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Mierzejewska A, Walędziak M, Merks P, Różańska-Walędziak A. Emergency contraception - A narrative review of literature. Eur J Obstet Gynecol Reprod Biol 2024; 299:188-192. [PMID: 38880026 DOI: 10.1016/j.ejogrb.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/02/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Emergency contraception includes several methods of contraception that can be used after unprotected sexual intercourse, after failure of any used method of contraception or in case of sexual abuse, to prevent pregnancy. PURPOSE OF THE STUDY The aim of the study was to analyze the available methods of emergency contraception, their mechanisms of action, efficacy, forms of administration, clinical applications and possible adverse effects. MATERIAL AND METHOD PubMed, Scopus and Cochrane datebases were searched for articles from 2010 to 2024 about emergency contraception. RESULTS The analyzed types of emergency contraception included single oral dose of ulipristal acetate, single oral dose of levonorgestrel and intrauterine system releasing levonorgestrel or copper intrauterine device. Taking emergency contraception in the optimum time according to the drug characteristics allows for avoiding pregnancy in more than 90% of cases (depending on the type of emergency contraception and time from unprotected intercourse). The analyzed literature shows that intrauterine copper intrauterine device is the most effective method of emergency contraception, also together with intrauterine system releasing levonorgestrel leading to the lowest rate of adverse effects. CONCLUSIONS Taking emergency contraception can result in various adverse effects, therefore it should be introduced after thorough analysis of woman's medical history, including gynecological and obstetric history and potential contraindications. Additionally, the patient should receive detailed information about the drug mechanism of efficacy and potential adverse effects.
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Affiliation(s)
- Anna Mierzejewska
- Department of Human Physiology and Pathophysiology,Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., 04-141, Warsaw, Poland.
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology,Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Rudzinski P, Lopuszynska I, Pazik D, Adamowicz D, Jargielo A, Cieslik A, Kosieradzka K, Stanczyk J, Meliksetian A, Wosinska A. Emergency contraception - A review. Eur J Obstet Gynecol Reprod Biol 2023; 291:213-218. [PMID: 37922775 DOI: 10.1016/j.ejogrb.2023.10.035] [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: 07/16/2023] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Emergency contraception (EC), or postcoital contraception, is a therapy aimed at preventing unintended pregnancy after an act of unprotected or under-protected sexual intercourse. Options include both emergency contraceptive pills (most commonly containing levonorgestrel or ulipristal acetate) and insertion of an intrauterine device. The aim of this paper is to summarize current evidence surrounding the use of emergency contraceptives and to present an evidence-based approach to EC provision. Emergency contraception is a safe and effective option in preventing unwanted pregnancy, irrespective of age, weight, or breastfeeding status. Efforts should be made to increase their availability, as well as knowledge of these methods, both among patients and healthcare providers.
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Affiliation(s)
- Patryk Rudzinski
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland.
| | - Inga Lopuszynska
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
| | - Dorota Pazik
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Dominik Adamowicz
- University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
| | - Anna Jargielo
- Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | | | | | - Justyna Stanczyk
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Astrik Meliksetian
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
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Sausjord IK, Acton LW, White KO, O'Connor SK, Lerner NM. Breastfeeding and Hormonal Contraception: A Scoping Review of Clinical Guidelines, Professional Association Recommendations, and the Literature. Breastfeed Med 2023; 18:645-665. [PMID: 37672571 DOI: 10.1089/bfm.2023.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background: Postpartum contraceptive use can help prevent short-interval pregnancies, which have been associated with adverse neonatal and maternal health outcomes. Many contraceptive methods are safe for postpartum use, but patients and providers may be confused as to what impact hormonal contraception has on lactation. We performed a scoping review of the most recent U.S.-based guidelines regarding hormonal contraception on lactation to provide synthesis and recommendations to aid providers in counseling their patients. Methods: We conducted a scoping review by identifying the most recent clinical recommendations and guidelines from the Centers for Disease Control and Prevention (CDC) and three maternal and child health professional associations (American College of Obstetricians and Gynecologists [ACOG], Society for Maternal-Fetal Medicine [SMFM], and Academy of Breastfeeding Medicine [ABM]). We also reviewed the citations in these guidelines used in their development. We then conducted an updated literature review to capture studies published since the most recent systematic reviews were conducted. Results: We reviewed 1 clinical guideline from the CDC and 2 systematic reviews cited in its references, 6 professional association recommendations, and 28 publications identified through the updated literature review. Progestin-only contraceptive methods continue to demonstrate safety in breastfeeding patients, while low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception. Discussion: Organizations should consider updating counseling recommendations regarding progestin-only contraceptives and lactation. Further research is needed to examine new contraceptive methods as well as the effect of hormonal contraception on lactation in the setting of preterm birth.
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Affiliation(s)
- Isabel K Sausjord
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lillian W Acton
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Katharine O White
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Sarah K O'Connor
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Natasha M Lerner
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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Hu D, Tang Y, Pei K. Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1605564. [PMID: 37124160 PMCID: PMC10133502 DOI: 10.3389/ijph.2023.1605564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions. Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI). Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6 months postpartum (OR = 2.24, 0.06, 95% CI = 1.46-3.44, 0.02-0.22, respectively), with no significant associations with contraceptive use at 12 months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1 year after childbirth. Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.
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Affiliation(s)
- Denghui Hu
- National Research Institute for Family Planning, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxiang Tang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kaiyan Pei
- National Research Institute for Family Planning, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Kaiyan Pei,
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Implementing a Novel Facility-Community Intervention for Strengthening Integration of Infant Nutrition and Family Planning in Mara and Kagera, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084105. [PMID: 33924578 PMCID: PMC8069723 DOI: 10.3390/ijerph18084105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.
