Contraception: X最新文献

{"title":"Ovulation suppression following subcutaneous administration of depot medroxyprogesterone acetate","authors":"Douglas J. Taylor ,&nbsp;Vera Halpern ,&nbsp;Vivian Brache ,&nbsp;Luis Bahamondes ,&nbsp;Jeffrey T. Jensen ,&nbsp;Laneta J. Dorflinger","doi":"10.1016/j.conx.2022.100073","DOIUrl":"10.1016/j.conx.2022.100073","url":null,"abstract":"<div><h3>Objectives</h3><p>To characterize the relationship between serum medroxyprogesterone acetate (MPA) concentrations and ovulation suppression, and to estimate the risk of ovulation for investigational subcutaneous regimens of Depo-Provera CI (Depo-Provera) and Depo-subQ Provera 104 (Depo-subQ).</p></div><div><h3>Study Design</h3><p>We performed a secondary analysis of 2 studies that assessed the pharmacokinetics and pharmacodynamics of MPA when Depo-Provera is administered subcutaneously rather than by the labeled intramuscular route. Each woman received a single 45 mg to 300 mg subcutaneous injection of Depo-Provera, a single 104 mg subcutaneous injection of Depo-subQ, or 2 injections of Depo-subQ at 3-month intervals. We used an elevation of serum progesterone ≥4.7 ng/mL as a surrogate for ovulation and non-parametric statistical methods to assess pharmacokinetic and pharmacodynamic relationships.</p></div><div><h3>Results</h3><p>This analysis included 101 women with body mass index (BMI) 18 to 34 kg/m². Return of ovulation occurred at a median MPA concentration of 0.07 ng/mL (95% CI: 0.06–0.08) and the 90th percentile was 0.10 ng/mL (95% CI: 0.09–0.14). Neither age, race, nor BMI significantly influenced this relationship. The estimated probabilities of ovulation within 4 months of a 104 mg subcutaneous injection and within 7 months of a 150 mg subcutaneous injection (6 plus a 1-month grace) were each below 2.2%.</p></div><div><h3>Conclusions</h3><p>The typical MPA concentration associated with loss of ovulation suppression is substantially less than the commonly cited threshold of 0.2 ng/mL. Based on our results, MPA levels would rarely be low enough to permit ovulation if the Depo-subQ reinjection interval were extended to four months or if 150 mg Depo-Provera were injected subcutaneously every 6 months.</p></div><div><h3>Implications</h3><p>Extending the three-month Depo-subQ reinjection interval by one month would result in a 25% reduction in yearly MPA exposure, with little risk of pregnancy. Off-label subcutaneous administration of 150 mg Depo-Provera every 6 months would be a highly effective repurposing of an excellent product, with a similar reduction in cumulative exposure.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151622000028/pdfft?md5=2d79ee1d1cafd191bb329d797158e41a&pid=1-s2.0-S2590151622000028-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43751673","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":"Observational study of feasibility and acceptability of the levonorgestrel-releasing intrauterine device as a long-acting reversible contraceptive in a primary care setting in India","authors":"Sharad Iyengar ,&nbsp;Kirti Iyengar ,&nbsp;Ankit Anand ,&nbsp;Virendra Suhalka ,&nbsp;Manju Jain","doi":"10.1016/j.conx.2022.100079","DOIUrl":"10.1016/j.conx.2022.100079","url":null,"abstract":"<div><h3>Objectives</h3><p>The levonorgestrel-releasing intrauterine device (LNG-IUD) is a well-accepted contraceptive across developed countries, yet there is limited experience in use and acceptance amongst women living in low-resource, developing country settings. We studied the feasibility of providing the LNG-IUD through a primary care service, and its acceptability amongst women living in a low-income, rural-tribal community in India.</p></div><div><h3>Study design</h3><p>We conducted an observational study of feasibility and acceptability at four health facilities (three rural, and one urban) in Rajasthan, India. Women seeking contraception were offered the LNG-IUD in addition to existing contraceptive methods. We followed all those who adopted LNG-IUD from August 2015 to September 2019 (<em>n</em>= 1266) till discontinuation or 12 months, whichever was earlier. The primary outcome was continuation rate and acceptability, and the secondary outcome was change in hemoglobin levels, which we measured before insertion and at 12-month follow-up, using Sahli's method.