Contraception and reproductive medicine最新文献

Background: The right to autonomy in family planning is a cornerstone of reproductive health. Yet, many women face challenges when seeking to discontinue provider-dependent contraceptive methods, such as implants and intrauterine devices (IUDs). This study explored the experiences of women in Eastern Uganda regarding the discontinuation of implants/IUDs.

Methods: Using a qualitative descriptive design, we conducted 15 in-depth interviews with women and six key informant interviews with healthcare providers. The study obtained ethical clearance and used a thematic analysis.

Results: Two themes were identified: (1) reasons for refusal and (2) women's reactions to refusal to discontinue IUDs/implants. Women were denied to discontinue IUDs/implants because the due date had not been reached, insertion cards were missing, and there were healthcare constraints, especially inadequate equipment. Early removal or discontinuation before the due date was considered as a waste of resources, unjustifiable, and it was seen to increase risk of pregnancy among young girls. Healthcare workers preferred to first counsel for side effects instead of heeding women's requests to discontinue IUDs/implants. Women often felt betrayed and powerless when they were denied to discontinue using IUDs/implants. They felt that their reproductive rights were undermined which fostered mistrust towards future use of provider-dependent contraceptives. Women reported physical, social, and mental health struggles including strained marital relationships following denial to discontinue IUDs/implants. Most of the women incurred costs in discontinuing the use of IUDs/implants in private facilities.

Conclusion: The findings underscore the need to uphold women's autonomy by improving access to removal services, and addressing systemic and provider-level barriers to discontinuation of IUDs/implants. Insertion cards should not be a mandatory requirement during discontinuation of contraceptives, while enhancing record-keeping systems can address the need for insertion cards. Respecting women's rights to discontinue contraceptives is essential for ensuring voluntary and sustained family planning use.

Background: The European Active Surveillance Study of LCS12 (EURAS-LCS12) investigates effectiveness and safety of intrauterine devices (IUDs) in routine clinical practice. Here, we aim to characterise the general population of IUD users across Europe recorded in a real-world setting.

Methods: EURAS-LCS12 is a prospective, non-interventional cohort study in ten European countries, that started in 2014. All types of approved IUDs were enrolled: levonorgestrel (LNG)-IUS 8 (LNG release rate ~ 8 µg/day); LNG-IUS 12 (LNG release rate ~ 12 µg/day; LNG-IUS 20 (LNG release rate ~ 20 µg/day; ); copper IUDs and other hormonal IUDs (OHIUD). A great variety of baseline characteristics and endpoints are assessed in patient-reported questionnaires. The follow-up duration aligns with the intended maximum duration of use of 3 to 5 years, depending on the respective IUD.

Results: Currently, 97,187 users are enrolled in the study, of whom the vast majority uses IUDs for contraceptive purposes (96.3%), and roughly two thirds are first-time IUD users (64.1%). Heavy menstrual bleeding (HMB) was reported as the second most common reason for IUD use but with apparent variations between devices and countries. Mean age of LNG-IUD 8 users was about 9 years lower compared with LNG-IUD 20 (26.2 vs. 34.6 years). Greatest differences in the proportion of gravid and parous women were observed between LNG-IUS 8 and OHIUD users (gravid: 38.6% vs. 89.8%; para: 30.6% vs. 88.0%).

Conclusions: With more than 97,000 IUD users, EURAS-LCS12 is one of the largest contemporary studies focusing on IUD usage and provides a substantial source of real-world data. IUD prescription patterns appear in line with assumptions that high-dose LNG-IUDs with longer approved durations of use are predominantly prescribed among older, gravid women, who may have completed their family planning, as opposed to younger nulligravidae. Overall, the study is a great source to depict which IUD type fits women with certain characteristics and needs at a certain time of life.

Trial registration: NCT02146950.

Introduction: Optimal luteal phase support (LPS) is essential for successful embryo transfer. In our previous study, we found that LPS combined with Gushen Antai pill (GSATP) could significantly improve ongoing pregnancy rate (OPR) and reduce threatened abortion rate after frozen-thawed embryo transfer (FET). Despite this, no high-quality studies have been performed on the combination of LPS and GSATP for the embryo transfer of fresh IVF cycles.

Methods: A randomized, double-blind, placebo-controlled trial started on June 15, 2021 at 20 reproductive centers of public tertiary hospitals. In total, 371 eligible women with expected normal ovarian reserve (NOR) were age-stratified and randomly assigned to either the GSATP group or the placebo group at random in an equal ratio. The primary outcome is OPR. The report presents data from an interim analysis used for regulatory submissions.

