1
|
Bullard KA, Ramanadhan S, Caughey AB, Rodriguez MI. Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 144:294-303. [PMID: 39053007 DOI: 10.1097/aog.0000000000005679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth. METHODS We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI , defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities. RESULTS Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796. CONCLUSION Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.
Collapse
Affiliation(s)
- Kimberley A Bullard
- Department of Obstetrics and Gynecology, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; and the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | | | | | | |
Collapse
|
2
|
Choo BV, Vostrcil LA, Plummer EL, Fairley CK, Bradshaw CS, McNamee K, Henzell H, Chen MY, Chow EPF, Phillips TR. Trends in different contraception methods among women attending the Melbourne Sexual Health Centre from 2011 to 2020. Public Health 2024; 233:130-136. [PMID: 38875732 DOI: 10.1016/j.puhe.2024.04.032] [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: 02/27/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN Repeated cross-sectional study. METHODS Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.
Collapse
Affiliation(s)
- B V Choo
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - L A Vostrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - E L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - K McNamee
- Sexual Health Victoria, Melbourne 3000, Australia.
| | - H Henzell
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - M Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - E P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - T R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
3
|
White KO, Treder KM, Fico P, Raskin E, Lerner NM. Development and Evaluation of a Novel Approach to Patient-Centered Contraceptive Counseling. Womens Health Issues 2024:S1049-3867(24)00050-1. [PMID: 39048462 DOI: 10.1016/j.whi.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES We aimed to develop and evaluate a novel model, PHI CARE, that provides a standardized framework for shared decision-making in contraceptive counseling. METHODS We developed the PHI CARE model with national experts, piloted it at three family planning clinics, and finalized it following additional patient and clinician review. We recruited pregnancy-capable people for an evaluation study via simulated contraceptive counseling and identified salient themes through inductive and deductive coding. RESULTS Participants (n = 12) felt that counseling with the PHI CARE model was an improvement over previous counseling experiences and led to feelings of empowerment; participants did not feel pressured to decide about method use, felt in control during the conversation, and appreciated the lack of assumptions about their desires around pregnancy. Despite the standardized format, participants felt the counseling was individualized, "values-based," and tailored to their preferences. CONCLUSION PHI CARE is a model to support clinicians and counselors in operationalizing the principles of shared decision-making in contraceptive counseling. Through standardization, PHI CARE allows for a more individualized experience for patients and addresses many critiques of traditional counseling. PRACTICE IMPLICATIONS PHI CARE is a memorable, brief tool that can be used for patient-centered contraceptive counseling in any clinical encounter.
Collapse
Affiliation(s)
- Katharine O White
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts.
| | - Kelly M Treder
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Placidina Fico
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Raskin
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Natasha M Lerner
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
4
|
Saadedine M, Faubion SS. Hormonal Contraception and Sexual Function: A Review, Clinical Insights, and Management Considerations. Obstet Gynecol Clin North Am 2024; 51:381-395. [PMID: 38777490 DOI: 10.1016/j.ogc.2024.02.008] [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] [Indexed: 05/25/2024]
Abstract
Most sexually active women of reproductive age have used contraception, with hormonal methods constituting approximately 40% of contraceptive choices. Among these hormonal options, combined oral contraceptives stand out as the most selected. Within this same demographic, sexual issues are prevalent. Although specific hormonal contraceptives have been implicated in sexual dysfunction among these women, the correlation lacks consistency across studies and varies between different types of hormonal contraception. This article assesses the available literature on the associations between various hormonal contraceptive methods and sexual function and provides practical management insights.
Collapse
Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
5
|
Zapata LB, Kortsmit K, Curtis KM, Romero L, Hurst S, Lathrop E, Acosta Perez E, Sánchez Cesáreo M, Whiteman MK. Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z-CAN) in Puerto Rico, 2016-2020. Stud Fam Plann 2024; 55:105-125. [PMID: 38659169 PMCID: PMC11299421 DOI: 10.1111/sifp.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The Zika Contraception Access Network (Z-CAN) provided access to high-quality client-centered contraceptive services across Puerto Rico during the 2016-2017 Zika virus outbreak. We sent online surveys during May 2017-August 2020 to a subset of Z-CAN patients at 6, 24, and 36 months after program enrollment (response rates: 55-60 percent). We described contraceptive method continuation, method satisfaction, and method switching, and we identified characteristics associated with discontinuation using multivariable logistic regression. Across all contraceptive methods, continuation was 82.5 percent, 64.2 percent, and 49.9 percent at 6, 24, and 36 months, respectively. Among continuing users, method satisfaction was approximately ≥90 percent. Characteristics associated with decreased likelihood of discontinuation included: using an intrauterine device or implant compared with a nonlong-acting reversible contraceptive method (shot, pills, ring, patch, or condoms alone); wanting to prevent pregnancy at follow-up; and receiving as their baseline method the same method primarily used before Z-CAN. Other associated characteristics included: receiving the method they were most interested in postcounseling (6 and 24 months) and being very satisfied with Z-CAN services at the initial visit (6 months). Among those wanting to prevent pregnancy at follow-up, about half reported switching to another method. Ongoing access to contraceptive services is essential for promoting reproductive autonomy, including supporting patients with continued use, method switching, or discontinuation.
Collapse
Grants
- CC999999 Intramural CDC HHS
- The CDC Foundation secured large-scale donations, offers of contraceptive products, support tools, and services from Bayer, Allergan, Medicines360, Americares and Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mylan, the Pfizer Foundation, Teva Pharmaceuticals, Church & Dwight Co., Inc., RB, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), Upstream USA, and Market Vision, Culture Inspired Marketing.
- Funding for the Z-CAN program via the CDC Foundation was made possible by the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the William and Flora Hewlett Foundation, the Pfizer Foundation, and the American College of Obstetricians and Gynecologists.
- This data collection was funded by the Centers for Disease Control and Prevention (CDC).
Collapse
Affiliation(s)
- Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Edna Acosta Perez
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Marizaida Sánchez Cesáreo
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| |
Collapse
|
6
|
Bullard KA, Hersh A, Caughey AB, Rodriguez MI. Expanding comprehensive pregnancy care for Emergency Medicaid recipients: a cost-effectiveness analysis. Am J Obstet Gynecol MFM 2024; 6:101364. [PMID: 38574857 PMCID: PMC11102284 DOI: 10.1016/j.ajogmf.2024.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Emergency Medicaid is a restricted benefits program for individuals who have low-income status and who are immigrants. OBJECTIVE This study aimed to compare the cost-effectiveness of 2 strategies of pregnancy coverage for Emergency Medicaid recipients: the federal minimum of covering the delivery only vs extended coverage to 60 days after delivery. STUDY DESIGN A decision analytical Markov model was developed to evaluate the outcomes and costs of these policies, and the results in a theoretical cohort of 100,000 postpartum Emergency Medicaid recipients were considered. The payor perspective was adopted. Health outcomes and cost-effectiveness over a 1- and 3-year time horizon were investigated. All probabilities, utilities, and costs were obtained from the literature. Our primary outcome was the incremental cost-effectiveness ratio of the competing strategies. RESULTS Extending Emergency Medicaid to 60 days after delivery was determined to be a cost-saving strategy. Providing postpartum and contraceptive care resulted in 33,900 additional people receiving effective contraception in the first year and prevented 7290 additional unintended pregnancies. Over 1 year, it resulted in a gain of 1566 quality-adjusted life year at a cost of $10,903 per quality-adjusted life year. By 3 years of policy change, greater improvements were observed in all outcomes, and the expansion of Emergency Medicaid became cost saving and the dominant strategy. CONCLUSION The inclusion of postpartum care and contraception for immigrant women who have low-income status resulted in lower costs and improved health outcomes.
