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Destaw A, Tesfaye M, Shifera N, Yosef T. Long-Acting Contraceptive Switching and Its Associated Factors among Married Women in Southwest Ethiopia. SAGE Open Nurs 2024; 10:23779608241262908. [PMID: 38887366 PMCID: PMC11181893 DOI: 10.1177/23779608241262908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/15/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Contraceptive switching from a more effective to a less effective method is a concern, especially in developing countries with high unmet needs for family planning. Indeed, the lack of understanding regarding the reasons behind contraceptive switching behavior in the study area poses a significant challenge in effectively addressing this issue. Objective This study aimed to assess the magnitude and factors associated with long-acting contraceptive switching in Mizan-Aman town, southwest Ethiopia. Methods A community-based cross-sectional study was conducted, involving 345 women randomly selected from the population of married women in their reproductive age group. Data collection was conducted through interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were employed to ascertain factors linked with contraceptive method switching status. Statistical significance was determined at a P-value of less than .05. Results Out of the 345 participants interviewed, the prevalence of switching from long-acting to short-acting contraceptives was 28.4%, 95% CI (13.6%, 33.2%). Upon adjusting for confounding variables, factors significantly associated with contraceptive switching included women aged 31-35 [adjusted odds ratio (AOR) = 0.58; 95% CI (0.36, 0.74)] and aged 41-49 [AOR = 0.54; 95% CI (0.48, 0.82)], those with formal education [AOR = 0.79; 95% CI (0.52, 0.87)], those desiring future pregnancy [AOR = 2.12; 95% CI (1.98, 3.38)], experiencing complications from previous method use [AOR = 3.67; 95% CI (2.57, 7.40)], and encountering stockouts of their preferred contraceptive choice [AOR = 2.01; 95% CI (1.39, 3.24)]. Conclusion and recommendation The study area exhibited a notable prevalence of switching from long-acting contraceptives. Complications arising from prior method use and the unavailability of preferred contraceptive options emerged as significant factors influencing this switching behavior. Thus, it underscores the importance of providing counseling and ongoing support to women, ensuring access to safer and more effective modern contraceptive methods.
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Affiliation(s)
- Alemnew Destaw
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Melkamsew Tesfaye
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Nigusie Shifera
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Tewodros Yosef
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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Mittal S, Gupta V, Saxena N, Lata K. Patient Perspectives on Contraceptive use in North India: A Case for Increased Contraceptive Counseling by Providers. J Obstet Gynaecol India 2023; 73:512-521. [PMID: 38205116 PMCID: PMC10774318 DOI: 10.1007/s13224-023-01781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/28/2023] [Indexed: 01/12/2024] Open
Abstract
Background Given the underutilization of contraception in India, this study was undertaken to gauge cisgender female clients' knowledge of, attitudes toward, and barriers to contraceptive usage in North India. Methodology The present study was done at a tertiary care Institute in North India, where 209 structured interviews were conducted with cisgender female patients attending the outpatient department. One-way chi-square tests for independence, Kruskal-Wallis test, and Wilcoxon test were applied to quantitative data. Themes from qualitative questions were coded and analyzed. Results Differences in awareness among contraceptives were found to be highly statistically significant (H (9) = 1022.3, p < 2.2 e-16). Friends or colleagues comprised the predominant information source for most contraceptive methods. Participants' contraceptive usage was low, with 27.27% stating no prior use and 47.47% indicating occasional use (X2 (3, N = 198) = 66.121, p < 2.89 e-14). Lack of perceived need, concern for side effects, fear and desire for children were top reasons for non-use of contraceptive methods. Majority of the participants (79.45%) expressed comfort speaking with their spouse about contraception, 47.18% with a medical provider, 32.82% with friends, 15.38% with family, 2.05% with a health educator, and 3.59% with no one. Participants indicated little prior contraceptive counseling experience. Conclusion Our study shows differential levels of awareness, usage, and barriers on contraceptive methods among participants. Results also suggest the importance of spouses and friends in clients' contraceptive decision-making process and their limited counseling experience with health care providers.
