Contraception: X最新文献

{"title":"Breaking the silence in the primary care office: patients' attitudes toward discussing abortion during contraceptive counseling","authors":"Shokoufeh Dianat ,&nbsp;Ilana A Silverstein ,&nbsp;Kelsey Holt ,&nbsp;Jody Steinauer ,&nbsp;Christine Dehlendorf","doi":"10.1016/j.conx.2020.100029","DOIUrl":"10.1016/j.conx.2020.100029","url":null,"abstract":"<div><h3>Objectives</h3><p>Abortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling.</p></div><div><h3>Study design</h3><p>In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes.</p></div><div><h3>Results</h3><p>We achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion.</p></div><div><h3>Conclusions</h3><p>Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma.</p></div><div><h3>Implications</h3><p>Mentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38165155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsatisfied contraceptive preferences due to cost among women in the United States","authors":"Kristen Lagasse Burke ,&nbsp;Joseph E. Potter ,&nbsp;Kari White","doi":"10.1016/j.conx.2020.100032","DOIUrl":"10.1016/j.conx.2020.100032","url":null,"abstract":"<div><h3>Objectives</h3><p>To examine prevalence and characteristics associated with cost barriers to preferred contraceptive use.</p></div><div><h3>Study design</h3><p>Among a nationally representative sample of women at risk of unplanned pregnancy in 2015–2017, we used Poisson regression to assess characteristics associated preferring a(nother) method in the absence of cost.</p></div><div><h3>Results</h3><p>Overall, 22% preferred to use a(nother) method. Women using less-effective methods, who were Black or Hispanic, ages 15–24 and had low incomes, were more likely to report cost barriers.</p></div><div><h3>Conclusions</h3><p>Using a preferred method is an indicator of access to care and reproductive autonomy. These results provide a benchmark to track the impact of policy changes.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38204025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System","authors":"Megan L. Kavanaugh,&nbsp;Ayana Douglas-Hall,&nbsp;Sean M. Finn","doi":"10.1016/j.conx.2019.100014","DOIUrl":"10.1016/j.conx.2019.100014","url":null,"abstract":"<div><h3>Objective</h3><p>To examine associations between health insurance coverage, income level and contraceptive use — overall and most/moderately effective method use — among women ages 18–44 at risk of pregnancy, within and across 41 United States jurisdictions in 2017.</p></div><div><h3>Study design</h3><p>Using data from the 2017 Behavioral Risk Factor Surveillance System, we calculated the proportions of women using any contraceptive method and using a most or moderately effective method for each state/territory and across all jurisdictions, categorized by health insurance coverage and income groups. For both contraceptive use outcomes, we ran simple and multivariable logistic regression models to test for significant differences in outcomes between insured and uninsured individuals.</p></div><div><h3>Results</h3><p>Across jurisdictions, compared to uninsured women, those who had health care coverage had higher levels of contraceptive use (65% versus 59%; p &lt; .001) and most/moderately effective contraceptive use (43% compared to 35%; p &lt; .001); low-income women with coverage also had higher levels of contraceptive use (64% versus 61%; p &lt; .05) and most or moderately effective contraceptive use (42% versus 36%; p &lt; .01) than their uninsured counterparts. Controlling for individual-level demographic characteristics, health insurance coverage was associated with increased odds of most or moderately effective contraceptive use across jurisdictions (adjusted odds ratio = 1.33, p &lt; .01). In 11 states, insured women had significantly higher odds of at least one contraceptive use metric than their uninsured counterparts.</p></div><div><h3>Conclusions</h3><p>Variation in contraceptive use across the states likely reflects broader demographic, social and structural differences across state and local populations. States' political will and support around contraceptive access likely play a role in individuals' ability to obtain and use contraception.</p></div><div><h3>Implications</h3><p>Our key finding that insurance coverage is significantly associated with use of most/moderately effective contraceptive methods across the states but not any contraceptive use underscores the importance of health insurance in aiding access to methods that are more costly and often require a visit to a health care provider.