Contraception: X最新文献

{"title":"From policy to practice: Experiences from the ECHO trial following revisions of the WHO medical eligibility criteria for contraceptive use (MEC) guidance on DMPA-IM","authors":"Petrus Steyn ,&nbsp;Mags Beksinska ,&nbsp;Melanie Pleaner ,&nbsp;Hui-Zhen Tam ,&nbsp;Jenni Smit ,&nbsp;Kathy Baisley ,&nbsp;Douglas Taylor ,&nbsp;Mandisa Singata-Madliki ,&nbsp;G. Justus Hofmeyr ,&nbsp;Thesla Palanee-Phillips ,&nbsp;James N. Kiarie","doi":"10.1016/j.conx.2024.100111","DOIUrl":"10.1016/j.conx.2024.100111","url":null,"abstract":"<div><h3>Objectives</h3><div>In 2017, the World Health Organization (WHO) medical eligibility criteria (MEC) for contraception category for intramuscular depot medroxyprogesterone acetate (DMPA-IM) was changed from MEC category 1 to 2 for women at high risk of HIV acquisition. We assessed the impact of communicating this category change among women in the Evidence for Contraceptive options and HIV Outcomes (ECHO) trial.</div></div><div><h3>Study design</h3><div>ECHO was conducted in eSwatini, Kenya, South Africa and Zambia. Women were randomized (1:1:1) to DMPA-IM, levonorgestrel (LNG) implant or copper intrauterine device (Cu IUD). We compared the hazards of DMPA-IM discontinuation and assessed sexual behavior and DMPA-IM satisfaction before and after MEC category change.</div></div><div><h3>Results</h3><div>In DMPA-IM users there was a decrease in the hazards of discontinuation after the MEC change (hazard ratio 0.37; 95% CI<!--> <!-->=<!--> <!-->0.26–0.52, <em>p</em> &lt; 0.001). No evidence of an effect of the MEC change was observed in sexual behaviour outcomes. There was some evidence of an increase in disatisfaction with DMPA-IM immediately after the MEC change, with the odds of women reporting a higher score (more dissatisfied) increasing by 1.38 compared with before the MEC change (95% CI<!--> <!-->=<!--> <!-->1.11–1.72).</div></div><div><h3>Conclusions</h3><div>While counseling on possible theoretical risks associated with contraceptive methods in the MEC is an important medical ethical standard, in this study it did not adversely impact continuation or sexual behavior, while there was some evidence on increase in dissatisfaction. There is however a need to monitor how changes in MEC categories are implemented.</div></div><div><h3>Implications</h3><div>Although we found no evidence in this analysis of an effect of the MEC change on any of the sexual behavioral outcomes among women after the change in category, it is still an important medical ethical standard to counsel on possible theoretical risks associated with contraceptive methods. Given the challenges of translating research findings to guidelines and further to counseling messages, evaluation of clinical guidelines implementation is necessary to understand the effects of implementation and to monitor both intended impacts and unintended consequences.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series","authors":"Sruthi Chandrasekaran ,&nbsp;Samantha Ruggiero ,&nbsp;Gabrielle Goodrick","doi":"10.1016/j.conx.2024.100104","DOIUrl":"10.1016/j.conx.2024.100104","url":null,"abstract":"<div><h3>Objective</h3><p>Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation.</p></div><div><h3>Study design</h3><p>We conducted a retrospective medical records review of adult patients who received mifepristone and repeated misoprostol for second trimester abortion with procedural evacuation backup at an Arizona clinic between October 2017 and November 2021. We extracted patient demographics; pregnancy and medical history; and preoperative, intraoperative, and postoperative data. We assessed abortion outcomes, including procedure timing, mode of completion (medication alone or medications and procedural evacuation), and safety.</p></div><div><h3>Results</h3><p>All 359 patients had a complete abortion with 63.5% of patients completing with medication alone and 36.5% with procedural evacuation backup. The median time from first dose of misoprostol to fetal expulsion was six hours, among those who completed the abortion with medications alone. Of those who received procedural evacuation as backup, the median time for procedural evacuation was 10 minutes. The vast majority of patients (99.4%) did not have any adverse events. Two safety incidents (0.6%) occurred, a broad right ligament tear and a uterine rupture.</p></div><div><h3>Conclusion</h3><p>Patients in one outpatient setting safely and effectively received medical management of second trimester abortion with procedural evacuation backup, and two thirds completed with medications alone.</p></div><div><h3>Implications</h3><p>Outpatient settings may consider medical management of abortion between 18 and 24 weeks with procedural evacuation back-up as a safe, effective, and manageable second trimester abortion option. Additional research is needed on patient experience and satisfaction.