Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1269163
J. Bitzer
Publication of the article by Skovlund et al. ‘Association of hormonal contraception with depression’ [1] has produced a strong media reaction in several countries, with recent headlines like those in the German magazines Gala ‘Finally proven: the Pill causes depression’ and Brigitte ‘Danish scientists show the Pill increases the risk of depression in young women by 80%’. Although the article’s authors refer to association and not causality in the title and in the conclusion, and indicate that ‘further studies are warranted to examine depression as a potential adverse effect of hormonal contraception’, social and other media have seized on the study as proof that the Pill causes depression. After the media storms surrounding thromboembolic risk and sexual dysfunction, we now seem to have another public health issue linked to hormonal contraceptives. No doubt we will soon read about the money we could save if women stopped taking the Pill, by reducing the consumption of antidepressants. First, we should ask the most important question: does this study prove that combined hormonal contraceptives cause depression? The answer, for several reasons, is no.
{"title":"Hormonal contraception and depression: another Pill scandal?","authors":"J. Bitzer","doi":"10.1080/13625187.2016.1269163","DOIUrl":"https://doi.org/10.1080/13625187.2016.1269163","url":null,"abstract":"Publication of the article by Skovlund et al. ‘Association of hormonal contraception with depression’ [1] has produced a strong media reaction in several countries, with recent headlines like those in the German magazines Gala ‘Finally proven: the Pill causes depression’ and Brigitte ‘Danish scientists show the Pill increases the risk of depression in young women by 80%’. Although the article’s authors refer to association and not causality in the title and in the conclusion, and indicate that ‘further studies are warranted to examine depression as a potential adverse effect of hormonal contraception’, social and other media have seized on the study as proof that the Pill causes depression. After the media storms surrounding thromboembolic risk and sexual dysfunction, we now seem to have another public health issue linked to hormonal contraceptives. No doubt we will soon read about the money we could save if women stopped taking the Pill, by reducing the consumption of antidepressants. First, we should ask the most important question: does this study prove that combined hormonal contraceptives cause depression? The answer, for several reasons, is no.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"7 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74903315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1266323
Joana Pereira, Raquel Pires, Anabela Araújo Pedrosa, L. Vicente, T. Bombas, M. C. Canavarro
Abstract Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16–17 years, n = 103; 18–19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion. Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18–19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age. Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.
{"title":"Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?","authors":"Joana Pereira, Raquel Pires, Anabela Araújo Pedrosa, L. Vicente, T. Bombas, M. C. Canavarro","doi":"10.1080/13625187.2016.1266323","DOIUrl":"https://doi.org/10.1080/13625187.2016.1266323","url":null,"abstract":"Abstract Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16–17 years, n = 103; 18–19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion. Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18–19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age. Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"8 1","pages":"53 - 61"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84336407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1255940
Joke Vandamme, A. Buysse, T. Loeys, C. Vrancken, G. T’Sjoen
Abstract Objectives: Male partners are often involved in induced abortion although they have no legal rights. It is, however, unknown how women’s thoughts and feelings regarding the decision for abortion are associated with the decisional experiences of the involved male partners and vice versa. Methods: Flemish women and their involved male partners (IMP) filled out a questionnaire on abortion motives and feelings of decisiveness in the abortion centre waiting room (N = 106 couples). Actor Partner Interdependence Models investigated whether the decisiveness of one partner was associated with a subjective feeling of autonomy (high internal, low external abortion motivation) and decisiveness of the other partner, above and beyond the own feeling of autonomy and personal vulnerabilities for being uncertain. Results: Partner congruence in motivation and decisiveness was substantial (r= 0.23 to 0.42), especially for cohabiting partners. The IMPs were less internally motivated for the abortion than the women but both partners reported more internal than external motives, and they both tended to feel certain. In contrast to the women, a higher subjective feeling of autonomy in the IMPs was not associated with feeling more certain. When accounting for partners’ living situation, levels of uncertainty were not only associated with personal vulnerabilities for being uncertain, but were also related to the degree of uncertainty and subjective level of autonomy of the other partner. Conclusions: Partners’ thoughts and feelings regarding the decision for abortion partially have an interpersonal basis and mostly run parallel despite an inherent gender difference in level and importance of decision autonomy.
