Contraception最新文献

Objective: In the United States, women disproportionately bear the responsibility of preventing pregnancy. Although vasectomy is safer, less invasive, and more cost-effective than tubal ligation, it remains significantly underutilized. To better understand this disparity, our study examines gender-based differences in contraceptive counseling during medical visits.

Study design: We examined data from the National Survey for Family Growth, a nationally representative weighted survey capturing data on reproductive health, contraceptive use, and family planning. Between 2017-2019, 11,347 respondents (6,141 females and 5,206 males) aged 15-49 were interviewed. Demographics and responses related to healthcare utilization were compared between males and females.

Results: During medical visits, males were less likely than females to receive contraceptive counseling (OR 0.12, [95% CI 0.11 - 0.14), STI prevention counseling (OR 0.09, [95% CI 0.06 - 0.12]), or permanent contraception counseling (OR 0.46, [95% CI 0.23-0.92]). Males without health insurance were less likely than insured males to have received vasectomy counseling (OR 0.29, [95% CI 0.04-0.52]) while a lack of insurance was unrelated to permanent contraception counseling in females.

Conclusion: Our study demonstrates gender-based disparities in counseling for reversible contraception, permanent contraception, and STI prevention. Medical providers must improve counseling of male patients for contraceptive options, especially vasectomy, as it remains amongst the safest and most cost-effective forms of contraception.

Implications: This study reveals that men are less likely than women to receive counseling on contraception, including permanent contraception during medical visits. Providers can promote reproductive health equity by engaging both men and women in discussions about contraception and family planning during routine care.

Objective: To evaluate how social media use may be associated with anxiety and pain scores among patients undergoing an IUD procedure in the office.

Study design: This was a prospective longitudinal study among subjects undergoing first time IUD insertion. Subjects completed a survey evaluating daily social media use and anticipated pain and anxiety scores by visual analog scale (VAS) of 0-10 prior to IUD insertion. The survey also asked about reproductive health (contraceptive use, sexual activity and pregnancy). IUD insertion occurred as standard of care. Within 15 min after IUD insertion, subjects completed another VAS about procedural pain.

Results: One hundred thirty-three subjects participated with mean age of 22.8 and range of 13-45. Most subjects reported using social media 1-3 h per day (41.4%) and 27.8% reported 3-6 h per day. Of those using social media, 80% reported seeing posts about IUDs; 67% of these subjects reported negative content about IUDs in these posts. Seeing negative posts about IUDs was associated with higher anticipated pain and anxiety scores (6.9 vs 5.4, p = <.001, and 6.8 vs 4.8, p = <.001). The mean anticipated pain score was 0.47 units higher than the mean procedural pain score (p value=0.040).

Conclusion: Exposure to negative IUD content on social media is associated with higher anticipated pain and anxiety scores prior to IUD insertion. These findings need further exploration to determine how patients utilize social media for medical procedures and the interplay between heightened anxiety and social media use.

Implications: This study highlights the intersection between social media exposure and patient experiences during IUD insertion and raises provider awareness about what patients may have increased anxiety about this procedure. By understanding how social media influences patients' experience, clinicians can take a proactive approach to patient education and support.

Objectives: To evaluate whether inpatient abortion approval mechanisms are used in U.S. non-religious obstetric tertiary care hospitals and describe the scope of use and perceived role of these mechanisms from the perspective of Labor and Delivery Medical Directors.

Study design: We conducted an exploratory cross-sectional, web-based survey in the Spring, 2024. Using purposeful distribution based on the January 2024 Guttmacher Institute's state abortion policy map, we recruited a convenience sample of Labor and Delivery Medical Directors divided between restricted, intermediate, and protective states with a goal of nine responses each. We included those that accepted high-risk maternal inpatient referrals, had a level II or III neonatal intensive care unit, and had ever provided inpatient induced abortions. The survey collected information on ability to provide abortion care, existing approval mechanisms, and reasons for use of these mechanisms in non-emergency and emergency situations.

Results: Of 45 invited directors, we received 37 (82.2%) responses of which 29 met inclusion criteria (11 restricted, nine intermediate, nine protective). Most respondents indicated ability to provide inpatient induced abortions in non-emergent (25 [86.2%]) and emergent (29 [100%]) situations. Among restrictive and intermediate settings, all reported having abortion-specific approval mechanisms in non-emergent situations. Primary reasons for approval mechanisms were avoiding potential legal risk (52.0%) and controversy among team members (32.0%).

Conclusions: Medical Directors of Labor and Delivery Units in our sample indicate that contemporary U.S. non-religious obstetric tertiary care hospitals, especially in politically restrictive settings, are utilizing approval mechanisms for inpatient induced abortion care. These mechanisms are perceived to be in place to avoid controversy, both legal and among hospital team members.

