Contraception: X最新文献

{"title":"Abortion service availability during the COVID-19 pandemic: Results from a national census of abortion facilities in the U.S.","authors":"Shelly Kaller ,&nbsp;M.G. Isabel Muñoz ,&nbsp;Subeksha Sharma ,&nbsp;Salma Tayel ,&nbsp;Chris Ahlbach ,&nbsp;Clara Cook ,&nbsp;Ushma D. Upadhyay","doi":"10.1016/j.conx.2021.100067","DOIUrl":"10.1016/j.conx.2021.100067","url":null,"abstract":"<div><h3>Objective</h3><p>This study assessed the impact of COVID-19 on abortion services in all 50 United States states and the District of Columbia.</p></div><div><h3>Study design</h3><p>ANSIRH's Abortion Facility Database is a systematic collection of data on all publicly-advertising abortion facilities in the United States, updated annually through online searches and mystery shopper phone calls. Research staff updated the database in May-August 2020, assessing the number of facilities that closed, limited or stopped providing abortions, and provided telehealth options in summer 2020 due to COVID-19.  We describe these changes using frequencies and highlighting themes and examples from coded qualitative data.</p></div><div><h3>Results</h3><p>Located primarily in the South and Midwest, 24 of 751 facilities that were open in 2019 temporarily closed due to the pandemic, with 9 still closed by August 2020. Other facilities described suspending abortions, referring abortion patients to other facilities, or limiting services to medication abortion. While most facilities required in-person visits for reasons like state abortion restrictions, 22% (<em>n</em> = 150) offered phone or telehealth consultations, no-test visits, or medication abortion by mail to reduce or eliminate patient time in the clinic. Some facilities used creative strategies to reduce COVID-19 risk like allowing patients to wait for visits in their cars or offering drive-through medication pick-up.</p></div><div><h3>Conclusions</h3><p>The COVID-19 pandemic caused several disruptions to abortion service availability, including closures. To reduce in-person visit time, some clinics shifted to offering medication abortion (versus procedural) or telehealth. While the pandemic and abortion restrictions increased barriers to abortion provision, facilities were resilient and adapted to provide safe care for their patients.</p></div><div><h3>Implications</h3><p>Barriers to abortion access were exacerbated during the COVID-19 pandemic, particularly in areas of the country with more restrictive policies toward abortion. Telehealth care protocols offered by many abortion facilities provide an option to reduce or eliminate in-person visits.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39221494","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":"Characteristics associated with use of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Burkina Faso, Democratic Republic of Congo, and Uganda","authors":"Philip Anglewicz ,&nbsp;Elizabeth Larson ,&nbsp;Pierre Akilimali ,&nbsp;Georges Guiella ,&nbsp;Patrick Kayembe ,&nbsp;Simon P.S. Kibira ,&nbsp;Fredrick Makumbi ,&nbsp;Scott Radloff","doi":"10.1016/j.conx.2021.100055","DOIUrl":"10.1016/j.conx.2021.100055","url":null,"abstract":"<div><h3>Objectives</h3><p>To what extent is DMPA-SC reaching new users versus encouraging method switching among existing users? Though increasingly-popular, little is known about characteristics of women using DMPA-SC in SSA. We compared characteristics of women using DMPA-SC with those of other modern methods, and identified the extent to which women using DMPA-SC switched from another method or are first-time users of contraception.</p></div><div><h3>Study design</h3><p>We used data collected by the Performance Monitoring for Action (PMA) Project between 2016 and 2019 from three countries, Burkina Faso, Democratic Republic of Congo, and Uganda. We tabulated characteristics of DMPA-SC, DMPA-IM, implant, and male condom users, and used multivariate analysis to compare characteristics of women using DMPA-SC those of the other three methods. We also examined previous contraceptive method use (if any) among women currently using DMPA-SC.</p></div><div><h3>Results</h3><p>We found that never-married women were more likely to use male condoms instead of DMPA-SC. Women with two or more children (compared to no children or one child) were more likely to use implants instead of DMPA-SC in both Uganda and DRC. DMPA-SC was the first method used by the majority of current users in Burkina Faso and Uganda. DMPA-SC users who previously used another method generally switched from less effective methods.</p></div><div><h3>Conclusions</h3><p>Although the characteristics of women using DMPA-SC varied across countries, DMPA-SC appears to be reaching new populations of women instead of inspiring existing modern users to switch to DMPA-SC, and appears to be appealing to first time users of contraception.