Global trends in use of long-acting reversible and permanent methods of contraception: Seeking a balance

Unwanted Family Planning Including Unwanted Sterilization: Preliminary Prevalence Estimates for India

Estimates of unwanted family planning (UFP), which are based on a desire to have a child in the next nine months among current contraceptive users, exclude women who are sterilized since these women are not asked about their fertility preferences; all sterilized women are assumed to have a "met need" for family planning. However, the India National Family Health Survey asks sterilized women if they regret being sterilized and whether they were told that the operation would result in their permanent inability to have children. We extend the concept of UFP by classifying sterilized women who express regret or who were not informed about the procedure's permanence, as having UFP. When limiting our analysis of UFP to nonsterilized contraceptive users, we find that 0.9 percent of Indian women had UFP in 2019-2021. In this period, 29.9 percent of Indian women were sterilized. We estimate that 4.9 percent of sterilized women express regret and 16.3 percent were not told of the procedure's permanence. Adding sterilized women who express regret raises our UFP estimate in India to 2.3 percent, while also including sterilized women who were not told about the procedure's permanence yields an overall UFP estimate of 6.9 percent in India.

Predictors of long-acting contraceptive utilization hot spots in Ethiopia: using geographical weighted regression analysis

Background

The use of long-acting contraceptives is a common health challenge in Ethiopia. Therefore, the current study aimed to assess the determinants of using long-acting contraceptive hot spots in Ethiopia using data from the Ethiopian Mini Demographic and Health Survey for 2019.

Methods

This study used data from the Ethiopia Mini Demographic and Health Survey 2019 and included a total weighted sample of 8,885 women in the analysis. The geographical variation of long-acting contraceptive usage was initially observed using hot spot analysis. Arc GIS version 10.7 was used for geographically weighted regression. Ordinarily, least squares regression was performed to identify predictors that explain the geographical variation in the use of long-acting contraceptives. Geographic weighted regression was used to predict the hot spot area of long-acting contraceptive methods.

Results

The overall prevalence of long-acting contraceptive utilization use was 6.9% (95% confidence interval: 6.4-7.45). Most of the statistically significant hot spots for long-acting contraceptives were found in lactated areas of the Oromia part of Amhara and Dire Dawa. Primary education, followers of the Muslim religion, marital status, and women with >4 children were the determinants of spatial variation use of hot spot areas for long-acting contraceptive methods.

Conclusions

A detailed map of long-acting contraceptive use hot spots and their determinants will enable decisions to target their sociodemographic-related predictors of women.

Epidemiological profile and effectiveness of immediate postpartum contraception in Brazilian women

Purpose

To determine the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum period and compare the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC.

Methods

We analyzed the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum. The data was collected by electronic medical records of postpartum women assisted at the University Hospital of São Bernardo do Campo (HMU-SBC) from January 2016 to December 2020. Also, we compared the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC by identifying women who returned for second delivery during the study period and analyzing the contraceptive method chosen in the first hospitalization. Then the pregnancies interval and the sociodemographic characteristics were analyzed according to contraceptive method type.

Results

Data from 20,896 women were collected, of which 8,183 (39%) opted for Cu-IUD, 559 (2.5%) DPMA, and 10,989 (52.5%) chose not to use contraception at the time of hospital discharge. When comparing these groups, women in the DPMA were younger (26.5 ± 7.3, p < 0.05), and NCM showed women with a lower number of pregnancies (2.2 ± 1.3, p < 0.05). Subjects in the TL group (4.6%) had the higher number of pregnancies (3.8 ± 1.2, p < 0.05), and ENG group, the highest number of miscarriages (1.6 ± 1.3, p < 0.05). Of those women who returned pregnant, 5.5% belonged to the DPMA group, 6% to the NCM group, and 2.3% to the Cu-IUD.