Implications: Our exploratory sample suggests U.S. non-religious tertiary care hospitals commonly apply approval mechanisms for inpatient abortion care to navigate vague legal standards and institutional risk. These approval mechanisms require additional steps, such as multiple physician approval, and focus on the perceived needs of hospitals and physicians rather than the patient.

Objective: To estimate the association between generic levonorgestrel (LNG) entry and access to emergency contraception in Japan's prescription-only context.

Study design: Interrupted time-series of monthly LNG tablets sold per 1000 women aged 15-49, May 2011-July 2025.

Intervention: March 2019 (implementation month excluded).

Results: 2881,950 tablets sold. Immediate level change: + 0.157/1000 (+28.4%; 95% CI -61.7% to +118.6%). Slope change: + 0.0009/month (95% CI - 0.0031-0.0048). By July 2025, sales exceeded the counterfactual by + 0.310/1000 (+30.5%; 95% CI 10.8-50.3%).

Conclusions: Generic entry produced gradual, not immediate, gains; price reductions alone may be insufficient without behind-the-counter or over-the-counter access.

Objectives: We compared changes in contraceptive agency among women initiating self-injectable contraception versus other methods.

Study design: From 2022-2024, we conducted a prospective cohort study with a convenience sample from communities and health facilities in Eastern and Northern Uganda; participants had chosen a new method within the prior two weeks. We compared changes in Agency in Contraceptive Decisions Scale scores, on a scale of 0-3, at 6 and 12 months between self-injection choosers and choosers of any other method (including provider-administered injection) using mixed effects models controlling for confounding. In three secondary analyses, we restricted the comparison group to provider-administered injectable choosers, restricted the comparison to choosers of any provider-administered method, and restricted the sample to women who used their chosen method during follow-up.

Results: Among 216 self-injection choosers, agency scores increased from mean= 2.65(SD=0.35) to 2.74(SD=0.31) at six months and decreased to 2.71(SD=0.32) at 12 months; scores among 1612 women choosing other methods started lower and increased more gradually from mean= 2.61(SD=0.36) at baseline to 2.63(SD=0.35) at six months and 2.67(SD=0.24) at 12 months. Interaction terms examining whether rate of change in agency differed between self-injection and other method choosers had a p-value of 0.03 at six months and 0.85 at 12 months; restricting to provider-administered injectable users or any provider-administered method users did not change results while restricting to those who used their chosen method during follow-up increased the six-month interaction term p-value to 0.20.

Conclusion: Small improvements in agency over six months among women choosing self-injection but not other methods corroborate its empowering potential. Less difference at 12 months suggests the effect may be limited to short-term improvements or stymied by lack of external enablers.

Implications: Greater improvement in agency over time with choosing self-injection compared to other contraceptive methods suggests self-injection may be uniquely empowering and should be offered alongside other contraceptive options. Research comparing outcomes between self-injection programmatic approaches addressing structural and social barriers would shed light on additional opportunities to help interested individuals benefit from the technology.

Objectives: Several novel male contraceptive methods are currently in development, yet data on women's perspectives in their male partners' use is limited. We sought to understand US women's interest in new male contraceptive methods, reasons for interest, and identify subgroups most interested.

Study design: In a national online survey of women aged 18-44 years old, recruited via Prime Panels, participants were asked about their interest in potential new male contraceptive methods. Multivariable regression analyses modeled the likelihood of expressing interest in these methods.

Results: 1029 women completed the online survey (mean age 28.6 years), from 49 US states; 30.9% Black/African American; 11.6% Hispanic/Latina; 71.6% nulliparous; 49.0% not wanting a(nother) child). Two-thirds (67.5%) reported interest in their partners using a new male method. Reasons included shared responsibility (60.6%), dual protection (42.2%), and avoiding side effects (36.0%). Nearly three-quarters (72.5%) of interested women thought their partner would be willing to try a new male method. Adjusted multivariable logistic regression analysis showed that for each additional prior contraceptive method used and reason previous contraceptive method(s) was discontinued, there was 26% increased odds of interest in male methods (95% CIs 1.12, 1.40 and 1.04, 1.52, respectively). Having a child(ren) was associated with half (0.52) the odds of interest in a male method (95% CI 0.34, 0.81). Other socio-demographic/attitudinal variables were not associated.

Conclusions: Over two-thirds of surveyed women expressed interest in new male methods. Women who used more contraceptive types and did not have children may be more likely to accept new male methods.

Implications: Many U.S. women are interested in male methods of contraception and believe their partners would be willing to try such methods. Research regarding male contraception should continue to integrate men's and their partners' perspectives to effectively expand available family planning options.

Objectives: To develop a well-understood consumer information leaflet for a prototype over-the-counter mifepristone-misoprostol medication abortion product.