</p></div><div><h3>Results</h3><p>Most users lived in villages, were illiterate, belonged to marginalized groups, had 2 or more children, and wished to limit births when they adopted the method. The 12-month continuation rate was 87.6%. Amongst all users, 7.4% of women sought removal for side effects and 2% for change in reproductive intention, while another 2% reported spontaneous expulsion. Most continuing users reported hypomenorrhea (54%) or amenorrhea (42%) by 12 months of use. User satisfaction was high at 91.6%, with 92% of women rating their experience as equaling or exceeding expectations. Moderate and severe anemia reduced, and mean hemoglobin levels increased by 0.7 g/dL (<em>p</em> &lt; 0.01).</p></div><div><h3>Conclusion</h3><p>Primary care clinics can feasibly deliver LNG-IUD, with high acceptability amongst women living in low resource settings. Given the paucity of long-acting reversible contraceptive options and high prevalence of anemia among women in India and similar countries, the method should be piloted through the public health system.</p></div><div><h3>Implications</h3><p>Long duration of contraceptive action, ability to reduce menstrual bleeding and reduce anemia, reversibility, and easy removal, combine to make LNG-IUD acceptable to women, especially in regions with high prevalence of anemia. This study demonstrates the feasibility and acceptability of introducing LNG-IUD in a low resource, primary care setting.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/48/main.PMC9287359.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40608952","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":"Pregnancy coercion and partner knowledge of contraceptive use among Ethiopian women","authors":"Jessica L. Dozier ,&nbsp;Linnea A. Zimmerman ,&nbsp;Bedilu A. Ejigu ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Robel Yirgu ,&nbsp;Shannon N. Wood","doi":"10.1016/j.conx.2022.100084","DOIUrl":"10.1016/j.conx.2022.100084","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the relationship between pregnancy coercion and partner knowledge of contraceptive use.</p></div><div><h3>Study design</h3><p>Cross-sectional Performance Monitoring for Action-Ethiopia data were collected in October-November 2019 from a nationally representative sample of women ages 15 to 49. The analytical sample (<em>n</em> = 2,469) included partnered women using contraception in the past year. We used multinomial logistic regression to examine associations between past-year pregnancy coercion (none, less severe, more severe) and partner knowledge/couple discussion of contraceptive use (overt use with couple discussion before method initiation (reference group), overt use with discussion after method initiation, and covert use of contraception).</p></div><div><h3>Results</h3><p>Most women reported their partner knew they were using contraception and had discussed use prior to method initiation (1,837/2,469, 75%); 16% used overtly and discussed use after method initiation, and 7% used contraception covertly. The proportion of covert users increased with pregnancy coercion severity (4%_none, 14%_{less severe}, 31%_{more severe}), as did the proportion of overt users who delayed couple contraceptive discussions, (14%_none, 23%_{less severe}, 26% _{more severe}); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%_none, 60%_{less severe}, 40%_{more severe}). The risk of covert use among women experiencing less severe pregnancy coercion was four times greater than women who experienced no pregnancy coercion (adjusted relative risk ratio, (aRRR) = 3.95, 95% confidence interval (CI) 2.20–7.09) and ten times greater for women who experienced the most severe pregnancy coercion (aRRR = 10.42, 95% CI 6.14–17.71). The risk of overt use with delayed couple discussion also increased two-fold among women who experienced pregnancy coercion compared to those who did not (less severe aRRR = 2.05, 95% CI 1.39–2.99; more severe aRRR = 2.89, 95% CI 1.76–4.73).</p></div><div><h3>Conclusion</h3><p>When experiencing pregnancy coercion, women may avoid or delay contraceptive conversations with their partners. Increased pregnancy coercion severity has the greatest association with covert use and couple contraceptive discussions.</p></div><div><h3>Implications</h3><p>The presence and timing of couple discussions about contraception are critical for ensuring safety for women experiencing pregnancy coercion. Screening for pregnancy coercion must be included within contraceptive counseling so that women can choose methods that maximize their reproductive autonomy.