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A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive. Clin Drug Investig 2020; 40:395-420. [PMID: 32162237 DOI: 10.1007/s40261-020-00901-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The levonorgestrel oral emergency contraceptive is well tolerated and effective, however its use is still limited, mainly due to safety concerns. OBJECTIVE This systematic review and meta-analysis aimed to summarize current evidence regarding the adverse events, and their prevalence, reported during the use of oral levonorgestrel emergency contraceptives. METHODS Four electronic databases and the US FDA Adverse Event Reporting System (FAERS) Public Dashboard were searched. Studies that reported or investigated safety outcomes or adverse reactions during the use of levonorgestrel as an emergency oral contraceptive were included. Data on study design, demographics of levonorgestrel and the control cohort, and reported adverse effects were extracted. RESULTS A total of 47 articles were included in this systematic review, from which it was shown that most of the adverse reactions were common and not serious. Uncommon adverse reactions identified included anorexia, ectopic pregnancy, exanthema, chloasma, miscarriage, and weight gain. Multiple serious adverse events, including convulsion, ectopic pregnancy, febrile neutropenia, stroke, abdominal hernia, anaphylaxis, cancer, ovarian cyst rupture, serious infections, and suicidal ideation, were reported. In addition, the prevalence of adverse events after a levonorgestrel 0.75 mg two-dose regimen and a levonorgestrel 1.5 mg single-dose regimen were not statistically different (p > 0.05). CONCLUSIONS The most common adverse effects of levonorgestrel were not serious. This systematic review shows that data regarding the adverse reactions of repeated use of levonorgestrel are scarce. Studies on the multiple uses of levonorgestrel emergency contraception are still required to ensure its safety.
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Abstract
BACKGROUND Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. OBJECTIVES To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy. SEARCH METHODS In February 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Popline and PubMed, The Chinese biomedical databases and UNDP/UNFPA/WHO/World Bank Special Programme on Human Reproduction (HRP) emergency contraception database. We also searched ICTRP and ClinicalTrials.gov as well as contacting content experts and pharmaceutical companies, and searching reference lists of appropriate papers. SELECTION CRITERIA Randomised controlled trials including women attending services for EC following a single act of unprotected intercourse were eligible. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcome was observed number of pregnancies. Side effects and changes of menses were secondary outcomes. MAIN RESULTS We included 115 trials with 60,479 women in this review. The quality of the evidence for the primary outcome ranged from moderate to high, and for other outcomes ranged from very low to high. The main limitations were risk of bias (associated with poor reporting of methods), imprecision and inconsistency.Comparative effectiveness of different emergency contraceptive pills (ECP)Levonorgestrel was associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84, 6 RCTs, n = 4750, I2 = 23%, high-quality evidence). This suggests that if the chance of pregnancy using Yuzpe is assumed to be 29 women per 1000, the chance of pregnancy using levonorgestrel would be between 11 and 24 women per 1000.Mifepristone (all doses) was associated with fewer pregnancies than Yuzpe (RR 0.14, 95% CI 0.05 to 0.41, 3 RCTs, n = 2144, I2 = 0%, high-quality evidence). This suggests that if the chance of pregnancy following Yuzpe is assumed to be 25 women per 1000 women, the chance following mifepristone would be between 1 and 10 women per 1000.Both low-dose mifepristone (less than 25 mg) and mid-dose mifepristone (25 mg to 50 mg) were probably associated with fewer pregnancies than levonorgestrel (RR 0.72, 95% CI 0.52 to 0.99, 14 RCTs, n = 8752, I2 = 0%, high-quality evidence; RR 0.61, 95% CI 0.45 to 0.83, 27 RCTs, n = 6052, I2 = 0%, moderate-quality evidence; respectively). This suggests that if the chance of pregnancy following levonorgestrel is assumed to be 20 women per 1000, the chance of pregnancy following low-dose mifepristone would be between 10 and 20 women per 1000; and that if the chance of pregnancy following levonorgestrel is assumed to be 35 women per 1000, the chance of pregnancy following mid-dose mifepristone would be between 16 and 29 women per 1000.Ulipristal acetate (UPA) was associated with fewer pregnancies than levonorgestrel (RR 0.59; 95% CI 0.35 to 0.99, 2 RCTs, n = 3448, I2 = 0%, high-quality evidence).Comparative effectiveness of different ECP dosesIt was unclear whether there was any difference in pregnancy rate between single-dose levonorgestrel (1.5 mg) and the standard two-dose regimen (0.75 mg 12 hours apart) (RR 0.84, 95% CI 0.53 to 1.33, 3 RCTs, n = 6653, I2 = 0%, moderate-quality evidence).Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73; 95% CI 0.55 to 0.97, 25 RCTs, n = 11,914, I2 = 0%, high-quality evidence).Comparative effectiveness of Cu-IUD versus mifepristoneThere was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74, 2 RCTs, n = 395, low-quality evidence).Adverse effectsNausea and vomiting were the main adverse effects associated with emergency contraception. There is probably a lower risk of nausea (RR 0.63, 95% CI 0.53 to 0.76, 3 RCTs, n = 2186 , I2 = 59%, moderate-quality evidence) or vomiting (RR 0.12, 95% CI 0.07 to 0.20, 3 RCTs, n = 2186, I2 = 0%, high-quality evidence) associated with mifepristone than with Yuzpe. levonorgestrel is probably associated with a lower risk of nausea (RR 0.40, 95% CI 0.36 to 0.44, 6 RCTs, n = 4750, I2 = 82%, moderate-quality evidence), or vomiting (RR 0.29, 95% CI 0.24 to 0.35, 5 RCTs, n = 3640, I2 = 78%, moderate-quality evidence) than Yuzpe. Levonorgestrel users were less likely to have any side effects than Yuzpe users (RR 0.80, 95% CI 0.75 to 0.86; 1 RCT, n = 1955, high-quality evidence). UPA users were more likely than levonorgestrel users to have resumption of menstruation after the expected date (RR 1.65, 95% CI 1.42 to 1.92, 2 RCTs, n = 3593, I2 = 0%, high-quality evidence). Menstrual delay was more common with mifepristone than with any other intervention and appeared to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than mifepristone (18 events in 95 women using Cu-IUD versus no events in 190 women using mifepristone, low-quality evidence). AUTHORS' CONCLUSIONS Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA may be more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was probably the main adverse effect of mifepristone and seemed to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than ECPs.
