Contraception最新文献

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ULTRASOUND ASSESSMENT FOR PLACENTA ACCRETA SPECTRUM PRIOR TO SECOND TRIMESTER DILATION AND EVACUATION 在第二产程扩张和排空前对胎盘重置频谱进行超声波评估
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110596
M Coley, K Meadows, M Hou, M Chen
{"title":"ULTRASOUND ASSESSMENT FOR PLACENTA ACCRETA SPECTRUM PRIOR TO SECOND TRIMESTER DILATION AND EVACUATION","authors":"M Coley,&nbsp;K Meadows,&nbsp;M Hou,&nbsp;M Chen","doi":"10.1016/j.contraception.2024.110596","DOIUrl":"10.1016/j.contraception.2024.110596","url":null,"abstract":"<div><h3>Objectives</h3><div>Ultrasound (US) markers for placenta accreta spectrum (PAS) are often undetectable until late second trimester, increasing the risk of complications during dilation and evacuation. We assessed the prevalence of these markers and their predictive value for complications in patients with prior cesarean delivery (CD) undergoing dilation and evacuation.</div></div><div><h3>Methods</h3><div>We included patients with prior CD who underwent dilation and evacuation between 14 0/7 and 23 6/7 weeks’ gestation from 05/2020-12/2021. We abstracted obstetric history, placental US findings, and perioperative data from electronic records. We compared complications between those with and without PAS-associated US markers defined by the Society of Maternal-Fetal Medicine. Bleeding complications were defined as ≥2 uterotonics use, blood transfusion, intrauterine balloon placement, uterine artery embolization, and hysterectomy.</div></div><div><h3>Results</h3><div>Of 770 patients undergoing dilation and evacuation, 209(27%) had one or more prior CDs. On US, 24(11%) patients had lacunae, 20(10%) had placenta previa, 12(6%) had abnormal flow, 7(3%) had bridging vessels, and 6(3%) had an abnormal uteroplacental interface. Based on these markers, 16(8%) were considered moderate risk for PAS. Complications occurred in 25(12%) patients, most commonly use of ≥2 uterotonics (10, 40%), blood transfusion (6, 24%), and intrauterine balloon placement (5, 20%). Patients with pre-procedure US indicating moderate risk for PAS were not more likely to have complications compared to those considered low risk [4(25%) vs 18 (9%); p=0.07].</div></div><div><h3>Conclusions</h3><div>US assessment for PAS did not predict higher bleeding complications during dilation and evacuation. Enhanced early second-trimester PAS risk characterization is necessary for improved perioperative readiness.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110596"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426347","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}
引用次数: 0
AWARENESS AND BELIEFS RELATED TO SELF-MANAGED ABORTION IN OHIO AFTER THE DOBBS DECISION 多布斯案判决后俄亥俄州对自我管理人工流产的认识和信念
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110599
KV McFarland
{"title":"AWARENESS AND BELIEFS RELATED TO SELF-MANAGED ABORTION IN OHIO AFTER THE DOBBS DECISION","authors":"KV McFarland","doi":"10.1016/j.contraception.2024.110599","DOIUrl":"10.1016/j.contraception.2024.110599","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to analyze the awareness and beliefs related to self-managed abortion after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>Utilizing a population-representative sample of adult, reproductive-age women in Ohio collected in September 2022 to August 2023 (n=2,473), we calculated the prevalence of three outcomes: (1) awareness of self-managed medication abortion (SMMA) measured with the question, “Have you heard of pills that you can buy and use at home to conduct an abortion without going to a clinic or consulting a doctor?”, (2) perceived meaning of term “self-managed abortion,” and (3) hypothetical actions if the respondent or someone close to them needed an abortion that was not legal in Ohio. We used chi-square tests to identify factors associated with SMMA awareness.</div></div><div><h3>Results</h3><div>About 41.6% of women reported being aware of SMMA. Awareness was statistically significantly associated with race and ethnicity (p=0.01) and socioeconomic status (p&lt;0.01), with non-Hispanic Black women and women with some college or less and &lt;$75K income reporting the lowest levels of awareness. Women selected a range of responses to describe what self-managed abortion means to them, including the morning after pill (30.3%). Few women (6.1%) would buy abortion pills online in response to the hypothetical question.</div></div><div><h3>Conclusions</h3><div>A minority of adult, reproductive-age women in Ohio are aware of SMMA, and awareness varies by race and socioeconomic status. The morning after pill was commonly indicated as a method of self-managed abortion. These findings highlight the need for more education about SMMA, to tailor education to specific populations, and distinguish it from emergency contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110599"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426350","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}