</p></div><div><h3>Implications</h3><p>It appears that DMPA-SC appeals to new contraceptive users in sub-Saharan Africa, which implies that DMPA-SC may have the potential to increase modern contraceptive prevalence in sub-Saharan African countries.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25345114","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 abortion at 13 or more weeks gestation provided through telemedicine: A retrospective review of services","authors":"Nathalie Kapp ,&nbsp;Kathryn Andersen ,&nbsp;Risa Griffin ,&nbsp;Amalia Puri Handayani ,&nbsp;Marlies Schellekens ,&nbsp;Rebecca Gomperts","doi":"10.1016/j.conx.2021.100057","DOIUrl":"10.1016/j.conx.2021.100057","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate medical abortion effectiveness and safety in women at 13 or more weeks gestation provided care through Women on Web's telemedicine service.</p></div><div><h3>Study Design</h3><p>We conducted a retrospective case study of abortions at 13 or more weeks gestation provided by Women on Web between 2016 and 2019. Women received mifepristone and misoprostol or misoprostol alone for abortion. We extracted demographic characteristics and outcome data for cases with pregnancy continuation outcomes.</p></div><div><h3>Results</h3><p>We identified 144 women who used medical abortion at 13 or more weeks; 131 (91%) provided abortion outcome data. Almost all, 118 (90%) received mifepristone and misoprostol. The population had an average age of 26 ± 5.8 years, 102 (78%) reported a gestational age of 13 to 15 weeks, 114 (87%) had experienced prior pregnancy, and represented all world regions. Overall, 13 (10%) women reported a continuing pregnancy, with 5 (5%) among women 13 to 15 weeks and 8 (28%) among those ≥16 weeks (<em>p</em> = 0.001); 38 (29%) reported adverse events (heavy bleeding, fever), 53 (43%) sought additional care from a health provider, and 18% of all cases received treatment with D&amp;C/aspiration.</p></div><div><h3>Conclusions</h3><p>Efficacy of self-administered medical abortion decreases as gestational age increases, risking continuation of pregnancy. Provision through telemedicine at 13 to 15 weeks appears safe and effective.</p></div><div><h3>Implications</h3><p>Limited data suggest that medical abortion through telemedicine services may be a safe option through 15 weeks gestation in settings where there is ready access to the formal health system. More research with adequate sample sizes and high rates of follow-up is needed to inform on the safety of telemedicine for pregnancies 13 weeks and greater.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25391959","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 U.S. adolescent sexual behavior and contraceptive use, 2006-2019","authors":"Laura D. Lindberg ,&nbsp;Lauren Firestein ,&nbsp;Cynthia Beavin","doi":"10.1016/j.conx.2021.100064","DOIUrl":"10.1016/j.conx.2021.100064","url":null,"abstract":"<div><h3>Objective</h3><p>This study examines changes over time in the prevalence of select sexual behaviors and contraceptive use measures in a national sample of U.S. adolescents.</p></div><div><h3>Study design</h3><p>We used data on adolescents aged 15-19 from the 2006-2010 (n=4,662), 2011-2015 (n=4,134), and 2015-2019 (n=3,182) National Surveys of Family Growth. We used logistic regression to identify changes between periods in sexual behaviors and contraceptive use by gender, and for some measures by age. We estimated probabilities of age at first penile-vaginal intercourse with Kaplan-Meier failure analysis.</p></div><div><h3>Results</h3><p>Over half of adolescents have engaged in at least one of the sexual behaviors measured. Males reported declines in sexual behaviors with a partner of a different sex. Adolescent males reported delays in the timing of first penile-vaginal intercourse. Adolescent females reported increases from 2006-2010 to 2015-2019 in use at last intercourse of any contraceptive method (86%, 95%CI 83-89; 91%, 95%CI 88-94), multiple methods (26%, 95%CI 22-31; 36%, 95%CI 30-43), and IUDs or implants (3%, 95%CI 1-4; 15%, 95%CI 11-20). Adolescent males reported increases in partners' use of IUDs or implants use from &lt;1% to 5% and recent declines in condom use at last intercourse (78%, 95%CI 75-82, 2011-2015; 72%, 95%CI 67-77, 2015-2019). Condom consistency declined over time. Males were more likely than females to report condom use at last intercourse and consistent condom use in the last 12 months.</p></div><div><h3>Conclusions</h3><p>These findings identify declines in male adolescent sexual experience, increased contraceptive use overall, and declines in consistent condom use from 2006 to 2019.