Contraception and reproductive medicine最新文献

Background: Modern contraceptives are crucial for reducing maternal and child mortality, yet Mozambique's contraceptive prevalence rate is very low, with significant regional disparities. This study investigates geographic variation in contraceptive use and the individual, community, and regional factors influencing it to guide equitable family planning interventions.

Methods: This study utilized data from the 2022/23 Mozambique Demographic and Health Survey, analyzing a weighted sample of 9,316 women aged 15-49. The outcome variable was modern contraceptive use, with predictors including individual factors such as age, education, wealth, and marital status, as well as community-level factors like residence and region. Data analysis was conducted using Stata 17 and ArcGIS 10.7, employing multilevel logistic regression and spatial techniques (Global Moran's I, Getis-Ord Gi*, interpolation, and SaTScan) to identify patterns and geographic clusters of contraceptive use.

Results: The study found a modern contraceptive prevalence of 34.8% (95% CI: 33.84-35.78). Key factors influencing usage included age, education, wealth, and healthcare access. Women aged 25-34 were 31% more likely to use contraceptives than those aged 15-24 (AOR: 1.31, 95% CI: 1.13-1.53). Secondary education more than doubled the likelihood (AOR: 2.25, 95% CI: 1.82-2.78), and wealthier women had a 74% higher likelihood (AOR: 1.74, 95% CI: 1.39-2.17). Fieldworker visits increased usage by 38% (AOR: 1.38, 95% CI: 1.15-1.64). Regional disparities were significant, with women in Cabo Delgado 81% (AOR: 0.19 95% CI: 0.14, 0.27) less likely to use contraceptives compared to Maputo. Higher usage was concentrated in Maputo and Southeastern Gaza. Spatial analysis revealed significant regional disparities, with hotspots in Maputo and Gaza, where women are 2.52 times more likely to use contraceptives, while rural areas like Cabo Delgado lag behind.

Conclusion: Modern contraceptive use in Mozambique remains low, with regional disparities. Key factors influencing use include age, education, wealth, and healthcare access. Older, educated, and wealthier women are more likely to use contraception. Media exposure and proximity to healthcare facilities also play a role. Regional differences persist, with lower usage in provinces like Cabo Delgado and higher usage in urban areas like Maputo and Gaza. Targeted interventions are necessary to address these disparities.

Background: Women's intention to use contraceptive methods is critical for better visualization of future needs and for making it more likely to translate into actual use. This study sought to examine the determinants of intention to use modern contraceptives among current non-users of reproductive age in Uganda.

Methods: The study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) dataset. The sample size consisted of 13,088 women aged 15-49 who were not using contraception. The dependent variable was the intention to use contraceptives. STATA version 17 was used for data analysis. A binary logistic regression model was used to identify the predictors of intention to use contraceptives at the 5% level of significance.

Results: Findings indicated that six in ten (60.2%) non-users of contraceptives had an intention to use them in the future. The odds of intention to use contraceptives were higher among women with secondary education (AOR 1.482, CI = 1.168-1.880), women who desired 3-4 children (AOR = 1.343, CI = 1.135-1.590), women with 3-4 living children (AOR = 1.817, CI = 1.391-2.373), women who have ever used a contraceptive method (AOR = 2.457, CI = 1.686-3.579), and women whose last pregnancy was unwanted (AOR = 1.720, CI = 1.231-2.405). On the other hand, the odds of intending to use contraceptives were lower among women aged 35-44 years (AOR = 0.242, CI = 0.143-0.284) and 45-49 years (AOR = 0.028, CI = 0.017-0.044), Muslim women (AOR = 0.676, CI = 0.559-0.817), Pentecostal women (AOR = 0.708, CI = 0.598-0.837), and formerly married women (AOR = 0.672, CI = 0.517-0.875).