引用次数: 0
KNOWLEDGE OF MEDICATION ADMINISTRATION INSTRUCTIONS AMONG TRADITIONAL MEDICATION ABORTION PATIENTS 传统药物流产患者对用药指导的了解情况
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110602
TX Chen, R Soon, M Tschann
{"title":"KNOWLEDGE OF MEDICATION ADMINISTRATION INSTRUCTIONS AMONG TRADITIONAL MEDICATION ABORTION PATIENTS","authors":"TX Chen,&nbsp;R Soon,&nbsp;M Tschann","doi":"10.1016/j.contraception.2024.110602","DOIUrl":"10.1016/j.contraception.2024.110602","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate patients’ immediate recall of medication abortion administration instructions.</div></div><div><h3>Methods</h3><div>This is a descriptive analysis of one cohort in a prospective non-inferiority study. We surveyed a convenience sample of medication abortion patients immediately after their appointment in Honolulu, HI between April 2023 and March 2024. Surveys assessed knowledge of medication abortion indications/contraindications, administration, and side effects/precautions, as well as their confidence in correctly completing the regimen. Incidentally, the clinic modified its written instructions for readability approximately halfway through recruitment; we compared outcomes before and after modification.</div></div><div><h3>Results</h3><div>We surveyed 100 patients. Mean age was 27.9 years (SD, 6.6). Thirty-two (32%) had undergone a medication abortion before. On average, patients correctly answered 79% (SD, 18%) of questions about medication abortion indications/contraindications, 97% (SD, 8.3%) of questions about medication regimen administration, and 93% (SD, 11%) of questions about side effects/precautions; the overall average number of correct answers for all questions was 90% (SD, 7.7%). Patients were completely or quite confident they could independently complete the process (n=95, 95%), teach a friend how to complete the process (n=86, 86%), recognize side effects (n=84, 84%), and seek emergency help when needed (n=95, 95%). Patient age, history of medication abortion, and the new medication abortion instructions were not associated with more accurate recall or higher confidence.</div></div><div><h3>Conclusions</h3><div>These findings may be a foundation for future studies that seek to compare the medication abortion knowledge and confidence of patients who pursue medication abortion outside of the clinic setting, such as advance provision or self-managed abortion, with that of traditional patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110602"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426353","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}
引用次数: 0
ADOLESCENT DEMAND FOR MEDICATION ABORTION FROM AN ONLINE TELEMEDICINE SERVICE BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION 多布斯诉杰克逊妇女健康组织案判决前后青少年对在线远程医疗服务药物流产的需求
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110563
DM Johnson, J Starling, R Gomperts
{"title":"ADOLESCENT DEMAND FOR MEDICATION ABORTION FROM AN ONLINE TELEMEDICINE SERVICE BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"DM Johnson,&nbsp;J Starling,&nbsp;R Gomperts","doi":"10.1016/j.contraception.2024.110563","DOIUrl":"10.1016/j.contraception.2024.110563","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to understand adolescent demand for medication abortion from an online telemedicine service, and to understand if demand varies due to state-level abortion bans and state-level parental involvement laws.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from an online telemedicine organization providing medication abortion in the US. We compared average weekly request rates by adolescent (under 18, 18-21) and adult (22+) age- groups and state policy environment pre and post the <em>Dobbs vs. JWHO</em> decision.