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000017/pdfft?md5=4b9a10865d037e23471fc79f87a10c0b&pid=1-s2.0-S2590151624000017-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139965477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does person-centered maternity care relate to postpartum contraceptive counseling and use? Evidence from a longitudinal study of women delivering at health facilities in Ethiopia","authors":"Elizabeth K. Stierman ,&nbsp;Celia Karp ,&nbsp;Jiage Qian ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Saifuddin Ahmed ,&nbsp;Andreea A. Creanga ,&nbsp;Linnea A. Zimmerman","doi":"10.1016/j.conx.2024.100109","DOIUrl":"10.1016/j.conx.2024.100109","url":null,"abstract":"<div><h3>Objectives</h3><p>This study examines the relationship between integrated, person-centered maternity care (PCMC), the provision of postpartum family planning (PPFP) services, and postpartum contraceptive use among women delivering at health facilities in Ethiopia.</p></div><div><h3>Study design</h3><p>We analyze 2019–2021 longitudinal data from a representative sample of pregnant and recently postpartum women in Ethiopia. This study examines baseline, 6-week, and 6-month survey data collected from women who delivered at a health facility.</p></div><div><h3>Results</h3><p>Maternity patients who reported more person-centered care were more likely to be counseled on postpartum contraceptive methods before discharge. Overall, 27.5% of women delivering in a health facility received family planning counseling before discharge, ranging from 15.2% in the lowest PCMC quintile to 36.3% in the highest PCMC quintile. The receipt of PPFP counseling was associated with increased odds of postpartum contraceptive use.</p></div><div><h3>Conclusions</h3><p>Findings suggest dimensions of quality care are interlinked, and person-centered care is associated with greater integration of recommended PPFP services into predischarge procedures. However, even among women who report relatively high levels of person-centered care, our results highlight that family planning is not routinely discussed prior to discharge from delivery, and very few women receive a contraceptive method or referral prior to discharge.</p></div><div><h3>Implications</h3><p>While most postpartum women report they wish to limit or space future pregnancies, the uptake of modern contraceptive methods in the postpartum period is low. As women increasingly opt to deliver in health facilities, further integration of family planning services into predischarge procedures within maternity care can improve contraceptive access.</p></div><div><h3>Data statement</h3><p>The data used in these analyses were collected as part of the PMA Ethiopia study. Data are publicly available at <span><span>https://www.pmadata.org/data/request-access-datasets</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000066/pdfft?md5=c2ae99f30af75ef06f555c6c381bb03a&pid=1-s2.0-S2590151624000066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing the effectiveness of 1.5 mg levonorgestrel for emergency contraception: The case for precoital use","authors":"Douglas J. Taylor ,&nbsp;Nathalie Kapp ,&nbsp;Markus J. Steiner","doi":"10.1016/j.conx.2024.100107","DOIUrl":"10.1016/j.conx.2024.100107","url":null,"abstract":"<div><h3>Objectives</h3><p>U.S. and World Health Organization Selected Practice Recommendations for Contraceptive Use state people may have an advanced supply of emergency contraception (EC) to minimize treatment delays. We sought to characterize the potential improvement in effectiveness of 1.5 mg levonorgestrel (LNG-EC) if it were taken up to a few hours before unprotected sex.</p></div><div><h3>Study design</h3><p>We expanded on an existing mathematical model for the maximum attainable effectiveness of LNG-EC, assuming it exclusively works to disrupt ovulation, and compared results with point estimates from nine studies when it was taken up to 72 hours after sex. We then modelled how effectiveness might have improved if subjects had taken LNG-EC up to 3 hours before sex.</p></div><div><h3>Results</h3><p>Taking LNG-EC immediately after sex could potentially reduce the risk of unintended pregnancy by 91%. However, population-average maximum attainable effectiveness levels ranged from just 49% to 67% when accounting for the distributions of postcoital treatment delays in the example studies. If half the subjects had taken it 3 hours before sex, then maximum effectiveness levels would have ranged from 70% to 81%.</p></div><div><h3>Conclusions</h3><p>At the individual level, taking LNG-EC a few hours before sex is a logical extension of Selected Practice Recommendations regarding an advanced supply of EC and, based on our modeling, should be advocated for people who can reasonably anticipate an unprotected sex act. In the absence of more clinical data, however, people should not routinely rely on precoital use of LNG-EC to prevent pregnancy unless modern, effective contraceptives are inaccessible to them.