Conclusions

Women who opted for Cu-IUD insertion were younger, had more pregnancies and vaginal delivery when compared to those who did not choose a method. Of those women who returned, the minority opted for Cu-IUD compared to those that opted for DPMA or no method.

Knowledge, beliefs and practices of nurses with long-acting reversible contraception, Cape Town

BACKGROUND

Implanon and copper intrauterine contraceptive device (IUCD) are long-acting reversible contraceptives (LARC) available in public primary health care (PHC) South Africa. These methods are the most effective forms of contraception.

AIM

To evaluate the knowledge, beliefs and practices on provision of LARC.

SETTING

Primary health care facilities within the Khayelitsha Eastern Substructure, Cape Town.

METHODS

A descriptive survey of all permanent nurses who provided contraception. Data were collected from 72/90 (80% response rate) via a validated questionnaire and evaluated using Statistical Package for Social Sciences (SPSS).

RESULTS

Knowledge of eligibility for LARC was tested. The mean knowledge scores for Implanon were 8.56/11 (s.d. 1.42) for the trained and 7.16/11 (s.d. 2.83) for the untrained (p = 0.007). The mean knowledge scores for IUCD were 10.42/12 (s.d. 1.80) for the trained and 8.03/12 (s.d. 3.70) for the untrained (p = 0.019). Participants believed that inaccessibility to training courses (29%), no skilled person available (24%) and staff shortages (35%) were barriers. Less than 50% of women were routinely counselled for LARC. Forty-one percent of nurses were trained and performed IUCD insertion, and 64% were trained and performed Implanon insertion, while 61% and 45% required further training. Confidence was low, with 32% trained and confident in IUCD and 56% trained and confident in Implanon insertion.

CONCLUSION

Lack of training, poor confidence and deficient counselling skills were barriers to effective LARC provision. The identified system-specific barriers must be addressed to improve uptake.Contribution: The first study to evaluate knowledge, beliefs and practices on LARC in providers in the Western Cape.

Bleeding profile satisfaction and pain and ease of placement with levonorgestrel 19.5 mg IUD: findings from the Kyleena® Satisfaction study

PURPOSE

To investigate bleeding profile satisfaction and pain and ease of placement with levonorgestrel 19.5 mg IUD in routine clinical practice.

METHODS

Women who independently chose levonorgestrel 19.5 mg IUD during routine counselling were invited to participate in this prospective, multinational, observational study. Patient-reported pain and clinician-reported ease of placement were assessed. Bleeding profile satisfaction was evaluated at 12 months/premature end of observation.

RESULTS

Most participants (77.8%, n = 878/1129) rated levonorgestrel 19.5 mg IUD placement pain as 'none' or 'mild' and most clinicians (91.1%, n = 1029/1129) rated placement as 'easy'. Pain was more often rated higher in nulliparous compared with parous (p < .0001) and younger (<26 years) compared with older participants (p < .0001), although 67.7% and 69.0% of nulliparous and younger participants respectively reported 'none' or 'mild' pain. Bleeding profile satisfaction at 12 months/end of observation was similar in parous (72.9%, n = 318/436) and nulliparous (69.6%, n = 314/451) participants. Most participants irrespective of age reported bleeding profile satisfaction, ranging from 67.8% (n = 206/304) for 18-25 years to 76.5% (n = 218/285) for >35 years.

CONCLUSION

We observed high bleeding profile satisfaction regardless of age or parity with levonorgestrel 19.5 mg IUD and confirmed that device placement is easy and associated with no more than mild pain in most cases in routine clinical practice. Real-world evidence from the Kyleena^® Satisfaction Study in routine clinical practice shows high bleeding profile satisfaction with levonorgestrel 19.5 mg IUD regardless of age or parity. IUD placement was easy and associated with little to no pain for most women.

