Contraception最新文献

{"title":"New copper intrauterine device approved by FDA in 2025: Longtime coming","authors":"David Hubacher","doi":"10.1016/j.contraception.2025.110899","DOIUrl":"10.1016/j.contraception.2025.110899","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110899"},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(25)00155-6","DOIUrl":"10.1016/S0010-7824(25)00155-6","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110964"},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(25)00116-7","DOIUrl":"10.1016/S0010-7824(25)00116-7","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110925"},"PeriodicalIF":2.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping access to medication abortion in Maputo, Mozambique","authors":"Christine M. Zachek ,&nbsp;Santos Guilherme M. Santos ,&nbsp;Maimuna Marenah ,&nbsp;Nafissa Bique Osman ,&nbsp;Sierra Washington","doi":"10.1016/j.contraception.2025.110911","DOIUrl":"10.1016/j.contraception.2025.110911","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize access to co-packaged mifepristone and misoprostol (“combi-pack”) for medication abortion in Maputo, Mozambique.</div></div><div><h3>Study design</h3><div>A cross-sectional, secret shopper study was conducted among pharmacies in Maputo between June and September 2022. Students were trained to act as patients seeking abortion. Shoppers visited all commercial pharmacies in Maputo to obtain information about combi-pack availability, administration, and side effects. Pharmacies were visited by two shoppers; one with a prescription and one without. Cost and availability were evaluated according to neighborhood socioeconomic status.</div></div><div><h3>Results</h3><div>We conducted 250 visits among 155 pharmacies. Combi-pack was available at 80.6% of pharmacies; only 8.4% required a prescription. Median cost was 1000 meticais ($15.65 USD) (range 350–1700 MT, $5.48–26.60 USD). Pharmacy worker instructions on combi-pack administration were fully accurate at only 3.7% of visits, while 45.2% gave partially correct instructions and 47.9% gave no instructions at all. Side effects and hospital precautions were discussed at 48.9% and 22.9% of pharmacy visits, respectively. Low-income neighborhoods were more likely to dispense combi-pack compared to high-income neighborhoods (94.9% vs. 68.9%, <em>p</em> = 0.001). Yet, combi-pack cost significantly more in low-income compared to high-income neighborhoods (median cost 1300 MT [$20.35 USD] vs. 950 MT [$14.87 USD], <em>p</em> &lt; 0.001). Dispensing combi-pack with or without a prescription was not significantly correlated with neighborhood income level.</div></div><div><h3>Conclusions</h3><div>Overall, combi-pack is widely available in Maputo with significant variations in dispensing practices and cost by neighborhood income level. Interventions to improve pharmacy-based counseling, specifically targeted towards low-income neighborhoods, are needed to increase access to safe abortion services.</div></div><div><h3>Implications</h3><div>Co-packaged mifepristone-misoprostol was widely available at commercial pharmacies in Maputo, Mozambique. Most pharmacies dispensed medication abortion without a prescription and provided limited information on medication administration and potential side effects, particularly in lower income neighborhoods. Improving pharmacist counseling and focusing interventions in low-income neighborhoods can promote safety of medication abortion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110911"},"PeriodicalIF":2.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mystery caller study on pain management options for intrauterine device placement","authors":"Mitali Sharma ,&nbsp;Francesca Selmoni ,&nbsp;Lynn L. Ngo ,&nbsp;Maya P. Pai ,&nbsp;Sheila K. Mody","doi":"10.1016/j.contraception.2025.110913","DOIUrl":"10.1016/j.contraception.2025.110913","url":null,"abstract":"<div><h3>Objectives</h3><div>To understand whether clinics present pain management options for intrauterine device (IUD) placement over the phone and whether these options align with current evidence for effective pain control during placement.</div></div><div><h3>Study design</h3><div>We used a mystery shopper approach and a standardized call script to collect information from a diverse, purposive sample of 100 clinics listed on <span><span>www.bedsider.org</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>We reached responsive personnel at 90 of the 100 selected clinics, of whom 32 (36%) would not provide information about pain control for IUD placement by phone or to non-established patients. Of the 58 clinics that provided information, four (6.9%) reported that they did not provide any options for pain management, and 54 (93.1%) presented at least one pharmaceutical option. The most common was ibuprofen, which was mentioned by 49 clinics (84.5%). Lidocaine, misoprostol, and naproxen were mentioned by 16 (27.6%), 14 (24.1%), and three (5.2%) clinics, respectively.</div></div><div><h3>Conclusions</h3><div>More than one third of clinics were unable to present pain control options over the phone. Among the 58 clinics that presented options to simulated patients calling to request an IUD placement, evidence-based pain control methods, such as lidocaine blocks, 10% lidocaine spray, or naproxen, were not often presented.</div></div><div><h3>Implications</h3><div>Given the barriers that pain and pre-procedure anxiety pose to uptake of IUDs, it is important for clinic staff to understand current guidelines for pain management during IUD placement as well as the pain control options offered for IUD placements at their clinic.