</p></div><div><h3>Implications</h3><p>This analysis contributes a timely update on adolescent sexual behavior trends and contraceptive use, showing that adolescent behaviors are complex and evolving. Sexual health information and services must be available so that young people have the resources to make healthy and responsible choices for themselves and their partners.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38919689","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":"Trauma exposure and adolescent attitudes toward having a baby: An exploratory survey","authors":"Karina M. Shreffler,&nbsp;Stacy Tiemeyer,&nbsp;Ronald B. Cox Jr.","doi":"10.1016/j.conx.2021.100058","DOIUrl":"10.1016/j.conx.2021.100058","url":null,"abstract":"<div><h3>Objectives</h3><p>To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood.</p></div><div><h3>Study design</h3><p>We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score.</p></div><div><h3>Results</h3><p>Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude (<em>p</em> &lt; 0.001) and a 15% increase in reporting a positive attitude toward having a baby (<em>p</em> &lt; 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby (<em>p</em>&lt;.01), but not an indifferent attitude toward having a baby.</p></div><div><h3>Conclusions</h3><p>Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence.</p></div><div><h3>Implications</h3><p>Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25440368","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":"Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia","authors":"Grace Sheehy ,&nbsp;Jessica L. Dozier ,&nbsp;Alexandria K. Mickler ,&nbsp;Mahari Yihdego ,&nbsp;Celia Karp ,&nbsp;Linnea A. Zimmerman","doi":"10.1016/j.conx.2021.100066","DOIUrl":"10.1016/j.conx.2021.100066","url":null,"abstract":"<div><h3>Objectives</h3><p>To generate regional, residential, and nationally representative estimates of knowledge of abortion legality and availability among women of reproductive age in Ethiopia, and examine how knowledge varies across regions and by urban/rural residence.</p></div><div><h3>Study Design</h3><p>Our study draws on data from a nationally representative, cross-sectional survey implemented in 2019 in each of Ethiopia's regional and administrative states, yielding a sample of 8,837 women aged 15 to 49. We compare weighted estimates and regional distributions of 3 outcomes: (1) general awareness and (2) correct knowledge of the abortion law, and (3) knowledge of facility-based abortion service availability.</p></div><div><h3>Results</h3><p>Significant regional and urban/rural disparities in knowledge of abortion legality and availability exist. Nationally, 27% of women are aware of the abortion law and just 5% of women have comprehensive knowledge of the law, while 30% know where to access facility-based abortion services. Regionally, estimates range significantly, from 2% in Somali to 45% in Addis Ababa for general awareness of the law, 0% in Afar to 27% in Harare for comprehensive knowledge of the law, and 8% in Afar to 57% in Tigray for knowledge of abortion availability. Knowledge of all measures is higher in urban than in rural areas.</p></div><div><h3>Conclusions</h3><p>Regional disparities in abortion knowledge may contribute to geographic inequities in access to and use of safe abortion care. Efforts to expand knowledge of abortion legality and availability are needed and should be tailored to regional contexts.</p></div><div><h3>Implications</h3><p>Knowledge of abortion legality and availability is imperative to protecting and expanding access to safe abortion care, especially in contexts like Ethiopia where abortion is available for multiple indications. Efforts to improve knowledge of abortion legality and availability are needed, and should be locally tailored to address regional inequities.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"3 ","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2021.100066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197178","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 risk scoring tool for predicting Kenyan women at high risk of contraceptive discontinuation","authors":"Claire W. Rothschild ,&nbsp;Barbra A. Richardson ,&nbsp;Brandon L. Guthrie ,&nbsp;Peninah Kithao ,&nbsp;Tom Omurwa ,&nbsp;James Mukabi ,&nbsp;Erica M Lokken ,&nbsp;Grace John-Stewart ,&nbsp;Jennifer A. Unger ,&nbsp;John Kinuthia ,&nbsp;Alison L. Drake","doi":"10.1016/j.conx.2020.100045","DOIUrl":"10.1016/j.conx.2020.100045","url":null,"abstract":"<div><h3>Objective</h3><p>We developed and validated a pragmatic risk assessment tool for identifying contraceptive discontinuation among Kenyan women who do not desire pregnancy.