Utilization of long-acting contraceptive methods and associated factors among married women in Farta Woreda, Northwest Ethiopia: a community-based mixed method study

BACKGROUND

Although long-acting contraceptive methods are highly effective, safe, and provide uninterrupted protection from unintended pregnancy compared to short-acting methods, evidences suggest that majority of women were relayed on short-acting contraceptive methods. Thus, this study aimed to determine the level of long-acting contraceptive methods utilization and associated factors among married women in Farta Woreda, Northwest Ethiopia, 2021.

METHODS

A community-based cross-sectional study supplemented with qualitative data was performed among 556 married women from March 1 to 31, 2021. A semi-structured interviewer-administered questionnaire and interview guides were used to collect the data. The data were entered into Epi data version 4.6 and analyzed by SPSS version 23 software. The association between variables was analyzed using bivariate and multivariable binary logistic regression. The level of statistically significant association was determined at a P-value < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.

RESULTS

The magnitude of long-acting contraceptive methods among married women in Farta Woreda was found to be 14.3% [95% CI 11.5-17.6]. Previous use of long-acting contraceptive methods (AOR = 5.83, 95% CI 3.03, 11.21), positive attitude towards long-acting contraceptives (AOR = 2.74, 95% CI 1.48, 5.07), having formal education for husbands' (AOR = 3.05, 95% CI 1.5, 6.21), and poor wealth index (AOR = 3.39, 95% CI 1.33, 8.67) were positively associated with utilization of long-acting contraceptive methods. Moreover, fear of side effects, misconceptions, and partner opposition were the most commonly identified barriers by the qualitative data.

CONCLUSION

Utilization of long-acting contraceptives among married women in Farta Woreda was low as compared to the 2020/21 national reproductive health strategy plan to increase the long-acting reversible and permanent contraceptive methods use to 50%. Previous use of long-acting contraceptives, positive attitude towards long-acting contraceptives, husband education, and household wealth index was found to be significantly associated with long-acting contraceptive utilization. Hence, it is better to work more on changing women's attitudes and increasing husband education.

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa

BACKGROUND

The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA.

METHODS

Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05.

RESULTS

The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03-1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41-1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure.

CONCLUSION

The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA.

Reasons given by women for discontinuing the use of progestogen implants at Koster Hospital, North West province

BACKGROUND

In 2014, the South African National Department of Health introduced a new addition to the long-acting reversible contraceptive (LARC) options available in the country. This was a single rod subdermal progestogen implant (Implanon®NXT) which provided 3 years of effective contraception cover. However, the new contraceptive device uptake and general acceptance amongst women quickly diminished, with a slew of requests for its removal. The aim of this study was to explore the reasons given by women for discontinuing the use of their progestogen implants at Koster Hospital, North West province, South Africa.

METHODS

A qualitative study was conducted using semistructured interviews. Thirteen women were purposively selected and interviewed at Koster Hospital Family Planning Unit. The transcriptions of the audio-taped interviews were analysed thematically.

RESULTS

The following themes emerged from the interviews as reasons the women discontinued their progestogen implants: side effects such as menstrual problems, arm discomfort and weight gain. Other themes were family or social factors and the desire to conceive.

CONCLUSION

The reasons for discontinuation of Implanon by women at Koster Hospital were the undesirable side effects they experienced whilst using the contraceptive device. These side effects were mainly menstrual problems, arm discomfort and weight gain. Family and other social dynamics also influenced some of the participants' decision to discontinue their contraceptive implants.

Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries: a multi-level analysis of recent demographic and health surveys

BACKGROUND

Long-acting reversible contraceptives (LARC) have been hailed as one of the safest and most effective methods of contraception. However, the use of LARC is low in the world, including Sub Saharan Africa; therefore, the aim of this study was to assess LARC utilization and associated factors among modern contraceptive users in high fertility SSA countries.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 14,828 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of long acting reversible contraception utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.