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38054527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion patients' preferences for care and experiences accessing services in Louisiana","authors":"Erin Carroll ,&nbsp;Kari White","doi":"10.1016/j.conx.2019.100016","DOIUrl":"10.1016/j.conx.2019.100016","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to compare abortion patients' expectations and preferences for care with their experiences accessing services in Louisiana where there are numerous restrictive abortion laws.</p></div><div><h3>Study design</h3><p>Between June 2018 and January 2019, we conducted in-depth interviews with 35 English-speaking Louisiana residents who were ≥<!--> <!-->18 years of age and seeking care from the three in-state facilities to explore their perspectives and experiences locating, obtaining and paying for abortion services. We analyzed interview transcripts using a theme-based approach and categorized themes into dimensions of health care access: availability/accessibility, accommodation, acceptability and affordability.</p></div><div><h3>Results</h3><p>Participants were surprised to learn that there were so few facilities providing abortion, which required some of them to drive between 1 and 3 h to the nearest clinic. Many were unable to schedule their visits at a convenient time or obtain care as early in pregnancy as desired because the next available appointment was often a week or more away. Protestor activity and congested waiting rooms did not provide most patients their desired level of privacy, but participants expressed diverse views about other approaches to care that would maintain their confidentiality. To pay for an unplanned health care expense that was not covered by insurance, many participants deferred paying monthly bills and borrowed money, which contributed to financial hardships and additional delays in care.</p></div><div><h3>Conclusions</h3><p>Many Louisiana abortion patients' expectations and preferences for care are not being met across multiple dimensions of health care access assessed in this study, and the state's highly regulated policy environment may limit options for tailoring services to patients' needs.</p></div><div><h3>Implications</h3><p>Abortion patients in Louisiana value accessible, timely, private and affordable services, but a constrained network of providers and medically unnecessary requirements make it difficult for them to obtain patient-centered care. Federal- and state-level policy changes, as well as local initiatives, could ensure abortion patients have access to quality, evidence-based services.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2019.100016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 1-year prospective, open-label, single-arm, multicenter, phase 3 trial of the contraceptive efficacy and safety of the oral progestin-only pill drospirenone 4 mg using a 24/4-day regimen","authors":"Thomas Kimble ,&nbsp;Anne E. Burke ,&nbsp;Kurt T. Barnhart ,&nbsp;David F. Archer ,&nbsp;Enrico Colli ,&nbsp;Carolyn L. Westhoff","doi":"10.1016/j.conx.2020.100020","DOIUrl":"10.1016/j.conx.2020.100020","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate contraceptive effectiveness and safety of oral drospirenone 4 mg 24/4-day regimen in the United States.</p></div><div><h3>Study design</h3><p>We performed a prospective, single-arm, multicenter phase 3 trial in sexually active women for up to thirteen 28-day treatment cycles. Primary outcome was the Pearl index, calculated using confirmed on-drug pregnancies and evaluable cycles in nonbreastfeeding women aged ≤<!--> <!-->35 years. We assessed adverse events (AEs), including hyperkalemia and venous thromboembolism.</p></div><div><h3>Results</h3><p>Of 1006 women who received at least one dose of drospirenone, 352 women (35.0%) completed the trial and 654 (65.0%) women discontinued before trial end. Most participants (92.2%) were ≤<!--> <!-->35 years; one third had a body mass index (BMI) ≥<!--> <!-->30 kg/m². Among nonbreastfeeding women aged ≤<!--> <!-->35 years, there were 17 pregnancies (Pearl index: 4.0; 95% confidence interval [CI], 2.3–6.4; <em>n</em> = 953), of which three were unconfirmed and two were from sites excluded from the main analysis for major breaches of Food and Drug Administration regulations. The Pearl index was 2.9 (95% CI: 1.5–5.1) for confirmed pregnancies among 915 nonbreastfeeding women aged ≤<!--> <!