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Haberland N, Rogow D. Sexuality education: emerging trends in evidence and practice. J Adolesc Health 2015; 56:S15-21. [PMID: 25528976 DOI: 10.1016/j.jadohealth.2014.08.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/12/2014] [Accepted: 08/15/2014] [Indexed: 11/18/2022]
Abstract
The International Conference on Population and Development and related resolutions have repeatedly called on governments to provide adolescents and young people with comprehensive sexuality education (CSE). Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs--including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy--and notes a recent shift toward this approach. It discusses the logic of an "empowerment approach to CSE" that seeks to empower young people--especially girls and other marginalized young people--to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society.
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Abstract
To examine how maternal and paternal pregnancy wantedness and couple concordance regarding pregnancy wantedness predict children's social-emotional development in kindergarten. We used data from nationally representative US sample from the Early Childhood Longitudinal Study Birth Cohort. Exposures of interest were maternal and paternal pregnancy wantedness, and couple concordance regarding pregnancy wantedness. Children's social-emotional development was evaluated by the child's kindergarten teacher using an adapted version of the Preschool and Kindergarten Behavior Scales. We examined bivariate associations between pregnancy wantedness and key socio-demographic variables in relation to children's social-emotional development. Multiple linear regression was used to assess the relationship between each pregnancy wantedness predictor and children's social-emotional development scores. Items related to child concentration and attention appeared to be the components driving almost all the associations with social-emotional development. Maternal report of unwanted pregnancy, resident father's report of mistimed pregnancy, and discordance of parental pregnancy wantedness (specifically when the mother wanted but the father did not want the pregnancy) predicted lower children's social-emotional development scores. Results suggest that maternal unwanted pregnancy and couple discordance in pregnancy wantedness were associated with poorer social-emotional development, especially in the area of concentration and attention, in kindergarten.
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Fiaveh DY, Izugbara CO, Okyerefo MPK, Reysoo F, Fayorsey CK. Constructions of masculinity and femininity and sexual risk negotiation practices among women in urban Ghana. CULTURE, HEALTH & SEXUALITY 2014; 17:650-662. [PMID: 25510551 DOI: 10.1080/13691058.2014.989264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Using qualitative data gathered through in-depth interviews with women in Accra, Ghana, this paper explores narratives of masculinity and femininity and sexual risk negotiation practices among women. While women framed 'proper' masculinity in terms of stereotypical reproductive norms, they also acknowledged the fluidity and multiplicity of masculinities. Femininity was more uniformly characterised in terms of physical attractiveness and beauty, responsibility and reproduction. These features, especially those related to adherence to morally and socially appropriate sexual norms (e.g., menstrual and bodily hygiene, unplanned pregnancy etc.), influenced women's approach to sexual negotiation. Work aiming to support women to negotiate sex safely needs to pay attention to their notions of gender and practices of sexual negotiation.
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Dias TZ, Passini R, Duarte GA, Sousa MH, Faúndes A. Association between educational level and access to safe abortion in a Brazilian population. Int J Gynaecol Obstet 2014; 128:224-7. [PMID: 25530513 DOI: 10.1016/j.ijgo.2014.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 09/15/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate sociodemographic factors associated with induced abortion. METHODS As part of a cross-sectional, descriptive study, 15 800 civil servants from Campinas, Brazil, were invited to complete a self-administered questionnaire about absolutely unwanted pregnancies in January 2010. Bivariate analysis and multivariate Poisson regression analysis were used to explore the associations between induced abortion and sociodemographic characteristics. RESULTS Overall, 1660 questionnaires were returned. Unwanted pregnancy was reported by 296 (17.8%) respondents, of whom 165 (55.7%) resorted to abortion. Multiple regression analysis showed that college education was the only variable associated with an increased chance of abortion. Among 157 participants who answered questions about the abortion procedure, 97 (61.8%) reported that it had been performed by a physician. Following abortion, 35 (22.9%) of 153 reported that medical care was required and 26 (16.6%) of 157 reported hospitalization, principally those with a lower level of education and those whose abortion had been performed by a nonphysician. CONCLUSION Compared with women with a college education, those with a lower education level were less likely to terminate an absolutely unwanted pregnancy and to have an abortion performed by a physician, and they were more likely to have complications. These findings confirm the social inequalities associated with abortion in Brazil.