{"title":"The decision to have an abortion from both partners’ perspectives: a dyadic analysis","authors":"Joke Vandamme, A. Buysse, T. Loeys, C. Vrancken, G. T’Sjoen","doi":"10.1080/13625187.2016.1255940","DOIUrl":"https://doi.org/10.1080/13625187.2016.1255940","url":null,"abstract":"Abstract Objectives: Male partners are often involved in induced abortion although they have no legal rights. It is, however, unknown how women’s thoughts and feelings regarding the decision for abortion are associated with the decisional experiences of the involved male partners and vice versa. Methods: Flemish women and their involved male partners (IMP) filled out a questionnaire on abortion motives and feelings of decisiveness in the abortion centre waiting room (N = 106 couples). Actor Partner Interdependence Models investigated whether the decisiveness of one partner was associated with a subjective feeling of autonomy (high internal, low external abortion motivation) and decisiveness of the other partner, above and beyond the own feeling of autonomy and personal vulnerabilities for being uncertain. Results: Partner congruence in motivation and decisiveness was substantial (r= 0.23 to 0.42), especially for cohabiting partners. The IMPs were less internally motivated for the abortion than the women but both partners reported more internal than external motives, and they both tended to feel certain. In contrast to the women, a higher subjective feeling of autonomy in the IMPs was not associated with feeling more certain. When accounting for partners’ living situation, levels of uncertainty were not only associated with personal vulnerabilities for being uncertain, but were also related to the degree of uncertainty and subjective level of autonomy of the other partner. Conclusions: Partners’ thoughts and feelings regarding the decision for abortion partially have an interpersonal basis and mostly run parallel despite an inherent gender difference in level and importance of decision autonomy.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"37 1","pages":"30 - 37"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90112742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1258461
K. Louie, E. Chong, Tamar Tsereteli, G. Avagyan, R. Abrahamyan, B. Winikoff
Abstract Objectives: The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia. Methods: Women seeking to terminate 13–22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24–48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. Results: A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4–17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2–6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. Conclusion: The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13–22 weeks’ gestation is an effective and acceptable option for women.
{"title":"Second trimester medical abortion with mifepristone followed by unlimited dosing of buccal misoprostol in Armenia","authors":"K. Louie, E. Chong, Tamar Tsereteli, G. Avagyan, R. Abrahamyan, B. Winikoff","doi":"10.1080/13625187.2016.1258461","DOIUrl":"https://doi.org/10.1080/13625187.2016.1258461","url":null,"abstract":"Abstract Objectives: The aim of the study was to assess the efficacy and acceptability of a regimen using mifepristone and buccal misoprostol with unlimited dosing for second trimester abortion in Armenia. Methods: Women seeking to terminate 13–22 week pregnancies were enrolled in the study. Participants swallowed 200 mg mifepristone in the clinic and were instructed to return to the hospital for induction 24–48 h later. During induction, women were given 400 μg buccal misoprostol every 3 h until the fetus and placenta were expelled. The abortion was considered a success if complete uterine evacuation was achieved without oxytocin or surgery. Results: A total of 120 women with a median gestational age of 18 weeks participated in the study. All women began misoprostol induction around 24 h after taking mifepristone. Complete uterine evacuation was achieved in 119 (99.2%) women. The median induction-to-abortion interval was 10.3 h (range 4–17.4) with a mean of 9.5 ± 2.5 h. A median of four misoprostol doses (range 2–6) with a mean of 4 ± 1 misoprostol doses were administered. The induction-to-abortion interval, number of misoprostol doses, pain score and analgesia use increased as gestational age advanced. Acceptability of the method was high among both patients and providers. Conclusion: The medical abortion regimen of 200 mg mifepristone followed 24 h later by induction with 400 μg buccal misoprostol administered every 3 h, with no limit on the number of doses used for the termination of pregnancies of 13–22 weeks’ gestation is an effective and acceptable option for women.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"26 1","pages":"76 - 80"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86775840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1241991