</div></div><div><h3>Results</h3><div>From September 1, 2021 and October 31, 2023, 232,089 people in 50 states requested medications, and 6% of requestors were under 18, 24% were 18-21, and 70% were 22+. The average per-capita weekly request rate among ages 18-21 increased from 8.3 in the baseline period to 25.7 post-<em>Dobbs</em>, a 17.4 increase (15.6-19.2, p&lt;0.001); average requests among adults increased from 3.3 in the baseline period to 11.1, a 7.8 increase (7.1-8.4, p&lt;0.001). The most restrictive abortion law states saw the highest increase in post-<em>Dobbs</em> requests among adolescents (25.4, 20.7-30.0; p&lt;0.001), compared to smaller increases among adolescents in states without restrictions (8.3, 7.2-9.5; p&lt;0.001). Among adolescents under 18, requests in states with parental involvement laws were higher than in states without, both at baseline (1.1, 0.8-1.4; p&lt;0.001) and post-<em>Dobbs</em> (4.4, 3.7-5.1; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Demand for medications among adolescents increased post-<em>Dobbs</em> in similar patterns to adults, and requests among 18-21 were higher than other ages groups. This may be because of internet engagement or fewer financial resources for clinic-based care. Specialized support is needed to assist adolescents pursuing medication abortion via online telemedicine.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110563"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426318","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}
引用次数: 0
EFFICACY AND SAFETY OF THE ESTETROL/DROSPIRENONE ORAL CONTRACEPTIVE IN US STUDY PARTICIPANTS WITH AND WITHOUT OBESITY 雌二醇/屈螺酮口服避孕药对肥胖症和非肥胖症美国研究参与者的疗效和安全性
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110562
AD Beasley, T Kimble, B Kaneshiro, R Maamari, JM Foidart, MD Creinin
{"title":"EFFICACY AND SAFETY OF THE ESTETROL/DROSPIRENONE ORAL CONTRACEPTIVE IN US STUDY PARTICIPANTS WITH AND WITHOUT OBESITY","authors":"AD Beasley,&nbsp;T Kimble,&nbsp;B Kaneshiro,&nbsp;R Maamari,&nbsp;JM Foidart,&nbsp;MD Creinin","doi":"10.1016/j.contraception.2024.110562","DOIUrl":"10.1016/j.contraception.2024.110562","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare contraceptive efficacy and safety of estetrol 15 mg/drospirenone 3 mg in US study participants with and without obesity.</div></div><div><h3>Methods</h3><div>We analyzed US population data from a phase 3 trial of estetrol/drospirenone use for up to 13 cycles. The study enrolled 1,864 healthy US and Canadian participants 16-50 years old with body mass index (BMI) 18-35 kg/m<sup>2</sup>. We evaluated efficacy (Pearl Index, pregnancies/100-person-years) in participants 16-35 years and safety (adverse events [AEs]) in all participants, with obesity defined as BMI≥30 kg/m<sup>2</sup>.</div></div><div><h3>Results</h3><div>We included 1,712 (91.8%) US participants; 1,531(89.4%) were 16-35 years. BMIs for 418 (24.4%) participants with obesity were 32.6±1.7 kg/m<sup>2</sup> overall and 32.6±1.8 kg/m<sup>2</sup> for 365 participants aged 16-35. For participants without obesity, BMIs were 23.9±3.2 kg/m2 and 23.8±3.3 kg/m<sup>2</sup>, respectively. Pearl indices for participants with and without obesity were 3.04 (95% CI, 1.116.61) and 2.86 (95% CI, 1.754.42), respectively (p&gt;0.05). AEs were reported by 418 (56.0%) and 670 (51.8%) of participants with and without obesity (p=0.13). The most common AE that differed between groups was weight gain (5.3% vs 2.7%, respectively, p=0.02). Two serious AEs (1 per group) were considered study treatment related. Discontinuation for an AE occurred in 40(9.6%) and 116 (9.0%), respectively (p=0.7).</div></div><div><h3>Conclusions</h3><div>Contraceptive efficacy did not differ for US estetrol/drospirenone users with and without obesity. Although participants with obesity more frequently report weight gain, overall AE discontinuation rates did not differ. These results demonstrate a favorable efficacy and safety profile of estetrol/drospirenone users with obesity.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110562"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426319","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}
引用次数: 0
COMPLICATIONS ASSOCIATED WITH MIFEPRISTONE USE FOR DILATION AND EVACUATION ABORTION PROCEDURES BETWEEN 22 AND 24 WEEKS’ GESTATION 在妊娠 22 至 24 周之间使用米非司酮进行扩张和排空人工流产手术的相关并发症
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110606
MB Wergeles, P Lohr, R Scott, M Lewandowska, A Andreeva