-->35 years from sites with no protocol violations. Nearly all (95.4%) treatment-emergent AEs were mild or moderate in intensity. No cases of venous thromboembolism were reported. The frequency of hyperkalemia was 0.5%. Women with baseline systolic/diastolic blood pressure ≥ 130/85 mmHg had a mean reduction from baseline in blood pressure at exit visit (−<!--> <!-->8.5/−<!--> <!-->4.9 mmHg; <em>n</em> = 119). No other clinically relevant changes were observed. Participant satisfaction was high.</p></div><div><h3>Conclusion</h3><p>Drospirenone 4 mg 24/4 regimen provides effective contraception with a good safety/tolerability profile in a broad group of women, including overweight or obese women.</p></div><div><h3>Implications</h3><p>This new progestin-only contraceptive, drospirenone 4 mg in a 24/4 regimen, provides a contraceptive option for the majority of women regardless of blood pressure or BMI.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100020"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis","authors":"Katherine Whitehouse ,&nbsp;Ashley Brant ,&nbsp;Marita Sporstol Fonhus ,&nbsp;Antonella Lavelanet ,&nbsp;Bela Ganatra","doi":"10.1016/j.conx.2020.100037","DOIUrl":"10.1016/j.conx.2020.100037","url":null,"abstract":"<div><h3>Background</h3><p>Mifepristone and misoprostol are recommended for second-trimester medical abortion, but consensus is unclear on the ideal regimen.</p></div><div><h3>Objectives</h3><p>The objectives were to systematically review randomized controlled trials (RCTs) investigating efficacy, safety and satisfaction of medical abortion at ≥<!--> <!-->12 weeks' gestation.</p></div><div><h3>Data sources</h3><p>We searched PubMed, Popline, Embase, Global Index Medicus, Cochrane Controlled Register of Trials and International Clinical Trials Registry Platform from January 2008 to May 2017.</p></div><div><h3>Study eligibility, participants and interventions</h3><p>We included RCTs on medical abortion at ≥<!--> <!-->12 weeks' gestation using mifepristone and/or misoprostol. We excluded studies with spontaneous abortion, fetal demise and mechanical cervical ripening and those not reporting ongoing pregnancy (OP).</p></div><div><h3>Study appraisal and synthesis methods</h3><p>After extracting prespecified data and assessing risk of bias in accordance with the Cochrane handbook, we used Revman5 software to combine data and GRADE to assess certainty of evidence.</p></div><div><h3>Results</h3><p>We included 43 of the 1894 references identified. Combination mifepristone–misoprostol had lower rates of OP [risk ratio (RR) 0.12, 95% confidence interval (CI) 0.04–0.35] vs. misoprostol only. A 24-h interval between mifepristone and misoprostol had lower OP rate at 24 h than simultaneous dosing (RR 3.13, 95% CI 1.23–7.94). Every 3-h dosing had lower OP rate at 48 h (RR 0.39, 95% CI 0.17–0.88).</p></div><div><h3>Limitations</h3><p>Direct comparisons of buccal misoprostol to sublingual or vaginal routes after mifepristone were limited. Evidence from clinical trials on how to best manage women with prior uterine incisions was lacking.</p></div><div><h3>Conclusion</h3><p>Our analysis supports the use of mifepristone 200 mg 1 to 2 days before misoprostol 400 mcg vaginally every 3 h at ≥<!--> <!-->12 weeks' gestation.</p></div><div><h3>Implications</h3><p>Where available, providers should use mifepristone plus misoprostol for second-trimester medical abortion. Vaginal misoprostol appears to be most efficacious with fewest side effects, but sublingual and buccal routes are also acceptable.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38500942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in medication abortion and the role of low-volume and nonmetropolitan mifepristone purchasers: 2008–2011 and 2014–2017","authors":"Rachel K. Jones","doi":"10.1016/j.conx.2020.100042","DOIUrl":"10.1016/j.conx.2020.100042","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to examine trends in the number of low-volume and nonmetropolitan mifepristone purchasers and their role in the expansion of medication abortion.</p></div><div><h3>Methods</h3><p>We use deidentified data from Danco Laboratories, the sole distributor of mifepristone during the study period, to examine trends in mifepristone distribution. We focus on customers who purchased &lt;<!--> <!-->100 doses a year and a subset of those who purchased &lt;<!--> <!-->10 doses for the periods of 2008–2011 and 2014–2017. We use data from the Guttmacher Institute Abortion Provider Census (APC) studies in 2008 and 2017 to examine the extent to which some facilities that purchased mifepristone may be missing from Guttmacher's APC.