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33486377","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":"An exploratory survey regarding the Maryland Contraceptive Equity Act: clinician awareness and impact on contraception provision","authors":"Aneesha Cheedalla ,&nbsp;Jessica K. Lee ,&nbsp;Anne E. Burke","doi":"10.1016/j.conx.2021.100071","DOIUrl":"10.1016/j.conx.2021.100071","url":null,"abstract":"<div><h3>Objective</h3><p>The Maryland Contraceptive Equity Act took effect in January 2018 with the goal of reducing insurance barriers to contraception. We sought to assess the Act's impact on contraceptive provision.</p></div><div><h3>Study Design</h3><p>From March-August 2019, we emailed an exploratory survey to clinicians providing contraception in Maryland that queried awareness of the Act and changing practices.</p></div><div><h3>Results</h3><p>The survey had a 13% response rate (164/1256 clinicians). Fifty (31%) were aware of the Act. Clinicians rated the Act was somewhat likely to change prescribing practices (3.5/5 point Likert Scale, SD 1.3).</p></div><div><h3>Conclusion</h3><p>The majority of clinicians providing contraception in Maryland are not aware of the Act. If aware of the Act, clinicians may change their contraceptive prescribing practices.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/29/main.PMC8790273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883369","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":"Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities","authors":"Hayley V. McMahon ,&nbsp;Celia Karp ,&nbsp;Suzanne O. Bell ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme ,&nbsp;Mahari Yihdego ,&nbsp;Linnea A. Zimmerman","doi":"10.1016/j.conx.2022.100087","DOIUrl":"10.1016/j.conx.2022.100087","url":null,"abstract":"<div><h3>Objectives</h3><p>Unsafe abortion is a leading cause of global maternal mortality and morbidity. This study sought to estimate availability of essential postabortion care (PAC) services among publicly managed health facilities in Ethiopia.</p></div><div><h3>Study design</h3><p>Data from public hospitals and health centers in Ethiopia were collected in 2020. Among facilities offering labor and delivery, we assessed the proportion that: (1) offered PAC, (2) were equipped for each PAC signal function, and (3) were equipped for all PAC signal functions falling within their scope of care by facility type.</p></div><div><h3>Analysis</h3><p>Our primary outcome was PAC service provision status. Descriptive statistics summarized the proportion of hospitals and health centers, respectively, categorized as each PAC status and with necessary equipment for individual signal functions. Per Federal Ministry of Health (FMOH) guidelines, hospitals are expected to provide comprehensive PAC, while health centers are expected to provide basic PAC.</p></div><div><h3>Results</h3><p>Altogether, 69.1% (<em>n</em> = 94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (<em>n</em> = 131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; <em>n</em> = 114) and uterine evacuation among health centers (84.6%; <em>n</em> = 170).</p></div><div><h3>Conclusion</h3><p>Meaningful progress has been made toward achieving the Ethiopian FMOH's goal of universal PAC service availability at hospitals and health centers by 2020. Despite this, sizable gaps remain and may endanger maternal health in Ethiopia, underscoring a need for continued prioritization of PAC services.</p></div><div><h3>Implications</h3><p>Ethiopia's commitment to PAC has fostered a service landscape that is stronger than many other low-resource settings; however, notable shortcomings are present. Further research is needed to understand the potential role of clinical training and supply-side interventions.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40495980","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":"DMPA-SC stock: Cross-site trends by facility type","authors":"Sophia Magalona ,&nbsp;Shannon N. Wood ,&nbsp;Frederick Makumbi ,&nbsp;Funmilola M. OlaOlorun ,&nbsp;Elizabeth Omoluabi ,&nbsp;Akilimali Z. Pierre ,&nbsp;Georges Guiella ,&nbsp;Jane Cover ,&nbsp;Philip Anglewicz","doi":"10.1016/j.conx.2022.100075","DOIUrl":"10.1016/j.conx.2022.100075","url":null,"abstract":"<div><h3>Objectives</h3><p>To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods.</p></div><div><h3>Study design</h3><p>We used repeated cross-sectional data from service-delivery-point surveys in six settings: Burkina Faso, Democratic Republic of Congo (Kinshasa and Kongo Central), Nigeria (Kano and Lagos), and Uganda, each with 3-5 rounds of data collected between 2016 and 2020. We analyzed trends in DMPA-SC availability using percent of service delivery points offering the method and percent experiencing stockouts; trends were compared with those for DMPA-IM, IUD, implants, and other short-acting methods, by facility type.