Open access journal of contraception最新文献

Purpose: We examined reimbursement policies for the removal and reinsertion of long-acting reversible contraception (LARC).

Patients and methods: We conducted a standardized, web-based review of publicly available state policies for language on reimbursement of LARC removal and reinsertion. We also summarized policy language on barriers to reimbursement for LARC removal and reinsertion.

Results: Twenty-six (52%) of the 50 states had publicly available policies that addressed reimbursement for LARC removal. Of these 26 states, 14 (28%) included language on reimbursement for LARC reinsertion. Eleven (42%) of 26 states included language on additional requirements for reimbursement for removal and/or reinsertion: five state policies included language with other requirements for removal only, three policies included language with additional requirements for reinsertion only, and three included language with additional requirements for both. Three state policies specified no restrictions be placed on reimbursement for removal and one specified no restrictions be placed on reimbursement for reinsertion.

Conclusion: Half of the states in the US do not have publicly available policies on reimbursement for the removal and reinsertion of LARC devices. Inclusion of unrestricted access to these services is important for contraceptive choice and reproductive autonomy.

Introduction: The study examines the feasibility, quality of counseling, and knowledge after a virtual Group Contraception Counseling (GCC) session.

Methods: At an urban academic hospital, we recruited English-speaking pregnant women aged 15-49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was participant perceived quality of contraception counseling measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcomes were knowledge change before and after counseling, and postpartum contraception uptake. We used an adjusted multivariable linear regression model to analyze knowledge scores.

Results: Twenty-two participants completed the study. Participants identified primarily as Black or Hispanic/Latinx (78%), in a partnership (50%), having completed college (59%), and having an annual income of less than $50,000 (78%). A total of 77% of participants recorded a perfect score for quality of counseling using the Person-Centered Contraceptive Counseling (PCCC) scale. There was an increase in knowledge after counseling (Mean difference (M)=0.07, p<0.01). Notably, certain subsets of participants had decrease in knowledge scores after counseling. Participants who used postpartum contraception were more likely to have increase in knowledge after counseling compared to those who did not (Mean difference (M)=0.09, p<0.01).

Conclusion: Our findings suggest virtual group contraception counseling is feasible for providing high-quality counseling and can possibly increase contraceptive knowledge.

Background: Depression is a global health concern with significant consequences, especially for women. Hormonal changes and gender disparities contribute to its prevalence. Hormonal contraceptives are widely used among women of reproductive age, but some users report mood-related side effects.

Purpose: This study aims to investigate the relationship between hormonal contraceptive use and depression among women in Mogadishu, Somalia.

Methods: An analytical cross-sectional study was conducted at two hospitals in Mogadishu, targeting married women aged 15-49 using hormonal contraceptives. A sample size of 227 participants was determined, and data was collected using semi-structured questionnaires, including the Patient Health Questionnaire-9 (PHQ-9) to assess depression. The data were analyzed using SPSS version 25, including multivariate logistic regression.

Results: The prevalence of depression among participants was 33.5%, with significant associations observed between depression and occupation, income level, type of hormonal contraceptive used, and duration of contraceptive use. Housewives, individuals with lower income, users of oral pills and implant methods, as well as those with shorter durations of contraceptive use, constituted the high-risk groups for depression.

Conclusion: Depression poses a concern among women using hormonal contraceptives in Mogadishu, Somalia. Healthcare providers should educate women about potential side effects and consider individualized contraceptive recommendations. Mental health support initiatives and awareness campaigns should be introduced. Future research is recommended to further understand and address depression in this context.

Tubal ligation has been used since the late nineteenth century to control undesired fertility in women. Over the years, there have been many improvements to the surgical technique, and the procedure has become a lot safer. Some recent developments, however, appear to make this procedure obsolete. In the first instance, there is now ample evidence that removing the Fallopian tubes rather than ligating them or closing them provides protection against developing ovarian carcinoma. The many surgical approaches and closure methods are therefore no longer appropriate. In the second instance, the use of long-acting reversible contraception has been shown to be as effective in preventing future pregnancy, more cost-effective and with even more health benefits than tubal ligation or tubectomy. This is especially true of the use of intrauterine levonorgestrel. The problem of regret and request for tubal ligation reversal, where that was performed, is eliminated as is the surgical concern of operating on older women with increased body mass index and medical co-morbidities.

[This corrects the article DOI: 10.2147/OAJC.S446263.].

Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1-2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.

Background: Despite efforts to increase modern contraceptive use in Ghana, prevalence rates remain low; particularly in Northern Ghana. This study, therefore, sought to determine the predictors of modern contraceptive use among couples in Northern Ghana. This research was the baseline assessment for a broader study aimed at determining the effect of an intervention to improve outcomes of modern contraception.