Collapse
Affiliation(s)
- Kimberley A Bullard
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez); Department of Obstetrics and Gynecology, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN (Dr Bullard)
| | - Alyssa Hersh
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez)
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez)
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez).
| |
Collapse
|
7
|
Jean de Dieu H, Lambert M. Predictors of contraceptive discontinuation in Rwanda: evidence from demographic and health survey 2019-2020. Contracept Reprod Med 2024; 9:19. [PMID: 38664853 PMCID: PMC11044445 DOI: 10.1186/s40834-024-00282-y] [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: 05/01/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite advancements, Rwanda continues to face challenges regarding contraceptive discontinuation. The 2019-2020 Rwanda Demographic and Health Survey (DHS) reported a 30% discontinuation rate among women within the first year of use. This study analyses predictors of discontinuation using this DHS data, with the goal of strengthening Rwanda's family planning programs. METHODS Data from the 2019-20 Rwanda DHS (14,634 women aged 15-49) was examined. A two-stage sampling design informed the survey. Life table methods and Cox proportional hazard models were used to analyze discontinuation rates, median usage duration across contraceptive methods, and the influence of demographic and other factors. RESULTS Results indicated a progressive rise in contraceptive discontinuation over different period: 16.69% at 6 months, 29.29% at 12 months, and 47.21% at 24 months. Pills and male condoms showed higher discontinuation probabilities early on. While injectables and LAM initially showed lower discontinuation, rates rose significantly by the 24th month. Health concerns and side effects were the primary reasons cited for discontinuation. The Cox proportional hazards analysis revealed significant factors influencing discontinuation: contraceptive method, desire for pregnancy, husband's disapproval, access/availability, and the desire for a more effective method. CONCLUSION This study highlights substantial contraceptive discontinuation rates in Rwanda, particularly for pills and injectables. Method type, health concerns, side effects, and method failure were associated with discontinuation. Interventions should focus on improving contraceptive continuation and investigating alternative methods with lower discontinuation tendencies.
Collapse
|
8
|
Chofakian CBDN, Borges ALV. Contraceptive switch and abandonment among women using the pill, condoms and injectables in Brazil. EUR J CONTRACEP REPR 2024; 29:15-23. [PMID: 38108084 DOI: 10.1080/13625187.2023.2289831] [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: 03/09/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of our study was to assess the covariates of contraceptive switching and abandonment among Brazilian women stratified by oral pills, condoms and injectables. MATERIALS AND METHODS Women attending primary health care services in three Brazilian mid- to large-sized cities were interviewed face-to-face about their contraceptive practices (n = 2,051). Data were collected using a contraceptive calendar. Analysis included estimates using Kaplan-Meier multiple-decrement life-table probabilities and discrete-time hazards modelling of switching from a method to another or to no method. RESULTS Among 3,280 segments of contraceptive use, we observed that five-year contraceptive switching rates ranged from 34.9% among injectable users to 56.1% among pill users. Of particular concern were the high discontinuation rates of abandonment, which ranged from 50.9% among injectable users to 77.4% among pill users. Covariates of method switching and abandonment varied by type of method, but age, race/ethnicity, religion and relationship status must be highlighted as key elements of discontinuation. CONCLUSION Contraceptive method switching and abandoning are frequent outcomes of contraceptive use. Understanding the factors that shape women's decisions to continue or discontinue the use of a contraceptive method can help tailoring comprehensive contraceptive counselling that meet their expectations and reproductive needs when starting using a method.
Collapse
Affiliation(s)
| | - Ana Luiza Vilela Borges
- Department of Public Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Cruz-Lama L, Villalobos R, Tello M, Cruz-Vargas JADL, Gutierrez EL. Factors associated with the discontinuation of hormonal contraceptives in women of Lima, Peru. Eur J Midwifery 2024; 8:EJM-8-01. [PMID: 38189079 PMCID: PMC10767759 DOI: 10.18332/ejm/174478] [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: 06/26/2023] [Revised: 10/18/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Family planning is a right and a tool that offers the possibility of choosing how many children to have. Its importance lies in the possibility of avoiding an unwanted pregnancy and its consequences. Our objective was to determine the factors associated with discontinuing hormonal contraceptives in women of childbearing age who attended the La Libertad Health Center in January 2023. METHODS The study was observational, analytical, and cross-sectional. A total of 100 women of childbearing age who were users of hormonal contraceptives were included. Descriptive statistics were performed, frequency measurements and measures of central tendency were calculated, bivariate statistics were performed and the prevalence ratio (PR) was calculated, and a robust Poisson regression model was performed to assess the associated independent factors. All calculations were made with a confidence level of 95%. RESULTS The educational level (PR=1.74; 95% CI: 1.22-2.48, p=0.006), the distance to the health center (PR=7.32; 95% CI: 1.1-48.5, p=0.001), having presented adverse events (PR=26.38; 95% CI: 3.8-183, p=0.001), and that the health staff had not identified the need for contraception (PR=3.12; 95% CI: 0.87-11.10, p=0.01) were associated with stopping a hormonal contraceptive. After introducing the variables to the regression model, the only independently associated factor was having presented an adverse event with the use of hormonal contraceptives (adjusted prevalence ratio, APR=3.33; 95% CI: 2.1-5.2, p<0.001). CONCLUSIONS In this population, the factors associated with the discontinuation of hormonal contraceptives were education level, distance to the health center, having presented some adverse event with its use, and that health staff had not identified the need for contraception. The only independently associated factor was having presented an adverse event.
Collapse
Affiliation(s)
- Lesly Cruz-Lama
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
| | - Robin Villalobos
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Mercedes Tello
- Ministerio de Salud, Dirección de Redes Integradas de Salud Lima Sur, Lima, Peru
| | | | - Ericson L. Gutierrez
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Nguyen BT, Heyrana K, Ohsfeldt R, Johnston A, Summers K. Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims. J Manag Care Spec Pharm 2023; 29:1303-1311. [PMID: 38058139 PMCID: PMC10776262 DOI: 10.18553/jmcp.2023.29.12.1303] [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: 12/08/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. OBJECTIVE To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. METHODS In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. RESULTS Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. CONCLUSIONS In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.
