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":"Women's empowerment and contraceptive use in ever-married adult women: Analysis of a population-based survey in Peru","authors":"Marisella Chuman-Sanchez ,&nbsp;Gustavo Tapia-Sequeiros ,&nbsp;Maryorie Katteryne Galeas-Torre ,&nbsp;Victor Roman-Lazarte","doi":"10.1016/j.conx.2024.100115","DOIUrl":"10.1016/j.conx.2024.100115","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the relationship between women's empowerment and the use of modern contraceptive methods.</div></div><div><h3>Study design</h3><div>A secondary analysis was conducted using the 2022 Demographic and Health Survey of Peru, selecting women who were married, ever married, or cohabiting with a partner. The survey-based Women’s Empowerment Index was employed to assess empowerment, and the dependent variable was the use of modern contraceptives at the time of the interview. Regression analysis was performed using generalized linear models of the Poisson family.</div></div><div><h3>Results</h3><div>Sixty percent of the selected women were using a contraceptive method at the time of the survey. We found an association between low empowerment levels and lower frequency of modern contraceptive use (aPR<!--> <!-->=<!--> <!-->0.87, <em>p</em> = 0.001). Additionally, among the empowerment domains, we observed that lower levels of independence (aPR<!--> <!-->=<!--> <!-->0.89, <em>p</em> = 0.001) and tolerance of intimate partner violence (aPR<!--> <!-->=<!--> <!-->0.75, <em>p</em> = 0.003) were associated with a lower frequency of modern contraceptive use.</div></div><div><h3>Conclusion</h3><div>Women's empowerment is related to the use of modern contraceptive methods, as well as its various domains. Future studies should evaluate different perspectives, such as empowerment and decision-making in the sexual and reproductive aspects.</div></div><div><h3>Implications</h3><div>The level of female empowerment is directly related to the use of modern contraceptive methods, a relevant situation in culturally diverse developing countries. Sexual health promoters need to encourage autonomy in the decision to use appropriate methods for proper family planning.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885265","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":"“We just need to create as many avenues for access as we possibly can”: Clinician and administrator attitudes toward telehealth medication abortion in the U.S. South","authors":"Parie Bhandari ,&nbsp;Subasri Narasimhan ,&nbsp;Anna Newton-Levinson","doi":"10.1016/j.conx.2024.100112","DOIUrl":"10.1016/j.conx.2024.100112","url":null,"abstract":"<div><h3>Objectives</h3><div>There is currently a gap in literature on the perspectives of sexual and reproductive health providers in the South toward telehealth abortion services. This research seeks to explore these perspectives to understand provider attitudes toward importance and priority of telehealth abortion to contribute to the development of a richer understanding of this in the South.</div></div><div><h3>Study design</h3><div>This study conducts a secondary analysis of data from the Provider Readiness for Virtual Implementation and Delivery of Medication Abortion Services (PROVIDA) study. We collected qualitative data regarding perspectives of 20 providers toward importance and priority of telehealth abortion during a series of in-depth interviews that took place from June 2021–2022.</div></div><div><h3>Results</h3><div>We identified four main themes: telehealth abortion is important for patient benefit in mitigating physical, administrative, financial, and privacy-related barriers; telehealth abortion is important for clinic benefit in improving clinic flow and sustainability; the political climate affects personal prioritization of telehealth abortion; and staff hesitance affects clinic prioritization of telehealth abortion.</div></div><div><h3>Conclusions</h3><div>Our analysis revealed telehealth abortion to be particularly important in mitigating physical barriers for patients and for clinic sustainability. We found the political climate to be the most notable factor influencing personal prioritization of telehealth abortion, with most participants noting it made telehealth abortion less of a priority. Additionally, our analysis found participant perception of staff hesitation to implement telehealth abortion to be the most notable factor affecting clinic prioritization. Future research should utilize these findings to inform studies examining the implementation climate of telehealth abortion in the South.</div></div><div><h3>Implications</h3><div>Highlighting insights from SRH professionals in restrictive environments, this study emphasizes the potential of telehealth abortion to mitigate the unique barriers to access and provision that abortion seekers and providers face in the U.S. South. This has important implications for motivating implementation in states where abortion is still legal but telehealth abortion is prohibited.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697906","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":"Validation of a family planning self-efficacy measure with married women in Bihar, India: Findings from the Bihar Integrated Family Planning Survey","authors":"Nandita Bhan ,&nbsp;Edwin Elizabeth Thomas ,&nbsp;Lotus McDougal ,&nbsp;Priya Nanda ,&nbsp;Tanmay Mahapatra ,&nbsp;Aritra Das ,&nbsp;Sweta Kumari ,&nbsp;Kalysha Closson ,&nbsp;Abhishek Singh ,&nbsp;Anita Raj","doi":"10.1016/j.conx.2024.100113","DOIUrl":"10.1016/j.conx.2024.100113","url":null,"abstract":"<div><h3>Objectives</h3><div>Adapting and testing a novel measure of family planning self-efficacy (FPSE) and examining its association with fertility intention and contraceptive use in India.</div></div><div><h3>Study design</h3><div>Data were analyzed from 13,901 non-sterilized, currently married women of reproductive age (15-49 years) in the Bihar Integrated Family Planning Survey (BIFS) 2021. We adapted an FP Self Efficacy measure comprising women’s agency to overcome barriers to accessing, discussing and using contraception, regardless of family pressure and social judgment. We used factor analyses to assess reliability and validity, and regression analyses to examine the associations of FPSE with key family planning outcomes.