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Affiliation(s)
- Jie Shen
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | - Yan Che
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | | | - Ke Chen
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | - Linan Cheng
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
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Tran NT, Yameogo WME, Gaffield ME, Langwana F, Kiarie J, Kulimba DM, Kouanda S. Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study. Open Access J Contracept 2018; 9:63-74. [PMID: 30519124 PMCID: PMC6236096 DOI: 10.2147/oajc.s170150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception. Methods Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural-urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health. Results Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3-6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services. Conclusion Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners.
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland, .,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia.,Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Wambi Maurice E Yameogo
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de la Santé Publique, Ouagadougou, Burkina Faso
| | - Mary Eluned Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland,
| | - Félicité Langwana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland,
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de la Santé Publique, Ouagadougou, Burkina Faso
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10
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Tran NT, Yameogo WME, Langwana F, Gaffield ME, Seuc A, Cuzin-Kihl A, Kouanda S, Mashinda D, Thieba B, Yodi R, Nyandwe Kyloka J, Millogo T, Coulibaly A, Bolangala B, Zan S, Kini B, Ouedraogo B, Puludisi F, Landoulsi S, Kiarie J, Reier S. Participatory action research to identify a package of interventions to promote postpartum family planning in Burkina Faso and the Democratic Republic of Congo. BMC Womens Health 2018; 18:122. [PMID: 29976182 PMCID: PMC6034289 DOI: 10.1186/s12905-018-0573-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The YAM DAABO study ("your choice" in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents. METHODS Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach - a research workshop gathering service providers, members of both country research teams, and the WHO coordination team. RESULTS As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners. CONCLUSIONS Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women's right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries. TRIAL REGISTRATION Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
- Institute of Demography and Socioeconomics (IDESO), University of Geneva, Boulevard du Pont d’Arve 40, 1211 Geneva, Switzerland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW 2007 Australia
| | - Wambi Maurice E. Yameogo
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Félicité Langwana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Mary Eluned Gaffield
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Armando Seuc
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Asa Cuzin-Kihl
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Désiré Mashinda
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Blandine Thieba
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Rachel Yodi
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Nyandwe Kyloka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tieba Millogo
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Abou Coulibaly
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Basele Bolangala
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Souleymane Zan
- World Health Organization Country Office in Burkina Faso, 158 Av. de l’Indépendance, 03, Ouagadougou 03, BP 7019 Burkina Faso
| | - Brigitte Kini
- World Health Organization Country Office in the Democratic Republic of Congo (DRC), Avenue des Cliniques N°42, BP 1899 Kinshasa I, Democratic Republic of the Congo
| | - Bibata Ouedraogo
- Centre Médical de Bokin, District sanitaire de Yako, Région du Nord, Burkina Faso
| | - Fifi Puludisi
- Centre Mère et Enfant (CME) de Bumbu, avenue Mafuta 48/49, Commune de Bumbu, Province de Kinshasa Democratic Republic of the Congo
| | - Sihem Landoulsi
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - James Kiarie
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Suzanne Reier
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
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Tran NT, Gaffield ME, Seuc A, Landoulsi S, Yamaego WME, Cuzin-Kihl A, Kouanda S, Thieba B, Mashinda D, Yodi R, Kiarie J, Reier S. Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: the YAM DAABO study protocol. BMC Health Serv Res 2018; 18:439. [PMID: 29890982 PMCID: PMC5996535 DOI: 10.1186/s12913-018-3199-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/10/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use. METHODS This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services. DISCUSSION Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies. TRIAL REGISTRATION Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
- Institute of Demography and Socioeconomics (IDESO), Geneva University, Boulevard du Pont d’Arve 40, 1211 Geneva, Switzerland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW 2007 Australia
| | - Mary Eluned Gaffield
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Armando Seuc
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Sihem Landoulsi
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Wambi Maurice E. Yamaego
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Asa Cuzin-Kihl
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Blandine Thieba
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Désiré Mashinda
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rachel Yodi
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - James Kiarie
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Suzanne Reier
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
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Özsoy S, Aksu H, Akdolun Balkaya N, Demirsoy Horta G. Knowledge and Opinions of Postpartum Mothers About the Lactational Amenorrhea Method: The Turkish Experience. Breastfeed Med 2018; 13:70-74. [PMID: 29131679 DOI: 10.1089/bfm.2017.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study was performed to investigate mothers' opinions and knowledge about the contraceptive feature of breastfeeding. BACKGROUND Breastfeeding is quite beneficial in terms of mother, baby, and public health. Although it has long been known to have a contraceptive effect and although it is common in many countries, women usually do not use it as a contraceptive method. MATERIALS AND METHODS This is a descriptive study and included 400 mothers in their early postpartum period. Data were collected with a questionnaire at face-to-face interviews within 3 days of giving birth. Obtained data were analyzed with descriptive statistics. RESULTS One third of the mothers were primiparous and 66.5% of the mothers had breastfeeding experience. Of these, 38.9% of the mothers said that they received knowledge about the contraceptive effect of breastfeeding and 68.9% of these mothers received this knowledge from a nurse. Seventeen percent of the mothers receiving this knowledge reported that breastfeeding was a contraceptive and 1.8% of the mothers reported that it was sometimes contraceptive. Around 41.3% of the mothers thought that they would be able to use breastfeeding as a contraceptive method. Almost all the mothers wanted to get information about the contraceptive feature of breastfeeding. CONCLUSIONS As our research shows, four of every five mothers in their early postpartum period turned out to believe that breastfeeding was not contraceptive, although the mothers are very eager and ready for this information. Therefore, it is important that health professionals providing antenatal and postnatal counseling about breastfeeding and contraception should offer women accurate information about this method.