Conclusions: The study found that the intention to use contraceptives among Ugandan women not currently using contraception was associated with having secondary education, a preference for having 3-4 children, having 3-4 living children, prior contraceptive use, and experiencing an unwanted pregnancy. The study recommends enhanced access to and completion of at least secondary education for girls. The study further recommends that policymakers and program implementers sensitise communities about the benefits of smaller family sizes through community dialogues highlighting the health, economic, and educational advantages for families and communities.

Background: Emergency Contraception (EC) is more popular among young people today, yet, there is little research on Over-the-counter procured EC among undergraduate students in African universities. This study's primary goal is to fill that gap.

Methods: This was an exploratory-cross-sequential study conducted in a public university in Ghana, using 145 purposively sampled sexually active undergraduate students. A structured questionnaire and in-depth interview guide designed by the author were used for data collection during the University's 2021/2022 Academic year. The questionnaire was administered online via students' social media platforms. In contrast, four group discussions were held with 20 female participants (5 each from levels 100, 200, 300, and 400). Quantitative data were analyzed using Stata Version 14.0 to generate the Median, Standard deviation, Chi-square, and Fisher Exact Test scores, Whilst Content analysis was done with the qualitative data to generate verbal quotes.

Results: There is demand and abuse of ECs among the students studied with about 99% usage to prevent pregnancy. Friends (81%) played a significant role in providing information about ECs to most participants (96%). About 80% of participants have used an EC at least once during the academic year and upon recommendation by friends (44%) and partners (39%). The most preferred ECs were Postinor-2 (61%) and Lydia post-pills (38%). Pharmacies on campus are the major (86%) suppliers at a cost between ghs5 and ghs15 cedis respectively. There were relationships between gender and choice of ECs (p = 0.001); age group and choice of ECs (p = 0.02); marital status and choice of ECs (p < 0.0001) as well as employment status of students and choice of ECs (p = 0.003). The qualitative findings provided relevant justifications for students' EC choices, sources, dosage, frequency, and motivations for use. The EC pills were taken routinely and soon after sexual intercourse sometimes overdosed for a perceived efficacy to prevent failure, regulate menses, or as an abortifacient. Male partners played a critical role in procuring and supervising the intake soon after sexual intercourse.

Conclusion: There is a high demand, usage, and general abuse of over-the-counter procured ECs among undergraduate students in the study area. These findings suggest that sexually active students are concerned about pregnancy prevention and need health education programs on modern contraceptive methods to prevent unwanted pregnancy and possible STIs. From unprotected sex.

Estradiol (E2) levels on the day progesterone starts may negatively impact implantation, ongoing pregnancy, and live birth rates in frozen embryo transfer (FET). Overall, while the picture isn't entirely clear, some evidence suggests maintaining estradiol levels within a specific range before starting progesterone might be beneficial for frozen transfer success. So we performed a systematic review and meta-analysis to find out the rate of pregnancy-related outcomes of frozen embryo transfer in different level of E2. This review was designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A multi database search was conducted (PubMed, Web of Science and Scopus) from the earliest date of each database until the 21st of April 2024. Data on the included articles including author, year, type of study, patients number, age, hormones like LH, FSH, successful pregnancy, live birth rate, and miscarriage were retrieved by two independent investigators. We categorized the values of E2 into five groups due to various values reported by studies to understand it better consisting of "Up to 200 pg/mL", "200-500 pg/mL", "500-1000 pg/mL", "1000-2000 pg/mL", "2000-3000 pg/mL" and "more than 3000 pg/mL". A forest plot was used to present the pooled measure. The analysis was performed using Stats version 13. A total of 14 studies containing 16,040 patients were included in the analysis. Studies reported a pooled prevalence of 57% with E2 level up to 200 pg/mL for clinical pregnancy. Also, studies reported a pooled prevalence of 46% with 200-500 pg/mL E2 for live birth rate. The lowest rate of miscarriage (6%) was observed in patients with 1000-2000 pg/mL E2 We found that the best level of E2 for having successful clinical pregnancy is up to 200 pg/mL and live birth rate is 200-500 pg/ml so we can say that E2 less than 500 pg/mL is a suitable value for pregnant.