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Affiliation(s)
- Sneha Mittal
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand India
- Present Address: University of Tennessee Health Science Center College of Medicine, Memphis, TN USA
| | - Vineeta Gupta
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand India
| | - Namrata Saxena
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand India
| | - Kirti Lata
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand India
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Donders G, Kopp Kallner H, Hauck B, Bauerfeind A, Frenz AK, Zvolanek M, Stovall DW. Bleeding profile satisfaction and pain and ease of placement with levonorgestrel 19.5 mg IUD: findings from the Kyleena ® Satisfaction study. EUR J CONTRACEP REPR 2023; 28:1-9. [PMID: 36342694 DOI: 10.1080/13625187.2022.2136939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate bleeding profile satisfaction and pain and ease of placement with levonorgestrel 19.5 mg IUD in routine clinical practice. METHODS Women who independently chose levonorgestrel 19.5 mg IUD during routine counselling were invited to participate in this prospective, multinational, observational study. Patient-reported pain and clinician-reported ease of placement were assessed. Bleeding profile satisfaction was evaluated at 12 months/premature end of observation. RESULTS Most participants (77.8%, n = 878/1129) rated levonorgestrel 19.5 mg IUD placement pain as 'none' or 'mild' and most clinicians (91.1%, n = 1029/1129) rated placement as 'easy'. Pain was more often rated higher in nulliparous compared with parous (p < .0001) and younger (<26 years) compared with older participants (p < .0001), although 67.7% and 69.0% of nulliparous and younger participants respectively reported 'none' or 'mild' pain. Bleeding profile satisfaction at 12 months/end of observation was similar in parous (72.9%, n = 318/436) and nulliparous (69.6%, n = 314/451) participants. Most participants irrespective of age reported bleeding profile satisfaction, ranging from 67.8% (n = 206/304) for 18-25 years to 76.5% (n = 218/285) for >35 years. CONCLUSION We observed high bleeding profile satisfaction regardless of age or parity with levonorgestrel 19.5 mg IUD and confirmed that device placement is easy and associated with no more than mild pain in most cases in routine clinical practice. Real-world evidence from the Kyleena® Satisfaction Study in routine clinical practice shows high bleeding profile satisfaction with levonorgestrel 19.5 mg IUD regardless of age or parity. IUD placement was easy and associated with little to no pain for most women.
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Affiliation(s)
- Gilbert Donders
- Department of Clinical Research for Women, Femicare VZW, Tienen, Belgium.,Department of Obstetrics and Gynecology, University Hospital, University of Antwerp, Antwerp, Belgium
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Brian Hauck
- Department of Obstetrics and Gynecology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Anja Bauerfeind
- Statistics and Methodology, ZEG - Berlin Center for Epidemiology and Health Research GmbH, Berlin, Germany
| | | | | | - Dale W Stovall
- Department of Obstetrics and Gynecology, Methodist Dallas Medical Center, Dallas, TX, USA
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Gebeyehu NA, Tegegne KD, Biset G, Sewuyew DA, Alemu BW, Yitayew AM. Discontinuation of long acting reversible contraceptive use and its determinants among women in Ethiopia: Systematic review and meta-analysis. Front Public Health 2022; 10:979231. [PMID: 36561863 PMCID: PMC9763286 DOI: 10.3389/fpubh.2022.979231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Contraception discontinuation is a major public health issue that leads to unwanted pregnancies and unsafe abortions. Therefore, this systematic review and meta-analysis aimed