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Affiliation(s)
- Sevgi Özsoy
- 1 Department of Obstetrics and Gynecological Nursing, Nursing Faculty, Adnan Menderes University , Aydın, Turkey
| | - Hilmiye Aksu
- 1 Department of Obstetrics and Gynecological Nursing, Nursing Faculty, Adnan Menderes University , Aydın, Turkey
| | - Nevin Akdolun Balkaya
- 2 Department of Nursing, Faculty of Health Sciences, Muğla Sıtkı Koçman University , Muğla, Turkey
| | - Gözde Demirsoy Horta
- 3 Department of Obstetrics and Gynecology Nursing, Institute of Health Sciences, Adnan Menderes University , Aydın, Turkey
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Norton M, Chandra-Mouli V, Lane C. Interventions for Preventing Unintended, Rapid Repeat Pregnancy Among Adolescents: A Review of the Evidence and Lessons From High-Quality Evaluations. GLOBAL HEALTH, SCIENCE AND PRACTICE 2017; 5:547-570. [PMID: 29284694 PMCID: PMC5752603 DOI: 10.9745/ghsp-d-17-00131] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/15/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2017, of the 22.5 million parenting adolescents (ages 15-19) in 60 countries, approximately 4.1 million gave birth to a second or higher-order child. Adolescent pregnancy in general, and rapid repeat pregnancies specifically, expose young mothers and their children to multiple health and socioeconomic risks. The purpose of this article is to review the impact of interventions designed to prevent unintended, rapid repeat pregnancies among adolescents, including those aimed at changing norms to postpone "intended" closely spaced pregnancies to promote healthy spacing. METHODS We searched PubMed and other databases for evaluations of interventions published in English from 1990 through 2016. We included evaluations that assessed a programmatic intervention specifically designed to prevent rapid repeat pregnancy (occurring less than 24 months after the index birth) or birth (occurring less than 33 months after the index birth), or that reported on contraceptive continuation for at least 2 years. We first assessed the quality of the evaluations, then ranked the interventions based on the quality of the evaluation and the level of impact on repeat pregnancy or birth (statistically significant impact, positive trends but not statistically significant, or no impact) to identify the most effective interventions. Finally, we extracted program design and implementation lessons from the interventions included in the high-quality evaluations. RESULTS Our search identified 2,187 articles, of which 40 evaluations met the inclusion criteria (24=high quality, 14=moderate quality, 2=less rigorous). We found 14 high-quality evaluations in which the intervention achieved a statistically significant impact on repeat pregnancy or birth. These interventions fell into 5 broad categories: (1) contraceptive services and information, with proactive monitoring of contraceptive use and outreach to families; (2) postpartum contraceptive counseling and services provided soon after delivery; (3) activities that help adolescents improve planning skills, including preparing contraceptive plans; (4) social and behavioral change activities that help adolescents understand the role contraception can play in determining positive life outcomes, and the implications of their reproductive health decisions for their future; and (5) activities that provide mentoring, goal setting, and motivation. CONCLUSION Effective interventions that prevent rapid adolescent childbearing link clinical contraceptive services with non-clinical activities that build planning skills, enhance understanding of the role that contraceptives can play in determining positive life outcomes, and provide mentoring and goal setting. Recognizing potentially synergistic effects, we recommend testing various combinations of these interventions, with access to contraception as the foundational activity.
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Affiliation(s)
- Maureen Norton
- United States Agency for International Development, Washington, DC, USA.
| | | | - Cate Lane
- Pathfinder International, Washington, DC, USA
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14
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Shaaban OM, Abbas AM, Mahmoud HR, Yones EM, Hassen SG, Zakherah MS. Counseling and in-advance provision of levonorgestrel emergency contraceptive pills decrease the rate of unplanned pregnancy during breastfeeding: a randomized controlled trial. J Matern Fetal Neonatal Med 2017; 32:1250-1255. [PMID: 29117764 DOI: 10.1080/14767058.2017.1403580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of counseling and in-advance provision of levonorgestrel emergency contraceptive pills (LNG-ECPs) during postpartum counseling on the incidence of occurrence of unplanned pregnancy during breastfeeding. MATERIALS AND METHODS The current study is an open-label, parallel, randomized controlled trial carried out in a university hospital in Egypt. All women who delivered and planning to birth-space and breastfeed for at least 1 year were approached for participation during a postpartum hospital stay. Eligible participants were randomly allocated to receive adequate lactational amenorrhea method (LAM) counseling Group 1 (LAM-only) or the above LAM counseling in addition to counseling and in advance provision of one packet of 0.75-mg LNG-ECPs Group 2 (LAM + EC). The two study groups were followed 6 months and the primary outcome was the unplanned pregnancy rate. RESULTS The study included 2708 women randomized into two groups; LAM-only and LAM + EC groups. Demographic characteristics were homogenous between the groups at the time of recruitment. Unplanned pregnancy was significantly higher in LAM-only group 70 (5.3%) as compared with 5 (0.4%) in LAM-EC group (p = .0001). Also, 619 women (46.6%) used LNG-ECPs with minor side effects like nausea in 175 (28.3%) women, headache in 94 (15.2%) women, vomiting in 24 (3.9%) women. CONCLUSION In-advance counseling and provision of LNG-ECPs for those opt to use LAM during postpartum family planning counseling can decrease the rate of unplanned pregnancy during breastfeeding and increase the initiation of long-term use of contraception.