</p></div><div><h3>Implications</h3><p>Based on mathematical modeling, individuals who anticipate needing to take LNG-EC for an impending unprotected act of sex could further reduce their chance of an undesired pregnancy by taking it a few hours in advance.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000042/pdfft?md5=5c64cf4a851ab4b573a91776200b11f3&pid=1-s2.0-S2590151624000042-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study","authors":"Abraham Fessehaye Sium,&nbsp;Amani Nureddin Abdu,&nbsp;Zerihun Beyene","doi":"10.1016/j.conx.2024.100110","DOIUrl":"10.1016/j.conx.2024.100110","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effectiveness and safety of dilation and evacuation (D&amp;E) to that of medication abortion at 15–24 weeks in a low-middle income country.</p></div><div><h3>Study design</h3><p>We conducted a retrospective cohort on effectiveness and safety of D&amp;E vs medication abortion at 15–24 weeks in an Ethiopian setting over a year (January 1–December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&amp;E group vs medication abortion group). <em>P</em>-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance.</p></div><div><h3>Results</h3><p>A total of 225 abortion cases (162 medication abortion cases and 63 D&amp;E cases) at gestational age of 15–24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&amp;E group compared to 21 ± 3 weeks in the medication abortion group (<em>p</em>-value<!--> <!-->&lt;<!--> <!-->0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&amp;E group and medication abortion groups, <em>p</em>-value<!--> <!-->=<!--> <!-->0.542). D&amp;E (AOR<!--> <!-->=<!--> <!-->2.92 [95% CI<!--> <!-->=<!--> <!-->0.62–13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar.</p></div><div><h3>Conclusion</h3><p>We found both abortion methods (D&amp;E and medication abortion) are effective with comparable complication rates.</p></div><div><h3>Implications</h3><p>D&amp;E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&amp;E in order for women to have a choice in their treatment options.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000078/pdfft?md5=f4cf2c2381c0def0532e91cb2471a6ce&pid=1-s2.0-S2590151624000078-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of delay-causing obstacles and mental health at the time of abortion seeking","authors":"Ortal Wasser ,&nbsp;Lauren J. Ralph ,&nbsp;Shelly Kaller ,&nbsp;M. Antonia Biggs","doi":"10.1016/j.conx.2024.100105","DOIUrl":"10.1016/j.conx.2024.100105","url":null,"abstract":"<div><h3>Objectives</h3><p>The delays and challenges people encounter when seeking abortion are well-documented, but their psychological implications are understudied. Aiming to fill this gap, we explored the associations between experiences of delay-causing obstacles to abortion care and adverse mental health symptoms among individuals seeking abortion care.</p></div><div><h3>Study design</h3><p>In 2019, we surveyed 784 people (of 1092 approached) ages 15–45 accessing abortion care in four clinics in abortion-supportive states: California, Illinois, and New Mexico. We conducted multivariable Poisson regressions to examine associations between experiencing delay-causing obstacles to abortion care and stress, anxiety, and depression at the abortion appointment. We also used Poisson regression to examine whether some individuals are more likely to experience delay-causing obstacles than others.</p></div><div><h3>Results</h3><p>Three in five participants (58%) experienced delay-causing obstacles when accessing abortion care. The most prevalent obstacles were cost-related (45%), followed by access-related (43%), and travel time-related (35%) delays. In adjusted analyses, experiencing any type of delay-causing obstacle to abortion care was significantly associated with more symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders. Participants were more likely to experience delay-causing obstacles if they traveled from another state or over 100 miles to reach the clinic, sought abortion beyond 13 weeks gestation, lacked money for unexpected expenses, and found it difficult to pay for the abortion.</p></div><div><h3>Conclusion</h3><p>Abortion is a time-sensitive healthcare, but most individuals are forced to delay care due to various obstacles that may have a negative impact on their psychological well-being.</p></div><div><h3>Implications</h3><p>Obstacles causing delays in accessing abortion care may contribute to elevated symptoms of stress, anxiety, and depression and higher risk of anxiety and depressive disorders for abortion patients. As restrictive policies increase, delays are likely to worsen, potentially leading to psychological harm for people seeking abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000029/pdfft?md5=9afc1159cd88ea22b96691c7ff671cb7&pid=1-s2.0-S2590151624000029-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140088463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the London Measure of Unplanned Pregnancy (LMUP) among a nationally representative sample of pregnant and postpartum women Ethiopia","authors":"Celia Karp ,&nbsp;Caroline Moreau ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Linnea A. Zimmerman","doi":"10.1016/j.conx.2023.100094","DOIUrl":"10.1016/j.conx.2023.100094","url":null,"abstract":"<div><h3>Objectives</h3><p>Rigorous measurement of pregnancy preferences is needed to address reproductive health needs. The London Measure of Unplanned Pregnancy (LMUP), developed in the UK, has been adapted for low-income countries. Psychometric properties of LMUP items remain uncertain in contexts with limited access to and use of health services.