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Sathitloetsakun S, Phutrakool P, Maitreechit D, Santibenchakul S, Jaisamrarn U, Puangsricharoen P. The prevalence of contraceptive use among postpartum women and its associated factors during the early phase of COVID-19 outbreak: a time series study. Reprod Health 2024; 21:80. [PMID: 38840252 PMCID: PMC11154988 DOI: 10.1186/s12978-024-01803-3] [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: 09/28/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Unintended pregnancies can adversely affect maternal health, preventable through timely postpartum contraception. During the COVID-19 pandemic, family planning services were constrained by policies that curtailed outpatient visits. We investigated the prevalence of postpartum contraceptive initiation at King Chulalongkorn Memorial Hospital (KCMH) during January to June 2020, comparing with the same period in 2019, and identified factors associated with such initiation. METHODS We reviewed the medical records of 4506 postpartum women who delivered at KCMH during the study period. Logistic regression was conducted to test the association between early COVID-19 phase deliveries and post-partum long acting reversible contraception (LARC) initiation including copper intrauterine devices, levonorgestrel intrauterine systems, contraceptive implants, and progestogen-only injectable contraceptives. RESULTS A total of 3765 women (83.6%), of whom 1821 delivered during the pandemic and 1944 during the historical cohort period, were included in this study. The proportion of women who initiated non-permanent modern contraceptives at six weeks postpartum was comparable between the COVID-19 (73.4%) and historical cohort (75.3%) (p = 0.27) periods. The proportion of women who initiated LARC at six weeks postpartumwas comparable between the historical cohort period (22.5%) and the COVID-19 (19.7%) (p = 0.05) period. Accessing a six-week postpartum check-up was independently associated with LARC initiation, of which the adjusted odds ratio (OR) (95% confidence interval) was 3.01 (2.26 to 4.02). CONCLUSIONS Our findings demonstrated that accessing postpartum care significantly associate with the use of LARC. The data suggest the strong influence of postpartum check-ups in facilitating the adoption of effective contraception, emphasizing the need for accessible postpartum care to sustain maternal health during health crises.
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Affiliation(s)
- Sarochinee Sathitloetsakun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Phanupong Phutrakool
- Chula Data Management Center, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Pimpitcha Puangsricharoen
- Division of Academic Affairs Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
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Rodgers DL, Bohrer MB, Morales AA, Needler MD, VandeKoppel P. Using Bibliometric Analysis to Map the Impact of a Simulation Program's Published Scholarly Works. Simul Healthc 2024; 19:179-187. [PMID: 38345225 DOI: 10.1097/sih.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
SUMMARY STATEMENT Bibliometrics quantitatively evaluates the targeted literature sources and can help define research and scholarly publications' impact and demonstrate connections for authors, departments, or universities. This article presents a methodology for simulation programs to evaluate their influence in terms of both impact and scope of their published simulation-based healthcare scholarly output. Using the authors' home university and healthcare system as an example, the article outlines a methodology to map research and scholarly works networks within the systems, identify and map connections outside the system, and quantifiably score the overall impact of the simulation program's scholarly output using a common scoring metric, the h-index. This generates an objective measure of impact, rather than a subjective opinion of an organization's research and scholarly impact. The combination of an institutional h-index with mapping of simulation-based healthcare scholarly output provides a full, objective description of the institution's output and provides a benchmark for other simulation programs for comparison.
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Affiliation(s)
- David L Rodgers
- From the Indiana University School of Medicine Interprofessional Simulation Center (D.L.R., M.D.N.), Bloomington, IN; Indiana University School of Medicine Department of Medicine (D.L.R.), Bloomington, IN; Indiana University School of Medicine (M.B.B., A.A.M.), Bloomington, IN; and Indiana University School of Medicine Department of Emergency Medicine (P.V.), Bloomington, IN
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Santibenchakul S, Thanativakul K, Jaisamrarn U. An educational video on long-acting reversible contraception as a counseling tool for postpartum adolescents. Contracept Reprod Med 2022; 7:24. [PMID: 36376899 PMCID: PMC9664812 DOI: 10.1186/s40834-022-00195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the effects of using an animated local language educational video to counsel postpartum adolescents on the benefits and use of long-acting reversible contraception (LARC). Materials and methods A two-stage, single group, experimental study was conducted. A total of 124 female adolescents aged < 20 years who had given birth within the last six weeks participated in the study. An educational video and a questionnaire were developed and validated. Participants were asked to fill out a questionnaire on basic demographic data, contraception preferences, and 10 true/false statements to test general contraceptive knowledge, after which they were shown an educational video in a private room. Following this, participants completed the second part of the questionnaire that assessed their knowledge using the same true/false statements and contraception preferences administered earlier. Results The mean age (standard deviation) of participants was 18.1 (1.5) years. Participants’ mean age (SD) at the time of their first sexual intercourse was 16.2 (1.6) years. Among the 124 participants, 31 (25%) indicated that they would use LARC before viewing the educational video. After viewing the educational video, this number increased to 48 (38.7%). The participants’ knowledge score was independently associated with their preference to select LARC (adjusted odds ratio 1.46, 95% confidence interval 1.09- 1.97). Conclusion This study demonstrated that counseling tools such as animated local language educational video might effectively improve contraceptive knowledge and the preference for LARC in postpartum adolescents. An educational video regarding LARC could be used as a counseling tool for postpartum adolescents.