Results: In the per-protocol cohort, the OPR in the GSATP group and placebo group were 40.3% and 38.4%, respectively. Nevertheless, the GSATP group showed a significantly lower incidence of vaginal bleeding (11.3% vs. 21.6%, p = 0.046), threatened miscarriage (16.0% vs. 29.4%, p = 0.021), and functional constipation (16.0% vs. 29.4%, p = 0.021) than the placebo group during the first trimester of pregnancy.

Discussion: In the interim analysis, while GSATP did not result in better pregnancy outcomes for NOR patients undergoing fresh embryo transfers, it did improve common symptoms observed during the early pregnancy phase, such as vaginal bleeding, threatened miscarriage, and functional constipation.

Trial registration: National Institutes of Health clinical trials database, NCT04872660. Registered 4 May 2021, https//clinicaltrials.gov/study/NCT04872660.

Background: Family planning is a fundamental strategy to enhance the well-being of women, their partners, and children however, disparities among certain groups of women of reproductive age (WR) persist. This study aims to estimate the prevalence of unmet family planning needs among WR in Malaysia and its associated factors.

Methods: Data from the 2022 national health survey were utilized. Face-to-face interviews were conducted using a standard questionnaire on contraceptive use among the eligible WR who provided written consent. Unmet needs refer to fecund WR who are not using any contraceptive method but wish to either limit childbearing (cease having children) or space pregnancies (delay their next birth).

Results: Out of 1,987 eligible WR, 1,877 respondents were interviewed, resulting in an 86.6% response rate. This study focused on 1,236 WR who were currently married or in a union and fecund. The prevalence of unmet family planning needs was 26.7% (95% CI: 22.6, 31.3) with 20.7% (95% CI: 17.1, 24.8) attributed to unmet needs for limiting and 6.0% (95% CI: 3.9, 9.3) for spacing. Unmet family planning needs were associated with WR who resided in Peninsular Malaysia (adjusted Odds Ratio (aOR) = 2.42, 95% CI: 1.36, 4.30), those employed in the private sector (aOR = 2.07, 95% CI: 1.16, 3.66), and those aged 35 years and above (aOR = 1.70, 95% CI: 1.08, 2.66).

Conclusions: Unmet family planning needs are prevalent in Malaysia and associated with specific WR groups. An in-depth study should follow these findings to identify barriers in accessing family planning services, which are currently available.

Background: Access to a full range of contraceptive options ensures that individuals can make autonomous decisions about their health and wellbeing. Contraceptive continuity requires that individuals have access in their local communities to a variety of methods, which may change throughout their reproductive lives. Individuals living in rural areas face healthcare access barriers which require special considerations to ensure continuous and effective utilization of contraception to support family planning decision-making. One particular type of family planning service-contraception provided to the postpartum individual-presents challenges related to reimbursement, provider training, and timing of placement, which can be complicated further for individuals who must travel for care.

Objective: This study sought to assess family planning provider perspectives in rural communities, including their knowledge, attitudes, and practices related to general contraception provision, provision of contraception in the specialized circumstance of the postpartum period, and provider assessment of barriers to care to identify strategies to improve access to contraception across the reproductive life cycle.

Methods: We conducted a mixed methods study with an electronic survey of 90 reproductive healthcare providers, and semi-structured follow-up interviews of 9 providers. All providers are currently licensed and provide patient care in Montana. The survey instrument was designed with feedback from physicians and nurses and included questions on contraceptive practices, knowledge, and barriers to providing contraceptive care. Quantitative survey results were analyzed using descriptive statistics and bivariate tests of significance. Qualitative interviews were coded using a combined inductive and deductive approach.

Results: Montana providers consistently reported cost and insurance-related procedural barriers. Additional important themes emerged from qualitative interviews regarding barriers to contraceptive access, including experiences with provider-, institutional-, and practice-level barriers, and provider philosophy and approach to contraceptive care.

Conclusions: This study identifies knowledge gaps, institutional and procedural barriers and facilitators, and provider approaches to contraceptive care in Montana. Findings suggest that the need to increase provider awareness of Montana Medicaid coverage of immediate postpartum contraception. Results should inform future interventions to increase access to hospital-based contraceptive care.

Background: Women with disabilities remain highly vulnerable to sexual and reproductive health problems, particularly in sub-Saharan Africa (SSA), where their sexual and reproductive rights, such as access to sexual health information and contraception, are often neglected. This study investigated the spatial patterns of the shared impact of sexual health knowledge and modern contraceptive use among women with disabilities in Africa.

