Contraception最新文献

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(24)00476-1","DOIUrl":"10.1016/S0010-7824(24)00476-1","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110762"},"PeriodicalIF":2.8,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757217","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":"Differential bone calcium retention with the use of oral versus vaginal hormonal contraception: A randomized trial using calcium-41 radiotracer","authors":"Emily A. Ricker ,&nbsp;Mary Jane De Souza ,&nbsp;Michael S. Stone ,&nbsp;George S. Jackson ,&nbsp;George P. McCabe ,&nbsp;Linda D. McCabe ,&nbsp;Connie M. Weaver","doi":"10.1016/j.contraception.2024.110778","DOIUrl":"10.1016/j.contraception.2024.110778","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess if hormonal contraception administered orally (combined oral contraceptive pill, COC) or vaginally (contraceptive vaginal ring) differentially affected bone calcium retention in young females.</div></div><div><h3>Study design</h3><div>Reproductive aged females (18–35 years) not using hormonal contraception were dosed with 50 nCi ⁴¹Ca as CaCl₂ in 10 mL of sterile saline (0.9%). Following an equilibration phase of ≥100 days and a baseline of two menstrual cycles, participants used COC and the ring for two cycles (49 days) each, in a randomized order, separated and followed by washouts of two menstrual cycles. Twenty-four-hour urine samples were collected monthly during equilibration and every around 10 days during baseline, interventions, and washouts to assess bone calcium retention through accelerator mass spectrometry analysis of the ⁴¹Ca:Ca ratio in urine. The effect of each contraception was determined by comparing ⁴¹Ca:Ca measured during each contraception intervention to ⁴¹Ca:Ca measured during the “control” (baseline and washout) phases using linear models and generalized linear mixed models.</div></div><div><h3>Results</h3><div>Eight reproductive aged females were studied. Compared with control phases (baseline and washouts), COC resulted in greater bone calcium retention (11.3%, 95% CI: 6.7%, 15.6%). The ring did not alter bone calcium retention (4.2%, 95% CI: −6.6%, 13.9%). COC produced a greater change in calcium retention than the ring (<em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Although many factors contribute to bone health, short-term COC improved bone calcium retention, suggesting a potential benefit of COC to bone in females. Conversely, the ring did not alter calcium retention, and may be neither beneficial nor deleterious for bone.</div></div><div><h3>Implications</h3><div>In this study, the effects of oral (pill) vs. vaginal (ring) hormonal contraception on bone calcium retention were assessed in young females. The pill improved bone calcium retention, suggesting a potential beneficial effect on bone health; the ring did not change bone calcium retention compared with control (no contraception).</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110778"},"PeriodicalIF":2.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775612","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":"Three-year efficacy, safety, and tolerability outcomes from a phase 3 study of a low-dose copper intrauterine device","authors":"Mitchell D. Creinin ,&nbsp;Lori M. Gawron ,&nbsp;Andrea H. Roe ,&nbsp;Paul D. Blumenthal ,&nbsp;Christy M. Boraas ,&nbsp;Melody Y. Hou ,&nbsp;Colleen McNicholas ,&nbsp;Mary Jo Schreifels ,&nbsp;Kevin Peters ,&nbsp;Kelly Culwell ,&nbsp;David K. Turok ,&nbsp;on behalf of the Copper 175mm2 IUD Phase 3 Clinical Investigator Group","doi":"10.1016/j.contraception.2024.110771","DOIUrl":"10.1016/j.contraception.2024.110771","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess 3-year efficacy, safety, and tolerability of the Cu 175 mm² intrauterine device (IUD).</div></div><div><h3>Study design</h3><div>This single-arm trial recruited participants at risk of pregnancy aged 17 to 45 years at 42 U.S. centers to receive a Cu 175 mm² IUD with a flexible nitinol frame. We assessed efficacy in participants aged ≤35 years at enrollment and assessed all other outcomes in the entire population. We calculated the Pearl Index (pregnancies/100 person-years) through 3 years as the primary efficacy outcome. The secondary outcomes included pregnancy percentages by life-table analysis, placement success, safety (adverse events), and tolerability.</div></div><div><h3>Results</h3><div>Of 1620 enrollees, 1601 (98.8%) had successful IUD placement, with 1397 aged ≤35 years at enrollment. We observed a 1-year Pearl Index of 0.94 (95% CI 0.43–1.78) and 1-year and cumulative 3-year life-table pregnancy rates of 1.26% (95% CI 0.57%–1.95%) and 2.47% (95% CI 1.34%–3.60%), respectively. The most common adverse events included bleeding and pain. Over 3 years, 15.4% of participants discontinued due to bleeding or pain. Device expulsions occurred in 36 (2.2%) and 63 (3.9%) participants over 1 and 3 years, respectively. Eight related serious adverse events occurred, including five ectopic pregnancies and one each of uterine perforation, anemia, and uterine hemorrhage. One- and three-year continuation rates were 78.9% and 49.6%, respectively.</div></div><div><h3>Conclusions</h3><div>These data support efficacy, safety, and tolerability of the Cu 175 mm² IUD during the first 3 years of use.