Methods: The study was a cross-sectional design. Data was collected from 508 couples (1016 participants), using a multistage sampling technique; both members of each couple were interviewed separately. Univariate and stepwise multivariate logistic regression were used to identify predictors associated with modern contraceptive use. Qualitative data were analyzed to triangulate the findings from the quantitative data.

Results: More than 97% of couples were Muslims. Qualitative data indicates that Muslims are less inclined to use Modern Contraceptives. Most participants had no education. The regression model shows that all demographic characteristics were not significant in Model 3 for men. Socio-culturally, men who gave the reason of "unconcerned" for men's non-involvement in contraceptive adoption, had less odds of using modern contraception (AOR=0.19). Men with high subjective norms were more than 15 times more likely to use modern contraception. Female farmers were less likely to use contraceptives (AOR= 0.45). Women who reported that "nothing prevented men" from getting involved in contraceptive adoption had greater odds of adopting modern contraception (AOR= 11.15). Women with good perceived behavioral control were more likely to use modern contraception (AOR=5.03). Women with high enacted stigma and men and women with high interspousal communication were more likely to adopt modern contraception.

Conclusion: Taking cognizance of demographic and sociocultural characteristics and behavioral constructs is needed when determining the predictors of modern contraceptive use among couples in Northern Ghana.

Background: In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants' perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations.

Methods: Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis.

Results: The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects.

Implications: Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women's feedback about the FP outreach program and our recommendations can inform future policies and interventions.

Background: Contraceptive adherence is the current and consistent use of a contraceptive method as prescribed by a health worker or family planning provider so as to prevent pregnancy. Globally, adherence is lowest among adolescents. This has greatly contributed to the high burden of adolescent pregnancies. Adherence and reasons for discontinuation among refugee adolescents are poorly understood. The aim of this study was to determine the rates and predictors of adherence to modern contraceptives among female refugee adolescents in northern Uganda.

Methods: This was a prospective single cohort study, nested into a randomised controlled trial (RCT) assessing the effect of peer counselling on acceptance of modern contraceptives. The RCT was conducted among female refugee adolescents in Palabek refugee settlement, northern Uganda. The study involved 272 new starters of modern contraceptives who were followed up for six months from May 2019 to January 2020. The outcome was measured at one, three, and six months after receiving a contraceptive method, and the predictors of adherence were determined using Generalised Estimating Equations (GEE). Data were analysed using STATA version 14.0.

Results: Adherence rates were low and reduced over time. By the end of the six months, only 44% of the participants were using a contraceptive method. Participants using long-acting reversible contraceptives (LARC) were more likely to adhere compared to those who were using short-acting reversible contraceptives (SARC) (OR: 3.37, 95% CI: 1.914-5.937, p<0.001).

Conclusion: Adherence to modern contraceptives was low, leaving adolescents at risk of unintended pregnancies. Participants using LARC were more likely to adhere than those using SARC. Interventions addressing fear of side effects and partner prohibition should be studied and implemented to enable adherence to modern contraceptives.

Purpose: Adolescent pregnancy remains an important public health issue in the United States as it has profound health consequences for both mother and child. Evidence shows that improved contraception use is a critical factor in decreasing rates of adolescent pregnancy. In order to provide effective and engaging contraception education, it is important to understand adolescents' attitudes, questions, and misconceptions around the topic and its delivery.

Methods: Two searches were conducted using PubMed. Articles were limited to those published in the last 10 years that were written in English. The first search was completed using the search terms "Adolescent attitudes on sex education in the United States", and resulted in 688 articles. The second search was completed using the search terms "Adolescent attitudes on contraception in the United States", and resulted in 840 articles. Articles including contraception but focusing more on HIV, pre-exposure prophylaxis (PrEP), LGBTQ+ health and practices, human papillomavirus (HPV) vaccination, and studies completed in other countries were excluded. Remaining articles were screened by the authors for inclusion, and articles were included if they addressed information on adolescent attitudes on both contraception for pregnancy prevention and sex education, including education by schools, community organizations, the media, peers, parents, and physicians. A total of 56 articles were included in the review.

Results: The overwhelming theme that emerged from the review is that adolescents prefer comprehensive sex education in a safe space that allows for exploration and questioning. Adolescents want to ask their parents questions about sexual health without fear of punishment, and they desire the opportunity to learn from their physicians in a confidential environment.

Conclusion: The foundation of effective sex education is a non-judgmental, confidential, and safe space where adolescents can ask questions. There are multiple resources that adolescents use to gather information and establish their preferences and attitudes.