Collapse
Affiliation(s)
- Brian T. Nguyen
- Department of Clinical Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Katrina Heyrana
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert Ohsfeldt
- Texas A&M School of Public Health, College Station
- Medical Decision Modeling, Inc., Indianapolis, IN
| | | | - Kent Summers
- AlphaScientia, a Red Nucleus company, King of Prussia, PA
| |
Collapse
|
12
|
Teshoma F, Tefera EG, Girma T, Ragasa MT, Yohannes E, Bulto GA, Wakgari N. Long-acting family planning switching and associated factors among revisit women in Toke Kutaye district of West Shoa Zone, Oromia Region public health facilities, Ethiopia: a mixed methods study. BMC Womens Health 2023; 23:512. [PMID: 37743477 PMCID: PMC10518956 DOI: 10.1186/s12905-023-02664-x] [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: 10/28/2022] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Switching from a long-acting family planning (LAFP) method to another could lead to an unintended pregnancy. However, the proportions of LAFP method switching and predictable factors are not well addressed. Therefore, the aim of this study was to determine the magnitude of LAFP method switching and associated factors among revisit women. The study also explored the reasons for the LAFP method switching among the revisited women. METHOD A mixed methods study was conducted among 377 reproductive age women attending public health facilities in Toke Kutaye district, West Shoa, Zone, Ethiopia, from 20 May 2021 to 28 July 2021. A systematic random sampling for quantitative and purposive sampling technique for qualitative study was used to select the study participants. A pretested structured questionnaire and in-depth interview were used to determine and explore long-acting family planning switching among revisit women. Data were analysed by Statistical Package for the Social Sciences (SPSS) version 21. Binary logistic regression was conducted to identify the dependent and independent variables at p-value < 0.05 along with 95% Confidence Interval (CI) and Adjusted Odds Ratio (AOR). The qualitative data were analysed using thematic analysis. RESULTS The magnitude of long-acting family planning method switching was 53.3%. Switching from an implant to other short-acting method was 39.8%, and switching from an intrauterine contraceptive device (IUCD) to other short-acting method was 13.5%. A formal education (AOR, 10.38, 95% CI: 3.48, 30.95), birth spacing (AOR, 5.52, 95% CI: 1.31, 23.33) and perceived infertility (AOR, 11.16, 95% CI: 5.55, 22.45) were factors associated with LAFP switching. The qualitative findings revealed that fear of side effects, lack of adequate information, religion, and misconceptions hinder users from maintaining the LAFP. CONCLUSIONS The study finds that the proportion of women switching from long-acting family planning was relatively higher than in other studies. The main reasons for LAFP switching were fear of side effects, lack of adequate information specific to LAFP and misconceptions. Therefore, the provision of quality contraceptive counselling by the service providers may mitigate the concern of IUD and implant switching. Furthermore, future prospective research at a larger sample size is needed.
Collapse
Affiliation(s)
- Fayera Teshoma
- Guder Hospital, West Shoa Zone, Oromia Region, Guder, Ethiopia
| | - Eden Girmaye Tefera
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia.
| | - Teka Girma
- Department of Public Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Misganu Teshoma Ragasa
- Department of Midwifery, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Ephrem Yohannes
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| |
Collapse
|
13
|
Nelson AL. Drospirenone and estetrol: evaluation of a newly approved novel oral contraceptive. Expert Opin Pharmacother 2023; 24:1757-1764. [PMID: 37691580 DOI: 10.1080/14656566.2023.2247979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/20/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Estetrol (E4) is a native estrogen produced only by the fetal liver during pregnancy. E4 is the first new estrogen to be used in hormonal contraception since the introduction of oral contraceptives in 1960. Ethinyl estradiol, the most commonly used estrogen in oral contraceptives today, increases the risks of thromboembolism and has other significant hepatic impacts, which induce important drug-drug interactions. On the other hand, Phase 2 E4 characterization studies demonstrated that E4 has negligible impacts on liver, breast, and vascular endothelium due to its distinct tissue selectivity. Combined with drospirenone (DRSP), E4 offers an improved safety profile for oral contraception. AREAS COVERED This paper briefly highlights the unique pharmacokinetic and pharmacodynamic features of E4. The efficacy, safety, and tolerability results from the Phase 2 and 3 studies of the E4/DRSP pill are discussed to provide the reader with a thorough understanding of E4 and information to use when counseling potential users. EXPERT OPINION The estetrol/drospirenone oral contraceptive is effective and well tolerated and provides good cycle control. In the future, estetrol may be the estrogen of choice if subsequent evidence verifies that it reduces the risks associated with current estrogens, such as venous thromboembolism and drug-drug interactions.
Collapse
Affiliation(s)
- Anita L Nelson
- Obstetrics and Gynecology, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, USA
| |
Collapse
|
14
|
Darney BG, Biel FM, Oakley J, Coleman-Minahan K, Cottrell EK. Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021. Obstet Gynecol 2023; 142:669-678. [PMID: 37535965 PMCID: PMC10424816 DOI: 10.1097/aog.0000000000005277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. METHODS We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. RESULTS Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. CONCLUSION Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.
Collapse
Affiliation(s)
- Blair G Darney
- Oregon Health & Science University, the OHSU-PSU School of Public Health, and OCHIN, Portland, Oregon; the National Institute of Public Health, Center for Population Health, Cuernavaca, Morelos, Mexico; and the College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, and the University of Colorado Population Center and the Population Program and Geography Department, University of Colorado Boulder, Boulder, Colorado
| | | | | | | | | |
Collapse
|
15
|
Increasing Access to Intrauterine Devices and Contraceptive Implants: ACOG Committee Statement No. 5. Obstet Gynecol 2023; 141:866-872. [PMID: 36961974 DOI: 10.1097/aog.0000000000005127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Indexed: 03/25/2023]
Abstract
Everyone who desires long-acting reversible contraception should have timely access to contraceptive implants and intrauterine devices. Obstetrician-gynecologists and other reproductive health care clinicians can best serve those who want to delay or avoid pregnancy by adopting evidence-based practices and offering all medically appropriate contraceptive methods. Long-acting reversible contraceptive devices should be easily accessible to all people who want them, including adolescents and those who are nulliparous and after spontaneous or induced abortion and childbirth. To achieve equitable access, the American College of Obstetricians and Gynecologists supports the removal of financial barriers to contraception by advocating for coverage and appropriate payment and reimbursement for all contraceptive methods by all payers for all eligible patients.