RESULTS

Overall prevalence of LARC utilization was observed to be 20.1% (19.45, 20.74). The factors significantly associated with the utilization were women's age ≥ 35 years (AOR = 1.42; 95% CI: 1.19,1.68), having media exposure (AOR = 1.13; 95% CI: 1.05, 1.28), number of alive children: 1-2 (AOR = 2.35; 95% CI: 1.38, 4.01), 3-4 (AOR = 2.98; 95% CI: 1.74, 5.10), [Formula: see text] 5 (AOR = 2.82; 95% CI:1.63, 4.86), have no history of abortion (AOR = 1.33; 95% CI: 1.17,1.51) and who have no big problem with distance to the health facility (AOR = 1.29; 95% CI: 1.16, 1.43).

CONCLUSION

The use of long acting reversible contraception in this study was relatively low. To improve the utilization of long acting reversible contraceptives governments, policymakers, and stakeholders should implement health promotion strategies through media and improve accessibilities of health facilities.

Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia

Background

Long Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia.

Methods

A Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching.

Results

Of the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children.

Conclusion

Discontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01357-2.

Ethiopia has a substantially greater percentage of unintended pregnancy than other developing and developed countries. Long-acting reversible contraception (LARC) has a potential to address a huge and growing unmet need in resource limited countries like Ethiopia, such as reducing unwanted births and abortion rates.

As part of this global approach to fertility management, Ethiopia has been implementing various strategies like an on-going task shifting and task sharing with the implanon scale up program, and IUD revitalization program starting from the community health services to higher level healthcare systems to increase access and utilization of long acting reversible family planning methods. However, discontinuing LARCs before the recommended duration use and switching to short-acting contraceptives have proven difficulty in Ethiopia. This may have led to low utilization rate of LARCs in Ethiopian contexts including the study area, when compared to the national target. Very low coverage of use of LARC among unmet need has shown by many studies in various corners of the country. Thus, determining the magnitude and factors of LARC discontinuing and switching is still a pressing need to establish additional strategies used to improve consistent use of LARC for the recommended duration and expand access to LARC for better planning of births.

In this study we assessed magnitude and factors of LARC discontinuation and switching from a relatively huge number of records extracted from systematically selected health facilities in Southern Ethiopia. Extracted data from registers of long acting reversible family planning methods were analysed using descriptive statistics and logistic regression. Accordingly, we found significant proportion women discontinued long acting reversible family planning methods before the recommended duration of use as well as switched from long acting reversible family planning methods to other modern short-acting methods due to various reasons. Only a number of children women had is associated with discontinuation and no single factor was associated with method switching in Southern Ethiopia. Family planning services should be re-evaluated with a focus on effective counseling on the side effects of LARCs approaches, and training for family planning providers, particularly community healthcare workers, should be provided.

Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women's response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1-1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04-1.2) once the model was adjusted for women's and their partner's characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

The use of long-acting and permanent contraceptive methods (LAPMs) among women who have completed childbearing in Indonesia: does informed choice matter?

OBJECTIVES

This study examined factors associated with long-acting and permanent contraceptive methods use among married women who completed childbearing in Indonesia.

METHODS

Data were extracted from the 2017 Indonesia Demographic and Health survey. Subjects of this study comprised 12,790 (weighted) married women aged 15-49 years who completed their childbearing and used modern contraceptive methods. Logistic regression adjusted for complex sample was used to assess factors associated with LAPMs use among women in Indonesia.

RESULTS

Only 28% of the participants used long-acting and permanent contraceptive methods. Older women, higher number of living children, higher educational level, informed choice, and living in urban areas were associated with higher likelihood of adopting long-acting and permanent contraceptive methods. Women who received comprehensive counselling on contraceptive methods were more likely to adopt long-acting and permanent contraceptive methods compared with women who did not receive comprehensive counselling on contraceptive methods (AOR = 1.23; 95% CI: 1.07-1.41). Women who attained secondary (AOR = 1.31; 95% CI: 1.14-1.50) or higher (AOR = 2.36; 95% CI: 1.91-2.91) educational level were more likely to use long-acting and permanent contraceptive methods compared to women with primary education or less. The use of long-acting and permanent contraceptive methods was higher among women aged 35-49 (AOR = 1.41; 95% CI: 1.24-1.61) and women who have three or more living children (AOR = 1.75; 95% CI: 1.57-1.96) than their counterparts.