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Manalew W, Hale N, Leinaar E, Sen B, Smith M, Khoury A. Medicaid Cost Savings from Provision of Contraception to Beneficiaries in South Carolina, 2012–2018. Popul Health Manag 2022; 25:542-550. [DOI: 10.1089/pop.2021.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W.Samuel Manalew
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Edward Leinaar
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Michael Smith
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Anderson S, Mauskopf J, Talbird SE, White A, Srinivasan M. Antiseizure medications and oral contraceptives: Impact of enzyme inducers on pregnancy outcomes and costs. Epilepsy Behav 2021; 125:108368. [PMID: 34775242 PMCID: PMC8683747 DOI: 10.1016/j.yebeh.2021.108368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To show the impact of drug-drug interactions (DDIs) associated with co-administration of enzyme-inducing (EI) antiseizure medications and oral contraceptives (OCs) on the annual number of unintended pregnancies, their outcomes, and their associated costs in the United States (US). METHODS A Microsoft Excel pregnancy-outcomes model was developed to determine the impact of DDIs in women who take an OC as well as an EI antiseizure medication known to lower the effectiveness of the OC in preventing pregnancy. The model compared the number of unintended pregnancies, the expected pregnancy outcomes, and associated costs in women taking an OC and an EI medication with a matched cohort of women who took an OC and an enzyme-neutral (EN) antiseizure medication that is known not to interact with OCs. The model perspectives were patients and third-party payers in the US. Unintended pregnancy rates, pregnancy outcomes, and cost inputs for the model were taken from published studies. RESULTS The results of the analysis showed an estimated increase in the annual number of unintended pregnancies in the US of 503 (a change from 1151 to 1654), an increase of 44.7%, for the estimated 71,922 women currently taking an OC plus an EI medication in the US when compared with a matched cohort taking an OC plus an EN medication. This resulted in an estimated annual healthcare cost increase of $3 million, which is an increase of 5.5% in the annual costs for contraception and pregnancy care. A scenario analysis showed that the annual number of unintended pregnancies could be lower (575 vs 1654) for a matched cohort of women taking EI medications and using a copper intrauterine device, a highly effective and nonhormonal form of contraception, rather than an OC. CONCLUSIONS Physicians treating women of reproductive age for epilepsy who wish to avoid pregnancy should consider the potential for DDIs that might result in unintended pregnancies. Thus, physicians should alert women using EI medications for epilepsy control to the increased potential for unintended pregnancies if they use OCs for contraception.
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Affiliation(s)
- Seri Anderson
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Josephine Mauskopf
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
| | - Sandra E. Talbird
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Annesha White
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, IREB Office 211, Fort Worth, TX 76107, USA.
| | - Meenakshi Srinivasan
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, IREB Office 211, Fort Worth, TX 76107, USA.