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Abstract
During the past decade, unmet need for family planning has remained high in Pakistan and gains in contraceptive prevalence have been small. Drawing upon data from a 2012 national study on postabortion-care complications and a methodology developed by the Guttmacher Institute for estimating abortion incidence, we estimate that there were 2.2 million abortions in Pakistan in 2012, an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 per 1,000 women in 2002. After taking into consideration the earlier study's underestimation of abortion incidence, we conclude that the abortion rate has likely increased substantially between 2002 and 2012. Varying contraceptive-use patterns and abortion rates are found among the provinces, with higher abortion rates in Baluchistan and Sindh than in Khyber Pakhtunkhwa and Punjab. This suggests that strategies for coping with the other wise uniformly high unintended pregnancy rates will differ among provinces. The need for an accelerated and fortified family planning program is greater than ever, as is the need to implement strategies to improve the quality and coverage of postabortion services.
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Aptekman M. Unmet contraceptive needs among refugees. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:e613-e619. [PMID: 25642489 PMCID: PMC4264828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe what women of reproductive age who received primary care at a refugee health clinic were using for contraception upon arrival to the clinic, and to quantify the unmet contraceptive needs within that population. DESIGN Retrospective chart review. SETTING Crossroads Clinic in downtown Toronto, Ont. PARTICIPANTS Women of reproductive age (15 to 49 years) who first presented for care between December 1, 2011, and December 1, 2012. To be included, a woman had to have had 2 or more clinic visits or an annual health examination. Exclusion criteria for the contraception prevalence calculation were female sexual partner, menopause, hysterectomy, pregnancy, or trying to conceive. MAIN OUTCOME MEASURES Contraception use prevalence was measured, as was unmet contraceptive need, which was calculated using a modified version of the World Health Organization's definition: the number of women with an unmet need was expressed as a percentage of women of reproductive age who were married or in a union, or who were sexually active. RESULTS Overall, 52 women met the criteria for inclusion in the contraceptive prevalence calculation. Of these, 16 women (30.8%) did not use any form of contraception. Twelve women were pregnant at some point in the year and stated the pregnancy was unwanted or mistimed. An additional 14 women were not using contraception but had no intention of becoming pregnant within the next 2 years. There were no women with postpartum amenorrhea not using contraception and who had wanted to delay or prevent their previous pregnancy. In total, 97 women were married or in a union, or were sexually active. Unmet need was calculated as follows: (12 + 14 + 0)/97 = 26.8%. CONCLUSION There was a high unmet contraceptive need in the refugee population in our study. All women of reproductive age should be screened for contraceptive need when first seeking medical care in Canada.
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Cagnacci A, Carluccio A, Piacenti I, Olena B, Arangino S, Volpe A. Use of contraception by women with induced abortion in Italy. MINERVA GINECOLOGICA 2014; 66:521-525. [PMID: 25373011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Aim of the present study was to investigate type of contraception, if any, used by women with induced abortion. METHODS Retrospective analysis on the medical records of 1782 women with induced abortion performed at the University Hospital of Modena (Italy) between 2009 and 2011. RESULTS Some kind of contraception was used by 81.1% of women with induced abortion. At time of conception most of these women (39%) had used withdrawal, 19% natural methods, 15.2% condom, 7% hormonal contraception (95% estrogen plus progestin for any route) and 0.4% copper-IUD. None was using implants or levonorgestrel-IUD. Figures of past use of hormonal contraception were much higher than those present at the time of the unwanted pregnancy (50.3% vs. 7%; P<0.0001). A higher prevalence of condom use (19.7% vs. 10.9%; P<0.0001), and a lower prevalence of natural methods (14.5% vs. 21.6%; P<0.001) were found in single vs. married women. Use of no contraception was more prevalent among low vs. highly educated women with induced abortion (22.2% vs. 14.2%; P<0.02), but was not related to marital status. Prevalence of use of the different contraceptives is different from the one described in the general population, suggesting differences in contraceptive efficacy among the different methods. CONCLUSION Women with induced abortion infrequently use long term or hormonal contraception. In half of the cases the latter has been used at least once in life, but then it has been abandoned. Appropriate education and contraceptive counselling, personalization and follow-up may reduce induced abortion.
