1
|
Bostick EA, Greenberg KB, Fagnano M, Baldwin CD, Halterman JS, Yussman SM. Adolescent Self-Reported Use of Highly Effective Contraception: Does Provider Counseling Matter? J Pediatr Adolesc Gynecol 2020; 33:529-535. [PMID: 32544517 DOI: 10.1016/j.jpag.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/25/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents. DESIGN A cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC). SETTING Rochester, New York. PARTICIPANTS Female students in 9th-12th grade in the Rochester City School District. INTERVENTIONS An anonymous, standardized survey was administered to collect data. MAIN OUTCOME MEASURES We studied associations between students' reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods. RESULTS Among 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P < .001) or SAC (adjusted odds ratio, 2.1; P = .007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception. CONCLUSION Adolescents' use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.
Collapse
Affiliation(s)
- Erica A Bostick
- Division of Adolescent Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
| | - Katherine B Greenberg
- Division of Adolescent Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Maria Fagnano
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Constance D Baldwin
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Jill S Halterman
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Susan M Yussman
- Division of Adolescent Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
2
|
Giho Y, Jones KA, Dick RN, Gold MA, Talis JM, Gmelin TA, Laird HJ, Vanek MS, Miller E. Feasibility and acceptability of using a web-based contraceptive support tool in a university health clinic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:336-340. [PMID: 30908150 DOI: 10.1080/07448481.2019.1577859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/07/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18-29) seeking contraceptive care at the UHC were enrolled in September 2015 (n = 46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2-4 weeks later. Electronic health records through 6 weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women's selection of more effective contraceptive methods, including LARCs.
Collapse
Affiliation(s)
- Yukiko Giho
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca N Dick
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center, New York, New York, USA
- dDepartment of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janine M Talis
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Theresa A Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hollis J Laird
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian S Vanek
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Amico JR, Heintz C, Bennett AH, Gold M. Access to IUD removal: Data from a mystery-caller study. Contraception 2020; 101:122-129. [DOI: 10.1016/j.contraception.2019.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 11/24/2022]
|
4
|
Gupta M, Verma M, Kaur K, Iyengar K, Singh T, Singh A. Competency assessment of the medical interns and nurses and documenting prevailing practices to provide family planning services in teaching hospitals in three states of India. PLoS One 2019; 14:e0211168. [PMID: 31693671 PMCID: PMC6834278 DOI: 10.1371/journal.pone.0211168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 10/21/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India. Study design A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills. Results About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training. Conclusions Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.
Collapse
Affiliation(s)
- Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Madhur Verma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiranjit Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Singh
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Manze MG, McCloskey L, Bokhour BG, Paasche-Orlow MK, Parker VA. The perceived role of clinicians in pregnancy prevention among young Black women. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 8:19-24. [PMID: 27179373 DOI: 10.1016/j.srhc.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/14/2015] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to identify young Black women's attitudes toward clinicians and understand how they affect contraceptive behavior. STUDY DESIGN AND MAIN OUTCOME MEASURES We conducted semi-structured qualitative interviews with women aged 18-23 who self-identified as Black or African-American and analyzed data using techniques informed by grounded theory. Initial codes were grouped thematically, and these themes into larger concepts. RESULTS Participants discussed two salient concepts related to pregnancy prevention: (1) sexual responsibility and self-efficacy and (2) the perceived limited role of health care clinicians. Women portrayed themselves as in control of their contraceptive decision-making and practices. Many viewed their life plan, to finish school and gain financial stability, as crucial to their resolve to use contraception. Participants gathered information from various sources to make their own independent decision about which method, if any, was most appropriate for their needs. Most had limited expectations of clinicians and considered in-depth conversations about details of contraceptive use to be irrelevant and unnecessary. CONCLUSION These findings help understand factors contributing to contraceptive decision-making. The patient-clinician interaction is a necessary focus of future research to improve sexual health discussions and understand if and what aspects of this interaction can influence behavior.
