Open access journal of contraception最新文献

Background: Conventional top-down health interventions often exclude adolescents and community stakeholders from service design and implementation, resulting in low uptake and a mismatch with young people's needs. The CAFFP-PAC initiative in Northern Uganda sought to explore how a community-led, adolescent-centered inception process could support integration of adolescent-friendly family planning and post-abortion care into primary healthcare services.

Methods: A participatory qualitative design was employed during an inception meeting in Lira City on April 1, 2025, guided by principles of community-based participatory research and citizen science. A total of 110 purposively selected stakeholders including adolescents, youth mentors, parents, educators, health professionals, and cultural and religious leaders engaged in dialogue circles, breakout sessions, simulations, and visual storytelling to co-develop integration strategies. Data were collected through audio recordings, field notes, and participatory tools, and analyzed using Braun and Clarke's thematic analysis framework.

Results: Six themes emerged: (1) meaningful participation of adolescents and stakeholders; (2) adolescent-friendly and confidential service environments; (3) health system readiness and provider attitudes; (4) addressing socio-cultural and gender norms; (5) integration strategies for CAFFP-PAC in primary care; and (6) sustained engagement and feedback mechanisms. Adolescents emphasized safe, private, and respectful care environments, while stakeholders stressed community ownership, trust-building, and reliance on local structures. Youth mentors, cultural leaders, and school clubs were identified as key enablers for service uptake.

Conclusion: A community-led inception process centered on adolescents and local voices is feasible and essential for successful CAFFP-PAC integration in Northern Uganda. Findings highlight the need to shift from provider-centered models to inclusive, participatory approaches that leverage community assets, foster adolescent agency, and ensure sustained engagement. Such approaches are vital for enhancing service accessibility, responsiveness, and sustainability in resource-constrained settings.

Background: Family planning is a key public health priority that supports informed reproductive choices. This study examined the socio-demographic determinants influencing contraceptive method preferences among women of reproductive age in Rwanda.

Methods: This study employed a cross-sectional design through analysis of data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS). The analysis included 5,578 women aged 15-49 years who were using any contraceptive methods. Logistic regression was applied to identify factors associated with the choice between modern and traditional contraceptive methods. A significance level of 5% (p < 0.05) was used to determine the associations.

Results: Overall, 91.1% of contraceptive users reported using modern methods, with implants being the most commonly used (42.9%) and female condoms the least used (0.05%). Factors significantly associated with modern methods choice included living in female-headed households (AOR = 1.22), older age (AOR = 2.68 for ages 30-34), married women (AOR = 1.92), and those in higher wealth quintile (AOR = 1.71). In contrast, living in rural areas (AOR = 0.77) and identifying as Adventist (AOR = 0.68), were associated with lower odds of modern contraceptive choice.

Conclusion: The findings underscore a strong preference for modern contraceptive methods among Rwandan women. However, sociodemographic disparities remain, particularly among rural population and specific religious groups. Tailored family planning policies are needed to address these gaps and ensure equitable access to modern contraceptive methods accross all population subgroups.

Introduction: The COVID-19 pandemic caused significant disruptions to sexual and reproductive health (SRH) services globally, with a pronounced impact on low- and middle-income countries like Nigeria. This study investigates how COVID-19 travel restrictions influenced the uptake of depot medroxyprogesterone acetate subcutaneous (DMPA-SC) and other injectable contraceptives in Nigeria.

Methods: This study analyzed 26 months of secondary logistics data from the national electronic Health Logistics Management Information System (e-HLMIS), covering 36 states and encompassing periods before, during, and after the implementation of travel restrictions. Statistical analyses, including one-way ANOVA and independent samples t-tests, were applied to assess trends in the consumption of DMPA-SC and compare them with other injectable contraceptives, such as intramuscular DMPA (DMPA-IM) and norethisterone enanthate (NET-EN).

Results: Findings showed a significant increase in DMPA-SC consumption during the travel restriction period, with mean consumption rising from 57,187 units pre-restriction to 103,249 units during the restriction. This increase persisted post-restriction, with mean consumption reaching 124,561 units. While the use of other injectable contraceptives also rose during the pandemic, their growth did not sustain as consistently as DMPA-SC.

Discussion: The results suggest that promoting self-administration of DMPA-SC was essential in maintaining contraceptive access when conventional healthcare services were disrupted. This study highlights the importance of adaptable healthcare delivery models, such as self-administration, in ensuring SRH service continuity during global crises. Additionally, it underscores the need for resilient supply chain management to secure contraceptive availability in emergencies, providing critical insights for policymakers and healthcare providers aiming to enhance SRH service resilience in future public health challenges.

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age, with an estimated prevalence of 5-10%. Women with PCOS are at increased risk for metabolic disturbances. A significant proportion of women with PCOS, ranging from 40 to 85%, are either overweight or obese. Oral contraception is the standard first line treatment for PCOS. However, certain conditions associated with PCOS, such as obesity, must be considered when deciding to prescribe combined oral contraception. It seems that there is no clinical advantage in using high-dose ethinyl estradiol over low-dose formulations. Lower-dose EE formulations may be considered a safer option for obese PCOS patients. Combined oral contraception containing natural estrogens, which have a beneficial effect on metabolic parameters, could also be a viable option for this group. Progestin-only (POPs) formulations have minimal metabolic effects, making them a safe contraceptive choice for patients with obesity and a high risk of coronary artery disease, cerebrovascular disease, venous thromboembolism, or hypertension. Non-oral contraceptive methods, such as transdermal patches and vaginal rings, offer a valuable alternative for women with PCOS who prefer not to use daily oral contraceptives. However, the absence of anti-androgenic progestins in these contraceptive methods may limit their effectiveness, especially for women with moderate to severe clinical signs of androgen excess. The use of LNG-IUDs in women with PCOS may be beneficial in several ways. First, in cases where other contraceptive methods are contraindicated, the LNG-IUD provides effective contraception while also regulating abnormal uterine bleeding. Additionally, the relative hyperestrogenism associated with anovulation in PCOS can lead to endometrial hyperplasia with atypia and, in severe cases, endometrial cancer. Therefore, in women with both PCOS and obesity, the LNG-IUD may be preferred over oral megestrol acetate for endometrial protection.

