Contraception最新文献

{"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":"A systematic comparison of implementation strategies at three U.S. clinic settings that expanded access to self-administered injectable contraception","authors":"Jennifer Karlin ,&nbsp;Tammy Bennett ,&nbsp;Leah Michael ,&nbsp;Sally Rafie ,&nbsp;Elise D. Berlan","doi":"10.1016/j.contraception.2025.110972","DOIUrl":"10.1016/j.contraception.2025.110972","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe experiences and systematically compare three U.S. clinics that initiated or expanded access to depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) for self-administration during the COVID-19 pandemic.</div></div><div><h3>Study design</h3><div>We used the Expert Recommendations for Implementing Change (ERIC) framework to systematically compare three case studies of implementation projects that expanded use of self-administered DMPA-SC in the United States during the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>All three settings used multiple implementation strategies and common strategies fell into five main categories including (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patients’ needs, (3) supporting changes in clinic workflow, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC. Ongoing implementation challenges identified include mitigating additional payment barriers for DMPA-SC and increasing access points beyond physical clinical sites.</div></div><div><h3>Conclusion</h3><div>The implementation strategies described in this study may be generalizable to other settings and help U.S.-based clinics and health care providers meet current recommendations for ensuring access to self-administration of DMPA-SC.</div></div><div><h3>Implications</h3><div>Three sites that successfully expanded access to self-administration in the U.S. demonstrate the importance of the following implementation strategies: (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patient’s needs, (3) supporting changes in clinic workflows, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110972"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144964","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":"Comparative performance of ultrathin and standard latex condoms: A randomized multicentre trial","authors":"Frederic Esclassan ,&nbsp;Nina Tank ,&nbsp;Alice Switonski ,&nbsp;Markus J. Steiner ,&nbsp;Sarah Hood ,&nbsp;Unnop Jaisamrarn","doi":"10.1016/j.contraception.2025.110970","DOIUrl":"10.1016/j.contraception.2025.110970","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess the performance of a natural rubber latex condom with a thickness of 42 µm, compared with two currently marketed alternatives.</div></div><div><h3>Study design</h3><div>In this blinded, three-way crossover, multicentre study, across four sites in Thailand, couples were randomized to receive one of three thicknesses of condom (42, 55, or 70 µm) at first visit. Couples received the remaining condoms at visits two and three, respectively. Participants were given seven condoms at each visit and asked to use at least five condoms of each thickness and report any clinical failures (slippage or breakage during intercourse or withdrawal from the vagina). Participants recorded adverse events and clinical failures within 2 hours of use.</div></div><div><h3>Results</h3><div>A total of 225 couples completed the study. Clinical failure rates were 1.37% (95% confidence intervals [CIs] 0.78, 2.22) in the 42 µm group, 2.12% (95% CI 1.38, 3.11) in the 55 µm group, and 1.68% (95% CI 1.03, 2.58) in the 70 µm group. The 42 µm condom was noninferior compared with each of the reference condoms and had a similar safety profile.</div></div><div><h3>Conclusions</h3><div>This ultrathin, natural rubber latex condom of &lt;50 µm has been clinically tested to current International Organization for Standardization standards. The 42 µm condom was as effective as the 55 and 70 µm condoms, demonstrating that performance in terms of failure rate, slippage, or breakage was not altered by its thinness.</div></div><div><h3>Implications</h3><div>This ultrathin NRL condom of &lt;50 µm has been clinically tested to current International Organization for Standardization standards. This could help to ease concerns about whether ultrathin condoms might compromise reliability and increase failure rate.