Collapse
Affiliation(s)
- Meredith G Manze
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA.
| | - Lois McCloskey
- Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | |
Collapse
|
6
|
Nerlander LM, Callaghan WM, Smith RA, Barfield WD. Short interpregnancy interval associated with preterm birth in U S adolescents. Matern Child Health J 2015; 19:850-8. [PMID: 25062997 PMCID: PMC5547434 DOI: 10.1007/s10995-014-1583-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A short interpregnancy interval (IPI) is a risk factor for preterm delivery among women of reproductive age. As limited data exist concerning adolescents, we aimed to examine the association between short IPIs and preterm birth among adolescents using a majority of US births. Using 2007-2008 US natality data, we assessed the relationship between IPIs <3, 3-5, 6-11, and 12-17 months and moderately (32-36 weeks) and very (<32 weeks) preterm singleton live births among mothers <20 years, relative to IPIs 18-23 months. Adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs) adjusted for maternal race, age, previous preterm deliveries, marital status, smoking and prenatal care were determined from a multivariable multinomial logistic regression model. In 2007-2008, there were 85,077 singleton live births to women aged <20 who had one previous live birth, 69 % of which followed IPIs ≤18 months. Compared with IPIs 18-23 months, short IPIs were associated with moderately preterm birth for IPIs <3 months (aOR 1.89, 95 % CI 1.70-2.10), 3-5 months (aOR 1.33, 95 % CI 1.22-1.47), and 6-12 months (aOR 1.11, 95 % CI 1.02-1.21). IPIs <3 and <6 months were also associated with very preterm birth, with aORs of 2.52 (95 % CI 1.98-3.22) and 1.68 (95 % CI 1.35-2.10) respectively. Many adolescent mothers with repeat births have short IPIs, and shorter IPIs are associated with preterm birth in a dose-dependent fashion. Increasing adolescent mothers' use of effective contraception postpartum can address both unintended adolescent births and preterm birth.
Collapse
Affiliation(s)
- Lina M Nerlander
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,
| | | | | | | |
Collapse
|
7
|
Amico J, Kumar B, Rosenstein H, Gold M. The Contraceptive Implant: An Updated Review of the Evidence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-014-0110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Hogmark S, Klingberg-Allvin M, Gemzell-Danielsson K, Ohlsson H, Essén B. Medical students' knowledge, attitudes and perceptions towards contraceptive use and counselling: a cross-sectional survey in Maharashtra, India. BMJ Open 2013; 3:e003739. [PMID: 24334156 PMCID: PMC3863118 DOI: 10.1136/bmjopen-2013-003739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, attitudes and perceptions towards contraceptive use and counselling among medical students in Maharashtra, India. SETTING Considerable global maternal mortality and morbidity could be avoided through the use of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. PARTICIPANTS A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. RESULTS Respondents expressed a desire to provide contraceptive services. A few students had experienced training in abortion care. There were misconceptions about modern contraceptive methods and the impact of sex education. Attitudes towards contraception were mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. CONCLUSIONS Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.
Collapse
Affiliation(s)
- Sara Hogmark
- Department of Obstetrics and Gynaecology, Falu County Hospital, Falun, Sweden
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, School of Social and Health Science, Dalarna University, Falun, Sweden
| | | | - Hannes Ohlsson
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health (IMCH), Uppsala University, Uppsala, Sweden
| |
Collapse
|
9
|
Nishtar NA, Sami N, Alim S, Pradhan N, Hasnain FU. Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan. Glob J Health Sci 2013; 5:1-8. [PMID: 23618469 PMCID: PMC4776775 DOI: 10.5539/gjhs.v5n3p1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 11/12/2022] Open
Abstract
Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers’ perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Method: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers’ improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area. Conclusion: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods.
Collapse
Affiliation(s)
- Noureen Aleem Nishtar
- Health Systems Division, Community Health Sciences Department. Aga Khan University, Karachi, Pakistan.