Introduction: Contraceptive discontinuation has become a widespread issue on a global basis. Implants, of which Implanon is the most popular, are only the second most widely used form of modern contraceptive in Ethiopia. However, Implanon was discontinued at a rate as high as 23.4% in Ethiopia within the first year of use. Therefore, the purpose of this study was to identify the incidence rate and predictors of unplanned discontinuation of Implanon in the first year of application at public hospitals in the North Shoa zone, Central Ethiopia.

Methods: A retrospective follow-up study was conducted at public hospitals in the North Shoa zone among women who use Implanon. A total of 429 women who wanted their Implanon removed after insertion were selected as study participants during the data collection period. Data were gathered from the family planning initiation and removal registration books as well as by contacting users directly. A log-rank test was used to assess the significance of observed differences between categorical variable strata. The acceleration failure time model with log-normal distribution was used to fit the survival data.

Results: The unplanned discontinuation rate Implanon in the first year of insertion was 19.1% with an estimated mean survival time of 10.9 months (95% CI: 10.65, 11.14). Women with an interval period of insertion (AAF = 1.53; 95% CI: 1.06, 2.21), women who chose implanon by themselves (AFF = 1.32; 95% CI: 1.02, 1.71), women who were satisfied with the service (AFF = 1.40; 95% CI: 1.06, 1.83), and women who were given instructions on what to do if they experienced side effects (AFF = 1.85; 95% CI: 1.40, 2.44), had a lower likelihood of discontinuing their implanon in the first year of insertion.

Conclusion: The risk of unplanned Implanon discontinuation was found to be high in the study area. Health care providers should pay close attention to clients' needs when delivering family planning services, and the client should ultimately decide whether to use the service. Family planning departments must also engage in early-side effects treatment and reassure clients to lessen discontinuation.

Background: There is a dearth of research on modern family planning practices in high focus states like West Bengal in India with diverse population groups and distinct health needs. Thus, this study aims to investigate the latest picture of modern contraceptive use and its associated socio-demographic factors among currently married non-pregnant of reproductive aged (15-49 years) women in West Bengal.

Methods: The study is based on secondary data, collected from the fifth round of the National Family Health Survey (NFHS-5; 2019-20). A total of 15,841 currently married non-pregnant women were included into this study. With the overarching goal of understanding the determinants and patterns of modern contraceptive use, the study employed a combination of bi-variate and multivariate analyses, including logistic regression.

Results: The results reveal that female sterilization is the most common modern contraceptive method across the state. Contraceptive use varies by district, from 43% in Puruliya to 77.3% in Birbhum. Women aged 30-34 were significantly more likely to use contraception (OR = 1.47), while those aged 45-49 were less likely to use it (OR = 0.74). Women with mixed gender composition of living children (OR = 1.48) were more likely to use contraception, compared to women with no children (OR = 0.21) or daughters only (OR = 0.80). SC women (OR = 1.63) and Christians (OR = 2.17) showed higher usage. Wealthier women (OR = 1.26) and urban residents also reported higher use. Moreover, son preference continues and women married after 18 are less likely to adopt modern methods. These findings highlight the need to improve reproductive health outcomes and overcome barriers to increasing contraceptive uptake.

Conclusion: Targeted interventions focusing on education, awareness-building, and improving access to diverse contraceptive options are recommended to empower women in making informed reproductive choices and advancing reproductive rights and health equity. Also, effective modern contraceptive services must overcome legal policy, social, cultural and structural barriers to benefit more women.

Background: Providing contraception to adolescents is a critical intervention in reducing adolescent and early pregnancy. However, many adolescents, including those attending school, still lack access to contraception. We adapted Baroudi's ecological framework of access to healthcare to explore the perspectives of school health practitioners about providing contraceptive services to school-going adolescents.