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Affiliation(s)
- Omar M Shaaban
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt
| | - Ahmed M Abbas
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt
| | - Hanaa R Mahmoud
- b Department of Obstetric and Gynecological Nursing, Faculty of Nursing , Assiut University , Assiut , Egypt
| | - Entsar M Yones
- b Department of Obstetric and Gynecological Nursing, Faculty of Nursing , Assiut University , Assiut , Egypt
| | - Shaimaa G Hassen
- b Department of Obstetric and Gynecological Nursing, Faculty of Nursing , Assiut University , Assiut , Egypt
| | - Mahmoud S Zakherah
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Assiut University , Assiut , Egypt
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Abstract
BACKGROUND Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. OBJECTIVES To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy. SEARCH METHODS In February 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Popline and PubMed, The Chinese biomedical databases and UNDP/UNFPA/WHO/World Bank Special Programme on Human Reproduction (HRP) emergency contraception database. We also searched ICTRP and ClinicalTrials.gov as well as contacting content experts and pharmaceutical companies, and searching reference lists of appropriate papers. SELECTION CRITERIA Randomised controlled trials including women attending services for EC following a single act of unprotected intercourse were eligible. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcome was observed number of pregnancies. Side effects and changes of menses were secondary outcomes. MAIN RESULTS We included 115 trials with 60,479 women in this review. The quality of the evidence for the primary outcome ranged from moderate to high, and for other outcomes ranged from very low to high. The main limitations were risk of bias (associated with poor reporting of methods), imprecision and inconsistency. Comparative effectiveness of different emergency contraceptive pills (ECP)Levonorgestrel was associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84, 6 RCTs, n = 4750, I2 = 23%, high-quality evidence). This suggests that if the chance of pregnancy using Yuzpe is assumed to be 29 women per 1000, the chance of pregnancy using levonorgestrel would be between 11 and 24 women per 1000.Mifepristone (all doses) was associated with fewer pregnancies than Yuzpe (RR 0.14, 95% CI 0.05 to 0.41, 3 RCTs, n = 2144, I2 = 0%, high-quality evidence). This suggests that if the chance of pregnancy following Yuzpe is assumed to be 25 women per 1000 women, the chance following mifepristone would be between 1 and 10 women per 1000.Both low-dose mifepristone (less than 25 mg) and mid-dose mifepristone (25 mg to 50 mg) were probably associated with fewer pregnancies than levonorgestrel (RR 0.72, 95% CI 0.52 to 0.99, 14 RCTs, n = 8752, I2 = 0%, high-quality evidence; RR 0.61, 95% CI 0.45 to 0.83, 27 RCTs, n = 6052, I2 = 0%, moderate-quality evidence; respectively). This suggests that if the chance of pregnancy following levonorgestrel is assumed to be 20 women per 1000, the chance of pregnancy following low-dose mifepristone would be between 10 and 20 women per 1000; and that if the chance of pregnancy following levonorgestrel is assumed to be 35 women per 1000, the chance of pregnancy following mid-dose mifepristone would be between 16 and 29 women per 1000.Ulipristal acetate (UPA) was associated with fewer pregnancies than levonorgestrel (RR 0.59; 95% CI 0.35 to 0.99, 2 RCTs, n = 3448, I2 = 0%, high-quality evidence). Comparative effectiveness of different ECP dosesIt was unclear whether there was any difference in pregnancy rate between single-dose levonorgestrel (1.5 mg) and the standard two-dose regimen (0.75 mg 12 hours apart) (RR 0.84, 95% CI 0.53 to 1.33, 3 RCTs, n = 6653, I2 = 0%, moderate-quality evidence).Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73; 95% CI 0.55 to 0.97, 25 RCTs, n = 11,914, I2 = 0%, high-quality evidence). Comparative effectiveness of Cu-IUD versus mifepristoneThere was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74, 2 RCTs, n = 395, low-quality evidence). Adverse effectsNausea and vomiting were the main adverse effects associated with emergency contraception. There is probably a lower risk of nausea (RR 0.63, 95% CI 0.53 to 0.76, 3 RCTs, n = 2186 , I2 = 59%, moderate-quality evidence) or vomiting (RR 0.12, 95% CI 0.07 to 0.20, 3 RCTs, n = 2186, I2 = 0%, high-quality evidence) associated with mifepristone than with Yuzpe. levonorgestrel is probably associated with a lower risk of nausea (RR 0.40, 95% CI 0.36 to 0.44, 6 RCTs, n = 4750, I2 = 82%, moderate-quality evidence), or vomiting (RR 0.29, 95% CI 0.24 to 0.35, 5 RCTs, n = 3640, I2 = 78%, moderate-quality evidence) than Yuzpe. Levonorgestrel users were less likely to have any side effects than Yuzpe users (RR 0.80, 95% CI 0.75 to 0.86; 1 RCT, n = 1955, high-quality evidence). UPA users were more likely than levonorgestrel users to have resumption of menstruation after the expected date (RR 1.65, 95% CI 1.42 to 1.92, 2 RCTs, n = 3593, I2 = 0%, high-quality evidence). Menstrual delay was more common with mifepristone than with any other intervention and appeared to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than mifepristone (18 events in 95 women using Cu-IUD versus no events in 190 women using mifepristone, low-quality evidence). AUTHORS' CONCLUSIONS Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA was more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was probably the main adverse effect of mifepristone and seemed to be dose-related. Cu-IUD may be associated with higher risks of abdominal pain than ECPs.