</div></div><div><h3>Results</h3><div>The study sample was relatively young (35% below 25 years of age), with 43% reporting no education and over half (52%) married before 18 years of age. The 9-item FPSE scale demonstrated high reliability (Cronbach’s α=0.82) with two factors – self-efficacy to access and discuss contraception versus self-efficacy to use contraception in the face of resistance. Higher FPSE was associated with spousal communication [AOR: 2.35 (95% CI: 2.18, 2.54), traditional [AOR: 1.24 (95% CI: 1.12,1.36)] and reversible modern contraception [AOR: 1.58 (95% CI: 1.43,1.75)], and fertility intention [AOR: 1.13 (95% CI: 1.01,1.25)].</div></div><div><h3>Conclusion</h3><div>FP Self Efficacy was found to be a reliable and valid measure associated with spousal communication, reversible contraception use and fertility intention.</div></div><div><h3>Implications</h3><div>Measures to capture reproductive agency, such as family planning self efficacy within FP programs, place women’s choice as central goals of FP programming and can help in meeting community needs and the demand for contraceptive use.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757507","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":"Adolescents’ political and personal responses to recent policies restricting abortion and gender-affirming care","authors":"Madeline Quasebarth,&nbsp;Vanya Manthena,&nbsp;Sophie Knifton,&nbsp;Lee Hasselbacher","doi":"10.1016/j.conx.2024.100116","DOIUrl":"10.1016/j.conx.2024.100116","url":null,"abstract":"<div><h3>Objectives</h3><div>Restrictive policies on abortion and gender-affirming care have increased in recent years, particularly in some Midwest states, and can have a disproportionate impact on young people. We sought to explore adolescent perspectives on such policies.</div></div><div><h3>Study design</h3><div>We conducted virtual semistructured interviews with 39 participants aged 16 to 19 residing in the Midwest between April and June 2023, exploring participant reactions to state policies on abortion and gender-affirming care.</div></div><div><h3>Results</h3><div>Analysis revealed most participants opposed these restrictions, expressing concerns about the politicization of health care and the impact on their lives and the lives of loved ones. Policies also influenced future living decisions, with many expressing that a state’s policies on abortion and gender-affirming care would impact whether they wanted to attend college or live there.</div></div><div><h3>Conclusions</h3><div>This study highlights the largely negative responses of young people who will be voting for the first time in the 2024 elections to restrictive policies on abortion and gender-affirming care in the Midwest.</div></div><div><h3>Implication</h3><div>Findings indicate that policy makers should take into account young peoples attitude towards gender affeiming care and abortion bans when conaidering future legislation.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945936","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":"Person-centered contraceptive counseling and associations with contraceptive practices among a nationally representative sample of women in Ethiopia","authors":"Celia Karp ,&nbsp;Shira Tikofsky ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Linnea Zimmerman","doi":"10.1016/j.conx.2024.100114","DOIUrl":"10.1016/j.conx.2024.100114","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate levels of person-centered contraceptive counseling among current and recent contraceptive users, assess for whom counseling differs, and examine the relationship between counseling and contraceptive practices, specifically use of provider-dependent methods and use of one’s preferred method, among women in Ethiopia.</div></div><div><h3>Study design</h3><div>This cross-sectional study uses nationally representative data collected by the Performance Monitoring for Action Ethiopia project among current and recent contraceptive users (<em>n</em> = 2731) aged 15–49 between October and November 2021. Descriptive analyses estimated person-centered counseling levels via the recently validated quality of contraceptive counseling short scale (QCC-10). Bivariable and multivariable logistic regression estimated associations with contraceptive practices.</div></div><div><h3>Results</h3><div>Contraceptive users in Ethiopia receive moderate quality counseling (mean QCC-10 score<!--> <!-->=<!--> <!-->2.69, range: 1.1–4.0) with significant social inequities in the receipt of person-centered care. Women who are younger, uneducated, not in union, from poorer households, or who sourced their method from a non-public facility reported less person-centered care. Strong relationships were observed between higher quality counseling and women’s contraceptive practices. Those receiving highest quality counseling had nearly double the odds of using provider-dependent methods compared to those reporting lowest quality counseling (AOR: 1.92; 95% CI: 1.16–3.18). Among current users, women reporting highest quality counseling had 62% higher odds of using their preferred method relative to women receiving poorest quality care (95% CI: 1.06–2.48).</div></div><div><h3>Conclusion</h3><div>Poorer quality care is associated with use of non-preferred methods and reliance on provider-independent methods. Efforts to reduce reproductive health disparities and promote contraceptive autonomy should prioritize a person-centered approach to contraceptive counseling for all.</div></div><div><h3>Implications</h3><div>Inequitable delivery of person-centered contraceptive care based on individuals’ sociodemographic characteristics, such as education or marital status, undermines women’s reproductive autonomy and hinders contraceptive experiences. Person-centered contraceptive counseling should be provided to all women in Ethiopia, regardless of their background, to support individuals in achieving their reproductive goals.</div></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885263","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":"Population differences in responses to male hormonal contraception (lessons learned from the WHO-CONRAD phase III study)","authors":"Michael Zitzmann","doi":"10.1016/j.conx.2024.100106","DOIUrl":"10.1016/j.conx.2024.100106","url":null,"abstract":"","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143097147","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}