C. Barnett, C. Hagemann, J. Dinger, Thai Do Minh, K. Heinemann
Abstract Objectives: To estimate the real-use contraceptive effectiveness of the combined oral contraceptive containing dienogest and estradiol valerate (DNG/EV) and whether DNG/EV compared to other combined oral contraceptives (oCOC) has a negative effect on return to fertility. Methods: Transatlantic, prospective, non-interventional cohort study conducted in the USA and seven European countries with two main exposure groups and one exposure subgroup: new users of DNG/EV and other COC (oCOC), particularly levonorgestrel-containing COCs (LNG). In a planned secondary analysis, pregnancy outcomes were investigated including contraceptive effectiveness and pregnancy following contraceptive cessation. The influence of age, parity and OC-type were assessed. Results: 50,203 COC users were followed for 105,761 woman-years (WY). There were 677 unintended pregnancies reported: 451 in the USA and 226 in Europe. The contraceptive failure rate in Europe was 0.5 events/100 WY (95% CI: 0.4–0.5) and in the USA 1.9 events/100 WY (95% CI: 1.7–2.1). Differences in compliance (1.3 pregnancies/100 WY) accounted for 90% of the geographical difference seen between Europe and the USA. DNG/EV showed lower contraceptive failure rates compared to the comparators; 0.9% DNG/EV, 2.1% oCOC and 2.8% LNG after 4 years. Overall, 1167 (2.3%) of women stopped contraceptive use with the intention of becoming pregnant with 89% conceiving within 2 years. No significant differences were seen between groups after adjusting for age. Conclusion/Discussion: DNG/EV is associated with similar contraceptive effectiveness in typical-use settings when compared to oCOC and LNG. There was no difference observed between cohorts in fertility following OC use.
{"title":"Fertility and combined oral contraceptives – unintended pregnancies and planned pregnancies following oral contraceptive use – results from the INAS-SCORE study","authors":"C. Barnett, C. Hagemann, J. Dinger, Thai Do Minh, K. Heinemann","doi":"10.1080/13625187.2016.1241991","DOIUrl":"https://doi.org/10.1080/13625187.2016.1241991","url":null,"abstract":"Abstract Objectives: To estimate the real-use contraceptive effectiveness of the combined oral contraceptive containing dienogest and estradiol valerate (DNG/EV) and whether DNG/EV compared to other combined oral contraceptives (oCOC) has a negative effect on return to fertility. Methods: Transatlantic, prospective, non-interventional cohort study conducted in the USA and seven European countries with two main exposure groups and one exposure subgroup: new users of DNG/EV and other COC (oCOC), particularly levonorgestrel-containing COCs (LNG). In a planned secondary analysis, pregnancy outcomes were investigated including contraceptive effectiveness and pregnancy following contraceptive cessation. The influence of age, parity and OC-type were assessed. Results: 50,203 COC users were followed for 105,761 woman-years (WY). There were 677 unintended pregnancies reported: 451 in the USA and 226 in Europe. The contraceptive failure rate in Europe was 0.5 events/100 WY (95% CI: 0.4–0.5) and in the USA 1.9 events/100 WY (95% CI: 1.7–2.1). Differences in compliance (1.3 pregnancies/100 WY) accounted for 90% of the geographical difference seen between Europe and the USA. DNG/EV showed lower contraceptive failure rates compared to the comparators; 0.9% DNG/EV, 2.1% oCOC and 2.8% LNG after 4 years. Overall, 1167 (2.3%) of women stopped contraceptive use with the intention of becoming pregnant with 89% conceiving within 2 years. No significant differences were seen between groups after adjusting for age. Conclusion/Discussion: DNG/EV is associated with similar contraceptive effectiveness in typical-use settings when compared to oCOC and LNG. There was no difference observed between cohorts in fertility following OC use.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"30 1","pages":"17 - 23"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85845224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1269162