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Srinivasan M, White A, Lott J, Williamson T, Kong SX, Plouffe L. Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States payer perspective. Gates Open Res 2021; 5:171. [DOI: 10.12688/gatesopenres.13430.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In the United States of America (USA), nearly 10 million women use oral contraceptives (OCs). Concomitant administration of certain medications can result in contraceptive failure, and consequently unintended pregnancies due to drug–drug interactions (DDIs). The objective of this analysis was to estimate the economic impact of unintended pregnancies due to DDIs among women of reproductive age using an OC alone or in combination with an enzyme inducer co-medication in the USA from a payer perspective. Methods: A Markov model using a cohort of 1,000 reproductive-age women was developed to estimate costs due to contraceptive failure for OC alone versus OC with concomitant enzyme inducer drugs. All women were assumed to begin an initial state, continuing until experiencing an unintended pregnancy. Unintended pregnancies could result in birth, induced abortion, spontaneous abortion, or ectopic pregnancy. The cohort was analyzed over a time horizon of 1 year with a cycle length of 1 month. Estimates of costs and probabilities of unintended pregnancy outcomes were obtained from the literature. Probabilities from the Markov cohort trace was used to estimate number of pregnancy outcomes. Results: On average, enzyme inducers resulted in 20 additional unintended pregnancies with additional unadjusted and adjusted costs median (range) of USD136,304 (USD57,436–USD320,093) and USD65,146 (USD28,491–USD162,635), respectively. The major component of the direct cost is attributed to the cost of births. Considering the full range of events, DDIs with enzyme inducers could result in 16–25 additional unintended pregnancies and total unadjusted and adjusted costs ranging between USD46,041 to USD399,121 and USD22,839 to USD202,788 respectively. Conclusion: The direct costs associated with unintended pregnancies due to DDIs may be substantial and are potentially avoidable. Greater awareness of DDI risk with oral contraceptives among payers, physicians, pharmacists and patients may reduce unintended pregnancies in at-risk populations.
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White A, Srinivasan M, Wingate LM, Peasah S, Fleming M. Development of a pharmacoeconomic registry: an example using hormonal contraceptives. HEALTH ECONOMICS REVIEW 2021; 11:10. [PMID: 33745016 PMCID: PMC7981865 DOI: 10.1186/s13561-021-00309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Disease-specific registries, documenting costs and probabilities from pharmacoeconomic studies along with health state utility values from quality-of-life studies could serve as a resource to guide researchers in evaluating the published literature and in the conduct of future economic evaluations for their own research. Registries cataloging economic evaluations currently exist, however they are restricted by the type of economic evaluations they include. There is a need for intervention-specific registries, that document all types of complete and partial economic evaluations and auxiliary information such as quality of life studies. The objective of this study is to describe the development of a pharmacoeconomic registry and provide best practices using an example of hormonal contraceptives. METHODS An expert panel consisting of researchers with expertise in pharmacoeconomics and outcomes research was convened and the clinical focus of the registry was finalized after extensive discussion. A list of key continuous, categorical and descriptive variables was developed to capture all relevant data with each variable defined in a data dictionary. A web-based data collection tool was designed to capture and store the resulting metadata. A keyword based search strategy was developed to retrieve the published sources of literature. Finally, articles were screened for relevancy and data was extracted to populate the registry. Expert opinions were taken from the panel at each stage to arrive at consensus and ensure validity of the registry. RESULTS The registry focused on economic evaluation literature of hormonal contraceptives used for contraception. The registry consisted of 65 articles comprising of 22 cost-effectiveness analyses, 9 cost-utility analyses, 7 cost-benefit analyses, 1 cost-minimization, 14 cost analyses, 10 cost of illness studies and 2 quality of life studies. The best practices followed in the development of the registry were summarized as recommendations. The completed registry, data dictionary and associated data files can be accessed in the supplementary information files. CONCLUSION This registry is a comprehensive database of economic evaluations, including costs, clinical probabilities and health-state utility estimates. The collated data captured from published information in this registry can be used to identify trends in the literature, conduct systematic reviews and meta-analysis and develop novel pharmacoeconomic models.