</div></div><div><h3>Implications</h3><div>In this Phase 3 trial, the investigational Cu 175 mm² demonstrated efficacy, safety, and tolerability with low rates of expulsion and discontinuation for bleeding and pain-related symptoms. This flexible, nitinol-framed, low-dose copper IUD comes preloaded and would expand contraceptive options beyond the single nonhormonal IUD currently available in the United States.</div></div><div><h3>Clinical Trial</h3><div>NCT03633799</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110771"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712183","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(24)00453-0","DOIUrl":"10.1016/S0010-7824(24)00453-0","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"140 ","pages":"Article 110741"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701578","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":"Immigration policy climate and contraceptive use among Mexican-origin women in the United States: Support for the “spill-over” hypothesis","authors":"Blair G. Darney ,&nbsp;Emily R. Boniface ,&nbsp;Fernando Riosmena ,&nbsp;Evelyn Fuentes-Rivera ,&nbsp;Biani Saavedra-Avendaño ,&nbsp;Kate Coleman-Minahan","doi":"10.1016/j.contraception.2024.110773","DOIUrl":"10.1016/j.contraception.2024.110773","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association between state-level Immigration Policy Climate (IPC) and the use of most or moderately effective contraceptive methods among US-born White, US-born Mexican-origin, and foreign-born Mexican-origin women.</div></div><div><h3>Study design</h3><div>We linked nationally representative survey data from three waves of the National Survey of Family Growth (2013–2019) with a novel and dynamic state-level measure of IPC. We compared the use of a most or moderately effective contraceptive method at the time of the survey among the three ethnicity and nativity groups alone and as an interaction with state IPC index score above or below the national mean in the year of the survey. We used multivariable logistic regression to adjust for individual- and state-level characteristics and test for heterogeneity of the effect of IPC.</div></div><div><h3>Results</h3><div>Weighted study sample included 31,528,602 respondents: 26,029,129 (82.5%; unweighted <em>n</em> = 5441) non-Latina White, 2,958,960 (9.4%; unweighted <em>n</em> = 971) US-born Mexican-origin, and 2,540,513 (8.1%; unweighted <em>n</em> = 719) foreign-born Mexican-origin. After adjusting for confounders, living in a state with a more inclusive immigration policy environment was associated with higher use of moderately or most effective contraception among Mexican-origin respondents, both US- (59.8% vs 52.2% less inclusive) and foreign-born (62.1% vs 55.9% less inclusive), but not US-born White (65.2% vs 67.8% less inclusive) respondents.</div></div><div><h3>Conclusions</h3><div>Our results support the “spillover” hypothesis; more exclusionary immigration policies were associated with lower utilization of effective contraceptive methods among both US-born Mexican-origin and Mexican immigrant women.</div></div><div><h3>Implications</h3><div>Mexican-origin women in states with more inclusive immigration policies are more likely to use effective contraception than those in states with exclusionary policies; this suggests that immigration policy climate may “spill over” into US-born Mexican-origin populations.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110773"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695372","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}

{"title":"Association of body mass index on time to fetal expulsion for individuals undergoing medication abortion over 13 weeks gestational duration","authors":"Megan Fuerst,&nbsp;Kristin C. Prewitt,&nbsp;Bharti Garg,&nbsp;Shaalini Ramanadhan,&nbsp;Leo Han","doi":"10.1016/j.contraception.2024.110752","DOIUrl":"10.1016/j.contraception.2024.110752","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association of body mass index (BMI, kg/m²) with time to fetal expulsion for individuals undergoing medication abortion over 13 weeks.</div></div><div><h3>Study design</h3><div>This is a retrospective cohort study of singleton pregnancies undergoing medication abortion &gt;13 weeks at a single academic medical center between 2020 and 2024. Our primary outcome was time to fetal expulsion. We categorized BMI into three groups (&gt;25, 25–29.9, and ≥30) and compared median time to fetal expulsion. We used multivariable logistic regression models to assess the association of BMI with time to delivery ≥24hours.</div></div><div><h3>Results</h3><div>Of the 428 charts reviewed, 382 patients met the inclusion criteria with an average gestational duration of 25.0 weeks. Of these, 162 (42.4%) had a BMI &gt;30 kg/m²; 120 individuals fell into the BMI 25 to 29.9 group (31.4%), and the remaining 100 individuals made up the BMI &lt;25 group (26.2%). The median time to expulsion differed significantly among BMI categories (12 hours for BMI &lt;25 [IQR 8–18], 14 hours for BMI 25–29.9 [IQR 8–22], 20 hours for BMI ≥30 [IQR 12–28], <em>p</em> &lt; 0.001). After adjusting for gestational duration, history of cesarean section, or prior vaginal deliveries, individuals with a BMI ≥30 had 6.62 times the odds (95% CI 3.27–13.44) of having a time to expulsion ≥24 hours compared to BMI &lt;25.