F. V. von Rosen, A. J. von Rosen, F. Müller-Riemenschneider, P. Tinnemann
Abstract Background: Lack of information has been described as a major factor in non-use of oral emergency contraception (EC) following unprotected intercourse. Despite the ongoing vociferous debate on liberalisation of access, little evidence is available on EC knowledge in Germany, particularly among adolescents. Methods: We conducted a cross-sectional survey among ninth graders in convenience sample of 13 Berlin schools. We assessed perceived and actual knowledge on the effectiveness, timeframe and availability of EC and on pregnancy risk in six scenarios. Results: A total of 1177 students between 13 and 16 years of age participated. Mean age was 14.6 years (standard deviation 0.67); 51.4% of participants were male. Whilst 8.7% had never heard of EC, 38.6% knew of its effectiveness, but only 12.7% knew the timeframe for EC. Of the sources of EC, only gynaecologists were widely known. Most students correctly evaluated pregnancy risk in given scenarios. Girls were more knowledgeable on most topics except for pregnancy risk. Attending a school of lower academic standard and being of immigrant background was associated with lower knowledge on the majority of items. Conclusions: Generally, students were aware of the existence of EC, but many lacked the knowledge of when to take it and how to access it. Especially in the light of the recent liberalisation of EC access in Germany, increased educational efforts are warranted to ensure that the population has the knowledge necessary to make a truly informed choice regarding its use.
{"title":"Awareness and knowledge regarding emergency contraception in Berlin adolescents","authors":"F. V. von Rosen, A. J. von Rosen, F. Müller-Riemenschneider, P. Tinnemann","doi":"10.1080/13625187.2016.1269162","DOIUrl":"https://doi.org/10.1080/13625187.2016.1269162","url":null,"abstract":"Abstract Background: Lack of information has been described as a major factor in non-use of oral emergency contraception (EC) following unprotected intercourse. Despite the ongoing vociferous debate on liberalisation of access, little evidence is available on EC knowledge in Germany, particularly among adolescents. Methods: We conducted a cross-sectional survey among ninth graders in convenience sample of 13 Berlin schools. We assessed perceived and actual knowledge on the effectiveness, timeframe and availability of EC and on pregnancy risk in six scenarios. Results: A total of 1177 students between 13 and 16 years of age participated. Mean age was 14.6 years (standard deviation 0.67); 51.4% of participants were male. Whilst 8.7% had never heard of EC, 38.6% knew of its effectiveness, but only 12.7% knew the timeframe for EC. Of the sources of EC, only gynaecologists were widely known. Most students correctly evaluated pregnancy risk in given scenarios. Girls were more knowledgeable on most topics except for pregnancy risk. Attending a school of lower academic standard and being of immigrant background was associated with lower knowledge on the majority of items. Conclusions: Generally, students were aware of the existence of EC, but many lacked the knowledge of when to take it and how to access it. Especially in the light of the recent liberalisation of EC access in Germany, increased educational efforts are warranted to ensure that the population has the knowledge necessary to make a truly informed choice regarding its use.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"40 1","pages":"45 - 52"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86298292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1255939
Longmei Tang, Shangchun Wu, Jiong Li, Kun Wang, Jialin Xu, M. Temmerman, Wei‐Hong Zhang
Abstract Objective: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. Methods: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. Results: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20–72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with ‘east region’, ORadj = 3.33, 95% CI: 2.12–5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38–3.15) provided more counseling; and compared with ‘middle school and below’, providers with higher education gave more counseling [ORadj(95% CI)] for ‘college’, ‘university’ and ‘master/doctor’ [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. Conclusions: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.