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110913"},"PeriodicalIF":2.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural abortion in individuals with opioid dependence: Patient characteristics and pain experience","authors":"Kari P. Braaten ,&nbsp;Alisa B. Goldberg ,&nbsp;Isabel R. Fulcher ,&nbsp;Jennifer Fortin ,&nbsp;Alischer A. Cottrill ,&nbsp;Elizabeth Janiak","doi":"10.1016/j.contraception.2025.110912","DOIUrl":"10.1016/j.contraception.2025.110912","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the prevalence and characteristics of individuals with opioid-dependence who have procedural abortions, and to compare their experience of procedural pain to individuals without opioid-dependence.</div></div><div><h3>Study design</h3><div>Cross-sectional study of procedural abortion patients at a high-volume ambulatory abortion practice. We offered an anonymous survey to all procedural abortion patients which included medical and demographic information, assessment of opioid dependence with the Rapid Opioid Dependence Screen (RODS), measurement of procedural pain, and satisfaction with pain control.</div></div><div><h3>Results</h3><div>We approached 1888 individuals, 1553 (82%) completed the survey and 1525 were included in analysis. Eighty-eight participants screened positive for opioid-dependence (5.9%). Opioid-dependent participants were older, more likely to use other drugs, pay for abortion with insurance, report chronic pain, disability, anxiety, depression, prior abortion, and more frequently presented at 15+ weeks. Opioid-dependent patients reported higher mean pain scores (35 vs. 22.5, <em>p</em> = 0.002), with a mean difference of 7.73 in logistic regression analysis accounting for relevant demographic and medical characteristics (<em>p</em> = 0.041). No interaction was seen between opioid-dependence and effect of intravenous (IV) moderate sedation, with reduction in mean pain scores of 13.76 points in opioid-dependent patients versus 14.54 among those without (<em>p</em> = 0.937). The odds unacceptable pain control did not differ between opioid-dependent and non-dependent individuals (OR 1.73, <em>p</em> = 0.18).</div></div><div><h3>Conclusions</h3><div>Procedural abortion patients with opioid-dependence differ from those without along several reproductive and demographic factors. They have higher mean pain scores but similar improvement in pain with IV moderate sedation. Satisfaction with pain control is similar for patients with and without opioid dependence.</div></div><div><h3>Implications</h3><div>Intravenous moderate sedation is effective in reducing pain in patients with opioid-dependence, despite their overall higher pain scores. It should not be restricted in these patients due to concerns for ineffectiveness as it may be an important factor in improving the abortion experience for these marginalized patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110912"},"PeriodicalIF":2.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to providing procedural abortion care among trained clinicians: An evaluation of an abortion training program","authors":"Julia Rollison ,&nbsp;Skye A. Miner ,&nbsp;Zachary Predmore","doi":"10.1016/j.contraception.2025.110901","DOIUrl":"10.1016/j.contraception.2025.110901","url":null,"abstract":"<div><h3>Objectives</h3><div>Understand the barriers and facilitators that clinicians face in delivering procedural abortion care following participation in an abortion training program and how these barriers may differ based on professional characteristics (e.g. specialty, career stage) and institutional factors (e.g., clinic policies).</div></div><div><h3>Study design</h3><div>This analysis is part of a larger evaluation of a clinical training program focused on equipping clinicians with procedural abortion skills. Data collection occurred 07/2020−01/2024 and included semi-structured interviews and post-program surveys collected annually following program completion. Program participants who completed at least two surveys are included.</div></div><div><h3>Results</h3><div>Forty-four ob-gyn and family medicine physicians met the inclusion criteria for this study. About one-third of program participants provided procedural abortion care 6 months following training and at their last survey (18-, 30- or 42 months post-training), and one-third did not provide at either time point. Barriers and facilitators for those providing abortion care often changed as program participants became more established in their practices (particularly post-residency). While local and state policies influenced the ability to provide care, other institutional and professional factors, including career stage, were often reported with some differences by specialty and career stage.</div></div><div><h3>Conclusions</h3><div>Structural and institutional barriers proved significant to those seeking to provide care post-training. Institutions looking to support abortion care should also ensure that this support is given to family medicine physicians. As program participants often had challenges finding work, training programs should focus on helping program participants build networks of providers to provide comprehensive training and job placement support.