Methods: We used the most recent Demographic and Health Survey (DHS) data involving 16,157 women with disabilities from ten African countries for this study. The data were analysed using both spatial and Bayesian inference to account for the shared component model patterns between sexual health knowledge and modern contraceptive use among women with disabilities while accounting for factors unique to each outcome. Bayesian inference via the Integrated Nested Laplace Approximation (INLA) was used for implementation. Priors for shared effects ​were set as log-normal distributions, while Gaussian priors were assigned to fixed effects. Intrinsic Conditional Autoregressive (ICAR) priors modelled spatial dependencies between districts, introducing spatial autocorrelation based on shared boundaries. Penalised Complexity (PC) priors controlled precision parameters to balance model complexity.

Results: The study revealed low sexual health knowledge (ranging from 3% in Nigeria to 27% in Uganda) and modern contraceptive use (ranging from 1% in DR Congo and Chad to 27% in Uganda) among women with disabilities across the countries surveyed. The spatial patterns showed diverse intra-country and inter-country disparities of sexual health knowledge and modern contraceptive use among the women, with lower shared impact observed in Mauritania, Nigeria, Uganda, Chad, and DR Congo relative to Kenya, Malawi, Mali, South Africa, and Rwanda. Factors that influence sexual health knowledge and modern contraceptive use among women with disabilities include education, marital status, place of residence, community literacy level, community socio-economic status, and age.

Conclusions and recommendations: Sexual health knowledge and modern contraceptive use among women with disabilities in Africa remain low, albeit with varied intra-country and inter-country spatial disparities. Therefore, spatial areas with low sexual health knowledge and modern contraceptive use should be given more attention when implementing measures to promote the use of modern contraceptives among women with disabilities. Promoting sexual health knowledge and modern contraceptive use among women with disabilities in Africa could significantly contribute towards the realisation of the 2030 Sustainable Development Goal agenda of "leaving no one behind".

Objective: Both early and late age at menarche have been associated with various health issues and may influence the risk of infertility. This present study investigated the relationship between age at menarche and infertility risk.

Methods: This study follows PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, Embase, and Cochrane were searched in December 2024. Odds ratios with 95% confidence intervals were estimated using a random-effects model. Heterogeneity was assessed with the I² index and chi-square, and publication bias was evaluated using Egger's test and a funnel plot. Sensitivity analysis and meta-regression examined study impact and variable influence on heterogeneity.

Results: Out of 7,267 articles screened, 18 primary studies were included, yielding 21 pieces of evidence. The odds ratio (OR) for infertility in the late menarche group compared to the normal menarche group was 1.44 (95% CI: 0.98-2.10), while the OR for the early menarche group versus the normal menarche group was 0.98 (95% CI: 0.68-1.42). Additionally, the OR for infertility in the early menarche group compared to the late menarche group was 0.77 (95% CI: 0.55-1.06). For primary infertility, the OR for the late menarche group relative to the normal menarche group was 1.98 (95% CI: 1.02-3.85), whereas the OR for the early menarche group compared to the late menarche group was 0.59 (95% CI: 0.36-0.97).

Conclusion: Although the overall meta-analysis lacked statistical significance, subgroup analysis revealed a notable association between late menarche and primary infertility. Women with late menarche had higher odds of infertility, supporting a dose-responsive relationship. The observed 44% increase in infertility odds highlights late menarche as a potential risk factor, warranting further investigation into its implications for reproductive health.

Background: The majority of feto-maternal morbidities and mortalities in sub-Saharan Africa, happen during the intrapartum period. Maternal mortality and morbidity have not decreased as much as anticipated, despite the significant progress made by many nations to improve access to maternity services. There are currently no nationally representative studies in sub-Saharan Africa assessing the quality of intrapartum care and its associated factors. Hence, this study aimed to determine the quality of intrapartum care and identify its associated factors using Demographic and Health Survey data from 35 countries.

Methods: Data from the most recent health and demographic surveys, which were carried out between 2006 and 2022 in 35 sub-Saharan African countries, were used. This analysis included a weighted sample of 353,483 women who had given birth within the last five years. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio tests, median odds ratios, and intra-class correlation coefficient values. Ultimately, factors were deemed statistically significant if they had a p-value < 0.05.