</p></div><div><h3>Study design</h3><p>Within a prospective cohort of contraceptive users, participants were randomly allocated to derivation (<em>n</em> = 558) and validation (<em>n</em> = 186) cohorts. Risk scores were developed by selecting the Cox proportional hazards model with the minimum Akaike information criterion. Predictive performance was evaluated using time-dependent receiver operating characteristic curves and area under the curve (AUC).</p></div><div><h3>Results</h3><p>The overall contraceptive discontinuation rate was 36.9 per 100 woman-years (95% confidence interval [CI] 30.3–44.9). The predictors of discontinuation selected for the risk score included use of a short-term method or copper intrauterine device (vs. injectable or implant), method continuation or switch (vs. initiation), &lt;<!--> <!-->9 years of completed education, not having a child aged &lt;<!--> <!-->6 months, and having no spouse or a spouse supportive of family planning (vs. having a spouse who has unsupportive or uncertain attitudes towards family planning). AUC at 24 weeks was 0.76 (95% CI 0.64–0.87) with 70.0% sensitivity and 78.6% specificity at the optimal cut point in the derivation cohort. Discontinuation was 3.8-fold higher among high- vs. low-risk women (95% CI 2.33–6.30). AUC was 0.68 (95% CI 0.47–0.90) in the validation cohort. A simplified score comprising routinely collected variables demonstrated similar performance (derivation-AUC: 0.73 [95% CI 0.60–0.85]; validation-AUC: 0.73 [95% CI 0.51–0.94]). Positive predictive value in the derivation cohort was 31.4% for the full and 28.1% for the simplified score.</p></div><div><h3>Conclusions</h3><p>The risk scores demonstrated moderate predictive ability but identified large proportions of women as high risk. Future research is needed to improve sensitivity and specificity of a clinical tool to identify women at high risk for experiencing method-related challenges.</p></div><div><h3>Implications</h3><p>Contraceptive discontinuation is a major driver of unmet contraceptive need globally. Few tools exist for identifying women who may benefit most from additional support in order to meet their contraceptive needs and preferences. This study developed and assessed the validity of a provider-focused risk prediction tool for contraceptive discontinuation among Kenyan women using modern contraception. High rates of early discontinuation observed in this study emphasize the necessity of investing in efforts to develop new contraceptive technologies and stronger delivery systems to better align with women's needs and preferences for voluntary family planning.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38351938","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":"Effect of efavirenz on levonorgestrel concentrations among Malawian levonorgestrel implant users for up to 30 months of concomitant use: a subanalysis of a randomized clinical trial","authors":"Jennifer H. Tang ,&nbsp;Nicole L. Davis ,&nbsp;Amanda H. Corbett ,&nbsp;Lameck Chinula ,&nbsp;Mackenzie L. Cottrell ,&nbsp;Yasaman Zia ,&nbsp;Gerald Tegha ,&nbsp;Frank Z. Stanczyk ,&nbsp;Stacey Hurst ,&nbsp;Mina C. Hosseinipour ,&nbsp;Lisa B. Haddad ,&nbsp;Athena P. Kourtis","doi":"10.1016/j.conx.2020.100027","DOIUrl":"10.1016/j.conx.2020.100027","url":null,"abstract":"<div><h3>Objectives</h3><p>Our primary objective was to compare geometric mean levonorgestrel concentrations between levonorgestrel implant users who were or were not taking the antiretroviral efavirenz, for up to 30 months after implant initiation. Our secondary objective was to evaluate the pregnancy rate among levonorgestrel implant users on efavirenz.</p></div><div><h3>Study design</h3><p>We performed a subanalysis of 42 Malawian women randomized to initiate the levonorgestrel implant as part of a parent randomized clinical trial. Our subset included 30 HIV-infected women taking efavirenz and 12 HIV-uninfected women not taking efavirenz. They underwent urine pregnancy testing every 3 months and serum levonorgestrel testing at day 3 and months 1, 3, 6, 12, 18, 24, 27 and 30 after implant initiation. Geometric mean levonorgestrel concentrations were calculated for efavirenz users and non-efavirenz users at each time point.</p></div><div><h3>Results</h3><p>The geometric mean levonorgestrel concentrations were lower for efavirenz users than non-efavirenz users at every time point; the geometric mean ratio for efavirenz users:non-efavirenz users ranged from 0.60 [90% confidence interval (CI) 0.46–0.79] at 1 month to 0.27 (90% CI 0.12–0.61) at 30 months after implant insertion. No pregnancies occurred over 60 woman-years of concomitant levonorgestrel implant and efavirenz use, although 11 women had levonorgestrel concentrations &lt;<!--> <!-->180 pg/mL (the previously suggested minimum threshold concentration for efficacy).