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110970"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144969","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":"Abortion experiences of individuals with a history of trauma(s): A qualitative study","authors":"Kristen Chalmers ,&nbsp;Diana Marino-Nunez ,&nbsp;Candice Norcott ,&nbsp;Danielle Young ,&nbsp;Julie Chor","doi":"10.1016/j.contraception.2025.110973","DOIUrl":"10.1016/j.contraception.2025.110973","url":null,"abstract":"<div><h3>Objective</h3><div>Individual trauma is highly prevalent among reproductive age individuals who can become pregnant. We sought to elicit perspectives of individuals with a history of trauma about their abortion experiences, trauma-activating factors in abortion care, and how to optimally incorporate trauma-responsive principles into abortion care.</div></div><div><h3>Study design</h3><div>Patients with a self-identified history of three types of trauma (sexual assault, interpersonal violence, adverse childhood experience) were recruited from family planning clinics in the Chicago-area to participate in semi-structured phone interviews. Qualitative data was analyzed using ATLAS.ti.</div></div><div><h3>Results</h3><div>Analysis of thirty interviews identified trauma-activating factors and trauma-responsive strategies throughout the abortion experience. Participants reported that, pre-abortion, restricted access and limited options activated trauma-related feelings of autonomy loss and a desire for unbiased information. During procedures, participants described how physical pain/discomfort and healthcare professional use of insensitive language worsened their experience. In contrast, use of neutral language, warnings prior to touch, proper draping, and checking-in and offering options helped mitigate effects of prior history of trauma(s). Post-procedurally, participants desired mental health support specifically addressing abortion-related stigma, though this resource was rarely available.</div></div><div><h3>Conclusions</h3><div>Throughout abortion care, numerous opportunities exist to help activate or mitigate trauma responses among individuals with a history of trauma. These opportunities exist at the level of the individual provider as well as the level of the clinic, and must be considered to fully address the needs of individuals seeking abortion who have experienced prior trauma(s).</div></div><div><h3>Implications</h3><div>Healthcare providers and systems can influence abortion experiences in ways that range from aggravating to ameliorating prior trauma for individuals with prior trauma experience(s). Therefore, trauma-responsive principles must be universally applied throughout abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110973"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144966","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":"Provider confidence and willingness to insert and remove long-acting reversible contraception methods in Kenyan public facilities","authors":"Katherine Tumlinson ,&nbsp;Stephanie Chung ,&nbsp;Brooke W. Bullington ,&nbsp;Dickens Otieno Onyango ,&nbsp;Leigh Senderowicz ,&nbsp;Abigael Mwanyiro ,&nbsp;Ben Wekesa ,&nbsp;Brian Frizzelle ,&nbsp;Ginger Golub ,&nbsp;Claire W. Rothschild ,&nbsp;Emilia Goland","doi":"10.1016/j.contraception.2025.110956","DOIUrl":"10.1016/j.contraception.2025.110956","url":null,"abstract":"<div><h3>Objective</h3><div>Use of long-acting reversible contraception (LARC) in Kenya has grown over the last decade, yet emerging evidence points to challenges in LARC removal. The objective of this paper is to document provider training in LARC insertion/removal and to better understand provider experience, confidence, and willingness to both insert and remove LARC.</div></div><div><h3>Study design</h3><div>In this paper we present a descriptive analysis of self-reported data from family planning providers working in all 137 public-sector healthcare facilities in Kisumu County (Western Kenya). We assess the frequency of public-sector provider training, experience, confidence, and willingness to insert and remove LARC, as well as the association between confidence and willingness to provide these services.</div></div><div><h3>Results</h3><div>A substantial proportion of providers in our study lacked training in the insertion and removal of both implants and intrauterine devices (IUDs). Overall, providers reported that they were more experienced, confident, and willing to insert implants rather than remove them. A fifth of providers trained in IUD insertion were not confident in their ability to insert IUDs and nearly 10% were not willing to perform insertion. In contrast, 8% of providers trained in IUD insertion were not confident in their ability to remove IUDs and 6% were not willing to remove them. Provider confidence was significantly associated with willingness to insert/remove both implant and IUD. Less than two-thirds of facilities demonstrated stock of the implant (61%) or IUD (58%).