Collapse
|
16
|
Simmons RG, Baayd J, Waters M, Diener Z, Turok DK, Sanders JN. Assessing contraceptive use as a continuum: outcomes of a qualitative assessment of the contraceptive journey. Reprod Health 2023; 20:33. [PMID: 36793112 PMCID: PMC9930211 DOI: 10.1186/s12978-023-01573-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. METHODS We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. RESULTS A person's contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any "right" method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. CONCLUSIONS Contraception is a unique health intervention that requires ongoing decision-making without a particular "right" answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person's contraceptive journey.
Collapse
Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Megan Waters
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Zoë Diener
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| |
Collapse
|
17
|
Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study. Contraception 2023; 118:109897. [PMID: 36240905 DOI: 10.1016/j.contraception.2022.09.135] [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: 01/18/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. STUDY DESIGN We conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. RESULTS At baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. CONCLUSION Sexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. IMPLICATIONS This study addressees gaps in knowledge about U.S. Latina adolescents' contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.
Collapse
|
18
|
Kappen M, Raeymakers S, Weyers S, Vanderhasselt MA. Stress and rumination in Premenstrual Syndrome (PMS): Identifying stable and menstrual cycle-related differences in PMS symptom severity. J Affect Disord 2022; 319:580-588. [PMID: 36162688 DOI: 10.1016/j.jad.2022.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Since the inclusion of Premenstrual Dysphoric Disorder (PMDD) as a mood disorder in the DSM-5, Premenstrual Syndrome (PMS) symptoms have received more attention from researchers and clinicians. In this large-scale study, we investigated core psychological concepts relevant to mood disorder vulnerability between people with 1) no to mild, 2) moderate to severe, and 3) PMDD levels of PMS symptoms. Several trait measures related to mood disorders including depressive symptoms, feelings of stress and anxiety, and ruminative thinking were measured (single measurement, N = 380) along with state (momentary) reports of stress and stress-related perseverative thinking (measured twice, once in the follicular and once in the premenstrual/luteal phase, N = 237). We consistently observed that participants with higher severity of PMS symptoms also scored higher on depression, anxiety, stress, and rumination (trait measures). We also found consistent increases in momentary stress and stress-related perseverative ruminative thinking with increased PMS symptoms at each of our two test moments (in the middle of the follicular and premenstrual/luteal phase respectively). Interestingly, we did not find significant differences between our two test moments for any group, despite PMS being characterized by specific systems in the premenstrual/luteal phase. However, this could be due to noise surrounding the testing moments due to the temporal resolution of the questionnaires and the menstrual cycle estimation method. Nevertheless, these results suggest that stress and rumination are important psychological mechanisms to consider in PMS. Future PMS research studying stress and rumination on a day-to-day basis in combination with hormonal measures is warranted.
Collapse
Affiliation(s)
- Mitchel Kappen
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
| | - Sofie Raeymakers
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| |
Collapse
|
19
|
Pooled analysis of two phase 3 trials evaluating the effects of a novel combined oral contraceptive containing estetrol/drospirenone on bleeding patterns in healthy women. Contraception 2022; 116:29-36. [PMID: 35921872 DOI: 10.1016/j.contraception.2022.07.010] [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: 02/15/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the bleeding patterns of a new combined oral contraceptive containing estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg in a 24/4-day regimen. STUDY DESIGN We pooled bleeding data from two parallel, open-label, 13-cycle phase 3 trials that enrolled participants 16 to 50 years old with body mass index (BMI) ≤35 kg/m2. Participants reported vaginal bleeding/spotting in daily diaries. For this bleeding analysis, we included participants with at least one evaluable cycle. We calculated mean frequencies of scheduled and unscheduled bleeding/spotting episodes and median duration of bleeding/spotting episodes, and assessed associations between treatment compliance, BMI and recent hormonal contraceptive use on bleeding/spotting outcomes. RESULTS We included 3409 participants with 33,815 cycles. Scheduled bleeding/spotting occurred in 87.2% to 90.4% of participants/cycle, with a median duration of 4 to 5 days. Unscheduled bleeding/spotting decreased from 27.1% in Cycle 1 to 20.6% in Cycle 2 to ≤17.5% from Cycle 5 onwards. Most (66.5%) unscheduled bleeding/spotting episodes were spotting-only. Between 5.8% and 7.8% of users/cycle experienced absence of any scheduled or unscheduled bleeding/spotting. Missing one or more active pills resulted in a higher occurrence of unscheduled bleeding/spotting (adjusted odds ratio [aOR] 2.13 [95% confidence interval 1.68-2.70]) and absence of scheduled bleeding/spotting (aOR 2.36 [1.82-3.07]). Participants with a BMI ≥30 kg/m2 reported more absence of scheduled bleeding/spotting (aOR 1.68 [1.37-2.05]). Switchers and starters reported similar frequencies of unscheduled bleeding/spotting (aOR 0.94 [0.83-1.07]) and absence of scheduled bleeding/spotting (aOR 1.00 [0.85-1.19]). Three percent of participants discontinued for a bleeding-related adverse event. CONCLUSION E4/DRSP use results in a predictable bleeding pattern with limited unscheduled bleeding/spotting. Noncompliance and BMI affect bleeding patterns. IMPLICATIONS STATEMENT Most estetrol/drospirenone users experience a predictable and regular bleeding pattern. Providers can educate patients about the expected bleeding patterns and should advise users that they may infrequently experience no scheduled bleeding/spotting. This information may improve user acceptability and continuation of this new oral contraceptive.
Collapse
|
20
|
Edwards AC, Larsson Lönn S, Crump C, Mościcki EK, Sundquist J, Kendler KS, Sundquist K. Oral contraceptive use and risk of suicidal behavior among young women. Psychol Med 2022; 52:1710-1717. [PMID: 33084550 PMCID: PMC8917871 DOI: 10.1017/s0033291720003475] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. METHODS We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. RESULTS In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. CONCLUSIONS Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.
Collapse
Affiliation(s)
- Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Sara Larsson Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
21
|
Educational Multimedia Tool Compared With Routine Care for the Uptake of Postpartum Long-Acting Reversible Contraception in Individuals With High-Risk Pregnancies: A Randomized Controlled Trial. Obstet Gynecol 2022; 139:571-578. [PMID: 35594122 DOI: 10.1097/aog.0000000000004718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies. METHODS In this single-center randomized trial, we assigned individuals aged 13-50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3-5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated. RESULTS From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome-available for more than 90% of participants-was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09-2.21; NNT nine, with 95% CI 5-42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03-1.32). CONCLUSION Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04291040. FUNDING SOURCE Funded in part by Investigator-Initiated studies of Organon.
Collapse
|
22
|
Costescu D, Chawla R, Hughes R, Teal S, Merz M. Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review. BMC Womens Health 2022; 22:82. [PMID: 35313863 PMCID: PMC8939098 DOI: 10.1186/s12905-022-01657-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Levonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia. METHODS Searches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to 'Humans' and 'Females'. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice. RESULTS Forty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs. CONCLUSIONS Bleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs.