</p></div><div><h3>Results</h3><p>Between 2008 and 2017, the number of medication abortions increased 73%, though the number of mifepristone purchasers only increased 15%. The number of low-volume mifepristone customers, or those who purchased &lt;<!--> <!-->100 tablets of mifepristone per year, decreased 8% over the study period, while the number purchasing &lt;<!--> <!-->10 tablets per year decreased 14%. However, in recent years, low-volume customers were more likely to have purchased mifepristone in multiple years. In nonmetropolitan areas, the number of sites purchasing mifepristone increased slightly but the amount of mifepristone that was purchased more than doubled between 2008 and 2017.</p></div><div><h3>Conclusions</h3><p>While reliance on medication abortion increased substantially between 2008 and 2017, there is no evidence that this was due to an increase in the number of facilities that purchased low volumes of mifepristone.</p></div><div><h3>Implications</h3><p>While their numbers declined, abortion providers purchasing low volumes of mifepristone likely played an important role for the individuals they cared for. Access to abortion could increase if a wider network of health care practitioners, especially those in settings that do not currently provide abortions, was able to offer medication abortion.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38605847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery","authors":"Elizabeth P. Gurney ,&nbsp;Arden McAllister,&nbsp;Britt Lang,&nbsp;Courtney A. Schreiber,&nbsp;Sarita Sonalkar","doi":"10.1016/j.conx.2020.100040","DOIUrl":"10.1016/j.conx.2020.100040","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to describe the sonographic position of copper intrauterine devices (IUDs) 6 months after insertion during cesarean delivery.</p></div><div><h3>Study design</h3><p>This prospective, observational study followed participants who received a copper IUD during cesarean delivery. We performed pelvic examination at 6 weeks and 6 months and sonography at 6 months to determine IUD position. Patients had additional examinations as needed to address complications.</p></div><div><h3>Results</h3><p>Sixty-nine participants provided outcomes through 6 months: 41 (59%) had correctly positioned IUDs, 21 (30%) had malpositioned intrauterine IUDs, 5 experienced expulsion (3 partial, 2 complete), and 2 had elective removal; 52 (75%) had missing strings. Missing strings at 6 weeks predicted an incorrect IUD position in 22 of 52 participants (positive predictive value 42%), and visible or palpable strings predicted a correct IUD position in 7 of 12 participants (negative predictive value 58%).</p></div><div><h3>Conclusion</h3><p>Although 59% of copper IUDs placed during cesarean were correctly positioned at 6 months, nearly one third were malpositioned.</p></div><div><h3>Implications</h3><p>Ultrasound may be indicated for patients receiving a copper IUD during cesarean delivery as checking IUD strings alone does not assure correct placement. Providers offering postpartum IUDs should ensure that appropriate processes for the evaluation and management of devices with missing strings or abnormal position are available to all patients regardless of insurance status.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100040"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38615956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive utility of unmet need on time to contraceptive adoption: a panel study of non-contracepting Ugandan women","authors":"Dana Sarnak ,&nbsp;Amy Tsui ,&nbsp;Fredrick Makumbi ,&nbsp;Simon P.S Kibira ,&nbsp;Saifuddin Ahmed","doi":"10.1016/j.conx.2020.100022","DOIUrl":"10.1016/j.conx.2020.100022","url":null,"abstract":"<div><h3>Objective</h3><p>The predictive utility of the unmet contraceptive need indicator is not well known, despite being recognized as a key family planning indicator for showing the extant demand for birth control. This study assesses the dynamic influence of unmet need on time to contraceptive adoption, as compared with that of contraceptive intentions and their concordance.</p></div><div><h3>Study design</h3><p>This observational study analyzed survey data, including a contraceptive calendar, reported by a panel of 747 non-contracepting, fecund and sexually active Ugandan women, first interviewed in a 2014 national survey and re-interviewed in 2018. We conducted descriptive, survival and multivariate Cox regression analysis of the influence of women's baseline measures of unmet need, self-reported intention to contracept and their concordance with time to adoption of modern contraception over 36 months.