{"title":"Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study","authors":"Longmei Tang, Shangchun Wu, Jiong Li, Kun Wang, Jialin Xu, M. Temmerman, Wei‐Hong Zhang","doi":"10.1080/13625187.2016.1255939","DOIUrl":"https://doi.org/10.1080/13625187.2016.1255939","url":null,"abstract":"Abstract Objective: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. Methods: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. Results: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20–72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with ‘east region’, ORadj = 3.33, 95% CI: 2.12–5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38–3.15) provided more counseling; and compared with ‘middle school and below’, providers with higher education gave more counseling [ORadj(95% CI)] for ‘college’, ‘university’ and ‘master/doctor’ [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. Conclusions: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"43 1","pages":"24 - 29"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84909558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/13625187.2016.1263292
I. La Vecchia, A. Paffoni, Marta Castiglioni, S. Ferrari, R. Bortolus, C. Ferraris Fusarini, N. Bettinardi, E. Somigliana, F. Parazzini
Abstract Objectives: Diet has been recognised as a crucial factor influencing fetal and maternal health. Adequate levels of substances such as homocysteine, folate and vitamin B12 have been associated with a higher rate of success in infertility treatments. Few data, however, are available on the average levels of micronutrients in the blood of reproductive-aged women, and specific values for adequate levels are not available. The aim of this cross-sectional study was to measure levels of folate, homocysteine and selected vitamins and minerals in women attending the infertility unit of an academic hospital for in vitro fertilisation (IVF). Methods: Fasting venous blood samples were taken in the morning during routine screening before IVF in order to measure: serum folate, red blood cell (RBC) folate, total plasma homocysteine, vitamin B12, vitamin A, vitamin E, serum iron and serum ferritin. Results: Among 269 women aged 37 ± 4 years, only 69% and 44% showed adequate levels of homocysteine and vitamin B12, respectively. Serum folate was appropriate in 78% of the study participants, but only a minority (12%) had a concentration of RBC folate regarded as optimal for the prevention of fetal neural tube defects. Serum levels of vitamin A, vitamin E, iron and ferritin were, however, appropriate in the vast majority of participants (>80%). Conclusion: Folate levels were largely inadequate among women attending an infertility clinic for IVF. Vitamin B12 levels were also found to be inadequate.
{"title":"Folate, homocysteine and selected vitamins and minerals status in infertile women","authors":"I. La Vecchia, A. Paffoni, Marta Castiglioni, S. Ferrari, R. Bortolus, C. Ferraris Fusarini, N. Bettinardi, E. Somigliana, F. Parazzini","doi":"10.1080/13625187.2016.1263292","DOIUrl":"https://doi.org/10.1080/13625187.2016.1263292","url":null,"abstract":"Abstract Objectives: Diet has been recognised as a crucial factor influencing fetal and maternal health. Adequate levels of substances such as homocysteine, folate and vitamin B12 have been associated with a higher rate of success in infertility treatments. Few data, however, are available on the average levels of micronutrients in the blood of reproductive-aged women, and specific values for adequate levels are not available. The aim of this cross-sectional study was to measure levels of folate, homocysteine and selected vitamins and minerals in women attending the infertility unit of an academic hospital for in vitro fertilisation (IVF). Methods: Fasting venous blood samples were taken in the morning during routine screening before IVF in order to measure: serum folate, red blood cell (RBC) folate, total plasma homocysteine, vitamin B12, vitamin A, vitamin E, serum iron and serum ferritin. Results: Among 269 women aged 37 ± 4 years, only 69% and 44% showed adequate levels of homocysteine and vitamin B12, respectively. Serum folate was appropriate in 78% of the study participants, but only a minority (12%) had a concentration of RBC folate regarded as optimal for the prevention of fetal neural tube defects. Serum levels of vitamin A, vitamin E, iron and ferritin were, however, appropriate in the vast majority of participants (>80%). Conclusion: Folate levels were largely inadequate among women attending an infertility clinic for IVF. Vitamin B12 levels were also found to be inadequate.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"224 1","pages":"70 - 75"},"PeriodicalIF":0.0,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89168182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-07DOI: 10.1080/13625187.2016.1234598
F. Fruzzetti, D. Perini, L. Fornaciari, M. Russo, F. Bucci, A. Gadducci