CONCLUSION

The use of long-acting and permanent contraceptive methods was still low, even though there were more than half of women completed childbearing. The informed choice had a key role in improving long-acting and permanent contraceptive methods uptake. Training programs on contraceptive counselling for health providers and improving couple's awareness on the effectiveness of long-acting and permanent contraceptive methods were suggested to increase long-acting and permanent contraceptive methods adoption.

Utilization of Immediate Postpartum Long Acting Reversible Contraceptives among Women Who Gave Birth in Public Health Facilities in Eastern Ethiopia: A Cross-Sectional Study

OBJECTIVE

Although importance of postpartum family planning is essential and immediate postpartum insertion of long acting and reversible contraceptives (LARC) is recommended, evidence on its uptake and associated factors is limited in Ethiopia. This study was conducted to assess utilization of immediate postpartum LARC among women who gave birth in selected public health facilities in eastern Ethiopia.

METHOD

An institution-based cross-sectional study was conducted among randomly selected women who gave birth in selected public health facilities in eastern Ethiopia from 10 March to 09 April 2020. At discharge, all eligible women who gave birth in the facilities were interviewed using a pretested structured questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with utilization of immediate postpartum LARC. Adjusted odds ratio (aOR) with 95% confidence interval was used to report association, and significance was declared at p value < 0.05.

RESULTS

From a total of 546 women invited to the study, 530 (97.1%) participated in the study and 98 (18.5%; 95% CI: 15.1%, 22.0%) reported starting long acting reversible contraceptives. Women who reported discussing about contraceptives with partners (aOR = 6.69, 95% CI: 3.54, 12.61) and receiving postpartum counselling on contraceptives (aOR = 5.37, 95% CI: 3.00, 9.63) were more likely to using contraception. However, women who live >30-minute walking distance from the nearest health facility (aOR = 0.47, 95% CI: 0.26, 0.85) and reported disrespect and abuse during childbirth (aOR = 0.22, 95% CI: 0.12, 0.40) were less likely to start LARC.

CONCLUSIONS

Almost one in five women delivering in public health facilities in eastern Ethiopia started using LARC. Provision of respectful maternity care including counselling on the importance of immediate postpartum family planning is essential for increasing its uptake.

Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review

OBJECTIVE

We sought to systematically review the literature on contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraception, and women seeking abortion services, globally.

STUDY DESIGN

We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding users' values and preferences for contraception. Results were divided into four sub-groups.

RESULTS

Twenty-three studies from 10 countries met the inclusion criteria. Values and preferences across all four sub-groups were influenced by method effectiveness, access, availability, convenience, cost, side effects, previous experience, partner approval, and societal norms. Similarities and differences were evident across sub-groups, especially concerning contraceptive benefits and side effects. No contraceptive method had all the features users deemed important. Many studies emphasized values and preferences surrounding long-acting reversible contraception (LARC), including convenience of accessing LARCs and concerns about side effect profiles.

DISCUSSION

Individuals must have access to a full range of safe and effective modern contraceptive options, allowing people to make decisions based on evolving contraceptive preferences over time. Future contraception guideline development, policy, and programmatic implementation should continue considering the added influence of these specific reproductive experiences on contraceptive values and preferences of users to improve access, counseling, and method choice.

Satisfaction and continuation with LNG-IUS 12: findings from the real-world kyleena® satisfaction study

PURPOSE

The Kyleena^® Satisfaction Study (KYSS) aimed to assess satisfaction and continuation with levonorgestrel-releasing intrauterine system (LNG-IUS) 12 (Kyleena^®) in routine clinical practice and to evaluate factors that influence satisfaction.