</div></div><div><h3>Conclusion</h3><div>Results raise important concerns about reproductive autonomy within the larger environment of family planning programs that heavily promote LARC use. Within Kisumu, public-sector providers require greater supplies and support to maintain confidence and ensure their willingness to engage in LARC insertion and removal in equal measure.</div></div><div><h3>Implications</h3><div>We find that many providers at public sector healthcare facilities in Kisumu, Kenya lacked training in LARC insertion and removal. Providers reported that they were more experienced, confident, and willing to insert rather than remove implants, which poses a potential threat to reproductive autonomy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110956"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133225","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":"Transcutaneous electrical nerve stimulation (TENS) for pain control during first-trimester procedural abortion: A blinded randomized controlled trial","authors":"Andrea Henkel ,&nbsp;Erica P. Cahill ,&nbsp;Sonia Chavez ,&nbsp;Jade M. Shorter ,&nbsp;Serena M. Liu ,&nbsp;Stephanie I. Amaya ,&nbsp;Simranvir Kaur ,&nbsp;Kate A. Shaw","doi":"10.1016/j.contraception.2025.110955","DOIUrl":"10.1016/j.contraception.2025.110955","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) to manage pain during first-trimester procedural abortion for those not eligible for or otherwise forgoing sedation.</div></div><div><h3>Study design</h3><div>This is a double-blinded, block-randomized superiority trial (IRB approved, NCT05320432) comparing TENS (placed posteriorly, T10-L1 and S2-S4) to sham for pain management during first-trimester procedural abortion. We enrolled pregnant people less than 12 weeks gestation, English- or Spanish-speaking at two outpatient clinics not receiving sedation. The primary outcome was self-reported pain by visual analog scale (VAS, 100 mm) with passage of largest cervical dilator. We planned to enroll 70 patients to detect a 15 mm difference in median pain score (80% power, α = 0.05).</div></div><div><h3>Results</h3><div>Between January 2023 and March 2024, we enrolled 70 participants. Baseline demographics were balanced between groups: median (range) gestational duration 6 (5−11) weeks, 35.7% nulliparous. Median (range) reported pain with passage of largest dilator was 44 mm (0−88) and 50 mm (0−96) in the TENS and sham groups, respectively (<em>p</em> = 0.56). We did not find a difference in median pain at any collected time point including placement of tenaculum, paracervical block, aspiration, or recovery. The active TENS group was more likely to say they would recommend this method of pain control to others (94 mm vs 73 mm, <em>p</em> = 0.01). More participants receiving TENS unit correctly identified their group allocation (91.4% vs 63.6%, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>While we did not demonstrate a difference in pain scores during the procedure, TENS is a non-pharmacologic alternative that may improve patient experience during uterine aspiration.</div></div><div><h3>Implications</h3><div>In a blinded randomized trial, the median pain scores during first-trimester procedure abortion did not differ between those receiving TENS or sham. However, those randomized to TENS were more likely to recommend the method. For those with contraindications to IV sedation, improved experience may justify offering TENS during first-trimester abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110955"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096186","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":"First trimester suction aspiration without septum resection for transverse vaginal septum: A case report","authors":"Abraham Fessehaye Sium ,&nbsp;Gebresilassie Andualem Asmare","doi":"10.1016/j.contraception.2025.110954","DOIUrl":"10.1016/j.contraception.2025.110954","url":null,"abstract":"<div><div>A 27 years-old G2 Para 1 patient with a known uterine didelphys presented at 11 weeks of gestation with 3 days of vaginal bleeding. Evaluation demonstrated a fetal demise and a thin transverse vaginal septum with a central dimple. We successfully performed a mannual vacuum aspiration without septoplasty by dilating the dimple with vacuum cannulas.