</p></div><div><h3>Results</h3><p>All settings showed increased offering of DMPA-SC over time for both private and public facilities. Larger proportions of public facilities provided DMPA-SC compared to private facilities (66%–97% vs 16%–50% by 2019–2020). DMPA-SC was provided by fewer facilities than DMPA-IM (90%–100% public, 34%–69% private by 2019–2020), but comparable to implants (83%–100% public, 15%–52% private by 2019–2020) and IUDs (55%–91% public, 0%–44% private by 2019–2020). Trends of DMPA-SC stock varied by setting, with more consistent stock available in private facilities in the DRC and in public facilities in Burkina Faso and Nigeria. Uganda showed decreasing stock in public facilities but increasing stock in private facilities.</p></div><div><h3>Conclusion</h3><p>DMPA-SC availability has been increasing since its introduction in sub-Saharan Africa, yet significant gaps in stock exist. Countries should consider alternative distribution models to address these issues.</p></div><div><h3>Implications</h3><p>Our findings may help inform countries about the need to monitor DMPA-SC availability and to consider solutions that ensure contraceptive options are available to women who need them and disruptions to contraceptive use are minimized.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151622000041/pdfft?md5=2b656ca268c0da1d394d1163166730ef&pid=1-s2.0-S2590151622000041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49395685","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":"Return to ovulation after Sayana Press is injected every 4 months for one year: Empirical and pharmacokinetic/pharmacodynamic modeling results","authors":"Douglas J. Taylor ,&nbsp;Jennifer Deese ,&nbsp;Luis Bahamondes ,&nbsp;Vivian Brache ,&nbsp;Nelio Veiga Jr ,&nbsp;Rachael Fuchs ,&nbsp;Vera Halpern ,&nbsp;Laneta J. Dorflinger","doi":"10.1016/j.conx.2022.100080","DOIUrl":"10.1016/j.conx.2022.100080","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize return to ovulation after injecting Sayana Press (104 mg/0.65 mL medroxyprogesterone acetate [MPA] in the Uniject device) every 4 months for 1 year of treatment.</p></div><div><h3>Study design</h3><p>We followed a subset of women for return to ovulation in a trial that demonstrated Sayana Press remains highly effective when the subcutaneous reinjection interval is extended from 3 to 4 months. We measured serum progesterone in weeks 38 to 42 and 46 to 50 after a final (third) injection and used a concentration ≥4.7 ng/mL as a surrogate for ovulation. We also performed pharmacokinetic and pharmacodynamic modeling to predict differences in MPA accumulation and return to ovulation had - contrary to fact - injections been given every 3 months.</p></div><div><h3>Results</h3><p>Ten of 19 women (53%; 95% confidence interval: 29–76) ovulated within 50 weeks of their last injection. We predicted that typical 12-month trough MPA concentrations are 34% lower (0.46 vs 0.69 ng/mL) and the median time from last dose to ovulation is 1.1 months shorter (13.1 vs 14.2 months) when injections are given every four months for 1 year.</p></div><div><h3>Conclusion</h3><p>Extending the Sayana Press reinjection interval from 3 to 4 months leads to less drug accumulation, without a noticeable loss in efficacy. Although the Sayana Press patient leaflet specifies that over 80% of women desiring pregnancy will conceive within a year of stopping the method (independent of treatment duration), our empirical and modeling results indicate women should anticipate waiting a year or more for fertility to return after repeat dosing, with a somewhat shorter delay were the reinjection interval extended to four months.</p></div><div><h3>Implications</h3><p>Providers should counsel women regarding the distinct possibility that return to fertility will take a year or longer following repeat use of Sayana Press. Extending the dosing interval from 3 to 4 months would result in approximately a 1-month shorter delay, without any appreciable reduction in contraceptive efficacy.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/1d/main.PMC9372597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40697332","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":"Effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester abortion past 20 weeks at a tertiary Hospital in Ethiopia: A retrospective review","authors":"Abraham Fessehaye Sium ,&nbsp;Tesfaye H. Tufa ,&nbsp;Jaclyn M. Grentzer ,&nbsp;Sarah Prager","doi":"10.1016/j.conx.2022.100082","DOIUrl":"10.1016/j.conx.2022.100082","url":null,"abstract":"<div><h3>Background</h3><p>Current literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting.