the COVID-19 pandemic and challenges related to using a non-classroom delivery intervention approach. Combined, these factors may have contributed to the study null findings. Moreover, it is difficult to know (or determine) the intervention's impact under more ideal conditions (i.e., no COVID pandemic). [ABSTRACT FROM AUTHOR]

While all modern contraceptive methods are available for free or at minimal cost in Nepal, contraceptive devices in Japan are mainly limited to condoms, requiring Nepalese migrant women to rely on their male partners for their use. Therefore, Nepalese migrants often seek contraceptive devices from Nepal or request friends or relatives to send them from their home country. This study aimed to identify the gaps and challenges associated with Nepalese migrants' needs for sexual and reproductive health services (SRHSs), particularly contraceptives, before and after their migration to Japan. A mixed-methods study was adopted, an explanatory sequential design (ESD) combining quantitative and qualitative approaches, and data were collected from 186 Nepalese migrants (80 females and 106 males) through an online survey and from two focus-group discussions (FGDs) conducted among 24 participants (14 females and 10 males). This study highlighted the obstacles faced by Nepalese migrants in accessing contraceptive services, such as limited options, language barriers, and high costs. The study also revealed the importance of pre-departure training in Nepal and organizing post-arrival training in Japan to increase Nepalese migrants' awareness of the SRHSs available in Japan, thereby helping to prevent SRH-related health problems, including unintended pregnancies and abortions, in Japan. [ABSTRACT FROM AUTHOR]

Background: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. Objective: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. Design: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. Methods: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Results: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03–1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Conclusion: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance. Plain Language Summary: A study found more women were unaware of pregnancy soon after birth before menses Unplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity. [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]