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Affiliation(s)
- Annesha White
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
- Department of Pharmacotherapy, UNT System College of Pharmacy, 3500 Camp Bowie Blvd, IREB 211, Fort Worth, TX 76107 USA
| | - Meenakshi Srinivasan
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
| | | | - Samuel Peasah
- Mercer University College of Pharmacy, Atlanta, GA 30341 USA
| | - Marc Fleming
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
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Kim CS, Lunde B, MacIsaac L, Arden M, Garney WR, Wilson KL, Li Y. Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis. Contraception 2020; 103:107-112. [PMID: 33221276 DOI: 10.1016/j.contraception.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of providing contraceptive implants in school-based health centers (SBHCs) compared to the practice of referring adolescents to non-SBHCs in New York City. STUDY DESIGN We developed a microsimulation model of teen pregnancy to estimate the cost-effectiveness of immediate provision of contraceptive implants at SBHCs over a 3-year time horizon. Model parameters were derived from both a retrospective chart review of patient data and published literature. The model projected the number of pregnancies as well as the total costs for each intervention scenario. The incremental cost-effectiveness ratio was calculated using the public payer perspective, using direct costs only. RESULTS The health care cost of immediate provision of contraceptive implants at SBHCs was projected to be $13,719 per person compared to $13,567 per person for delayed provision at the referral appointment over 3 years. However, immediate provision would prevent 78 more pregnancies per 1000 adolescents over 3 years. The incremental cost-effectiveness ratio for implementing in-school provision was $1940 per additional pregnancy prevented, which was less than the $4206.41 willingness-to-pay threshold. Sensitivity analyses showed that the cost-effectiveness conclusion was robust over a wide range of key model inputs. CONCLUSION Provision of contraceptive implants in SBHCs compared to non-SBHCs is cost-effective for preventing unintended teen pregnancy. Health care providers and policymakers should consider expanding this model of patient-centered health care delivery to other locations.
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Affiliation(s)
- Chi-Son Kim
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, United States.
| | - Britt Lunde
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laura MacIsaac
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Martha Arden
- Division of Adolescent Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, NY, United States
| | - Whitney R Garney
- College of Education and Human Development, Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Kelly L Wilson
- College of Education and Human Development, Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Yan Li
- Department of Population Health Science and Policy, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Mazza D, Amos N, Watson CJ, McGeechan K, Haas M, Peipert JF, Lucke J, Taft A, McNamee K, Black KI. Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial longitudinal follow-up protocol. BMJ Open 2020; 10:e035895. [PMID: 32963063 PMCID: PMC7509957 DOI: 10.1136/bmjopen-2019-035895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/30/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Through addressing main barriers to the uptake of long-acting reversible contraceptives (LARCs) among Australian women, the Australian Contraceptive ChOice pRoject (ACCORd) trialled an educational intervention targeting general practitioners (GPs) and provided those in the intervention group with a rapid referral service for quick insertion. The cluster randomised controlled trial resulted in greater uptake of LARC in the intervention group. This protocol paper describes a longitudinal follow-up to the ACCORd Study to assess the long-term efficacy and cost-effectiveness of the intervention. METHODS AND ANALYSIS Women participants (patients of ACCORd GPs) completed a baseline, 6-month and 12-month survey. These participants will be invited to complete an additional follow-up survey 3 years post completion of their baseline interview. Based on the original ACCORd Study tools, the online survey will address long-term outcomes including contraceptive continuation rates and reproductive history, any unintended pregnancies, satisfaction and concerns with their current contraceptive method, and an assessment of quality of life. We will analyse data using binary regression models with generalised estimating equations and robust standard errors to account for clustering. DISCUSSION Demonstration of sustained use, effectiveness at reducing unwanted pregnancies and cost-effectiveness of this strategy among this cohort of Australian primary care patients, will strengthen the policy and programme urgency of addressing wider dissemination of these strategies and replicating the study elsewhere. ETHICS AND DISSEMINATION The ACCORd Study received approval from the Monash University Human Research Ethics Committee: CF16/188-201000080. Additionally, an amendment to conduct this 3-year longitudinal follow-up survey has been approved. The trial follow-up outcomes will be disseminated through formal academic pathways, including journal articles, national and international conferences and reports as well as using more 'mainstream' strategies such as seminars, workshops and media engagement. Additionally, outcomes will be communicated through policy briefs to Australian state and federal governments. TRAIL REGISTRATION NUMBER This trial is registered with the Australian and New Zealand Trials Registry ACTRN12615001346561. Recruitment and data collection have been completed for the baseline, 6-month and 12-month surveys. Data collection for the 3-year survey commenced in August 2019.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Natalie Amos
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Cathy J Watson
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Kevin McGeechan
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marion Haas
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeffrey F Peipert
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | | | - Kirsten I Black
- Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
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Melo CRME, Borges ALV, Duarte LS, Nascimento NDC. Contraceptive use and the intention to become pregnant among women attending the Brazilian Unified Health System. Rev Lat Am Enfermagem 2020; 28:e3328. [PMID: 32813784 PMCID: PMC7426141 DOI: 10.1590/1518-8345.3451.3328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/08/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the use of contraceptive methods and the intention to become pregnant among women attending the Brazilian Unified Health System. METHOD a cross-sectional study conducted with 688 women aged 18-49 years old, attending the Family Health Strategy Facilities in the eastern part of the city of São Paulo, Brazil, who were awaiting medical or nursing consultation. Data were obtained through interviews with a structured instrument, allocated in tablets. The analysis was conducted with "strong desire to avoid pregnancy" as the dependent variable. Chi-square and multiple logistic regression were used, calculated in Stata 14.2. RESULTS 56.5% used some contraceptive method, covariates of the strong desire to avoid pregnancy were marital status (OR=0.49; CI95%=0.33-0.74), parity - two and more children (OR=15.9; IC95%=4.29-59.1); and pregnancy planning - planned (OR=0.69; IC95%=0.73-0.94) and ambivalent (OR=2.94; IC95%=1.30-3.83). There was no statistical difference between the strong desire to avoid pregnancy and the type of contraceptive used. CONCLUSION women with a strong desire to avoid pregnancy used basically the same types of contraceptive methods as women in general, which shows that they have not been supported to achieve their reproductive preferences.