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Fantasia HC, Sutherland MA, Fontenot H, Ierardi JA. Knowledge, attitudes and beliefs about contraceptive and sexual consent negotiation among college women. JOURNAL OF FORENSIC NURSING 2014; 10:199-207. [PMID: 25411811 DOI: 10.1097/jfn.0000000000000046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
College women have the highest rates of sexual violence, sexually transmitted infections, and unintended pregnancy compared with women in all other age groups. Although much is known about sexual risk behaviors among college women, less is known about how women negotiate consent for contraceptive use during sexual encounters. Therefore, the purpose of this qualitative descriptive study was to explore college women's knowledge, attitudes, and beliefs about contraceptive and sexual consent during dating relationships. Twenty-six women participated in five focus groups on two college campuses in the northeastern United States. Content analysis was used to analyze the data. The three main categories that emerged from the analysis included the influence of alcohol on sexual behaviors, lack of negotiation for sexual consent and contraceptive use, and fear of pregnancy. The results of this study highlight the complex social interactions and norms that college women encounter when making decisions regarding sexual activity and contraceptive use. The results of this study can inform the role of college health providers and forensic nurses to promote sexual health and safety when they interact with college women.
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Heitmann RJ, Mumford SL, Hill MJ, Armstrong AY. Estimated economic impact of the levonorgestrel intrauterine system on unintended pregnancy in active duty women. Mil Med 2014; 179:1127-32. [PMID: 25269131 PMCID: PMC6258204 DOI: 10.7205/milmed-d-14-00055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Unintended pregnancy is reportedly higher in active duty women; therefore, we sought to estimate the potential impact of the levonorgestrel-containing intrauterine system (LNG-IUS) could have on unintended pregnancy in active duty women. A decision tree model with sensitivity analysis was used to estimate the number of unintentional pregnancies in active duty women which could be prevented. A secondary cost analysis was performed to analyze the direct cost savings to the U.S. Government. The total number of Armed Services members is estimated to be over 1.3 million, with an estimated 208,146 being women. Assuming an age-standardized unintended pregnancy rate of 78 per 1,000 women, 16,235 unintended pregnancies occur each year. Using a combined LNG-IUS failure and expulsion rate of 2.2%, a decrease of 794, 1588, and 3970 unintended pregnancies was estimated to occur with 5%, 10% and 25% usage, respectively. Annual cost savings from LNG-IUS use range from $3,387,107 to $47,352,295 with 5% to 25% intrauterine device usage. One-way sensitivity analysis demonstrated LNG-IUS to be cost-effective when the cost associated with pregnancy and delivery exceeded $11,000. Use of LNG-IUS could result in significant reductions in unintended pregnancy among active duty women, resulting in substantial cost savings to the government health care system.