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110954"},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087058","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":"Estimating emergency contraception efficacy with levonorgestrel and copper intrauterine devices","authors":"Susan E. Nourse,&nbsp;Alexandra L. Woodcock,&nbsp;Kathryn S. Brown,&nbsp;Alexandra Gero,&nbsp;Lori M. Gawron,&nbsp;David K. Turok","doi":"10.1016/j.contraception.2025.110946","DOIUrl":"10.1016/j.contraception.2025.110946","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to determine observed vs expected pregnancy risk among levonorgestrel 52 mg and copper T380A intrauterine device (IUD) emergency contraception (EC) users.</div></div><div><h3>Study design</h3><div>This is a secondary analysis of participants seeking EC randomly assigned to a levonorgestrel 52 mg or copper T380A IUD. Participants had at least one episode of unprotected intercourse (UPI) in the 5 days preceding enrollment and reported all episodes in the preceding 5 days. We report the proportion of pregnancies prevented of those expected at 1 month following IUD insertion using an established approach that assigns pregnancy risk by menstrual cycle day of intercourse. We calculated proportion of pregnancies prevented using both the day of most recent UPI and all reported UPIs within 5 days of presentation.</div></div><div><h3>Results</h3><div>One pregnancy occurred among the 312 participants who received the levonorgestrel 52 mg IUD, with 137 (43.9%) reporting multiple episodes of UPI. No pregnancies occurred among the 318 participants who received the copper IUD, of whom 142 (44.6%) reported multiple episodes. In the levonorgestrel 52 mg IUD group, 14.8 pregnancies were expected using the most recent episode of UPI, and 22.0 pregnancies were expected using all episodes within 5 days of presentation. In the copper IUD group, we calculated 15.0 and 23.1 expected pregnancies, respectively. Levonorgestrel 52 mg IUDs prevented 93.2% to 95.7% of expected pregnancies, and copper IUDs prevented 100% of expected pregnancies.</div></div><div><h3>Conclusions</h3><div>The results of this analysis provide additional data quantifying the pregnancy risk reduction for both the levonorgestrel 52 mg IUD and copper IUD in a realistic population of EC users.</div></div><div><h3>Implications</h3><div>The levonorgestrel 52 mg IUD for emergency contraception prevented 93% to 96% of expected pregnancies using an established pregnancy risk method, while copper IUD users experienced 100% pregnancy prevention.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110946"},"PeriodicalIF":2.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082365","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":"Not here, not now: a mystery caller study of availability of mifepristone in community pharmacies in Alberta, Canada","authors":"Erin A. Brennand ,&nbsp;Natalie V. Scime ,&nbsp;Beili Huang ,&nbsp;Alam Randhawa ,&nbsp;Shunaha Kim-Fine ,&nbsp;Orly Aziza ,&nbsp;Jadine Paw ,&nbsp;Erin L. Nelson","doi":"10.1016/j.contraception.2025.110945","DOIUrl":"10.1016/j.contraception.2025.110945","url":null,"abstract":"<div><h3>Objectives</h3><div>This study assessed same-day availability, dispensing practices, and information provision for mifepristone in Alberta pharmacies.</div></div><div><h3>Study design</h3><div>Cross-sectional data from 1620 pharmacies (&gt;99% response) were collected from pharmacy respondents using a mystery caller approach (January to October 2024). Using a standardized script, team members inquired about mifepristone availability, Alberta’s coverage plan, and dispensing. Outcomes included (1) same-day stock availability, (2) willingness to order, (3) refusal to order, and (4) conscientious objection. Accuracy of cost information and adherence to regulatory standards were assessed. Geographic patterns and associations with the deprivation index of pharmacy location were explored.</div></div><div><h3>Results</h3><div>Same-day dispensing was available at 12.9% pharmacies, and 76.2% offered to order it, with delivery times estimated from the next day to 10 days. A small number of pharmacies (<em>n</em> = 86, 5.3%) did not offer to order with no reason given; conscientious objection was reported by 90 pharmacies (5.6%), of which only 10.0% (<em>n</em> = 9) provided onward referrals. Awareness of Alberta’s universal coverage for mifepristone was low; 71.1% of respondents incorrectly stated that uninsured patients must pay out of pocket. Mifepristone was less often in stock in Alberta’s two major cities; pharmacies in high-deprivation areas were less likely to have mifepristone in stock and more often expressed conscientious objection.