Study design: From July 2022 to February 2024, we recruited a general population of English-speaking reproductive-age females to review a leaflet during cognitive video interviews. We revised the leaflet iteratively throughout the interviews until reaching saturation in participant feedback.

Results: Sixty-three people aged 13 to 49 completed interviews and found the consumer information leaflet to be easy to understand, suggesting minor improvements.

Conclusions: Information related to the use of medication abortion, formatted as a consumer information leaflet for an over-the-counter product, is well understood by potential users.

Objective: As part of an over-the-counter switch application to the US Food and Drug Administration for a norgestrel 0.075 mg progestin-only pill (Opill), we aimed to determine if key messages from the proposed Drug Facts Label were adequately understood by potential users.

Study design: We conducted videoconference interviews with 703 individuals aged 11 to 50 years, who were female or born with a uterus, located throughout the United States. We drew our sample from two populations: (1) a general population and (2) a population that primarily included individuals with a history of breast cancer. Fourteen primary label message end points were selected based on messages from the Drug Facts Label with the greatest potential for clinical risk if misunderstood and were assessed against an a priori threshold of 90% correct or acceptable responses that was evaluated using the lower limit of the 95% confidence interval (CI). Nineteen secondary label message end points represented important messages but with lower potential for clinical risk if misunderstood, and had no preset thresholds.

Results: For nine of the 14 primary label messages, the end point met or exceeded the 90% threshold based on the lower limit of the 95% CI; the remaining five primary label messages were also well-understood, with point estimates ≥85% and lower limits of the 95% CI >82%. Sixteen of the 19 secondary label message end points were understood by ≥90% of the participants.

Conclusions: The Drug Facts Label for a norgestrel 0.075 mg progestin-only pill was well-understood by a diverse sample of potential users.

Implications: Study findings suggest that information in the label is sufficient to enable people to self-select for the norgestrel oral contraceptive and use it over time. These findings, along with other research, supported the US Food and Drug Administration's approval of norgestrel 0.075 mg for nonprescription status.

Objectives: Deeper contraceptive implant removal remains a difficult skill. Clinicians involved in the care of women need trainings and expertise in advanced techniques to localize and remove contraceptive implants. We developed a low-cost high-fidelity animal model as a new model training for deep contraceptive implant removal. We aimed to evaluate the chicken leg model by experts from French centers of experience and non-experts interested in deep implant removal.

Study design: In this training study, 34 gynecologists were invited to participate in the training program for both superficial and deep implant localization and removal in chicken leg model using ultrasonography (US). Each part of the training program was timed from the moment when the probe was placed on the model to the location of the implant and self-evaluated using a five-point Likert scale.

Results: The participants were able to locate superficial or deep implants in all cases. US detection for superficial and deep implants in the transverse view was easier than US visualization in the longitudinal axis although it took more time for participants to find the deep implant in transverse view. Surgical removal was always possible. There was no statistically significant difference between experts and non-experts.

Conclusions: Our chicken leg model could be relevant, effective and useful as a training program for healthcare professionals involved in deep implant removal.

Implications: Our results seem to confirm that our chicken leg model may be an easy-to-use, useful and reproducible training program for healthcare professionals involved in deep implant removal.

Objectives: To assess longitudinal trends in contraceptive prescribing following medication abortion (MA) in general practice.

Study design: Retrospective cohort study of patients aged 14-49 years who were provided MA in the Australian general practice setting between 2013 and 2022. Data, including prescribed medications, were sourced from the national general practice dataset, MedicineInsight. The primary outcome was the proportion prescribed a contraceptive within 60 days of MA.

Results: Among 4543 undergoing MA, 1841 (40.5%) received a contraceptive prescription within 60 days, with a modest increase over time from 32.0% in 2013-41.3% in 2022. Among those prescribed contraceptives, the most common types were the combined oral contraceptive pill (34.0%), levonorgestrel intrauterine device (27.0%), implant (24.6%) and injection (11.2%), with 931 (50.6%) of prescriptions provided on the same day as MA. The likelihood of receiving a contraceptive prescription was higher among those aged 14-19 years (RR 1.40; 1.21-1.62) and 20-24 years (RR 1.20; 1.08-1.34) compared with the 30-34-year-old group, and in those who were existing patients than new to the practice at time of MA provision (RR 1.15; 1.02-1.31). A positive linear relationship was observed between increasing socioeconomic status and increasing remoteness and higher rates of contraceptive prescription (both p < 0.001).

Conclusions: Less than half of patients undergoing MA in the general practice setting are provided a contraceptive prescription within 60 days of MA, most commonly the combined oral contraceptive pill. A most increase in contraceptive provision is evident over time, with provision varying significantly according to contraceptive type and patient characteristics.

Implications: Further research is required to understand underlying reasons for observed variation in contraceptive provision following MA in the general practice setting to ensure all individuals are being provided access to appropriate contraceptive information and services as part of high-quality abortion care.