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Gerlinger C, Trussell J, Mellinger U, Merz M, Marr J, Bannemerschult R, Schellschmidt I, Endrikat J. Different Pearl Indices in studies of hormonal contraceptives in the United States: impact of study population. Contraception 2014; 90:142-6. [PMID: 24813941 PMCID: PMC4096582 DOI: 10.1016/j.contraception.2014.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/21/2014] [Accepted: 03/23/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the impact of subject characteristics on efficacy as measured by the Pearl Index (PI) in clinical trials and to make study populations similar by matching. METHODS Our analysis used US data from four large Phase III studies. We compared results from one fertility control patch study with pooled data from three studies with virtually identical design on oral hormonal contraceptives. First, we identified three characteristics that had the most impact on the PI. Second, we used these three variables and matched subjects from the patch study with those from the oral contraceptive (OC) studies. Finally, we calculated the PIs for matched and unmatched subjects from both the patch study and the OC studies. RESULTS A total of 3706 subjects were included in our analysis. The variables 'Hispanic ethnicity', 'previous pregnancy' and 'previous use of hormonal contraceptives' had the most impact on the PI. The PIs for the matched patch cohort and the matched OC cohort were 2.97 and 2.48, respectively. Those for the unmatched patch cohort and the unmatched OC cohort were 10.17 and 0.90, respectively. CONCLUSION Subject characteristics strongly influence the PI in clinical studies of hormonal contraceptives. In particular, Hispanic ethnicity, previous pregnancies and no previous use of hormonal contraceptives result in a higher PI. IMPLICATIONS PIs from different clinical trials cannot be meaningfully compared unless subject characteristics that have most impact on the PI are similar or are made to be similar statistically as we did here by matching.
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111
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Beguy D, Mumah J, Gottschalk L. Unintended pregnancies among young women living in urban slums: evidence from a prospective study in Nairobi city, Kenya. PLoS One 2014; 9:e101034. [PMID: 25080352 PMCID: PMC4117474 DOI: 10.1371/journal.pone.0101034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 06/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the significant proportion of young people residing in slum communities, little attention has been paid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harsh environment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes, especially during this key developmental period. This paper aims to fill this research gap by examining the levels of and factors associated with unintended pregnancies among young women aged 15-22 in two informal settlements in Nairobi, Kenya. METHODS We use data from two waves of a 3-year prospective survey that collected information from adolescents living in the two slums in 2007-2010. In total, 849 young women aged 15-22 were considered for analysis. We employed Cox and logistic regression models to investigate factors associated with timing of pregnancy experience and unintended pregnancy among adolescents who were sexually active by Wave 1 or Wave 2. FINDINGS About two thirds of sexually experienced young women (69%) have ever been pregnant by Wave 2. For 41% of adolescents, the pregnancies were unintended, with 26% being mistimed and 15% unwanted. Multivariate analysis shows a significant association between a set of factors including age at first sex, schooling status, living arrangements and timing of pregnancy experience. In addition, marital status, schooling status, age at first sex and living arrangements are the only factors that are significantly associated with unintended pregnancy among the young women. CONCLUSIONS Overall, this study underscores the importance of looking at reproductive outcomes of early sexual initiation, the serious health risks early fertility entail, especially among out-of school girls, and sexual activity in general among young women living in slum settlements. This provides greater impetus for addressing reproductive behaviors among young women living in resource-poor settings such as slums.
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112
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Lamina MA. Characteristics of Abortion Care Seekers in Western Nigeria. West Afr J Med 2014; 33:189-194. [PMID: 26070823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Induced abortion remains a major challenge in Nigeria and indeed the developing world because of its contribution to maternal morbidity and mortality. In Nigeria, abortion law is restrictive, and therefore abortion is provided clandestinely. Information on characteristics of abortion care seekers is available but requires updating. Hence, the need to carry out this study in order to suggest effective and proper intervention strategies to combat the problem of unwanted pregnancy and unsafe abortion. STUDY DESIGN This was a prospective hospital-based study. Data collection was done by making use of a pretested standardized questionnaire. RESULTS About two-fifths (42.8%) of the respondents were between the ages of 15 and 24 years, of which the adolescents between the ages of 15 and 19 years constituted 11.7%. Slightly less than half (48.4%) of the respondents were unmarried, while married women constituted 51%. Students were the single highest group (32.4%), closely followed by trading, which was the predominant economic activity (32.3%). Respondents terminated their pregnancies mainly because they were unmarried, students or did not desire to have children. Most of the respondents (43.4%) obtained abortion service from health facility they had used previously as a family clinic, while 38.6% of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 29.9%. CONCLUSION Abortion needs cut across all reproductive age groups. Reproductive health services including sexuality education and contraception should be provided for women while major governmental policy changes should be made to make abortion care accessible and safe.