Objective: The Medicaid Consent to Sterilization policy is a known barrier to permanent contraception (PC) fulfillment and is associated with disparities in fulfillment. While physician perspectives regarding the policy are well described, knowledge of how patients with Medicaid seeking PC perceive this waiting period is limited.

Study design: We interviewed 81 participants with a documented desire for PC at discharge from their hospital-based delivery at four medical centers across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative methodologies and thematic content analysis.

Results: Of the 81 participants interviewed, the 56 participants subject to the mandatory waiting period through insurance status or state residency were included in this analysis. Key positive themes included the role of the waiting period in facilitating minimization of regret, independent decision making, and protection against coercion and bias. Key negative themes included interference with reproductive autonomy, harm to the patient-clinician relationship, and introduction of unwanted doubt into contraceptive decisions. In addition, participants expressed both indifference and nuance when discussing the waiting period, and misinformation about the waiting period was prevalent during interviews. Participants with favorable opinions commonly changed their mind regarding PC, while participants with negative opinions were steadfast in their desires for PC and often experienced PC non-fulfillment.

Conclusion: Postpartum patients hold diverse views on the current Medicaid Consent to Sterilization policy's mandated waiting period. Patient engagement is fundamental when reevaluating and revising this policy to balance supporting autonomous decision-making about PC while protecting against reproductive coercion and regret.

Implications: In policy revision discussions, it is important to consider whether a mandated waiting period is the best way to minimize regret and promote autonomy. Revision that accounts for the complexity of patient desires and needs is imperative to achieving the dual goals of minimizing coercion and ensuring autonomously-desired provision.

Hormonal contraceptives have given women historic freedoms and control over their fertility. At the same time, the potential side effects and unintended consequences of hormonal contraceptive use remain unclear due to a severe lack of funding and research. In this review, we summarize what is currently known about the impact of hormonal contraceptive use on mood symptoms, depression, and premenstrual disorders, and propose using the Social Signal Transduction Theory of Depression as a framework to generate predictions about the mechanistic pathways through which contraceptive use is associated with depression risk. The highest-quality evidence suggests that some types of contraceptives increase depression risk for some women. However, some contraceptives also appear to decrease depression risk in some instances. Key risk factors that predict depression following hormonal contraceptive use include age/age at onset of contraceptive use and mental health history/susceptibility. Hormonal contraceptives differ in ways that influence mood-related outcomes and can be used to treat depression in some women, especially those whose depression symptoms fluctuate across the cycle, indicating the potential presence of a premenstrual disorder. Looking forward, research, and funding for this research, is needed to elucidate the mechanistic pathways through which the use of different contraceptives impacts mood in different women to allow for a precision medicine approach to contraceptive treatment. In the meantime, health care providers should adopt patient-centered, "mindful prescribing" approaches to contraceptive counseling.

Current literature suggests that emergency contraception, defined as a therapy aimed at preventing an unwanted pregnancy after unprotected or insufficiently protected intercourse, is used more by cancer survivors than by the general population. This may be related to reduced use of contraception in women after cancer diagnosis and, when it is used, to a choice of less effective methods, even in the absence of contraindications to hormonal options. The purpose of this review is to analyze the use of contraception in these patients, its predictors and the preferred methods, as well as to try to define timing and characteristics of an effective contraception counseling. Factors identified as predictors of contraception usage were younger age, having a partner and better sexual function, having children, past use and having received contraception counseling by a gynecologist, especially in the previous year. Contraception counseling should start before oncological therapies, together with information regarding fertility and sexual health, preferably by the gynecologist of the oncofertility unit, with a specific expertise in dealing with cancer patients. Increased awareness of oncologists and family medicine doctors is fundamental to optimize contraception use and compliance with the prescribed method. Major guidelines regarding oncological care in women of fertile age already recommend contraception counseling, but optimal timing and mode of the consultation(s) options should be further researched, to be better detailed in all relevant documents.

Background: The patient-centred counselling tools are a comprehensive resource to assist community pharmacists in providing effective treatment choices and assisting with decision-making.

Aim: To identify and select suitable tools community pharmacists use with targeted patient-centred outcomes for dispensing contraceptives.

Methods: Five electronic databases, Web of Science, Cochrane Library, PubMed, Scopus, and Google Scholar as additional sources for published and unpublished studies, were searched to identify literature for contraceptive tools or strategies for pharmacists to decide on contraceptive choice and dispensing by pharmacist. Studies involving pharmacists or tools suitable for pharmacists from any country, published since 1990 were considered.

Results: A total of 21 publications met the inclusion criteria. Robvis' tool was used for visualizing the risk of bias for each result. There were three studies that used the tools specifically by community pharmacists and others focused on general family planning users and pharmacists. The suitability of patient-centred interventions in community pharmacy settings was further evaluated.

Conclusion: The evidence for special tools for pharmacists for dispensing contraceptives in community settings is limited and further research is needed to develop and evaluate novel interventions for pharmacists in community settings.

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.