| | | | | | | | | |
Collapse
|
10
|
A qualitative study of contraceptive understanding among young adults. Contraception 2012; 86:543-50. [PMID: 22464411 DOI: 10.1016/j.contraception.2012.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 01/19/2012] [Accepted: 02/29/2012] [Indexed: 11/22/2022]
|
11
|
Rethinking school-based health centers as complex adaptive systems: maximizing opportunities for the prevention of teen pregnancy and sexually transmitted infections. ANS Adv Nurs Sci 2012; 35:E37-46. [PMID: 22565796 DOI: 10.1097/ans.0b013e3182537419] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article examines school-based health centers (SBHCs) as complex adaptive systems, the current gaps that exist in contraceptive access, and the potential to maximize this community resource in teen pregnancy and sexually transmitted infection (STI) prevention efforts. Adolescent pregnancy is a major public health challenge for the United States. Existing community resources need to be considered for their potential to impact teen pregnancy and STI prevention efforts. SBHCs are one such community resource to be leveraged in these efforts. They offer adolescent-friendly primary care services and are responsive to the diverse needs of the adolescents utilizing them. However, current restrictions on contraceptive availability limit the ability of SBHCs to maximize opportunities for comprehensive reproductive care and create missed opportunities for pregnancy and STI prevention. A clinical case explores the current models of health care services related to contraceptive care provided in SBHCs and the ability to meet or miss the needs of an adolescent seeking reproductive care in a SBHC.
Collapse
|
12
|
Akers AY, Gold MA, Borrero S, Santucci A, Schwarz EB. Providers' perspectives on challenges to contraceptive counseling in primary care settings. J Womens Health (Larchmt) 2010; 19:1163-70. [PMID: 20420508 PMCID: PMC2940510 DOI: 10.1089/jwh.2009.1735] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although three quarters of reproductive-age women see a health provider annually, less than half receive recommended contraceptive counseling services. We sought to explore providers' perspectives on the challenges to contraceptive counseling in primary care clinics to develop strategies to improve counseling services. METHODS A qualitative, focus group (n = 8) study was conducted in November and December 2007; 48 of 90 providers practicing in four primary care clinics at the University of Pittsburgh Medical Center participated. Providers included physicians, nurses, and pharmacists working in these clinics' multidisciplinary teams. Discussions explored perceived barriers to the provision of counseling services. All groups were audiorecorded, transcribed, and entered into Atlas.Ti, a qualitative data management software. The data were analyzed using a grounded theory approach to content analysis. RESULTS Perceived patient, provider, and health system barriers to contraceptive counseling were identified. Perceived patient barriers included infrequent sexual activity, familiarity with a limited number of methods, desire for pregnancy despite medical contraindications, and religious beliefs. Provider barriers included lack of knowledge, training, and comfort; assumptions about patient pregnancy risk; negative beliefs about contraceptive methods; reliance on patients to initiate discussions; and limited communication between primary care providers (PCPs) and subspecialists. Health system barriers included limited time and competing medical priorities. CONCLUSIONS PCPs vary widely in their knowledge, perceived competence, and comfort in providing contraceptive counseling. General efforts to improve integration of contraceptive counseling into primary care services in addition to electronic reminders and efficient delivery of contraceptive information are needed.
Collapse
Affiliation(s)
- Aletha Y Akers
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213-3180, USA.
| | | | | | | | | |
Collapse
|
13
|
Critical gaps in universal access to reproductive health: contraception and prevention of unsafe abortion. Int J Gynaecol Obstet 2010; 110 Suppl:S13-6. [PMID: 20451196 DOI: 10.1016/j.ijgo.2010.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Unsafe abortion accounts for a significant proportion of maternal deaths, yet it is often forgotten in discussions around reducing maternal mortality. Prevention of unsafe abortion starts with prevention of unwanted pregnancies, most effectively through contraception. When unwanted pregnancies occur, provision of safe, legal abortion services can further prevent unsafe abortions. If complications arise from unsafe abortion, emergency treatment must be available. Recommendations made on this issue during the Precongress Workshop held prior to the 2009 FIGO World Congress in Cape Town, South Africa, were part of a report that was adopted by the FIGO General Assembly. These recommendations address prevention of unsafe abortion and its consequences and support access to safe abortion care to the full extent allowed by national laws, along with 6 strategies for implementation, including integration of family planning into other reproductive health services, adequate training for providers, task-sharing with mid-level providers, and using evidence to discuss this issue with key stakeholders.