</p></div><div><h3>Results</h3><p>The study found women classified as having unmet need were slower to adopt contraception than those without unmet need, after adjustment for background covariates (aHR<!--> <!-->=<!--> <!-->0.79, 95% CI<!--> <!-->=<!--> <!-->0.57–1.10). Women intending future contraceptive use were significantly faster to adopt (aHR<!--> <!-->=<!--> <!-->1.45, 95% CI<!--> <!-->=<!--> <!-->1.22–1.73) than those not intending. Women with no unmet need but intending to use had the highest rate of adoption compared to those with no need and no intention to use (aHR<!--> <!-->=<!--> <!-->2.78, 95% CI<!--> <!-->=<!--> <!-->1.48–5.25).</p></div><div><h3>Conclusions</h3><p>The unmet need indicator underperforms in predicting future contraceptive adoption compared to contraceptive intentions, which merits further consideration as a complementary predictor of future use. Non-contracepting women with unmet need but no intention to use contraception in particular warrant programmatic attention.</p></div><div><h3>Implications</h3><p>A non-contracepting woman wanting to limit or space her births is defined as having unmet need, but little is known if she subsequently adopts contraception. By contrasting a woman's unmet need with her expressed intention to use, we offer reasons to further consider self-reported contraceptive intentions as a better predictor of adoption and the underlying latent demand for volitional regulation of fertility.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100022"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Interpersonal Quality of Family Planning Scale in a rural Indian setting","authors":"Nicole E. Johns ,&nbsp;Anvita Dixit ,&nbsp;Mohan Ghule ,&nbsp;Shahina Begum ,&nbsp;Madhusudana Battala ,&nbsp;Gennifer Kully ,&nbsp;Jay Silverman ,&nbsp;Christine Dehlendorf ,&nbsp;Anita Raj ,&nbsp;Sarah Averbach","doi":"10.1016/j.conx.2020.100035","DOIUrl":"10.1016/j.conx.2020.100035","url":null,"abstract":"<div><h3>Objectives</h3><p>The provision of high-quality family planning (FP) counseling can both enhance clients' experience of care and improve their ability to make and act on their contraceptive decisions. The Interpersonal Quality of Family Planning (IQFP) scale measures FP counseling quality and has been validated in the United States. We aimed to explore whether it remains appropriate for use in a low-/middle-income country (LMIC).</p></div><div><h3>Study design</h3><p>We surveyed 1201 nonsterilized married women ages 18–29 in Maharashtra, India, between September 2018 and June 2019. Respondents rated their FP provider from “poor” (1) to “excellent” (5) across 11 IQFP items. We assessed scale reliability via Cronbach's <em>α</em> test and used exploratory factor analysis to evaluate unidimensionality and regression models of plausibly related outcomes to assess construct validity.</p></div><div><h3>Results</h3><p>Five hundred four women (42%) had seen an FP provider within the past year, 491 (97%) of whom answered all items. Mean IQFP score was 2.62 out of 5 (SD 0.94, range 1–5). Scale reliability was high (<em>α</em> <!-->=<!--> <!-->0.97). Exploratory factor analyses support unidimensionality (all factor loadings &gt;<!--> <!-->0.4). A 1-point increase in average IQFP score was associated with nearly double the odds of current modern contraceptive use (adjusted odds ratio<!--> <!-->=<!--> <!-->1.73, 95% confidence interval<!--> <!-->=<!--> <!-->1.36–2.19).</p></div><div><h3>Conclusions</h3><p>The IQFP scale shows good reliability and construct validity in this context, and its use in LMIC settings should be broadly considered. A higher IQFP score was associated with greater odds of contraceptive use. The reported FP counseling quality was low, so future public health efforts should aim to increase counseling quality to better meet the needs of women in low-resource settings like rural India. Measurement tools like IQFP can support success evaluation of the quality of care provided by family planning programs.</p></div><div><h3>Implications</h3><p>The Interpersonal Quality of Family Planning scale is a useful tool in rural India, a different context than the one in which it was developed. Use of the IQFP scale should be considered in other low-/middle-income countries to better measure the quality of family planning care provided.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38264540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}