</div></div><div><h3>Implications</h3><div>Institutional, career and personal factors have compounding effects on individuals’ ability to utilize their abortion training. While abortion training programs are helpful in training providers, program participants from these programs need additional networking and institutional supports to be able to provide procedural abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110901"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(25)00073-3","DOIUrl":"10.1016/S0010-7824(25)00073-3","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110882"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in hCG levels after very early medication abortion for pregnancy of unknown location or probable intrauterine pregnancy","authors":"Tagrid Jar-Allah ,&nbsp;Karin Brandell ,&nbsp;Frida Gyllenberg ,&nbsp;Janina Kaislasuo ,&nbsp;Helena Kopp-Kallner ,&nbsp;Kristina Cederblad ,&nbsp;Oskari Heikinheimo ,&nbsp;Kristina Gemzell-Danielsson ,&nbsp;Helena Hognert ,&nbsp;On behalf of the VEMA (Very Early Medication Abortion) Study Group","doi":"10.1016/j.contraception.2025.110902","DOIUrl":"10.1016/j.contraception.2025.110902","url":null,"abstract":"<div><h3>Objective(s)</h3><div>To evaluate changes in serum/plasma human chorionic gonadotropin (hCG) from baseline levels in very early medication abortion (VEMA) in pregnancies of unknown location (PUL) and probable intrauterine pregnancy (IUP) to confirm treatment success.</div></div><div><h3>Study design</h3><div>A prospective cohort was selected from the VEMA randomized controlled trial conducted at 26 sites across nine countries. Patients with a gestational age ≤42 days without confirmed IUP on ultrasound (<em>n</em> = 741) received medication abortion according to WHO guidelines, hCG was measured at mifepristone intake and repeated on day 7 (+/-2). Changes in hCG were analyzed to distinguish the trends associated with complete abortion versus ectopic pregnancy, ongoing pregnancy, and incomplete abortion.</div></div><div><h3>Results</h3><div>Among 533 cases with complete abortion, a decline in hCG level of ≥80% was observed in 96.8 of cases 7 (+/-2) days post-abortion. The mean hCG decline for complete abortions was 94% (CI: 93.2–94.9). None of the ectopic pregnancies 8 (1.7%) or ongoing pregnancies 21 (2.9%), showed a decline of ≥80%. Rising or insufficient decline (&lt;80%) indicated ectopic and ongoing pregnancy. The hCG trend following complete abortion was significantly different from all other outcomes (<em>p</em> &lt; 0.001), but trends did not distinguish between ectopic, ongoing pregnancy, or incomplete abortion.</div></div><div><h3>Conclusion(s)</h3><div>A hCG decline of ≥80% within 7 (+/-2) days can effectively confirm complete abortion and rule out ectopic and ongoing pregnancies in early medication abortion. These results highlight the effectiveness of hCG monitoring as a reliable follow-up tool for managing VEMA without confirmed IUP.</div></div><div><h3>Implications</h3><div>This study highlights the value of hCG monitoring in early medication abortions in pregnancy of unknown location to differentiate between complete or incomplete abortion, ectopic, or ongoing pregnancy. An hCG decline of ≥80% within 7 (+/-2) days post-mifepristone can confirm complete abortion and help exclude ectopic and ongoing pregnancy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110902"},"PeriodicalIF":2.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge gaps and information needs and preferences regarding oral contraceptive pills and over-the-counter access: A focus group study with Black and Latinx young people assigned female at birth","authors":"Riley J. Steiner ,&nbsp;Sarah M. Axelson ,&nbsp;Claudia Nuñez-Eddy ,&nbsp;Kelsie Williams ,&nbsp;Robin Watkins ,&nbsp;Tiffany Lloyd ,&nbsp;Francisco Zamudio","doi":"10.1016/j.contraception.2025.110900","DOIUrl":"10.1016/j.contraception.2025.110900","url":null,"abstract":"<div><h3>Objective</h3><div>On July 13, 2023, the Food and Drug Administration (FDA) approved a progestin-only oral contraceptive pill (OCP) for over-the-counter (OTC) use without an age restriction. Prior to this approval, we launched a qualitative study with Black and Latinx young people to inform access to an OTC OCP. Here we present findings related to knowledge gaps and information needs and preferences.</div></div><div><h3>Study design</h3><div>From April 26 to July 27, 2023, we held eight in-person focus groups (prior to the FDA approval) and one virtual focus group (after the FDA approval) with 65 pregnancy-capable young people aged 15–24 years (median 18 years) who identified as Black and/or Latinx. Community partners in Los Angeles, CA, Syracuse, NY, and Jackson, MS recruited participants from youth-serving programs and via social media. Authors double-coded focus group transcripts and analyzed the data thematically.</div></div><div><h3>Results</h3><div>Participants largely did not know that an OTC OCP was possible. Many participants wanted to learn about an OTC OCP from health care providers and consult with a provider for follow-up as needed. Participants wanted to know about effectiveness and side effects, including at point-of-sale. Some participants had misconceptions about the safety of OCPs in general.</div></div><div><h3>Conclusions</h3><div>Findings suggest that Black and Latinx young people want information about an OTC OCP from providers. Providers can help support equitable access to an OTC OCP by educating young people about OTC availability and the safety and effectiveness of this option regardless of cost or location. Such education can address broader misconceptions about OCPs.</div></div><div><h3>Implications</h3><div>Results can inform efforts to increase awareness of an OTC OCP among Black and Latinx young people. Health care providers should provide information about effectiveness and side effects of this option.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"147 ","pages":"Article 110900"},"PeriodicalIF":2.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}