to estimate discontinuation of contraceptives and its determinants in Ethiopia. Methods PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region, study setting, and publication. The pooled odds ratio for associated factors was also computed. Results Out of 654 studies assessed, 20 met our criteria and were included in the study. The total number of study participants was 8,780. The pooled prevalence of discontinuation of long acting reversible contraceptive use was 36.94% (95% CI: 28.547-45.326). According to sub-group analysis, Amhara region (45%) and institution-based studies (47.9%) had the highest prevalence. The most common reason for contraceptive discontinuation was negative side effect (42.3%).Women experienced side effects (AOR = 2.833:95% CI:2.005-4.003), didn't receive counseling on side effects (AOR = 2.417; 95% CI: 1.591-3.672), didn't appoint follow up (AOR = 2.820; 95% CI: 2.048-3.881), dissatisfied with the given service (AOR = 5.156; 95% CI: 3.644-7.296), and a desire to be pregnant (AOR = 2.366; 95% CI: 1.760-3.182) were predictors of discontinuation of contraceptives. Conclusion In Ethiopia, the pooled prevalence of long acting contraceptive discontinuation was high. Side effects, not being informed about side effects, dissatisfaction with the provided service, no insertion follow-up, and a desire to become pregnant were all associated factors. Healthcare professionals should focus on the client's reproductive goals, proper management of side effects, counseling, and post-insertion visits. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022347860, identifier CRD42022347860.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia,*Correspondence: Natnael Atnafu Gebeyehu
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Gebyaw Biset
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Dagne Addisu Sewuyew
- Department of Midwifery, College of Medicine and Health Science, Debretabore University, Debre Tabor, Ethiopia
| | - Biresaw Wassihun Alemu
- Department of Midwifery, College of Medicine and Health Science, Injbara University, Injbara, Ethiopia
| | - Alemker Mola Yitayew
- School of Medicine, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
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Perelló Capó J, López González G, Rius-Tarruella J, Calaf Alsina J. Real-world satisfaction and menstrual bleeding pattern with available LNG-IUD among Spanish young women. EUR J CONTRACEP REPR 2022; 27:461-472. [PMID: 36148980 DOI: 10.1080/13625187.2022.2112562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/05/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the satisfaction and menstrual bleeding pattern with levonorgestrel-releasing intrauterine systems (LNG-IUD) in young women. METHODS A prospective, multicentre, non-interventional study with 1-year follow-up was conducted in Spain. Participants were women between 18 and 30 years old who freely choose any available LNG-IUD for contraception. Satisfaction with LNG-IUD was measured with a 5-point Likert scale. Type of LNG-IUD, menstrual bleeding pattern and satisfaction with it, easiness of insertion and pain during procedure were collected. RESULTS A total of 555 women (37.3% parous, 62.7% nulliparous) (mean age 25.8 ± 3.5) completed the study. After 12 months, 92.4% of women were satisfied or very satisfied with the LNG-IUD, with no differences by parity status, type of IUD or baseline menstrual bleeding pattern. Satisfaction with the LNG-IUD correlated with satisfaction with menstrual bleeding pattern at 12 months. Up to 88.7% of women were satisfied or very satisfied with their menstrual bleeding pattern at 12 months in comparison to 41.5% at baseline (p < 0.001). Adverse events (AE)-related discontinuation rate was low (2.2%). CONCLUSIONS Satisfaction with LNG-IUD is very high among young Spanish women, regardless of parity and menstrual bleeding pattern at baseline.