Abstract Objectives: The aim of the study was to examine, in a sample of Italian women, the rate of discontinuation of use of hormonal contraception. Methods: In a retrospective cross-sectional study, data were collected from a chart review of 1809 women using or stopping the hormonal contraceptive prescribed by their physician. The name of the contraceptive and the reason for discontinuation were taken from the charts. The differences between the methods regarding reasons for discontinuation were analysed. Results: Of the 1809 women examined, 34.9% had discontinued their hormonal contraception: 6.9% did so for non-method-related reasons, 20.5% due to minor side effects, 4.4% due to major side effects and 3.8% due to difficulties with compliance. Irregular bleeding, weight gain and headache were the main reasons reported for discontinuation. Pills containing 30 μg or 20 μg ethinylestradiol (EE) and the vaginal ring were the most used contraceptive methods. Women using the vaginal ring discontinued less frequently compared with pill users (p < .005). Pills containing 20 μg and 30 μg EE had the same discontinuation rate. Venous thrombosis was the most frequently reported major side effect leading to discontinuation. Conclusion: About one-third of women who used modern hormonal contraceptives discontinued the method. Although the percentage of women who gave up as a result of minor side effects was lower than it used to be, and the use of low doses of EE by the vaginal route has decreased the rate of discontinuation, physicians should counsel women about the possibility of side effects and encourage them to seek advice before stopping.
{"title":"Discontinuation of modern hormonal contraceptives: an Italian survey","authors":"F. Fruzzetti, D. Perini, L. Fornaciari, M. Russo, F. Bucci, A. Gadducci","doi":"10.1080/13625187.2016.1234598","DOIUrl":"https://doi.org/10.1080/13625187.2016.1234598","url":null,"abstract":"Abstract Objectives: The aim of the study was to examine, in a sample of Italian women, the rate of discontinuation of use of hormonal contraception. Methods: In a retrospective cross-sectional study, data were collected from a chart review of 1809 women using or stopping the hormonal contraceptive prescribed by their physician. The name of the contraceptive and the reason for discontinuation were taken from the charts. The differences between the methods regarding reasons for discontinuation were analysed. Results: Of the 1809 women examined, 34.9% had discontinued their hormonal contraception: 6.9% did so for non-method-related reasons, 20.5% due to minor side effects, 4.4% due to major side effects and 3.8% due to difficulties with compliance. Irregular bleeding, weight gain and headache were the main reasons reported for discontinuation. Pills containing 30 μg or 20 μg ethinylestradiol (EE) and the vaginal ring were the most used contraceptive methods. Women using the vaginal ring discontinued less frequently compared with pill users (p < .005). Pills containing 20 μg and 30 μg EE had the same discontinuation rate. Venous thrombosis was the most frequently reported major side effect leading to discontinuation. Conclusion: About one-third of women who used modern hormonal contraceptives discontinued the method. Although the percentage of women who gave up as a result of minor side effects was lower than it used to be, and the use of low doses of EE by the vaginal route has decreased the rate of discontinuation, physicians should counsel women about the possibility of side effects and encourage them to seek advice before stopping.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"55 1","pages":"449 - 454"},"PeriodicalIF":0.0,"publicationDate":"2016-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89444796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-05DOI: 10.1080/13625187.2016.1239819
G. F. van den Berg, C. Picavet, R. Hoopman, P. Lohr, E. O. D. Op de Coul
Abstract Background: Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB). Methods: A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis. Results: Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP (‘abortion pill’). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients. Conclusion: HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.
{"title":"Chlamydia screening and prophylactic treatment in termination of pregnancy clinics in the Netherlands and Great Britain: a qualitative study","authors":"G. F. van den Berg, C. Picavet, R. Hoopman, P. Lohr, E. O. D. Op de Coul","doi":"10.1080/13625187.2016.1239819","DOIUrl":"https://doi.org/10.1080/13625187.2016.1239819","url":null,"abstract":"Abstract Background: Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB). Methods: A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis. Results: Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP (‘abortion pill’). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients. Conclusion: HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"57 1","pages":"467 - 473"},"PeriodicalIF":0.0,"publicationDate":"2016-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81045426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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