{"title":"COMPLICATIONS ASSOCIATED WITH MIFEPRISTONE USE FOR DILATION AND EVACUATION ABORTION PROCEDURES BETWEEN 22 AND 24 WEEKS’ GESTATION","authors":"MB Wergeles,&nbsp;P Lohr,&nbsp;R Scott,&nbsp;M Lewandowska,&nbsp;A Andreeva","doi":"10.1016/j.contraception.2024.110606","DOIUrl":"10.1016/j.contraception.2024.110606","url":null,"abstract":"<div><h3>Objectives</h3><div>Dilation and evacuation is the most common method of procedural abortion after 20 weeks’ gestation. Adequate cervical dilation is essential for safe dilation and evacuation. In 2017, the British Pregnancy Advisory Service (BPAS) added mifepristone to their regimen of osmotic dilators for cervical ripening before dilation and evacuation. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening.</div></div><div><h3>Methods</h3><div>BPAS provided data which included dilation and evacuation procedures that occurred between 22 weeks’ and 23 weeks and 6 days’ gestation, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone use, the association between mifepristone use and dilation and evacuation complications was established. Multivariate logistic regression was used to calculate the odds for complications with and without mifepristone use while controlling for potential confounders.</div></div><div><h3>Results</h3><div>There were 6,516 dilation and evacuation procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (OR: 2.40, 95% CI: 1.62, 3.54). They also had higher odds of bleeding (OR: 3.08, 95% CI: 1.12, 8.48). Odds for cervical injury (OR: 2.21, 95% CI: 0.84, 5.80) and infection (OR: 1.89, 95% CI: 0.46, 7.69) were not different between those who did and did not receive mifepristone.</div></div><div><h3>Conclusions</h3><div>The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of dilation and evacuation, without attenuating the risk of complications related to cervical dilation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110606"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426513","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}
引用次数: 0
BY ADOLESCENTS, FOR ADOLESCENTS: CO-CREATING ‘FIRST STEPS,’ A MESSAGING TOOLKIT TO IMPROVE ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH SERVICES AND EDUCATION 由青少年做,为青少年做:共同创建 "第一步"--改善青少年性与生殖健康服务和教育的信息工具包
IF 2.8 2区 医学
Contraception Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110642
L Gerchow, Y Lanier, A Fayard, A Squires
{"title":"BY ADOLESCENTS, FOR ADOLESCENTS: CO-CREATING ‘FIRST STEPS,’ A MESSAGING TOOLKIT TO IMPROVE ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH SERVICES AND EDUCATION","authors":"L Gerchow,&nbsp;Y Lanier,&nbsp;A Fayard,&nbsp;A Squires","doi":"10.1016/j.contraception.2024.110642","DOIUrl":"10.1016/j.contraception.2024.110642","url":null,"abstract":"<div><h3>Objectives</h3><div>Adolescents experience poor sexual and reproductive health outcomes, yet existing education and health services are insufficient. This study aims to improve adolescent sexual health knowledge and outcomes by co-creating service improvements with adolescent mothers based on their experiences from pre-pregnancy through parenting.</div></div><div><h3>Methods</h3><div>Using human-centered design, 16 adolescent mothers in New York City participated in 47 interviews to identify problems in adolescent sexual and reproductive health services and education. In two co-creation workshops, participants (n=10) designed solution prototypes, with a specific focus on improving contraceptive counseling. Healthcare stakeholders (n=10) informed prototype refinement.</div></div><div><h3>Results</h3><div>Participants highlighted deficiencies in sexual health education and emphasized the roles of healthcare providers and parents, rather than schools, in improving it. Adolescent participants designed messaging to support quality conversations between adolescents, parents, and providers and created a pre-appointment checklist to help young patients initiate conversations with providers. Young participants stressed that the toolkits address topics beyond STIs and pregnancy, like emotional health and relationships. They created guidelines for healthcare providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to respectfully support young parents. Healthcare stakeholders recommended adding information on confidential care and supporting LGBTQ youth and suggested dissemination techniques. Prototypes were revised based on feedback.</div></div><div><h3>Conclusions</h3><div>This study highlighted the important roles that parents and healthcare workers play in adolescent sexual health education. Co-created toolkits offer a practical approach for providers, adolescents, and parents to have adolescent-centered conversations that promote adolescent autonomy, safety, and well-being.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110642"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426898","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}
引用次数: 0
Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention 美国变性男性和不同性别者使用避孕药具的情况:使用、不使用的原因以及用于避孕的方法。
IF 2.8 2区 医学