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Abstract
Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are “forgettable” and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent.
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Affiliation(s)
- Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Amanda Black
- Department of Obstetrics and Gynecology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, Canada
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Kaitz M, Mankuta D, Mankuta L. Long-acting reversible contraception: A route to reproductive justice or injustice. Infant Ment Health J 2019; 40:673-689. [PMID: 31329311 PMCID: PMC6972575 DOI: 10.1002/imhj.21801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article presents information on unintended pregnancies and the ongoing efforts of policy makers to promote long-acting reversible contraception (LARC) to reduce the numbers of such pregnancies. Also discussed is the tension between the encouragement of LARC to promote the public's interests in achieving that goal versus the need to assure that all women can decide about their bodies and reproductive needs. Our discussion includes information, primarily from the United States, on (a) risks associated with unintended pregnancies, (b) LARC devices approved in the United States (copper intrauterine devices (IUDs), hormone IUDs, and implants), (c) public and social benefits of increasing the use of LARC, (d) disadvantages and barriers to using LARC, (e) dangers of promoting LARC in unjust ways, and (f) the meaning of reproductive justice and its connection to social justice. By sharing the information with the audience of this journal, we hope that it will be integrated into clinical work and research on mental health and development. We also hope that experts in those fields will become discussants in the conversation regarding women's reproductive health and social justice that is taking place in the United States and elsewhere.
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Affiliation(s)
- Marsha Kaitz
- Department of PsychologyHebrew UniversityJerusalemIsrael
| | - David Mankuta
- Department of Obstetrics and GynecologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Lihi Mankuta
- Department of MedicineFaculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
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Intrauterine Contraception: Knowledge and Prescribing Practices of Canadian Health Care Providers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1084-1092. [PMID: 30898549 DOI: 10.1016/j.jogc.2018.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/23/2018] [Accepted: 11/24/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Contraception is an important issue in the lives of women, their partners, and society. Canadians and their health care providers play a critical role in contraceptive decision making that influences individuals and Canadian society. The purpose of this study was to gather data on contraception-related knowledge, counselling, and prescribing practices of Canadian health care providers. METHODS This project reported on the outcomes of an educational initiative, designed as a quality improvement initiative (time series level II-3), focused on Canadian health care providers' contraception-related knowledge, counselling, and prescribing practices. Outcomes were intended to inform the development of tools, resources, and educational programming. Part 1 was an online program to identify educational and knowledge gaps for health care providers. Part 2 was a practice assessment exploring and measuring health care providers' contraceptive counselling and prescribing practices. RESULTS A total of 4300 health care providers completed the program between July 6, 2015 and August 30, 2016. Knowledge significantly increased; post-test scores were higher than pretest scores. After completion, all participants felt more comfortable, knowledgeable, and inclined to change their practice around prescribing intrauterine contraception (IUC). The 4300 providers reported on their contraception counselling experiences with 10 patients following participation in Part 1. Forty percent of patients were using oral contraceptives, and 53% were dissatisfied with their current type of contraception. After counselling, patients reported being most comfortable with IUC (55%). Both short- and long-acting types of contraception were most often discussed or offered (74% of the time), followed by long-acting reversible contraception only (21%) and short-acting methods only (5%). CONCLUSION This training program filled an education need for patients and gave providers tools to change their behaviour and practice around IUC prescribing. On the basis of these data, a practice assessment model was deemed a successful way to change behaviour.
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