BMJ Sexual & Reproductive Health最新文献

Background: Pregnancy within a year of childbirth has negative impacts on women and their children's health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our pilot randomised controlled trial (RCT) aimed to establish the feasibility of a main RCT of the effects of the DHI compared with standard care on long-acting contraception use.

Methods: Our pilot RCT recruited 52, 20-24 weeks pregnant women in NHS Lothian, UK between October 2022 and April 2023. Participants were randomised 7:3 to receive either the DHI (n=37) in addition to standard care, or standard care alone (n=15). Telephone survey follow-up was at 24 weeks' gestation and 6 weeks postpartum. Semi-structured qualitative interviews (n=10) were conducted with participants receiving the DHI.

Results: All eligible women joined the study and completed follow-up. All intervention participants found the animation highly acceptable; one participant requested text message discontinuation. We completed followed up on 37/37 (100%) of participants. DHI participants reported they valued access to credible contraceptive information that supported decision making in a non-pressurised way.

Conclusions: Our DHI is highly acceptable and a trial is feasible. A larger trial is needed to establish if the DHI increases uptake of long-acting reversible contraception postpartum and reduces unintended pregnancies within 12 months of childbirth.

Trial registration number: (Trial registration ISRCTN48521918).

Background: The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant.

Objectives: To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery.

Search strategy: A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011.

Selection criteria: Primary publications of randomised and non-randomised trials, observational studies and case reports were included.

Data collection and analysis: Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence.

Main results: We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population.

Conclusions: Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted.

Background: Misinformation about abortion is widespread and was exacerbated by the overturn of Roe v Wade. Young adults are among those facing the most direct impacts of new abortion restrictions and are more likely to access health information from online sources, where misinformation is prevalent. We explored how young adults perceive and evaluate abortion-related information in a time of heightened abortion restrictions.

Methods: We conducted in-depth, semi-structured interviews with 25 young adults (aged 18-24 years, 56% assigned female at birth), recruited across 17 US states (44% living in states with restrictive abortion policies), between June and September 2022. We derived themes from the interviews using reflexive thematic analysis.

Results: While many participants were aware of and had personally encountered abortion misinformation, their susceptibility to false claims varied substantially based on their previous knowledge of abortion and exposure to anti-abortion rhetoric. Participants tended to reject some common myths regarding the medical risks of abortion (eg, association with breast cancer), while expressing a wider range of views regarding its impacts on fertility and mental health. When presented with contradictory sources of abortion information, most participants were unable to confidently reject the misleading source. Knowledge gaps left participants vulnerable to misinformation, while prior scepticism of anti-abortion rhetoric protected participants against misinformation.

Conclusions: In this diverse national sample, young adults demonstrated a range of perceptions of abortion misinformation and approaches to identify it. These results lay the groundwork for future observational and experimental research in public health communication.