</p></div><div><h3>Study design</h3><p>This cross-sectional study examines the six-item LMUP’s psychometric properties among a nationally representative sample of 2855 pregnant and postpartum women in Ethiopia. Principal components analysis (PCA) and confirmatory factor analysis (CFA) estimated psychometric properties. Hypothesis testing examined associations between the LMUP and other measurement approaches of pregnancy preferences using descriptive statistics and linear regression.</p></div><div><h3>Results</h3><p>The six-item LMUP had acceptable reliability (α = 0.77); two behavioral items (contraception, preconception care) were poorly correlated with the total scale. A four-item measure demonstrated higher reliability (α = 0.90). Construct validity via PCA and CFA indicated the four-item LMUP’s unidimensionality and good model fit; all hypotheses related to the four-item LMUP and other measurement approaches were met.</p></div><div><h3>Conclusions</h3><p>Measurement of women’s pregnancy planning in Ethiopia may be improved through use of a four-item version of the LMUP scale. This measurement approach can inform family planning services to better align with women’s reproductive goals.</p></div><div><h3>Implications</h3><p>Improved pregnancy preference measures are needed to understand reproductive health needs. A four-item version of the LMUP is highly reliable in Ethiopia, offering a robust and concise metric for assessing women’s orientations toward a current or recent pregnancy and tailoring care to support them in achieving their reproductive goals.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"5 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of intrauterine device insertions by newly trained providers: The ECHO trial experience","authors":"Irina Yacobson ,&nbsp;Valentine Wanga ,&nbsp;Khatija Ahmed ,&nbsp;Tsungai Chipato ,&nbsp;Peter Gichangi ,&nbsp;James Kiarie ,&nbsp;Cheryl Louw ,&nbsp;Susan Morrison ,&nbsp;Margaret Moss ,&nbsp;Nelly R. Mugo ,&nbsp;Thesla Palanee-Phillips ,&nbsp;Melanie Pleaner ,&nbsp;Caitlin W. Scoville ,&nbsp;Katherine K. Thomas ,&nbsp;Kavita Nanda ,&nbsp;for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium","doi":"10.1016/j.conx.2023.100092","DOIUrl":"10.1016/j.conx.2023.100092","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the rates of failed insertion, expulsion, and perforation when intrauterine device (IUD) insertions were done by newly trained clinicians, and to examine factors that may affect these outcomes.</p></div><div><h3>Study design</h3><p>We evaluated skill-based outcomes following IUD insertion at 12 African sites in a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Before trial initiation, we provided competency-based IUD training to clinicians and offered ongoing clinical support. We used Cox proportional hazards regression to examine factors associated with expulsion.</p></div><div><h3>Results</h3><p>Among 2582 IUD acceptors who underwent first attempted IUD insertion, 141 experienced insertion failure (5.46%) and seven had uterine perforation (0.27%). Perforation was more common among breastfeeding women within three months postpartum (0.65%) compared with non-breastfeeding women (0.22%). We recorded 493 expulsions (15.5 per 100 person-years, 95% confidence interval [CI] 14.1─16.9): 383 partial and 110 complete. The risk of IUD expulsion was lower among women older than 24 years (aHR 0.63, 95% CI 0.50─0.78) and may be higher among nulliparous women. (aHR 1.65, 95% CI 0.97─2.82). Breastfeeding (aHR 0.94, 95% CI 0.72─1.22) had no significant effect on expulsion. IUD expulsion rate was highest during the first three months of the trial.</p></div><div><h3>Conclusions</h3><p>IUD insertion failure and uterine perforation rates in our study were comparable to those reported in the literature. These results suggest that training, ongoing support, and opportunities to apply new skills were effective in ensuring good clinical outcomes for women receiving IUD insertion by newly trained providers.</p></div><div><h3>Implications</h3><p>Data from this study support recommendations to program managers, policymakers, and clinicians that IUDs can be inserted safely in resource-constrained settings when providers receive appropriate training and support.