</div></div><div><h3>Conclusion</h3><div>Same-day mifepristone availability in Alberta pharmacies is limited, and adherence to referral standards among objectors is poor. Awareness of universal coverage is suboptimal, raising concern about overcharging. Enhancing access may require collaboration between abortion providers and pharmacies, increased communication about coverage policies, and innovative solutions related to dispensing.</div></div><div><h3>Implications</h3><div>Limited same-day access to mifepristone, compounded by poor adherence to regulatory standards and low awareness of public coverage, highlights equity gaps in abortion care across Alberta, Canada. Targeted policy reforms and pharmacist education are needed to improve timely, reliable access, particularly for socioeconomically disadvantaged communities.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110945"},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011081","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":"Psychometric evaluation of the desire to avoid pregnancy scale in India","authors":"Sarah Averbach ,&nbsp;Nicole E. Johns ,&nbsp;Shweta Tomar ,&nbsp;Marielle E. Meurice ,&nbsp;Namratha Rao ,&nbsp;Mohan Ghule ,&nbsp;Anita Raj","doi":"10.1016/j.contraception.2025.110940","DOIUrl":"10.1016/j.contraception.2025.110940","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the psychometric performance of the Desire to Avoid Pregnancy (DAP) scale in India.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;We utilized survey data from married women enrolled in a family planning intervention in Maharashtra, India, who provided responses to the 14-item DAP scale at 18-month intervention study follow-up. We assessed scale internal consistency using Cronbach α and used exploratory factor analysis to evaluate scale unidimensionality and item response theory (IRT) to assess item performance. We used regression models to assess whether DAP predicts current reported contraceptive use, as well as future contraceptive use and pregnancy, to evaluate construct validity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 1088 participants responded to 18-month intervention study follow-up survey; 99% of eligible participants (887/888) provided the full-scale response. One item, \"makes me smile,\" performed in the reverse direction as anticipated (negative item-test correlation) and was excluded for use in this analysis. The mean 13-item DAP score (DAP-13) was 2.14 of 4 (SD 0.95, range 0–4); internal consistency was high (Cronbach α = 0.92). Most items fit the partial credit model on IRT. Exploratory factor analyses supported either a one- or two-factor model; the unidimensional model was considered acceptable for use as the single factor explained 71% of all variance, and all items had stable absolute factor loadings ≥0.38. DAP-13 score only differed by parity; nulliparous women had the lowest scores (0.56), followed by women with one (1.94), two (2.60), or three or more births (2.56; &lt;em&gt;p&lt;/em&gt; &lt; 0.001). A one-point increase in DAP-13 was associated with greater odds of current contraception use reported at time of DAP assessment (adjusted odds ratio [aOR] 1.79, 95% CI 1.43–2.26), subsequent contraception use reported 18 months after DAP assessment (aOR 1.88, 95% CI 1.44–2.44), and half the odds of subsequent pregnancy in the 18-month period after DAP assessment (aOR 0.57, 95% CI 0.46–0.71).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The DAP scale demonstrated good reliability and unidimensionality in this population. Higher DAP scores were associated with higher odds of contraception use and lower odds of pregnancy, supporting construct validity. Future research on the DAP scale in Maharashtra should explore alternative translations of the \"makes me smile\" item that better capture local expressions of joy about potential childbearing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Implications&lt;/h3&gt;&lt;div&gt;A modified version of the DAP scale is acceptable for use in an Indian population and can be utilized in future research and program evaluation that focus on contraception and pregnancy prevention in this context. One item was excluded and requires additional formative research to better capture the intended emotional valence in this cultural context.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical trial registration number&lt;/h3&gt;&lt;","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"148 ","pages":"Article 110940"},"PeriodicalIF":2.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055163","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}