Collapse
|
14
|
Mbizvo MT, Zaidi S. Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): the case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions. Int J Gynaecol Obstet 2010; 110 Suppl:S3-6. [PMID: 20451907 DOI: 10.1016/j.ijgo.2010.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The new target for achieving universal access to reproductive health was integrated within the revised Millennium Development Goal framework in October 2008, following reaffirmation of this ICPD goal at the 2005 World Summit. To achieve this goal, the Alliance for Women's Health identified 3 issues needing urgent attention: (1) adolescent sexual and reproductive health; (2) unsafe abortions and related mortality and morbidity; and (3) HIV prevention and care. These themes were discussed in Cape Town at the FIGO 2009 Precongress Workshop convened by the Alliance. The critical gaps identified by the Workshop included: the lack of information on sexual and reproductive health (SRH) issues for adolescents, such as safe sexual practices, contraception, risks related to early childbearing; unsafe abortion and its adverse consequences; and inadequate linkages between sexual and reproductive health and HIV interventions that result in missed opportunities for addressing both. Recommendations included the use of innovative information dissemination techniques, ensuring access to family planning and comprehensive abortion care to the full extent allowed by national laws, in accordance with FIGO and WHO guidelines, and promotion of universal HIV counseling and testing with opt-out strategies within SRH services and information on SRH in all HIV services.
Collapse
Affiliation(s)
- Michael Takura Mbizvo
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | | |
Collapse
|
15
|
Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes. Contraception 2009; 81:112-6. [PMID: 20103447 DOI: 10.1016/j.contraception.2009.08.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 08/05/2009] [Accepted: 08/07/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many obstacles to intrauterine contraception (IUC) use exist, including provider and patient misinformation, high upfront cost and clinician practice patterns. The aim of our study was to investigate knowledge and attitudes about IUC among obstetricians and gynecologists in the area of Saint Louis. STUDY DESIGN We mailed a self-administered, anonymous survey to 250 clinicians who provide obstetric and gynecologic care in Saint Louis City and County which included questions about demographics, training, family planning visits and intrauterine contraceptive knowledge and use. RESULTS The overall survey response rate among eligible clinicians was 73.7%. Clinicians who had recently finished training or saw higher numbers of contraceptive patients per week were more likely to insert IUC than clinicians who completed training prior to 1989 or saw fewer contraceptive patients. Several misconceptions among clinicians were identified, including an association between intrauterine contraceptives and an elevated risk of pelvic inflammatory disease. CONCLUSIONS Physician misconceptions about the risks of IUC continue to occur. Improved clinician education is greatly needed to facilitate the use of these highly effective, long-acting, reversible methods of contraception.
Collapse
|
16
|
Shields WC. A fast track solution for reducing unintended pregnancies in the US: increase federal support for life-long provider education and training in reproductive health. Contraception 2009; 80:231-3. [PMID: 19698813 DOI: 10.1016/j.contraception.2009.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 06/01/2009] [Indexed: 11/29/2022]
|
17
|
Palena C, Bahamondes MV, Schenk V, Bahamondes L, Fernandez-Funes J. High rate of unintended pregnancy among pregnant women in a maternity hospital in Córdoba, Argentina: a pilot study. Reprod Health 2009; 6:11. [PMID: 19619304 PMCID: PMC2722579 DOI: 10.1186/1742-4755-6-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 07/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Argentina has a new law on Reproductive Health, many barriers continue to exist regarding provision of contraceptive methods at public healthcare facilities. METHODS We asked 212 pregnant women selected at random at the Maternity and Neonatal Hospital, Córdoba, Argentina, to participate in our descriptive study. Women were asked to complete a structured questionnaire. The objectives were to determine the rate of unintended pregnancies, reasons for not using contraception, past history of contraceptive use, and intended future use. RESULTS Two hundred women responded to the questionnaire. Forty percent of the women stated that they had never used contraception and pregnancy was declared unintended by 65%. In the unintended pregnancy group, almost 50% of women said that they had not been using a contraceptive method because they were "unaware about contraception", and 25% stated that their contraceptive method had failed. Almost 85% of women stated that they intended to use contraception after delivery. CONCLUSION Approximately two-thirds of all pregnancies in this sample were unintended. Although the data is limited by the small sample size, our findings suggest that our government needs to invest in counseling and in improving the availability and access to contraceptive methods.
Collapse
Affiliation(s)
- Celina Palena
- Maternity and Neonatal Hospital, Córdoba, Argentina.
| | | | | | | | | |
Collapse
|