Collapse
Affiliation(s)
- Dustin Costescu
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | | | | | - Stephanie Teal
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Martin Merz
- Medical Affairs and Pharmacovigilance, Pharmaceuticals MA TA Women's Health Care, Bayer AG, Building S101, 10/244, 13342, Berlin, Germany.
| |
Collapse
|
23
|
Peasah SK, Kohli M, Munshi KD, Henderson R, Mueller M, Manolis C, Huang Y, Swart EC, Neilson L, Good CB. Twelve month oral contraceptive pill prescriptions: Role of policy mandates on utilization. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100094. [PMID: 35478503 PMCID: PMC9031085 DOI: 10.1016/j.rcsop.2021.100094] [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: 09/21/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
Recent studies have suggested that extended duration oral contraceptive pills (OCP), such as the 12-month duration, have a positive impact on pregnancy rates but negative impact on pill wastage. Several states have since been mandating health plans to offer extended duration OCP as an option for women. The objective of the study was to evaluate the impact of these mandates on utilization of extended duration OCPs. Using claims data of a large pharmacy benefit manager for commercially insured women from 2018 to 2019, use, adherence, continuity, and wastage of OCPs by women dispensed one-month only, three-months only, 6 or 12-months only, and other months (which includes other months and mixed duration OCP) was retrospectively analyzed. OCP dispensed by year, and adherence, continuity, wastage over a 15-month period were summarized using Chi square and ANOVA. There were 874,420 and 875,914 women in this study in 2018 and 2019 respectively. Of these, 34% were from states with the mandate (SWM). Most women filled the one-month and three-month duration, with very low overall 6 or 12-month duration claims. Proportion of utilizers of 6 or 12- month duration was higher in SWM than in those without, although differences in absolute rates were very low. Patients with OCP discontinuation, gaps ≥7 and 14 days, were fewer among those filling 6 or 12-month duration but conversely, wastage was higher in this group compared to those filling one or three-month duration. Our findings suggest that, among commercially insured women, extended duration OCP mandates have so far not had much influence on use of 6 or 12-month duration OCP prescriptions.
Collapse
Affiliation(s)
- Samuel K. Peasah
- Value-Based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, USA
- Corresponding author.
| | | | | | | | | | | | - Yan Huang
- Value-Based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, USA
| | - Elizabeth C.S. Swart
- Value-Based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, USA
| | - Lynn Neilson
- Value-Based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, USA
| | - Chester B. Good
- Value-Based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, USA
| |
Collapse
|
24
|
Anastasiou E, McCarthy KJ, Gollub EL, Ralph L, van de Wijgert JH, Jones HE. The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review. Contraception 2022; 107:1-9. [PMID: 34752778 PMCID: PMC8837691 DOI: 10.1016/j.contraception.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. STUDY DESIGN Systematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). RESULTS Among nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5-2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. CONCLUSION We found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. IMPLICATIONS Use of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.
Collapse
Affiliation(s)
- Elle Anastasiou
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Katharine J. McCarthy
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Erica L. Gollub
- College of Health Professions, Health Science Program, Pace University, 861 Bedford Rd, Pleasantville, NY 10570, USA
| | - Lauren Ralph
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1330 Broadway Suite 1100 Oakland CA 94612 USA
| | - Janneke H.H.M. van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Stratenum room 7.127, 3584 Utrecht, Netherlands
| | - Heidi E. Jones
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA,CUNY Institute for Implementation Science in Public Health, 55 W. 125th St., New York, NY 10027, USA
| |
Collapse
|
25
|
Novick AM, Johnson RL, Lazorwitz A, Belyavskaya A, Berkowitz L, Norton A, Sammel MD, Epperson CN. Discontinuation of hormonal contraception due to changes in mood and decreases in sexual desire: the role of adverse childhood experiences. EUR J CONTRACEP REPR 2022; 27:212-220. [PMID: 35133231 DOI: 10.1080/13625187.2022.2030702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate if adverse childhood experiences are associated with hormonal contraception discontinuation due to mood and sexual side effects. MATERIALS AND METHODS Women, ages 18-40 (N = 826), with current and/or previous hormonal contraceptive use completed surveys on demographics, contraceptive history, and the Adverse Childhood Experiences Questionnaire. We characterised women into high (≥2 adverse experiences) and low (0 or 1) adverse childhood experience groups. We calculated risk ratios for associations between adverse childhood experiences and outcomes of interest using log binomial generalised linear models, and adjusted for relevant demographic variables. RESULTS Women in the high adverse childhood experiences group (n = 355) were more likely to report having discontinued hormonal contraception due to decreases in sexual desire (adjusted risk ratio 1.44, 1.03-2.00, p = .030). Covariates included age, current hormonal contraception use, and various demographic variables associated with discontinuation. Adverse childhood experiences were not associated with mood or sexual side effects among current (n = 541) hormonal contraceptive users. CONCLUSIONS Self-reported adverse childhood experiences were associated with greater likelihood of discontinuing hormonal contraception due to behavioural side effects, particularly decreases in sexual desire. Identification of risk factors for behavioural side effects can assist patients and clinicians in making informed choices on contraception that minimise risk of early discontinuation.
Collapse
Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Aaron Lazorwitz
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Anna Belyavskaya
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Lily Berkowitz
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Aileen Norton
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.,Department of Family Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
26
|
Construction and validation of a test of knowledge of contraceptive methods for adolescents. INTERACCIONES: REVISTA DE AVANCES EN PSICOLOGÍA 2021. [DOI: 10.24016/2021.v7.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Valid and reliable instruments are required to measure the level of information on contraceptive methods in adolescents to promote their correct use. Objective: To construct and validate a test of knowledge of contraceptive methods for adolescents between 15 and 19 years old. Method: A 36-item test was developed that included the different contraceptive methods and information on the characteristics, use, efficacy, advantages and disadvantages of these methods. Once validated by expert judges, a college in Ecatepec was randomly selected as data collection site. Students of the three school grades answered the test. Results: The test was applied to a total of 229 students between 15 and 19 years old (M = 16.22; SD = .978). The majority were women (66%), single (88.5%) and lived with their parents (62.9%). Of the 36 initial items, 31 showed discriminatory power between those who performed well on the test and those who did not. The difficulty index of the questionnaire was .45 and revealed a reliability index value of .739. Around 60% of the participants obtained a percentage below 50% of correct answers in the entire test. Only about 4% of participants got a percentage of correct responses higher than 70%. The categories of characteristics and use were those in which the participants performed best when answering 48% of these questions correctly. The worst was effectiveness, advantages and disadvantages with 33%. Conclusion: The test’s psychometric properties showed that it is a valid and reliable test for its application in Mexican adolescents. The results indicate that most adolescents of the simple do not have complete information about contraceptive methods and that they know the least about their effectiveness and side effects.