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Abstract
BACKGROUND Unsafe abortion refers to a procedure for terminating an unintended pregnancy performed either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. OBJECTIVES The objectives of the study are to assess the factors attributing to practice of unsafe abortion and to suggest feasible and cost-effective measures to counter the same. METHODS An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and World Health Organization. Keywords used in the search include unsafe abortion and unintended pregnancy. RESULTS Multiple socio-demographic determinants and barriers such as illiterate women, poor socio-economic status, poor awareness about abortion services, associated stigma, and untrained health professionals have been identified resulting in restricted utilization/access of women to safe abortion services. Consequences of unsafe abortion have been alarming, seriously questioning the quality of health care delivery system. CONCLUSION Concerted and dedicated efforts of government in collaboration with the private sector, community members and non-governmental organizations are needed to ensure that women have a better access to contraceptives, abortion services, and post-abortion care that are safe, affordable, and free from stigma.
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Contraceptive implants: pregnancies and problems with removal. PRESCRIRE INTERNATIONAL 2014; 23:157. [PMID: 25121153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Wado YD, Afework MF, Hindin MJ. Effects of maternal pregnancy intention, depressive symptoms and social support on risk of low birth weight: a prospective study from southwestern Ethiopia. PLoS One 2014; 9:e96304. [PMID: 24848269 PMCID: PMC4029816 DOI: 10.1371/journal.pone.0096304] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) is the principal risk factor for neonatal and infant mortality in developing countries. This study examines the effects of unwanted pregnancy, prenatal depression and social support on the risk of low birth weight in rural southwestern Ethiopia. We hypothesized that unwanted pregnancy and prenatal depression increase the risk of low birth weight, while social support mediates this association. METHODS Data for the study comes from a prospective study in which women were followed from pregnancy through to delivery. Six hundred twenty two women were followed and 537 birth weights were measured within 72 hours. Multivariable log binomial regression was used to model the risk of low birth weight. RESULTS The mean birth weight was 2989 grams (SD ± 504 grams), and the incidence of LBW was 17.88%. The mean birth weight of babies after unwanted pregnancy was 114 g lower compared to births from intended pregnancy. Similarly, mean birth weight for babies among women with symptoms of antenatal depression was 116 grams lower. Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with LBW. The relationship between antenatal depressive symptoms and LBW was mediated by the presence of social support, while the association between LBW and unwanted pregnancy remained after multivariable adjustment. CONCLUSION The incidence of low birth weight is high in the study area. Poverty, nonuse of antenatal care, low social support and unwanted pregnancy contribute to this high incidence of low birth weight. Hence, identifying women's pregnancy intention during antenatal care visits, and providing appropriate counseling and social support will help improve birth outcomes.
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Wiegratz I, Bassol S, Weisberg E, Mellinger U, Merz M. Effect of a low-dose contraceptive patch on efficacy, bleeding pattern, and safety: a 1-year, multicenter, open-label, uncontrolled study. Reprod Sci 2014; 21:1518-25. [PMID: 24784719 DOI: 10.1177/1933719114532840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This Phase III, uncontrolled, open-label, multicenter study was conducted to investigate the contraceptive efficacy, bleeding pattern, and cycle control of a novel once-a-week contraceptive patch, delivering low-dose ethinyl estradiol (EE) and gestodene (GSD) at the same systemic exposure seen after oral administration of a combined oral contraceptive containing 0.02 mg EE/0.06 mg GSD. Participants were women aged 18 to 35 years, all of whom received the EE/GSD patch for 13 cycles each of 21 treatment days (one patch per week for 3 weeks) followed by a 7-day, patch-free interval. The primary efficacy variable was the occurrence of unintended pregnancies during the study period as assessed by life table analysis and the Pearl Index. Secondary efficacy variables were days with bleeding during four 90-day reference periods and during 1 treatment year, bleeding pattern, and cycle control. The Kaplan-Meier probability of contraceptive protection after 364 treatment days was 98.8% and the adjusted Pearl Index was 0.81. The percentage of participants with intracyclic bleeding/spotting decreased over time, from 11.4% to 6.8% in cycles 1 and 12, respectively. Almost all participants (range: 90.8%-97.6%) experienced withdrawal bleeding across the study period. Compliance was very high (mean: 97.9%; median: 100%). The most frequent adverse events were headache (9.5%) and application site reaction (8.5%); no clinically significant safety concerns were observed. Results suggest the EE/GSD patch is highly effective in preventing pregnancy. Menstrual bleeding pattern was favorable and within the ranges expected of a healthy female population. The patch was well tolerated and treatment compliance was high.