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"5 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“If I use family planning, I may have trouble getting pregnant next time I want to”: A multicountry survey-based exploration of perceived contraceptive-induced fertility impairment and its relationship to contraceptive behaviors","authors":"Suzanne O. Bell ,&nbsp;Celia Karp ,&nbsp;Caroline Moreau ,&nbsp;PMA Principal Investigators Group ,&nbsp;Alison Gemmill","doi":"10.1016/j.conx.2023.100093","DOIUrl":"10.1016/j.conx.2023.100093","url":null,"abstract":"<div><h3>Objectives</h3><p>We aim to assess women’s perceptions regarding contraceptive effects on fertility across a diversity of settings in sub-Saharan Africa and how they vary by women’s characteristics. We also aim to examine how such beliefs relate to women’s contraceptive practices and intentions.</p></div><div><h3>Study design</h3><p>This study uses cross-sectional survey data among women aged 15 to 49 in nine sub-Saharan African geographies from the Performance Monitoring for Action project. Our main measure of interest assessed women’s perceptions of contraceptive-induced fertility impairment. We examined factors related to this belief and explored the association between perceptions of contraceptive-induced fertility impairment and use of medicalized contraception (intrauterine device, implant, injectable, pills, emergency contraception) and intention to use contraception (among nonusers).</p></div><div><h3>Results</h3><p>Between 20% and 40% of women across study sites agreed or strongly agreed that contraception would lead to later difficulties becoming pregnant. Women at risk of an unintended pregnancy who believed contraception could cause fertility impairment had reduced odds of using medicalized contraception in five sites; aORs ranged from 0.07 to 0.62. Likewise, contraceptive nonusers who wanted a/another child and perceived contraception could cause fertility impairment were less likely to intend to use contraception in seven sites, with aORs between 0.34 and 0.66.</p></div><div><h3>Conclusions</h3><p>Our multicountry study findings indicate women’s perception of contraceptive-induced fertility impairment is common across diverse sub-Saharan African settings, likely acting as a deterrent to using medicalized contraceptive methods.</p></div><div><h3><strong>Implications</strong></h3><p>Findings from this study can help improve reproductive health programs by addressing concerns about contraception to help women achieve their reproductive goals.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"5 ","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10127128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and intended practice of abortion among medical students in Thailand after the amendment of the Thai abortion law","authors":"Rada Poolkumlung ,&nbsp;Ratthapong Rongkapich ,&nbsp;Natchanika Sinthuchai ,&nbsp;Somsook Santibenchakul ,&nbsp;Vorachart Meevasana ,&nbsp;Unnop Jaisamrarn","doi":"10.1016/j.conx.2023.100091","DOIUrl":"10.1016/j.conx.2023.100091","url":null,"abstract":"<div><h3>Objectives</h3><p>Following the amendment of the Thai abortion law in February 2021, the authors conducted an anonymous survey to assess knowledge, attitude, and intended practice toward abortion among fifth-year medical students at Chulalongkorn University.</p></div><div><h3>Study design</h3><p>The authors developed a self-administrated questionnaire consisting of three parts: knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. Pilot testing showed a high Cronbach's alpha and test-retest reliability coefficient.</p></div><div><h3>Results</h3><p>Of the 292 surveyed medical students, 70% completed the questionnaire. The mean ± standard deviation of the knowledge part was 6.9 ± 1.8, of which the maximum score was 10. Nearly half of the participants (45.6%) answered at least 80% of the knowledge statements correctly. Sixty-four percent of participants answered correctly on the gestational limit for first-trimester abortion. Around one-third of participants answered correctly on the gestational limit for second-trimester abortion. Most participants (86.8%) agreed that abortion is a woman’s right. The most acceptable conditions for abortion were pregnancy as a result of rape (93%) and serious anomalies that cause a nonviable neonate (95.6%).</p></div><div><h3>Conclusions</h3><p>Participants exhibited a lack of understanding regarding the legal gestational limit, which is a key aspect of the amendment. The findings of this study urge medical schools to emphasize the revised Thai abortion law in the Obstetrics and Gynecology curriculum.</p></div><div><h3>Implications</h3><p>Our results show that encouraging medical students to have up-to-date knowledge regarding the amendment of Thai abortion law may support their future decision to provide safe abortion services.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"5 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/f1/main.PMC10140783.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}