Collapse
|
27
|
Ocampo Cañas JA, Pinilla Alfonso MJ, Navarro Plazas CDP, Mejia Arbelaez CM, Patiño Rueda JS. Experiences of women with Zika virus (ZIKV) versus the provision of health services in two cities in Colombia: A qualitative study. PLoS One 2021; 16:e0260583. [PMID: 34855811 PMCID: PMC8638867 DOI: 10.1371/journal.pone.0260583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In February 2016, the World Health Organization (WHO) declared the epidemic of the ZIKA virus (ZIKV) in Latin America to be a public health emergency. In Colombia, 11,944 pregnant women registered a ZIKV infection during the epidemic. So far, little is known about the experiences of women infected with ZIKV during their pregnancy, especially those relating to the provision of health services during the period of the epidemic. OBJECTIVE To explore the experiences of pregnant women diagnosed with ZIKV infection about the provision of health services in two Colombian cities, considering the perspective of sexual and reproductive rights. METHODS Qualitative study under the grounded theory approach, which uses semi-structured interviews as tools to explore the biographical experience of mothers during their gestation process and ZIKV infection, dividing the interview into two broad categories: before and during pregnancy. RESULTS Twenty-two women were interviewed, 10 in Cali and 12 in Villavicencio. The average age at the time of pregnancy was 27.6 years. Most women were not planning at the time of pregnancy and the pregnancy was unwanted. Most campaigns focused on mosquito eradication rather than on sexual and reproductive health campaigns. The quality of health care was not sufficient, adequate, or appropriate. Also, the breakdown of the health system to deal with the pandemic was also noted. Some women were treated with disrespect by health professionals. Voluntary termination of pregnancy was inadequately advised, and women lost autonomy regarding decisions about their health. CONCLUSIONS In the health care of ZIKV epidemics, it is necessary to include the gender perspective, more specifically, sexual and reproductive rights. In addition, these epidemics must be addressed through a comprehensive, appropriate, and not fragmented health system, in which sexual and reproductive rights must be mainstreamed in all health promotion and prevention programs.
Collapse
Affiliation(s)
- Jovana Alexandra Ocampo Cañas
- Research Line on Health Systems, Childhood, Gender, Interculturality and Tropical Diseases, Research Group on Public Health, Medical Education and Medical Professionalism, School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Maria Janeth Pinilla Alfonso
- Research Line on Health Systems, Childhood, Gender, Interculturality and Tropical Diseases, Research Group on Public Health, Medical Education and Medical Professionalism, School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Clemencia del Pilar Navarro Plazas
- Research Line on Health Systems, Childhood, Gender, Interculturality and Tropical Diseases, Research Group on Public Health, Medical Education and Medical Professionalism, School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Carlos Mauricio Mejia Arbelaez
- Research Line on Health Systems, Childhood, Gender, Interculturality and Tropical Diseases, Research Group on Public Health, Medical Education and Medical Professionalism, School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| | - Jhon Sebastián Patiño Rueda
- Research Line on Health Systems, Childhood, Gender, Interculturality and Tropical Diseases, Research Group on Public Health, Medical Education and Medical Professionalism, School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
| |
Collapse
|
28
|
Zettermark S, Khalaf K, Perez-Vicente R, Leckie G, Mulinari D, Merlo J. Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden: a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). BMJ Open 2021; 11:e049553. [PMID: 34598985 PMCID: PMC8488727 DOI: 10.1136/bmjopen-2021-049553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES From a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach. DESIGN Observational prospective cohort study using record linkage of national Swedish registers. SETTING The population of Sweden. PARTICIPANTS All 915 954 women aged 12-30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up. PRIMARY OUTCOME MEASURE Use of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up. RESULTS Previously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24-30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level. CONCLUSIONS Our study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.
Collapse
Affiliation(s)
- Sofia Zettermark
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kani Khalaf
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - George Leckie
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Center for Multilevel Modelling, School of Education, University of Bristol, Bristol, UK
| | - Diana Mulinari
- Department of Gender Studies, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Center for Primary Health Care Research, Region Skåne, Region Skane Health Care, Malmö, Sweden
| |
Collapse
|
29
|
Are Births More Likely to be Intended Following Use of Long-Acting Reversible Contraceptives? An Analysis of U.S. Births in 2003–2015. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Geist C, Everett BG, Simmons RG, Sanders JN, Gawron LM, Myers K, Turok DK. Changing lives, dynamic plans: Prospective assessment of 12-month changes in pregnancy timing intentions and personal circumstances using data from HER Salt Lake. PLoS One 2021; 16:e0257411. [PMID: 34543298 PMCID: PMC8451991 DOI: 10.1371/journal.pone.0257411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To explore the association between changes in personal circumstances and shifts in pregnancy intentions. STUDY DESIGN New start contraceptive clients, who desired to prevent pregnancy for at least one year enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative (September 2015 -March 2017) and responded to the question "What are your future pregnancy plans?" at enrollment and 12-month follow-up. We estimated multivariable binary logistic fixed-effects regressions to examine the association between changes in personal circumstances and a change from never desiring a pregnancy at enrollment to considering one in the future at 12-month follow-up. RESULTS The majority of the 2825 participants (2246, 79%) maintained their pregnancy timing intention over the 12-month study period. Multivariable analyses of the 208 participants who changed from never desiring a pregnancy to considering pregnancy in the future at 12-month follow-up indicated that entering cohabitation (aOR 3.14, 95% CI 1.30-7.58), increased household income (aOR 1.06, 95% CI 1.00-1.13), and changes from unemployment to full-time employment (aOR 5.94, 95% CI 1.29-27.36) are associated with increased the odds of desiring a future pregnancy after never wanting one a year prior. CONCLUSIONS Pregnancy intentions are dynamic over twelve months and covary with partner status, household income, and employment status. Pregnancy intentions are linked to changes in life circumstances. Health care providers need to frequently assess pregnancy intentions and resulting contraceptive or preconception needs.
Collapse
Affiliation(s)
- C. Geist
- Department of Sociology and Division of Gender Studies, University of Utah, Salt Lake City, Utah
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - B. G. Everett
- Department of Sociology and Division of Gender Studies, University of Utah, Salt Lake City, Utah
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - R. G. Simmons
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - J. N. Sanders
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - L. M. Gawron
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - K. Myers
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| | - D. K. Turok
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah
| |
Collapse
|
31
|
Eeckhaut MCW, Rendall MS, Zvavitch P. Women's Use of Long-Acting Reversible Contraception for Birth Timing and Birth Stopping. Demography 2021; 58:1327-1346. [PMID: 34251428 PMCID: PMC9341462 DOI: 10.1215/00703370-9386084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of long-acting reversible contraceptive (LARC) methods-intrauterine devices (IUDs) and implants-has recently expanded rapidly in the United States, and these methods together approach the contraceptive pill in current prevalence. Research on LARCs has analyzed their use to reduce unintended pregnancies but not their use to enable intended pregnancies. Knowledge of both is necessary to understand LARCs' potential impacts on the reproductive life courses of U.S. women. We combine data from two nationally representative surveys to estimate women's likelihood and timing of subsequent reproductive events, including births resulting from an intended pregnancy up to nine years after discontinuing LARC use. We estimate that 62% of women will give birth, and 45% will give birth from an intended pregnancy. Additionally, 18% will have a new LARC inserted, and 13% will transition to sterilization. Most of these reproductive events occur within two years after discontinuing LARC use. Births from an intended pregnancy are especially common when no intervening switch to another contraceptive method occurs. We infer that women's motives for using LARC are varied but include the desire to postpone a birth, to postpone a decision about whether to have a(nother) birth, and to transition definitively to the completion of childbearing.