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MESH Headings
- Administration, Cutaneous
- Administration, Oral
- Adolescent
- Adult
- Australia
- Chile
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Drug Administration Schedule
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Europe
- Female
- Humans
- Medication Adherence
- Menstruation/drug effects
- Mexico
- Norpregnenes/administration & dosage
- Norpregnenes/adverse effects
- Pregnancy
- Pregnancy, Unplanned
- Pregnancy, Unwanted
- Time Factors
- Transdermal Patch
- Young Adult
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Sõritsa D, Lahe J. The possibility of compensation for damages in cases of wrongful conception, wrongful birth and wrongful life. An Estonian perspective. EUROPEAN JOURNAL OF HEALTH LAW 2014; 21:141-160. [PMID: 24851650 DOI: 10.1163/15718093-12341311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
While case law in cases of wrongful conception, wrongful birth and wrongful life is completely missing in Estonia, this article is aimed at providing possible solutions under Estonian law to some of the legally complex problems that these cases contain. Through the analysis of Estonian, German and U.S. legal literature and case law, the article is mainly focused on proposing some solutions to the legal problems concerning compensable damage, but also explains the Estonian legal framework of the contractual and delictual basis for compensation for the damages. The application of several grounds for the possibility of limiting the compensation in the afore-mentioned cases are analysed.
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Bajos N, Le Guen M, Bohet A, Panjo H, Moreau C. Effectiveness of family planning policies: the abortion paradox. PLoS One 2014; 9:e91539. [PMID: 24670784 PMCID: PMC3966771 DOI: 10.1371/journal.pone.0091539] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/12/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The relation between levels of contraceptive use and the incidence of induced abortion remains a topic of heated debate. Many of the contradictions are likely due to the fact that abortion is the end point of a process that starts with sexual activity, contraceptive use (or non-use), followed by unwanted pregnancy, a decision to terminate, and access to abortion. Trends in abortion rates reflect changes in each step of this process, and opposing trends may cancel each other out. This paper aims to investigate the roles played by the dissemination of contraception and the evolving norms of motherhood on changes in abortion rates. METHODS Drawing data from six national probability surveys that explored contraception and pregnancy wantedness in France from 1978 through 2010, we used multivariate linear regression to explore the associations between trends in contraceptive rates and trends in (i) abortion rates, (ii) unwanted pregnancy rates, (iii) and unwanted birth rates, and to determine which of these 3 associations was strongest. FINDINGS The association between contraceptive rates and abortion rates over time was weaker than that between contraception rates and unwanted pregnancy rates (p = 0.003). Similarly, the association between contraceptive rates and unwanted birth rates over time was weaker than that between contraceptive rates and unwanted pregnancy rates (p = 0.000).
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Clark JT, Clark MR, Shelke NB, Johnson TJ, Smith EM, Andreasen AK, Nebeker JS, Fabian J, Friend DR, Kiser PF. Engineering a segmented dual-reservoir polyurethane intravaginal ring for simultaneous prevention of HIV transmission and unwanted pregnancy. PLoS One 2014; 9:e88509. [PMID: 24599325 PMCID: PMC3943718 DOI: 10.1371/journal.pone.0088509] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/07/2014] [Indexed: 11/06/2022] Open
Abstract
The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems.