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Affiliation(s)
- Josep Perelló Capó
- Santa Creu i Sant Pau Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Joaquim Calaf Alsina
- Santa Creu i Sant Pau Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Silva CF, Silva I, Rodrigues A, Sá L, Beirão D, Rocha P, Santos P. Young People Awareness of Sexually Transmitted Diseases and Contraception: A Portuguese Population-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13933. [PMID: 36360810 PMCID: PMC9656238 DOI: 10.3390/ijerph192113933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Adolescents and young adults are an important target concerning reducing health-risk behavior adoption, including sexual health. Studying their knowledge concerning sexuality and their main counsellors, can be an important step in targeting an updated health promotion approach. This study characterized adolescents and young adults' knowledge and attitudes about sexually transmitted diseases (STDs), and contraception, prospecting for their main trusted counseling sources. We conducted a cross-sectional, population-based, self-report survey of 746 individuals aged between 14 and 24 years from Paredes, Portugal. The questionnaire included many dimensions, as demographic characteristics, youth behavior, currently sexually active status, main counselors concerning health topics, awareness, and knowledge about STDs and contraception. Mean age of the participants was 18.3 years, 50.5% of them had started their sexual activity. Males present themselves as more sexually active, starting earlier, and have more sexual partners than females. Participants reported an adequate knowledge perception about STDs and contraception methods, however we found different patterns on specific STDs and contraceptive methods, according to gender, age, and sexually active status. Our results help design specific interventions to reach youth, community, and healthcare providers, pointing out the value of bringing people to the center of health policies.
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Affiliation(s)
- Carlos Franclim Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
| | - Inês Silva
- Unidade de Saúde Familiar São João do Porto, Rua Miguel Bombarda, 234, 4050-377 Porto, Portugal
| | - Alexandra Rodrigues
- Serviço de Dermatologia do Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Luísa Sá
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
| | - Daniel Beirão
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
| | - Paula Rocha
- Center for Research in Higher Education Policies (CIPES), Universities of Aveiro and Porto, Rua 1º Dezembro 399, 4450-227 Matosinhos, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
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Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women's contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:267-274. [PMID: 35228303 DOI: 10.1136/bmjsrh-2021-201301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Contraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women's contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake. METHOD We used Facebook advertising to recruit young women aged 16-25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations). RESULTS A total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11). CONCLUSIONS Many young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Pip Buckingham
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edwina McCarthy
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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Bolarinwa OA, Nwagbara UI, Okyere J, Ahinkorah BO, Seidu AA, Ameyaw EK, Igharo V. Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries. Int Health 2021; 14:492-500. [PMID: 34405873 PMCID: PMC9450634 DOI: 10.1093/inthealth/ihab053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA). Methods Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15–49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05. Results The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child. Conclusions The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Ugochinyere Ijeoma Nwagbara
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast,PMB, Ghana.,College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, QLD4811, Australia.,Department of Estate Management, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana
| | | | - Victor Igharo
- John's Hopkins Centre for Communications Programs, 111 Market Place Suite 310 Baltimore, MD, USA
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Le Guen M, Schantz C, Régnier-Loilier A, de La Rochebrochard E. Reasons for rejecting hormonal contraception in Western countries: A systematic review. Soc Sci Med 2021; 284:114247. [PMID: 34339927 DOI: 10.1016/j.socscimed.2021.114247] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading "hormonophobia", i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.
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Affiliation(s)
- Mireille Le Guen
- Centre for Demographic Research, Université catholique de Louvain, Place Montesquieu 1, L2.08.03, B-1348, Louvain-la-Neuve, Belgium; Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Clémence Schantz
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) and Université de Paris, Inserm ERL 1244, 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Arnaud Régnier-Loilier
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France.
| | - Elise de La Rochebrochard
- Institut National d'Études Démographiques (Ined), 9 Cours des Humanités, F-93300, Aubervilliers, France; Univ. Paris-Saclay, UVSQ, Inserm, CESP, F-94807, Villejuif, France.
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Karakoyun T, Podhaisky HP, Frenz AK, Schuhmann-Giampieri G, Ushikusa T, Schröder D, Zvolanek M, Lopes Da Silva Filho A. Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study. JMIR Med Inform 2021; 9:e24633. [PMID: 34255688 PMCID: PMC8317031 DOI: 10.2196/24633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone–based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods The MyIUS app is classified as a medical device and uses an artificial intelligence–based bleeding pattern prediction algorithm to estimate a woman’s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting.
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Affiliation(s)
| | | | | | | | | | - Daniel Schröder
- BAYOOMED Medical Software Development, BAYOONET AG, Darmstadt, Germany
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