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Key Words
- female
- humans
- pregnancy
- contraception, postcoital
- contraception, postcoital/adverse effects
- contraception, postcoital/methods
- contraceptives, postcoital
- contraceptives, postcoital/administration & dosage
- contraceptives, postcoital/adverse effects
- drug administration schedule
- estradiol
- estradiol/administration & dosage
- estradiol/adverse effects
- intrauterine devices, copper
- intrauterine devices, copper/adverse effects
- intrauterine devices, medicated
- intrauterine devices, medicated/adverse effects
- levonorgestrel
- levonorgestrel/administration & dosage
- levonorgestrel/adverse effects
- mifepristone
- mifepristone/administration & dosage
- mifepristone/adverse effects
- norpregnadienes
- norpregnadienes/administration & dosage
- norpregnadienes/adverse effects
- pregnancy rate
- randomized controlled trials as topic
- unsafe sex
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Affiliation(s)
- Jie Shen
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | - Yan Che
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | | | - Ke Chen
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
| | - Linan Cheng
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan UniversityCentre for Clinical Research and Training2140 Xie Tu RoadShanghaiChina
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Lee JK, Schwarz EB. The safety of available and emerging options for emergency contraception. Expert Opin Drug Saf 2017; 16:1163-1171. [PMID: 28730840 DOI: 10.1080/14740338.2017.1354985] [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] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Emergency contraception (EC) is a way to significantly reduce the chance of becoming pregnant after an episode of unprotected intercourse. Considerable data support the safety of all available and emerging options for EC. Areas covered: This review presents a comprehensive summary of the literature regarding the safety of EC as well as directions for further study. PubMed was searched for all relevant studies published prior to June 2017. Expertopinion: All available methods of EC (i.e., ulipristal acetate pills, levonorgestrel pills, and the copper-IUD), carry only mild side effects and serious adverse events are essentially unknown. The copper IUD has the highest efficacy of EC methods. Given the excellent safety profiles of mifepristone and the levonorgestrel IUD, research is ongoing related to use of these products for EC.
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Affiliation(s)
- Jessica K Lee
- a Department of Obstetrics and Gynecology , Johns Hopkins University , Baltimore , MD , USA
| | - Eleanor Bimla Schwarz
- b Department of General Internal Medicine , UC Davis, Division of General Internal Medicine , Sacramento , CA , USA
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Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol 2017; 3:1. [PMID: 28101373 PMCID: PMC5237348 DOI: 10.1186/s40748-016-0040-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022] Open
Abstract
Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
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Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, California, USA
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology & Women's Health, University of Hawaii John A. Burns School of Medicine, Hawaii, USA
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Blazer C, Prata N. Postpartum family planning: current evidence on successful interventions. Open Access J Contracept 2016; 7:53-67. [PMID: 29386937 PMCID: PMC5683159 DOI: 10.2147/oajc.s98817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations.
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Affiliation(s)
- Cassandra Blazer
- Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Ndola Prata
- Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
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20
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Hussainy SY, Ghosh A, Taft A, Mazza D, Black KI, Clifford R, Gudka S, Mc Namara KP, Ryan K, Jackson JK. Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia. BMJ Open 2015; 5:e010009. [PMID: 26656987 PMCID: PMC4679989 DOI: 10.1136/bmjopen-2015-010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. METHODS AND ANALYSIS Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. ETHICS AND DISSEMINATION The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.
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Affiliation(s)
| | - Ayesha Ghosh
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Isla Black
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rhonda Clifford
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Sajni Gudka
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Peter Mc Namara
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
- Deakin University and Flinders University, Melbourne, Victoria, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - John Keith Jackson
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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Cleland J, Shah IH, Daniele M. Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities. Stud Fam Plann 2015; 46:423-41. [DOI: 10.1111/j.1728-4465.2015.00041.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- John Cleland
- Emeritus Professor of Medical Demography, Department of Population Health; London School of Hygiene & Tropical Medicine; Keppel Street London WC1E 7HT United Kingdom
| | - Iqbal H. Shah
- Doctoral student, Faculty of Epidemiology and Population Health, Department of Population Health; London School of Hygiene & Tropical Medicine; Keppel Street London WC1E 7HT United Kingdom
| | - Marina Daniele
- Principal Research Scientist, Department of Global Health and Population; Harvard T.H. Chan School of Public Health; Boston Massachusetts
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Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception. Contraception 2015; 93:93-112. [PMID: 26546020 DOI: 10.1016/j.contraception.2015.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) provide recommendations for use of emergency contraceptive pills (ECPs), including levonorgestrel (LNG) and combined oral contraceptives (COCs). A new ECP formulation, ulipristal acetate (UPA), is now available worldwide. To determine whether LNG, UPA or COC (Yuzpe) ECPs are safe for women with certain characteristics or medical conditions, we searched the PubMed and Cochrane databases for articles published from date of inception until May 2015 pertaining to the safety of LNG, UPA or Yuzpe ECP use. For direct evidence, we considered studies that looked at safety outcomes among women with certain medical conditions or characteristics taking ECPs compared with women not taking ECPs. For indirect evidence, we considered studies that reported pharmacokinetic (PK) data for ECP use among women with certain medical conditions or characteristics and studies that reported safety outcomes among healthy women taking ECPs. Five studies provided direct evidence; of these five studies, four examined LNG or Yuzpe use among pregnant or breastfeeding women, and one reported risk of ectopic pregnancy among women repeatedly using LNG ECPs. Poor pregnancy outcomes were rare among pregnant women who used LNG or Yuzpe ECPs during the conception cycle or early pregnancy. Breastfeeding outcomes did not differ between women exposed to LNG ECP and those unexposed, and there was no increased risk of ectopic pregnancy versus intrauterine pregnancy after repeated use of LNG ECPs compared with nonuse. Forty-five studies provided indirect evidence. One PK study demonstrated that LNG passes into breastmilk but in minimal quantities. In addition, nine studies examined pregnancy outcomes following ECP failure among healthy women, and 35 articles reported adverse events. Studies suggest that serious adverse events are rare among women taking any of these ECP formulations. IMPLICATIONS Evidence on safety of ECPs among women with characteristics or medical conditions listed within WHO and CDC family planning guidance is limited. However, both direct and indirect evidence for our study question did not suggest any special safety concerns for the use of ECPs among women with particular medical conditions or personal characteristics, such as pregnancy, lactation or frequent ECP use.