</div></div><div><h3>Conclusions</h3><div>Individuals with a BMI &gt;30 had significantly longer second and third trimester time to fetal expulsion. Induction protocols and counseling may need to be adjusted based on body size.</div></div><div><h3>Implications</h3><div>Individuals with a BMI &gt;30 undergoing a medication abortion &gt;13 weeks have longer time to fetal expulsion than those with a BMI &lt;25. More research is needed to optimize induction protocols and abortion care for high BMI individuals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110752"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689384","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":"Characteristics of patients requesting an abortion beyond 14 weeks of gestation: Retrospective study in Brussels","authors":"Virginia Morolli ,&nbsp;Nassiba Menghoum ,&nbsp;Yannick Manigart ,&nbsp;Serge Rozenberg","doi":"10.1016/j.contraception.2024.110751","DOIUrl":"10.1016/j.contraception.2024.110751","url":null,"abstract":"<div><h3>Objectives</h3><div>The debate over extending the legal time limit for abortion in Belgium has intensified in recent years. Health care providers must refer patients seeking abortion beyond the legal deadline to other countries, such as the Netherlands, where the time limits are more permissive. In light of this situation, we analyzed the demographic and social characteristics of patients requesting abortion after 14 weeks of gestation and compared them with those seeking the procedure within the legal limits.</div></div><div><h3>Study design</h3><div>This retrospective study examines the sociodemographic characteristics of individuals requesting abortion at City Planning Brussels between January 1, 2022, and March 30, 2023. We employed logistic regression to identify predictive factors for late abortion.</div></div><div><h3>Results</h3><div>We analyzed 627 abortion requests, with 593 occurring before 14 weeks and 34 after 14 weeks. Patients seeking abortion due to precarity or rape had a higher risk of presenting beyond the legal time limit (odds ratio [OR] 3.64, <em>p</em> = 0.001, and OR 3.96, <em>p</em> = 0.009, respectively). Factors that appeared to reduce this risk included requests for abortion based on personal reasons (lack of desire for a child) and being covered by mutual health insurance (OR 0.22, <em>p</em> &lt; 0.001, and OR 0.25, <em>p</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Management of late abortion in Belgium is difficult due to law’s restriction. Our data indicate that the circumstances resulting in late abortion requests are often complex, frequently involving factors such as financial difficulties and precarity. A law modification is necessary to provide uniform and effective care for these patients.</div></div><div><h3>Implications</h3><div>Since late abortion requests predominantly come from vulnerable patients, revising the law is essential to ensure consistent and equitable care for these individuals. These patients often encounter penalties due to their personal and financial challenges, highlighting the need for a legal framework that better addresses their specific circumstances.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110751"},"PeriodicalIF":2.8,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678002","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":"Provision of medication and procedural abortion among Massachusetts obstetrician-gynecologists","authors":"Sara Neill ,&nbsp;Avina Joshi ,&nbsp;Emily Hoe ,&nbsp;Jennifer Fortin ,&nbsp;Alisa B. Goldberg ,&nbsp;Elizabeth Janiak","doi":"10.1016/j.contraception.2024.110770","DOIUrl":"10.1016/j.contraception.2024.110770","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of the study was to understand the rates of first-trimester medication and procedural abortion provision, sufficiency in abortion training, and factors associated with abortion provision among obstetrician-gynecologists (OB/GYNs) in Massachusetts.</div></div><div><h3>Study design</h3><div>Electronically fielded surveys of a census of OB/GYNs in Massachusetts in 2021 queried physicians on abortion provision, training, practice type, and demographics. Using weighting to account for nonresponse, we generated estimates of the proportion of OB/GYNS providing abortion and used multivariate regression analysis to explore factors associated with abortion provision including practice type, physician sex, and sufficient abortion training.</div></div><div><h3>Results</h3><div>A total of 198 OB/GYNs responded to the survey (response rate = 29%). Of 158 OB/GYNs not in training, 55% provide some abortion care. More respondents reported sufficient training for surgical abortion (84%) than for medication abortion (43%). The most cited reasons for not providing abortion care were lack of integration into their clinical practice (29%), institutional opposition (27%), or personal opposition to abortion (23%). In multivariate analysis, female physicians were more likely to provide abortion care (adjusted odds ratio [aOR] 2.72, 95% CI [1.63–4.55], <em>p</em> &lt; 0.01), and those with insufficient training less likely to provide abortion (aOR 0.18, 95% CI [0.10–0.33], <em>p</em> = 0.01). Those in private practice (aOR 0.47, 95% CI [0.28–0.80], <em>p</em> &lt; 0.01) or “other” practice types (aOR 0.16, 95% CI [0.09–0.27], <em>p</em> &lt; 0.01) were less likely to provide abortion compared to physicians in academic practices.