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Austveg B. Unwanted pregnancies continue to be a major problem for women's health. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:2444-5. [PMID: 24326486 DOI: 10.4045/tidsskr.13.1510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Alfsen GC, Hernæs L. Dead infants and unmarried women--from forensic pathology reports 1910-12. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:2493-7. [PMID: 24326502 DOI: 10.4045/tidsskr.13.0897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The lack of access to contraceptives and poor control over their own pregnancies represented a major problem for women 100 years ago. An unwanted pregnancy could lead to social exclusion and loss of paid work, and clandestine births and infanticide thus posed a social problem. A review of the archives of the Norwegian Board of Forensic Medicine in the period 1910 to 1912 shows that one-fifth of all expert opinions were related to infants and pregnancy. Autopsies performed on children constituted over one-third of all forensic autopsies during this period. Although the reports provide a timely reminder of the value of hard-earned rights in Norway, the lack of control over their own sexuality and unwanted pregnancies are unfortunately still the reality for a large proportion of the world's women.
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Prata N, Holston M, Fraser A, Melkamu Y. Contraceptive use among women seeking repeat abortion in Addis Ababa, Ethiopia. Afr J Reprod Health 2013; 17:56-65. [PMID: 24558782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Limited access to modern contraceptives in populations that desire smaller families can lead to repeat unintended pregnancy and repeat abortions. We conducted an analysis of the medical records of 1,200 women seeking abortion-related services in public and private facilities in Addis Ababa, Ethiopia from October 2008 to February 2009. We examined the characteristics of initial and repeat abortion clients including prior contraceptive use and subsequent method selection. The incidence of repeat abortion was 30%. Compared with women seeking their first abortion, significantly more repeat abortion clients had ever used contraceptives and they were nearly twice as likely to leave the facility with a method. However, repeat abortion clients were significantly more likely to have ever used short-term reversible methods and to choose short-term methods post-abortion. Contraceptive counseling services for repeat abortion clients' should address reasons for previous contraceptive failure, discontinuation, or non-use. Post-abortion family planning services should be strengthened to help decrease repeat abortion.
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Shneyderman Y, Kiely M. Intimate partner violence during pregnancy: victim or perpetrator? Does it make a difference? BJOG 2013; 120:1375-85. [PMID: 23786367 PMCID: PMC3775877 DOI: 10.1111/1471-0528.12357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To differentiate between forms of intimate partner violence (IPV) (victim only, perpetrator only, or participating in reciprocal violence) and examine risk profiles and pregnancy outcomes. DESIGN Prospective. SETTING Washington, DC, July 2001 to October 2003. SAMPLE A total of 1044 high-risk African-American pregnant women who participated in a randomised controlled trial to address IPV, depression, smoking and environmental tobacco smoke exposure. METHODS Multivariable linear and logistic regression. MAIN OUTCOME MEASURES Low and very low birthweight, preterm and very preterm birth. RESULTS Five percent of women were victims only, 12% were perpetrators only, 27% participated in reciprocal violence and 55% reported no IPV. Women reporting reciprocal violence in the past year were more likely to drink, use illicit drugs and experience environmental tobacco smoke exposure and were less likely to be very happy about their pregnancies. Women reporting any type of IPV were more likely to be depressed than those reporting no IPV. Women experiencing reciprocal violence reported the highest levels of depression. Women who were victims of IPV were more likely to give birth prematurely and deliver low-birthweight and very-low-birthweight infants. CONCLUSIONS We conclude that women were at highest risk for pregnancy risk factors when they participated in reciprocal violence and so might be at higher risk for long-term consequences, but women who were victims of IPV were more likely to show proximal negative outcomes like preterm birth and low birthweight infants. Different types of interventions may be needed for these two forms of IPV.
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Marions L. [Zero vision for abortions is not a goal. The goal is to avoid unwanted pregnancies]. LAKARTIDNINGEN 2013; 110:1652. [PMID: 24199439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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