Collapse
Affiliation(s)
- Mieke C W Eeckhaut
- Department of Sociology and Criminal Justice, University of Delaware, Newark, DE, USA
| | - Michael S Rendall
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Polina Zvavitch
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, USA
| |
Collapse
|
32
|
Saya GK, Premarajan KC, Roy G, Sarkar S, Kar SS, Olickal JJ. Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India. Fam Pract 2021; 38:387-394. [PMID: 33367643 DOI: 10.1093/fampra/cmaa133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.
Collapse
Affiliation(s)
- Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kariyarath Cheriyath Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
33
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Daniel Schröder
- BAYOOMED Medical Software Development, BAYOONET AG, Darmstadt, Germany
| | | | | |
Collapse
|
34
|
Jaisamrarn U, Santipap M, Santibenchakul S. Discontinuation rates of different contraceptive methods in Thai women up to 1-year after method initiation. Sci Rep 2021; 11:10819. [PMID: 34031521 PMCID: PMC8144200 DOI: 10.1038/s41598-021-90373-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the discontinuation rate and the reason for discontinuation of common contraceptives used by reproductive-aged Thai women. We recruited 1880 women aged 18-45 years from the Family Planning Clinic of the Chulalongkorn Hospital in Bangkok. The participants were followed at three, six and twelve months. A Cox proportional hazards model was used to determine personal risks of discontinuing contraceptives. The incidence rate for discontinuation of combined oral contraceptive pills (COCs), depot medroxyprogesterone acetate (DMPA), copper intrauterine device (IUD), and contraceptive implant(s) were 21.3, 9.2, 4.4, and 2.3/100 person-years, respectively. Most of the women who discontinued (185/222) discontinued contraceptives due to side effects. Compared to contraceptive implant users, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of discontinuing COCs, DMPA, and the copper IUD were 9.6 (4.3-21.8), 4.2 (1.8-10.0), and 2.2 (0.8-5.9), respectively. Lower income, higher parity, history of miscarriage, and history of abortion were independent predictors of contraceptive discontinuation in a multivariable model.
Collapse
Affiliation(s)
- Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand
| | - Monchai Santipap
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand. .,Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand.
| |
Collapse
|
35
|
McCloskey LR, Wisner KL, Cattan MK, Betcher HK, Stika CS, Kiley JW. Contraception for Women With Psychiatric Disorders. Am J Psychiatry 2021; 178:247-255. [PMID: 33167674 DOI: 10.1176/appi.ajp.2020.20020154] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices. METHODS A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. RESULTS The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. CONCLUSIONS Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.
Collapse
Affiliation(s)
- Leanne R McCloskey
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Katherine L Wisner
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Minaz Kolia Cattan
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Hannah K Betcher
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Catherine S Stika
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| | - Jessica W Kiley
- Department of Psychiatry, Asher Center for the Study and Treatment of Depressive Disorders (Wisner; formerly Betcher, Cattan), and Department of Obstetrics and Gynecology (McCloskey, Stika, Kiley), Feinberg School of Medicine, Northwestern University, Chicago; Mayo Clinic, Rochester, Minn. (Betcher); AbbVie, Inc., North Chicago (Cattan)
| |
Collapse
|
36
|
Black KI, McGeechan K, Watson CJ, Lucke J, Taft A, McNamee K, Haas M, Peipert JF, Mazza D. Women's satisfaction with and ongoing use of hormonal long-acting methods compared to the oral contraceptive pill: Findings from an Australian general practice cluster randomised trial (ACCORd). Aust N Z J Obstet Gynaecol 2021; 61:448-453. [PMID: 33599984 DOI: 10.1111/ajo.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long-acting reversible contraceptives (LARC). AIMS Using survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG-IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP). MATERIALS AND METHODS We used the data from participants' baseline, six and 12-month surveys to identify new users of implants, LNG-IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side-effects. Proportions were compared using χ2 tests. RESULTS Of the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study's first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve-month continuation rates for the LNG-IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG-IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods. CONCLUSIONS This study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side-effects. Since hormonal LARC methods have the highest contraceptive efficacy, these should be offered first-line to women.
Collapse
Affiliation(s)
- Kirsten I Black
- Sydney School of Medicine (Central Clinical School) Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney Local Area Health Service, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cathy J Watson
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | | | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
37
|
Ontiri S, Mutea L, Naanyu V, Kabue M, Biesma R, Stekelenburg J. A qualitative exploration of contraceptive use and discontinuation among women with an unmet need for modern contraception in Kenya. Reprod Health 2021; 18:33. [PMID: 33563304 PMCID: PMC7871615 DOI: 10.1186/s12978-021-01094-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. METHODS Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. RESULTS Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side effects, method failure, peer influence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five reasons were provided for those not willing to use in the future: fear of side effects, cost of contraceptive services, family conflicts over the use of modern contraceptives, reduced need, and a shift to traditional methods. CONCLUSION This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users.
Collapse
Affiliation(s)
- Susan Ontiri
- Jhpiego Corporation, Johns Hopkins University Affiliate, Nairobi, Kenya. .,Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.
| | | | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Mark Kabue
- Jhpiego Corporation, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Regien Biesma
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| |
Collapse
|
38
|
Burke KL, Thaxton L, Potter JE. Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas. Contracept X 2020; 3:100052. [PMID: 33490950 PMCID: PMC7809391 DOI: 10.1016/j.conx.2020.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas. STUDY DESIGN Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued. RESULTS Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1-75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50-0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12-1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12-1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method. CONCLUSIONS Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable. IMPLICATIONS Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.