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Abstract
BACKGROUND It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective contraception is used to prevent these pregnancies, including difficulty in obtaining contraceptives. The lactational amenorrhoea method (LAM) is a contraceptive method where the mother is informed and supported in how to use breastfeeding for contraception. LAM is available and accessible to many women. OBJECTIVES To assess the effectiveness of LAM, as defined in the 1988 Bellagio Consensus statement, as a contraceptive method in fully breastfeeding women, who remain amenorrheic, using pregnancy and menstruation life tables. SEARCH METHODS We searched MEDLINE, EMBASE, POPLINE, and LILACS to 10 October 2014; reference lists of studies; review articles; books related to LAM; published abstracts from breastfeeding, reproductive health conferences; e-mails with study coordinators. SELECTION CRITERIA Out of 459 potentially relevant studies, 159 investigated the risk of pregnancy during LAM or lactational amenorrhoea. Our inclusion criteria were as follows: prospective study; cases (intervention group) and, if available, controls, had to be sexually active; pregnancy had to be confirmed by physical examination or a pregnancy test. Our endpoints were life table menstruation rates and life table pregnancy rates. We included 15 studies reporting on 11 intervention groups and three control groups. We identified one additional uncontrolled study in the 2007 update and one additional controlled study in this 2015 update. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, resolving disagreements through discussion. We analysed the studies using narrative methods because of their heterogeneity. MAIN RESULTS For the primary outcome, pregnancy, two controlled studies of LAM users reported life table pregnancy rates at six months of 0.45% and 2.45%, one controlled study reported 5% pregnancies in the absence of life table rates per month, and eight uncontrolled studies of LAM users reported pregnancy rates of 0% to 7.5%. Life table pregnancy rates for fully breastfeeding women who were amenorrheic but not using any contraceptive method were 0.88% in one study and 0.9% to 1.2% (95% confidence interval 0.0 to 2.4) in a second study, depending on the definition of menstruation used. The life table menstruation rate at six months in all studies varied between 11.1% and 39.4%. AUTHORS' CONCLUSIONS We found no clear differences in life table pregnancy rates between women using LAM and being supported in doing so, and fully breastfeeding amenorrheic women not using any method. As the length of lactation amenorrhoea in women using LAM differed greatly between the populations studied, and was population specific, it is uncertain whether LAM extends lactational amenorrhoea.
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Affiliation(s)
- Carla Van der Wijden
- VU University Medical CenterInstitute for Research in Extramural MedicineAmsterdamNetherlands
| | - Carol Manion
- FHI 360PO Box 13950Research Triangle ParkNorth CarolinaUSA27709
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Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review. Hum Reprod 2015; 30:751-60. [PMID: 25678571 PMCID: PMC4447791 DOI: 10.1093/humrep/dev019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies.
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Affiliation(s)
- ESHRE CapriWorkshop Group
- Correspondence address. P.G. Crosignani, Scientific Direction, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Via M. Fanti, 6, 20122 Milano, Italy, E-mail:
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Lopez LM, Grey TW, Stuebe AM, Chen M, Truitt ST, Gallo MF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev 2015; 2015:CD003988. [PMID: 25793657 PMCID: PMC10644229 DOI: 10.1002/14651858.cd003988.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Postpartum contraception improves the health of mothers and children by lengthening birth intervals. For lactating women, contraception choices are limited by concerns about hormonal effects on milk quality and quantity and passage of hormones to the infant. Ideally, the contraceptive chosen should not interfere with lactation or infant growth. Timing of contraception initiation is also important. Immediately postpartum, most women have contact with a health professional, but many do not return for follow-up contraceptive counseling. However, immediate initiation of hormonal methods may disrupt the onset of milk production. OBJECTIVES To determine the effects of hormonal contraceptives on lactation and infant growth SEARCH METHODS We searched for eligible trials until 2 March 2015. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, POPLINE, Web of Science, LILACS, ClinicalTrials.gov, and ICTRP. We also examined review articles and contacted investigators. SELECTION CRITERIA We sought randomized controlled trials in any language that compared hormonal contraception versus another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception includes combined or progestin-only oral contraceptives, injectable contraceptives, implants, and intrauterine devices.Trials had to have one of our primary outcomes: breast milk quantity or biochemical composition; lactation initiation, maintenance, or duration; infant growth; or timing of contraception initiation and effect on lactation. Secondary outcomes included contraceptive efficacy while breastfeeding and birth interval. DATA COLLECTION AND ANALYSIS For continuous variables, we calculated the mean difference (MD) with 95% confidence interval (CI). For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio (OR) with 95% CI. Due to differing interventions and outcome measures, we did not aggregate the data in a meta-analysis. MAIN RESULTS In 2014, we added seven trials for a new total of 11. Five reports were published before 1985 and six from 2005 to 2014. They included 1482 women. Four trials examined combined oral contraceptives (COCs), and three studied a levonorgestrel-releasing intrauterine system (LNG-IUS). We found two trials of progestin-only pills (POPs) and two of the etonogestrel-releasing implant. Older studies often lacked quantified results. Most trials did not report significant differences between the study arms in breastfeeding duration, breast milk composition, or infant growth. Exceptions were seen mainly in older studies with limited information.For breastfeeding duration, two of eight trials indicated a negative effect on lactation. A COC study reported a negative effect on lactation duration compared to placebo but did not quantify results. Another trial showed a lower percentage of the LNG-IUS group breastfeeding at 75 days versus the nonhormonal IUD group (reported P < 0.05) but no significant difference at one year.For breast milk volume, two older studies indicated lower volume for the COC group versus the placebo group. One trial did not quantify results. The other showed lower means (mL) for the COC group, e.g. at 16 weeks (MD -24.00, 95% CI -34.53 to -13.47) and at 24 weeks (MD -24.90, 95% CI -36.01 to -13.79). Another four trials did not report any significant difference between the study groups in milk volume or composition with two POPs, a COC, or the etonogestrel implant.Seven trials studied infant growth; one showed greater weight gain (grams) for the etonogestrel implant versus no method for six weeks (MD 426.00, 95% CI 58.94 to 793.06) but less compared with depot medroxyprogesterone acetate (DMPA) from 6 to 12 weeks (MD -271.00, 95% CI -355.10 to -186.90). The others studied POPs, COCs versus POPs, or an LNG-IUS. AUTHORS' CONCLUSIONS Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alison M Stuebe