</p></div><div><h3>Conclusions</h3><p>Efavirenz users had lower levonorgestrel concentrations than non-efavirenz users, and one third of our concomitant efavirenz and levonorgestrel implant users had concentrations &lt;<!--> <!-->180 pg/mL. Continued evaluation of the contraceptive efficacy of the levonorgestrel implant may be needed for efavirenz users.</p></div><div><h3>Implications</h3><p>Among 42 Malawian women using the levonorgestrel implant for contraception, women who were taking the antiretroviral efavirenz had lower serum levonorgestrel concentrations than women who were not taking efavirenz. However, none of the women who were taking efavirenz became pregnant over 60 women-years of follow-up.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38751899","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":"Experiences of harassment and empowerment after sharing personal abortion stories publicly","authors":"Katie Woodruff,&nbsp;Rosalyn Schroeder,&nbsp;Stephanie Herold,&nbsp;Sarah C.M. Roberts,&nbsp;Nancy F. Berglas","doi":"10.1016/j.conx.2020.100021","DOIUrl":"10.1016/j.conx.2020.100021","url":null,"abstract":"<div><h3>Objective</h3><p>In recent years, in an attempt to counter stigma and increase empathy, public education campaigns have encouraged people to share their personal abortion stories. This exploratory study sought to document negative and positive experiences of those who have shared their abortion stories publicly.</p></div><div><h3>Study design</h3><p>We conducted an anonymous online survey of people who have shared their abortion story publicly (<em>N</em> = 88), recruited via partners affiliated with two abortion story-sharing campaigns. The survey asked about the context in which respondents shared their abortion story, any negative and positive experiences online and in “real life” as a result of story sharing, and any problems or benefits resulting from these experiences. We analyzed survey data using descriptive statistics, bivariate analyses and categorizing responses to open-ended questions.</p></div><div><h3>Results</h3><p>Sixty percent of respondents reported experiencing harassment and other negative incidents after sharing their story publicly. These experiences contributed to emotional stress, problems with loved ones and difficulties at work and/or school. These harms were reported even by many respondents who used only a first name or alias when sharing their story. Despite this, positive experiences as a result of story sharing were reported by four out of five respondents and motivated many to continue sharing their story.</p></div><div><h3>Conclusions</h3><p>This exploratory study indicates that many people who share their abortion story publicly find it to be an empowering, rewarding experience. Yet they also experience harassment and threats at high rates. Future research should explore both positive and negative experiences in more depth.</p></div><div><h3>Implications</h3><p>Sharing one's personal abortion story as part of a public education campaign can be a positive, empowering experience. Nevertheless, policymakers, journalists and reproductive health advocates should recognize the potential harms experienced by people who share their abortion story publicly and consider measures to support these individuals.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059602","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":"Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception","authors":"Maricianah Onono ,&nbsp;Kavita Nanda ,&nbsp;Kate B. Heller ,&nbsp;Doug Taylor ,&nbsp;Irina Yacobson ,&nbsp;Renee Heffron ,&nbsp;Margaret Phiri Kasaro ,&nbsp;Cheryl E. Louw ,&nbsp;Zelda Nhlabasti ,&nbsp;Thesla Palanee-Phillips ,&nbsp;Jenni Smit ,&nbsp;Imelda Wakhungu ,&nbsp;Peter B. Gichangi ,&nbsp;Nelly R. Mugo ,&nbsp;Charles Morrison ,&nbsp;Jared M. Baeten ,&nbsp;for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium","doi":"10.1016/j.conx.2020.100026","DOIUrl":"10.1016/j.conx.2020.100026","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant.</p></div><div><h3>Study design</h3><p>We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use.</p></div><div><h3>Results</h3><p>A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36–0.96], 1.06 for copper IUD (95% CI 0.72–1.50) and 0.63 for LNG implants (95% CI 0.39–0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58–1.25), 1.11 for copper IUD (95% CI 0.77–1.54) and 0.63 for LNG implants (95% CI 0.39–0.96).</p></div><div><h3>Conclusions</h3><p>In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women.</p></div><div><h3>Implications statement</h3><p>Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38077735","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}