</div></div><div><h3>Conclusions</h3><div>Only half of OB/GYNs in a state supportive of abortion provide abortion. Despite high patient interest in medication abortion, a majority of OB/GYNs report insufficient training in medication abortion.</div></div><div><h3>Implications</h3><div>This study highlights the need for support from practice, institution, and health system leaders to facilitate the provision of abortion care and the need for increased training among OB/GYNs in medication abortion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110770"},"PeriodicalIF":2.8,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678021","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":"Permanent contraception in the childfree population: An exploratory study","authors":"Ashley B. Parker ,&nbsp;Jessica E. Morse ,&nbsp;Amy G. Bryant","doi":"10.1016/j.contraception.2024.110746","DOIUrl":"10.1016/j.contraception.2024.110746","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe the childfree population seeking permanent contraception, identify barriers to receiving care, and characterize the incidence of regret.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional survey of people in the United States, aged 18 years and older, without biological children, and who are seeking or have previously sought a permanent contraception procedure. Participants completed an online REDCap survey distributed over social media platforms, including Reddit, TikTok, and Facebook.</div></div><div><h3>Results</h3><div>A total of 400 respondents completed the survey, of whom 151 (38%) underwent a permanent contraception procedure, 44 (11%) had found a doctor to perform a procedure but not yet undergone it, 32 (8%) had been unable to find a doctor to do the procedure, 83 (21%) were seeking a doctor, and 90 (22%) had not yet sought a doctor.</div><div>Respondents were predominantly White (88%), identified as women (83%), and were diverse in sexual orientation (heterosexual 42%, bisexual 41%). Reasons for seeking permanent contraception included not wanting children (96%), fear of pregnancy/childbirth (70%), the current state of the world (68%), environmental reasons (59%), and medical reasons (32%). Barriers to care included cost of the procedure (30%) and inability to find a doctor who would perform the procedure (42%).</div><div>Of the 151 respondents who had undergone a permanent contraception procedure, 70 (46%) asked more than one doctor for the procedure. Of those with permanent contraception, 97% answered “yes” to “Do you think sterilization as a permanent method of birth control was a good choice for you?”</div></div><div><h3>Conclusions</h3><div>Childfree individuals have a variety of reasons for seeking sterilization and may be at a lower risk of regret than reported in the literature for parous people with permanent contraception.</div></div><div><h3>Implications</h3><div>Clinicians should be aware of the barriers to permanent contraception for patients who do not desire to have children. Providing patient-centered, individualized care to patients seeking permanent contraception can ensure that patients do not face unnecessary barriers to care and feel heard and empowered to enact their reproductive preferences.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110746"},"PeriodicalIF":2.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633768","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":"Conservative political rhetoric and associated enduring threat to constitutional right to abortion—A case study from Brazil","authors":"Roberto Gonzalez Duarte ,&nbsp;Israel Júnior Borges Do Nascimento","doi":"10.1016/j.contraception.2024.110737","DOIUrl":"10.1016/j.contraception.2024.110737","url":null,"abstract":"<div><div>Abortion is a critical public issue in Brazil where over 800,000 abortions might occur each year, with approximately 250,000 admitted to emergency departments due to complications from unsafe procedures. A new bill seeks to amend the Brazilian Penal Code (<em>Código de Processo Penal</em>), classifying the practice as a felony for patients over 22 gestational weeks, even in cases where the practice is already legally foreseen (e.g., derived from sexual abuse, as an attempt to save pregnant individuals at high risk or due to fetuses’ anencephaly). This bill undermines several Sustainable Development Goals endorsed by the United Nations, particularly those related to health (Goal 3), gender equality (Goal 5), and inequality and poverty reduction (Goal 10). Among the extensive list of potential solutions to the abortion challenge that Brazil currently faces, a feasible and plausible alternative relates to investment in education, in particular sexual education aimed at adolescents.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110737"},"PeriodicalIF":2.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633528","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}