</p></div><div><h3>Methods</h3><p>This is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2^nd trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies.</p></div><div><h3>Results</h3><p>More than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%.</p></div><div><h3>Conclusion</h3><p>In this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies.</p></div><div><h3>Implications</h3><p>In an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33438190","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":"Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia","authors":"Linnea A. Zimmerman ,&nbsp;Dana O. Sarnak ,&nbsp;Celia Karp ,&nbsp;Shannon N. Wood ,&nbsp;Mahari Yihdego ,&nbsp;Solomon Shiferaw ,&nbsp;Assefa Seme","doi":"10.1016/j.conx.2022.100074","DOIUrl":"10.1016/j.conx.2022.100074","url":null,"abstract":"<div><h3>Objective</h3><p>Our objectives were to assess the prevalence of specific side-effects experienced by current and recent contraceptive users, describe patterns of side-effects that users were concerned about, and share measurement lessons learned.</p></div><div><h3>Study design</h3><p>Data come from the PMA Ethiopia 2019 nationally-representative, cross-sectional survey. Our analytic sample included women who were current (weighted <em>n</em> = 2190; unweighted <em>n</em> = 2020) or recent (past 24 months; weighted <em>n</em> = 627; unweighted <em>n</em> = 622) users of a hormonal method or IUD. We provide descriptive statistics of the percentage of current/recent users who report currently/ever experiencing specific side-effects, not experiencing but being concerned about experiencing specific side-effects, and both currently experiencing and being concerned about experiencing specific side-effects. All analyses are stratified by method type (implant, injectable, pill) to explore variation by method.</p></div><div><h3>Results</h3><p>Among current users, 648/2190 women (30%) reported experiencing any side-effect, while 252/644 (40%) of recent users reported ever experiencing any side-effect. Bleeding changes were reported most frequently and were higher among implant and injectable users. More recent users reported side-effects that were associated with physical discomfort, such as headaches, than current users. About one-third of current and recent users reported being concerned about at least one side-effect that they had not experienced, with about 15% of current and recent users reporting concerns about bleeding changes (307/2190 and 112/627, respectively) and concerns about physical discomfort (334/2019 and 98/627, respectively).</p></div><div><h3>Conclusions</h3><p>While bleeding changes are common, users report a range of side-effects related to physical discomfort underscoring the need for comprehensive counseling. We highlight challenges in measuring side-effects using quantitative tools and pose recommendations for future research and measurement efforts.</p></div><div><h3>Implications</h3><p>: Experiencing and fearing contraceptive-induced menstrual bleeding changes and physical discomfort, particularly headaches, is high among hormonal contraceptive and IUD users in Ethiopia. counseling that addresses an array of side-effects is needed. Additional research is also needed to disentangle the effect of experiencing versus fearing side-effects on contraceptive use.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"4 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259015162200003X/pdfft?md5=a1575c2b208f96e47e59793cc006ec18&pid=1-s2.0-S259015162200003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47704154","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":"Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas","authors":"Kristen Lagasse Burke ,&nbsp;Lauren Thaxton ,&nbsp;Joseph E. Potter","doi":"10.1016/j.conx.2020.100052","DOIUrl":"10.1016/j.conx.2020.100052","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas.</p></div><div><h3>Study design</h3><p>Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued.</p></div><div><h3>Results</h3><p>Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1–75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50–0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12–1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12–1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method.</p></div><div><h3>Conclusions</h3><p>Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable.</p></div><div><h3>Implications</h3><p>Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38861064","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}