Contraception Pub Date : 2024-09-26 DOI: 10.1016/j.contraception.2024.110719
Juno Obedin-Maliver , Ava Snow , Sachiko Ragosta , Laura Fix , Jen Hastings , Micah E. Lubensky , Matthew R. Capriotti , Zubin Dastur , Annesa Flentje , Mitchell R. Lunn , Heidi Moseson
{"title":"Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention","authors":"Juno Obedin-Maliver ,&nbsp;Ava Snow ,&nbsp;Sachiko Ragosta ,&nbsp;Laura Fix ,&nbsp;Jen Hastings ,&nbsp;Micah E. Lubensky ,&nbsp;Matthew R. Capriotti ,&nbsp;Zubin Dastur ,&nbsp;Annesa Flentje ,&nbsp;Mitchell R. Lunn ,&nbsp;Heidi Moseson","doi":"10.1016/j.contraception.2024.110719","DOIUrl":"10.1016/j.contraception.2024.110719","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use.</div></div><div><h3>Study design</h3><div>We analyzed data from a cross-sectional, online survey of <em>N</em> = 1694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use.</div></div><div><h3>Results</h3><div>Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal intrauterine device (IUD) (24.8%), and abstinence (19.2%). Some reported formerly (<em>n</em> = 55, 6.6%) or currently (<em>n</em> = 30, 3.6%) relying on testosterone for pregnancy prevention. Only four of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%).</div></div><div><h3>Conclusions</h3><div>Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.</div></div><div><h3>Implications</h3><div>TGD individuals use a range of birth control methods for pregnancy prevention and clinicians should not assume preferences for certain forms of contraception based on gender identity (e.g.<em>, estrogen avoidance). Clinicians should engage in patient-centered counseling and shared decision-making to provide high-quality contraceptive care to patients of all genders.</em></div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110719"},"PeriodicalIF":2.8,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth 超越耻辱:临床医生在为性取向和性别少数群体青年提供避孕咨询时的偏见。
IF 2.8 2区 医学
Contraception Pub Date : 2024-09-25 DOI: 10.1016/j.contraception.2024.110718
Emily S. Mann , Joline Hartheimer , Brooke W. Bullington , Madeline J. Thornton , Kavita S. Arora , Bianca A. Allison
{"title":"Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth","authors":"Emily S. Mann ,&nbsp;Joline Hartheimer ,&nbsp;Brooke W. Bullington ,&nbsp;Madeline J. Thornton ,&nbsp;Kavita S. Arora ,&nbsp;Bianca A. Allison","doi":"10.1016/j.contraception.2024.110718","DOIUrl":"10.1016/j.contraception.2024.110718","url":null,"abstract":"<div><h3>Objectives</h3><div>Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth.</div></div><div><h3>Study design</h3><div>We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis.</div></div><div><h3>Results</h3><div>When discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants’ acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants’ conceptualizations of their SGM youth patients’ identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care.</div></div><div><h3>Conclusions</h3><div>Many clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.</div></div><div><h3>Implications</h3><div>This qualitative study of pediatric clinicians’ self-reported contraceptive care delivery revealed limited acceptance of sexual and gender minority youth identities and biased assumptions about which patients may need or desire specific contraceptive methods. Such practices overlook clinically-relevant differences among pediatric patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110718"},"PeriodicalIF":2.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334429","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}
引用次数: 0
Society of Family Planning Research Practice Support: Approaching the concepts of gender and sex in family planning research 在计划生育研究中处理性别和性的概念。
IF 2.8 2区 医学
Contraception Pub Date : 2024-09-20 DOI: 10.1016/j.contraception.2024.110708
Heidi Moseson , Iris Olson , Stef M. Shuster , Miles S. Harris , Angel M. Foster , Leo Han , Brooke A. Levandowski
{"title":"Society of Family Planning Research Practice Support: Approaching the concepts of gender and sex in family planning research","authors":"Heidi Moseson ,&nbsp;Iris Olson ,&nbsp;Stef M. Shuster ,&nbsp;Miles S. Harris ,&nbsp;Angel M. Foster ,&nbsp;Leo Han ,&nbsp;Brooke A. Levandowski","doi":"10.1016/j.contraception.2024.110708","DOIUrl":"10.1016/j.contraception.2024.110708","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110708"},"PeriodicalIF":2.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303414","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}
引用次数: 0
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