Methods: This is an exploratory qualitative research study. We employed purposive sampling to recruit school health practitioners directly involved in implementing sexual and reproductive health policies or interventions in public secondary schools. From September to October 2023, we conducted semi-structured interviews with forty-nine participants. We followed Braun and Clarke's approach of thematic analysis and adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist for qualitative research reporting.

Results: In our study, participants highlighted the importance of having access to accurate information about contraception and being knowledgeable about school health policies. They also identified socio-cultural norms, denialism and misconceptions as potential barriers to contraception access. Notably, they suggested that strengthened parental involvement and the presence of nurses in schools could significantly improve the provision of contraceptive services to school-going adolescents.

Conclusions: Our study offers valuable insights into the perspectives of school health practitioners about providing contraception to adolescents. These findings highlight the implications of implementing the Integrated School Health Policy and the Policy on the prevention and management of learner pregnancy in schools. The results of this study could provide valuable insights to policymakers, decision-makers, nurses, and teachers from the Departments of Education and Health. Those insights could enhance the development of school health policies and the implementation of contraception-related programmes for adolescents in secondary schools. This, in turn, would contribute to reducing adolescent pregnancies in South Africa.

Background: Contraception knowledge and attitudes are largely formed from conversations within one's social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy.

Methods: This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) instrument and for Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) using a modified instrument within the health information education literature.

Results: The 174 videos with educational content scored as understandable but not actionable in PEMAT-A/V assessment, with videos created by healthcare providers (HCPs) performing better than those by non-HCPs in six of eleven domains of understandability. Videos overall scored well in relevance and purpose within the CRAAP assessment. Videos created by HCP's (n = 99) scored higher than those by non-HCPs (n = 75) in relevance (score = 3.9 versus 3.3), authority (score = 4.8 versus 1.7), accuracy (score = 6.0 versus 3.5), and purpose (score = 7.1 versus 5.7) [all p < 0.001]. Regarding video engagement, the median number of views among the videos in the cohort was 604,450. Of all video views, 79.2% were of HCP-created videos and 20.8% were of non-HCP videos.

Discussion: Much of the contraceptive educational messaging on TikTok is understandable, relevant, and accurate. HCP-created videos overall scored better as compared to other creators, though even HCP-created videos score fail to provide actionable recommendations. The videos created by HCP also had greater metrics of engagement. Given this, we encourage HCPs to use social media to better inform its users.

Background: Unplanned pregnancy could be a socio-economic burden for many young women in sub-Saharan Africa (SSA) which often leads to pregnancy termination. The role of age at sexual debut in pregnancy termination in countries with lower income remains unknown. Hence, this study examines the association between age at sexual debut and pregnancy termination among sexually active young women between the ages of 15 -24 in 23 SSA countries.

Methods: Cross-sectional secondary datasets from the most recent Demographic and Health Survey conducted in 23 countries in SSA conducted between 2010 and 2018 among 34,343 sexually active young women were analysed using bivariate and multivariable logistic regression to examine the association between age at sexual debut and pregnancy termination with statistical significance of p < 0.05.

Results: The pooled prevalence of pregnancy termination among sexually active young women in SSA was 11.00%. Higher odds of pregnancy termination were found among those who had early sexual debut (below 16 years) [(aOR = 1.34, 95% CI = (1.22-1.48)] compared to those who had late sexual debut. Furthermore, those who were exposed to mass media [(aOR = 1.29, 95% CI = (1.16-1.43)] were more likely to report pregnancy termination compared to those who were not exposed. On the other hand, those residing in rural areas and those within the richest wealth index were associated with lower odds of pregnancy termination.

Conclusion: The study concluded that early sexual debut of sexually active young women in SSA was significantly associated with pregnancy termination. Mass media exposure was found to be a risk factor for pregnancy termination whilst residing in rural areas, and those within the richest wealth index were protective factors. Interventions should be designed to target young women with early sexual debut to provide comprehensive sexual and reproductive health education to enable them to make informed decisions on pregnancy termination.