- University of North Carolina School of MedicineDepartment of Obstetrics and Gynecology3010 Old Clinic BuildingCB 7516Chapel HillNorth CarolinaUSA27599
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Sarah T Truitt
- Alaska Native Medical CenterDepartment of Obstetrics and Gynecology4320 Diplomacy DriveAnchorageAlaskaUSA
| | - Maria F Gallo
- The Ohio State UniversityDivision of EpidemiologyColumbusOhioUSA
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Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Pamela Berens
- 1 Department of Obstetrics and Gynecology, University of Texas , Houston, Texas
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Kaplanoglu M, Kaplanoglu D, Usman MG. Postpartum contraception in adolescents: data from a single tertiary clinic in southeast of Turkey. Glob J Health Sci 2014; 7:80-6. [PMID: 25716393 PMCID: PMC4796411 DOI: 10.5539/gjhs.v7n2p80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/04/2014] [Indexed: 12/03/2022] Open
Abstract
Aim: We aimed to evaluate the postpartum contraception preferences of adolescent women in this study. Material and Method: This descriptive study was prepared after a retrospective analysis of file records of primigravida women who had given birth at the Adiyaman University School of Medicine Training and Research Hospital Department of Obstetric and Gynecology between January 2010 and June 2012. More than 12 months had passed after birth. The adolescents who were included in the study and the control group women were called by phone and invited to our clinic. A total of 506 adolescents and 1,046 control group women came to the clinic and were evaluated. The control group was formed of women between the age of 20-35 years who gave given birth in our clinic during the same period and were randomly selected. Postpartum obstetric history, contraception methods and data of these patients were recorded. Results: The mean age was 18.3±0.4 years and 28.2±4.9 years in the adolescent group and control group respectively. No contraception other than lactation amenorrhea was used by 256 women of the adolescent group (50.6%) and 345 women of the control group (33%). The most commonly used contraceptive method in both groups other than lactation amenorrhea was condoms (160 women (64%) and 230 women (32.8%) respectively). The annual contraceptive failure rate was 3.95% in the adolescent group and 1.72% in the control group. The highest failure rate was with lactation amenorrhea in both groups. Discussion: Adolescent women mostly use contraceptive methods with low reliability such as lactation amenorrhea and the calendar method in the postpartum period. Providing adequate contraceptive education is therefore important. On the other hand, starting such training starting in the early postnatal period will prevent recurring adolescent pregnancies with a short pregnancy interval.
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Elder JP, Pequegnat W, Ahmed S, Bachman G, Bullock M, Carlo WA, Chandra-Mouli V, Fox NA, Harkness S, Huebner G, Lombardi J, Murry VM, Moran A, Norton M, Mulik J, Parks W, Raikes HH, Smyser J, Sugg C, Sweat M. Caregiver behavior change for child survival and development in low- and middle-income countries: an examination of the evidence. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 1:25-66. [PMID: 25207447 PMCID: PMC4263266 DOI: 10.1080/10810730.2014.940477] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children's Fund convened, on June 3-4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers' behaviors are given.
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Affiliation(s)
- John P. Elder
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Willo Pequegnat
- National Institute of Mental Health, Bethesda, Maryland, USA
| | - Saifuddin Ahmed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gretchen Bachman
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, USA
| | - Merry Bullock
- American Psychological Association, Washington, District of Columbia, USA
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Nathan A. Fox
- Department of Human Development, University of Maryland, College Park, Maryland, USA
| | - Sara Harkness
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Gillian Huebner
- Center on Children in Adversity, United States Agency for International Development, Washington, District of Columbia, USA
| | - Joan Lombardi
- Bernard van Leer Foundation, Washington, District of Columbia, USA
| | | | - Allisyn Moran
- Office of Health, Infectious Disease and Nutrition, United States Agency for International Development, Washington, District of Columbia, USA
| | - Maureen Norton
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, District of Columbia, USA
| | | | - Will Parks
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Helen H. Raikes
- Department of Child, Youth and Family Studies, University of Nebraska, Lincoln, Nebraska, USA
| | - Joseph Smyser
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Caroline Sugg
- British Broadcasting Company, London, United Kingdom
| | - Michael Sweat
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Preterm birth and neonatal mortality in a rural Bangladeshi cohort: implications for health programs. J Perinatol 2013; 33:977-81. [PMID: 23949837 DOI: 10.1038/jp.2013.91] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To estimate the burden of prematurity, determine gestational age (GA)-specific neonatal mortality rates and provide recommendations for country programs. STUDY DESIGN Prospective data on pregnancy, childbirth, GA and newborn mortality collected by trained community health workers from 10 585 mother-newborn pairs in a community-based study. RESULT A total of 19.4% of newborn infants were preterm; 13.5% were late preterm (born between 34 and 36 weeks of gestation), 3.3% were moderate preterm (born at 32 to 33 weeks) and 2.6% were extremely preterm (born at 28 to 31 weeks of gestation). Preterm babies experienced 46% of all neonatal deaths; 40% of preterm deaths were in late preterm, 20% in moderate preterm and 40% in very preterm infants. The population attributable fraction of neonatal mortality in premature babies was 0.16 for very preterm, 0.07 for moderately preterm and 0.10 for late preterm. CONCLUSION In settings where the majority of births and newborn deaths occur at home and successful referral is a challenge, moderate and late preterm babies may be an important target group for home-based or first-level facility-based management.
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Response to letter to the editor. Contraception 2013; 87:504-5. [PMID: 23290430 DOI: 10.1016/j.contraception.2012.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022]
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Cost-effectiveness of increased access to emergency contraceptive pills: probably not. Contraception 2013; 87:504. [PMID: 23290429 DOI: 10.1016/j.contraception.2012.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 11/20/2012] [Indexed: 12/30/2022]
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