BMJ Sexual & Reproductive Health最新文献

Background: Contraception has revolutionised women's health, enabling planned pregnancies and improved outcomes for mothers and babies. However, disparities exist in rates of unintended pregnancies and contraceptive uptake among ethnic groups. The reasons for this are poorly understood.

Objective: To understand women from ethnic minorities' perspectives about contraception.

Methods: Our qualitative study used a participatory action research approach, utilising community research link workers. Public engagement was embedded in the study's conception. We used focus groups and interviews to elicit perspectives, then analysed the data using thematic analysis. The study participants were women who self-identified as being from an ethnic minority group in Sheffield, UK.

Results: Thirty-six women participated in four focus groups and five interviews. Thematic analysis revealed four themes: (1) The role of contraception in a woman's life, (2) External influencers, (3) Cultural and religious considerations and (4) Everyone is different (individuality). Contraceptive needs should be considered holistically, rather than with a siloed, targeted approach. 'External influencers', such as partners, family and communities, determine how contraception is accessed and experienced. 'Cultural considerations', such as personal, sociocultural and religious factors specific to women from ethnic minorities, influence contraceptive choice.

Conclusions: This study provides a transcultural perspective of the issues at play when a woman from an ethnic minority makes a decision about contraception. Practitioners and health providers must be culturally competent and tailor consultations and services to the individual.

Background: Recent media attention has been given to an apparent shift away from hormonal methods of contraception. While an increase in fertility awareness-based or 'natural' family planning methods is reported in the grey literature, there are no robust data to determine any such trend in the UK.

Methods: We compared self-reported contraceptive use at conception among patients presenting for abortion at British Pregnancy Advisory Service from January to June 2018 (N=33 495) and January to June 2023 (N=55 055) using chi-square (χ²) tests of association.

Results: Reported use of fertility awareness-based methods of contraception around the time of conception increased from 0.4% in 2018 to 2.5% in 2023 (p<0.001). In contrast, use of hormonal methods of contraception decreased from 18.8% in 2018 to 11.3% in 2023 (p<0.001) and use of long-acting reversible contraception fell from 3% to 0.6% (p<0.001). Those reporting using no contraception at the time of conception significantly increased by 14% (p<0.001) when comparing data from 2018 (55.8%) with data from 2023 (69.6%).

Conclusions: Significantly fewer abortion patients report using effective methods of contraception around conception while also reporting an increased use of fertility awareness-based methods. Further research is needed to understand the reasons for this change.

Introduction: We aim to describe and compare the prevalence of subjective side effects associated with hormonal contraceptive use among reproductive healthcare users seeking either abortion care or contraceptive services.

Methods: This substudy derives from a previously reported cross-sectional survey involving 1006 users of public reproductive healthcare services in the Helsinki metropolitan area in Finland. We included all 813 respondents with a history of hormonal contraceptive use (mean age 27 years, IQR 24-33 for abortion care; 24 years, IQR 19-30 for contraceptive services). The study followed STROBE guidelines.

Results: Altogether 400 respondents sought abortion care, while 413 sought contraceptive services (counselling, prescription renewal, symptoms and/or dissatisfaction with their contraceptive method). Combined oral contraceptives and progestin-only pills were the most used methods in both groups. Respondents seeking abortion care reported contraception-associated weight changes, sex-related problems, mood changes, and acne more frequently than those seeking contraceptive services (p-value<0.05 for all). Some 52% of respondents seeking abortion care reported mood changes compared with 29% of those seeking contraceptive services, with a crude OR of 2.7 (95% CI 2.00 to 3.57). After adjustment, the OR for reporting mood changes among respondents seeking abortion care was 1.5 (95% CI 1.05 to 2.23).

Conclusions: Mood changes associated with hormonal contraceptive use were the most frequently reported side effect among all respondents. These findings suggest a need for individualised counselling on mood-related side effects as mood changes may contribute to higher discontinuation rates.

Background: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.

Methods: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.

Results: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.

Conclusions: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.

Background: In many countries, persons seeking medical abortion with mifepristone followed by misoprostol can self-administer the second drug, misoprostol, at home, but self-administration of the first drug, mifepristone, is not allowed to the same extent.

Objectives: This systematic review aims to evaluate whether the efficacy, safety and women's satisfaction with abortion treatment are affected when mifepristone is self-administered at home instead of in a clinic.

Search strategy: A literature search covered CINAHL, Cochrane Library, Embase, Ovid MEDLINE and APA PsycInfo in October 2022.

Selection criteria: Eligible studies focused on persons undergoing medical abortion comparing home and in-clinic mifepristone intake. Outcomes included abortion effectiveness, compliance, acceptability, and practical consequences for women.

Data collection and analysis: Two reviewers independently assessed eligibility and risk of bias. Meta-analysis included similar studies while those differing in design were synthesised without meta-analysis.

Results: Six studies (54 233 women) of medical abortions up to 10 weeks were included. One randomised controlled trial and one retrospective register study had moderate risk of bias, and four non-randomised clinical trials where women could choose the place for intake of mifepristone had serious risk of bias. There was no difference in abortion effectiveness (high confidence) or compliance (moderate confidence) between mifepristone administered at home or in-clinic. No differences in complications were detected between groups and most women who chose home administration of mifepristone expressed a preference for this approach.

Conclusions: Our systematic review demonstrates that the effectiveness of medical abortion is comparable regardless of mifepristone administration and intake, at home or in the clinic.