Results: About 28.58% (95% CI: 28.43-28.73) of the study subjects had received quality intrapartum care. Factors the like respondent's age [AOR = 1.49; 95% CI (1.42, 1.57)], educational status [AOR = 1.80; 95% CI (1.76, 1.85)], working status [AOR = 1.03; 95% CI (1.01, 1.05)], media exposure [AOR = 1.19; 95% CI (1.16, 1.21)], household wealth index [AOR = 1.53; 95% CI (1.49, 1.56)], family size [AOR = 0.90; 95% CI (0.88, 0.92)], healthcare decisions [AOR = 1.04; 95% CI (1.01, 1.06)], sex of the household head [AOR = 1.08; 95% CI (1.05, 1.10)], ANC visits attended during pregnancy [AOR = 0.60; 95% CI (0.59, 0.61)], number of children ever born [AOR = 0.57; 95% CI (0.55, 0.58)], age at first birth [AOR = 1.06; 95% CI (1.04, 1.08)], mode of delivery [AOR = 0.71; 95% CI (0.68, 0.73)], and residence [AOR = 1.09; 95% CI (1.06, 1.11)] were significantly associated with the quality of intrapartum care.

Conclusions: In the present study, less than one in three mothers had received quality intrapartum care. Respondent's age, educational status, working status, media exposure, household wealth index, healthcare decisions, sex of the household head, age at first birth, and residence were associated with the quality of intrapartum care. Health policy makers and program planners should empower women through comprehensive education and mass media campaigns in order to maximize the quality of intrapartum care. It is also advised that each country's Ministry of Health assess its community health professionals and medical fac

Background: Despite efforts to improve its uptake, contraceptive use in Nigeria remains low. Understanding regional disparities and sociodemographic determinants of contraceptive intention is crucial for developing effective family planning strategies. This study aimed to investigate these factors in women of reproductive age in Nigeria.

Methods: This cross-sectional study analysed data from 36,179 women aged 15-49 participating in the 2018 Nigerian Demographic and Health Survey (NDHS). Bivariate and multivariable logistic regression analyses were conducted to assess the association between sociodemographic factors and contraceptive use intention.

Results: The overall prevalence of contraceptive intentions was 39.18%, with significant regional variation. South East had the highest intention at 44.85%, while North East had the lowest intention at 34.76%. Education was a strong predictor, with those with higher education showing 2.657 times greater odds of using contraception (AOR: 2.657, 95% CI: 2.339-3.019, p < 0.001). Muslim women and rural residents exhibited lower odds of intention, while women aged 20-24 years had the highest odds (AOR: 1.305, 95% CI: 1.187-1.435, p < 0.001).

Conclusion: There were significant regional disparities and complex sociodemographic patterns in contraceptive intention among Nigerian women. Tailored interventions addressing educational, religious, economic, and geographical barriers are required to increase contraceptive uptake and improve reproductive health outcomes.

Introduction: Accessing quality and equitable contraceptive services is significant for reaching the recently announced Sustainable Development Goals. In Ethiopia, women with disabilities continue to confront several barriers to accessing adequate contraceptive services. Nevertheless, little is known about contraceptive uptake and associated factors among pregnant women with disabilities in Ethiopia. This study aimed to assess the contraceptive uptake and associated factors among pregnant women with disabilities in the Central Ethiopia Regional State, Ethiopia.

Methods: A community-based cross-sectional study was conducted, with 562 study participants recruited using a multistage random sampling procedure. Data were collected through face-to-face interviews using the Kobo Toolbox. A bivariate and multivariable logistic regression model was used to identify variables associated with contraceptive uptake. At p < 0.05, the association of variables was found to be statistically significant.

Result: In this study, only 38.1% (95% CI: 33.5, 42.3) of study participants used contraceptives. The significantly associated factors were: women's age (≥ 35 years, AOR = 0.17, 95% CI: 0.07, 0.46, p < 0.0001), marital status (AOR = 0.21, 95% CI: 0.12, 0.64, p < 0.0001), women education (tertiary and above, AOR = 8.44, 95% CI: 4.2, 13.2, p < 0.0001), number of pregnancies (AOR = 0.28, 95% CI: 0.17, 0.45, p < 0.0001), lack of contraceptives awareness (AOR = 0.12. 95% CI: 0.06, 0.24 p < 0.0001), contraceptive service accessibility (AOR = 6.02, 95% CI: 3.8, 9.54, p < 0.0001), and spousal support to use contraceptives (AOR = 4.52, 95% CI: 2.85, 7.2, p < 0.0001).

Conclusion: This finding concludes that there is a significant unmet need for contraceptive services among pregnant women with disabilities in the Central Ethiopia Regional State, Ethiopia. To enhance contraceptive uptake, it is suggested to engage husbands in health promotion initiatives, implement community-based awareness campaigns, train healthcare providers on the unique needs of women with disabilities and design disability-friendly health facilities.