Collapse
Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center, University of Texas at Austin, Austin, TX, USA
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
| | - Lauren Thaxton
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
- Dell Medical School, Department of Women's Health, University of Texas at Austin, Austin, TX, USA
| | - Joseph E. Potter
- Population Research Center, University of Texas at Austin, Austin, TX, USA
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
- Dell Medical School, Department of Women's Health, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
39
|
Harper CC, Comfort AB, Blum M, Rocca CH, McCulloch CE, Rao L, Shah N, Oquendo Del Toro H, Goodman S. Implementation science: Scaling a training intervention to include IUDs and implants in contraceptive services in primary care. Prev Med 2020; 141:106290. [PMID: 33096126 PMCID: PMC8032203 DOI: 10.1016/j.ypmed.2020.106290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Building capacity for contraceptive services in primary care settings, including for intrauterine devices (IUDs) and implants, can help to broaden contraceptive access across the US. Following a randomized trial in family planning clinics, we brought a provider training intervention to other clinical settings including primary care in all regions. This implementation science study evaluates a national scale-up of a contraceptive training intervention to varied practice settings from 2013 to 2019 among 3216 clinic staff serving an estimated 1.6 million annual contraceptive patients. We measured providers' knowledge and clinical practice changes regarding IUDs and implants using survey data. We estimated the overall intervention effect, and its relative effectiveness in primary care settings, with generalized estimating equations for clustered data. Patient-centered counseling improved, along with comfort with method provision and removal. Provider knowledge increased (p < 0.001), as did evidence-based counseling for IUDs (aOR 3.3 95% CI 2.8-3.9) and implants (aOR 3.5, 95% CI 3.0-4.1), and clinician competency in copper and levonorgestrel IUDs (aORs 1.8-2.6 95% CIs 1.5-3.2) and implants (aOR 2.4 95% CI 2.0-2.9). While proficiency was lower initially in primary care, gains were significant and at times greater than in Planned Parenthood health clinics. This intervention was effectively scaled, including in primary care settings with limited prior experience with these methods. Recent changes to Title X family planning funding rules exclude several large family planning providers, shifting greater responsibility to primary care and other settings. Scaling effective contraceptive interventions is one way to ensure capacity to offer patients full contraceptive services.
Collapse
Affiliation(s)
- Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America.
| | - Alison B Comfort
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America
| | - Maya Blum
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, United States of America
| | - Lavanya Rao
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America
| | - Nishant Shah
- Consultant, Bixby Center for Global Reproductive Health, University of California, San Francisco, School of Medicine, United States of America
| | - Helen Oquendo Del Toro
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, United States of America
| | - Suzan Goodman
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco School of Medicine, United States of America; Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States of America
| |
Collapse
|
40
|
Final Program Data and Factors Associated With Long-Acting Reversible Contraception Removal: The Zika Contraception Access Network. Obstet Gynecol 2020; 135:1095-1103. [PMID: 32282596 DOI: 10.1097/aog.0000000000003835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe characteristics of the full population of women who participated in the Zika Contraception Access Network program in Puerto Rico during the virus outbreak and to examine factors associated with removal of a long-acting reversible contraception (LARC) method by a Zika Contraception Access Network provider during the program's duration (May 2016-September 2017). METHODS We conducted an observational cohort study. The Zika Contraception Access Network program was designed to increase access to contraception services in Puerto Rico for women who chose to prevent pregnancy during the Zika virus outbreak as a primary strategy to reduce adverse Zika virus-related pregnancy and birth outcomes. Among program participants, an observational cohort of women served by the Zika Contraception Access Network Program, we describe their demographic and program-specific characteristics, including contraceptive method mix before and after the program. We also report on LARC removals by Zika Contraception Access Network providers during the program. We examined factors associated with LARC removal using multivariable logistic regression. RESULTS A total of 29,221 women received an initial Zika Contraception Access Network visit during the program. Ninety-six percent (27,985) of women received same-day provision of a contraceptive method and 70% (20,381) chose a LARC method. While the program was active, 719 (4%) women who chose a LARC at the initial visit had it removed. Women with a college degree or higher were more likely to have their LARC removed (adjusted prevalence ratio [aPR] 1.24); breastfeeding women (aPR 0.67) and those using a LARC method before Zika Contraception Access Network (aPR 0.55) were less likely to have their LARC removed. CONCLUSION The Zika Contraception Access Network program was designed as a short-term response for rapid implementation of contraceptive services in a complex emergency setting in Puerto Rico and served more than 29,000 women. The Zika Contraception Access Network program had high LARC uptake and a low proportion of removals by a Zika Contraception Access Network provider during the program. A removal-inclusive design, with access to removals well beyond the program period, maximizes women's reproductive autonomy to access LARC removal when desired. This model could be replicated in other settings where the goal is to increase contraception access.
Collapse
|
41
|
Beyond safety and efficacy: sexuality-related priorities and their associations with contraceptive method selection. Contracept X 2020; 2:100038. [PMID: 32954251 PMCID: PMC7486436 DOI: 10.1016/j.conx.2020.100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection. Study design Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18–45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates. Results Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as quite or extremely important were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection. Conclusions Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities. Implications Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW Long-acting reversible contraception (LARC) is increasingly used by adolescents and young adults (AYAs). Subsequent to LARC insertion, AYAs are presenting to their primary care providers with LARC concerns. This article seeks to equip primary care clinicians with the tools necessary to assess and manage common LARC-associated side effects. RECENT FINDINGS Side effects are common with progestin-only LARC, and can precipitate early discontinuation of an otherwise effective, low-maintenance form of contraception. Abnormal uterine bleeding, pelvic pain, acne, and weight change are often cited as progestin-only LARC side effects, yet the causes are poorly understood despite extensive research. While most side effects improve with time, therapeutic interventions are available for patients with undesirable side effects that prefer medical management. Research emphasizes the importance of proper patient counseling and clinical follow-up. SUMMARY Counseling remains essential in the management of LARC-associated side effects. However, options are available to temporarily mitigate such side effects and increase LARC satisfaction. While these therapeutic options are prescribed based on expert opinion, such regimens remain inadequately studied in AYA populations.
Collapse
|
43
|
Campelia GD, Abbe C, Nickels LM, McElmeel E, Amory JK. "Shared risk": Reframing risk analysis in the ethics of novel male contraceptives. Contraception 2020; 102:67-69. [PMID: 32474061 DOI: 10.1016/j.contraception.2020.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Carmen Abbe
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | | | | | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States.
| |
Collapse
|
44
|
Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial. PLoS Med 2019; 16:e1002832. [PMID: 31226123 PMCID: PMC6588214 DOI: 10.1371/journal.pmed.1002832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda. METHODS AND FINDINGS We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65-12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31-4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66-9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40-9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control (P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contraception, or intrauterine devices (IUDs). Similar proportions of women changed contraceptive methods over the 6-month follow-up in the voucher and control groups (N = 8, 5% versus N = 5, 4%; P = 0.467). More women in the control group discontinued contraception for 1 to 2 weeks (N = 19, 13% versus N = 7, 5%; P = 0.008) or more than 4 weeks (N = 15, 10% versus N = 3, 2%; P = 0.002) compared to those given a family planning voucher. The main limitation of this study is that its findings may not be generalized to settings without improved availability of contraceptives in publicly funded facilities. CONCLUSION These findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time. TRIAL REGISTRATION ClinicalTrials.gov NCT02964169.
Collapse
|