MATERIALS AND METHODS

This prospective, observational, multicentre, single-arm cohort study, with 1-year follow-up, was conducted in Belgium, Canada, Germany, Mexico, Norway, Sweden, Spain and the United States from 2017 to 2018. During routine counselling, women who independently selected to use LNG-IUS 12 were invited to participate in the study. KYSS assessed LNG-IUS 12 satisfaction, continuation and safety.

RESULTS

Overall, there were 1126 successful LNG-IUS 12 placements, with insertion attempted in 1129 women. Most participants (833/968, 86.1%, 95% CI 83.7-88.2%, with satisfaction outcome data available) reported satisfaction with LNG-IUS 12 at 12 months (or at the final visit if the device was discontinued prematurely). Satisfaction was not associated with age, parity or motivation for choosing LNG-IUS 12. The majority of women (919/1129, 81.4%) chose to continue after 12 months. Discontinuation was not correlated with age or parity. Overall, 191 women (16.9%) reported a treatment-emergent adverse event.

CONCLUSIONS

Results from KYSS provide the first real-world evidence assessing LNG-IUS 12, and demonstrate high satisfaction and continuation rates irrespective of age or parity. Clinical trial registration: NCT03182140.

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

BACKGROUND

Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception.

METHODS

We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle-Ottawa Scale to assess risk of bias and excluded studies with medium-high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis.

RESULTS

Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium-high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC.

CONCLUSIONS

Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO [CRD42016038254].

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

OBJECTIVES

To review ethical aspects of the promotion and provision of long-acting reversible contraception (LARC). Specifically, to examine (1) the tension between informational exchange and the active promotion of LARC methods to new and existing contraceptive users by healthcare professionals; and (2) the distinct ethical issues arising from the promotion of LARC methods by state-sponsored actors and healthcare professionals.

METHODS

Narrative review and ethical analysis.

FINDINGS

There is an ethical difference between raising awareness/informational provision and actively promoting or prioritising specific contraceptive methods. It matters whether the policy choice is made, or the promotional activity about contraception is undertaken, by individual healthcare professionals at a local level or by more remote state-sponsored actors, because the relationship between the promoter and the (potential) contraceptive user is of a different kind. Imposing a dual responsibility upon healthcare professionals for raising awareness/informational exchange and the active promotion of LARC creates an unnecessary tension and barrier for the delivery of patient-centred care.

CONCLUSIONS

This review highlights the need for ethical reflection on the central role of the promoting agent and the distinction between facilitating informational awareness and active promotion of LARC. LARC methods should not be prioritised in isolation and without regard to the wider implications of public promotion. A balanced narrative and information-sharing programme that respects the individual interests of each contraceptive user is called for, especially in direct professional/service user relationships. No assumption should be made that user decision-making will necessarily be determined and influenced solely by the relative effectiveness of the contraceptive method.

Geographic variation and associated factors of long-acting contraceptive use among reproductive-age women in Ethiopia: a multi-level and spatial analysis of Ethiopian Demographic and Health Survey 2016 data

Background

High fertility rates and unintended pregnancies are public health concerns of lower and middle income countries such as Ethiopia. Long acting contraceptives (LACs) take the lion’s share in reducing unintended pregnancies and high fertility rates. Despite their numerous advantages, the utilization of LACs remains low in Ethiopia. This study is aimed to explore the geographic variation and associated factors of long acting contraceptive use among reproductive-age women in Ethiopia.

Methods

This is a secondary data analysis of 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of weighted sample sizes of 10,439 reproductive-age women were included in the final analysis. To clean and analyze the none-spatial data Stata 14 was used while ArcGIS 10.6 and SaTScanTM version 9.6 software were used for spatial analysis. Multilevel Mixed-effect Logistic regression model was used to identify associated factors of LACs utilization. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to identify significant variables.

Results

Long acting contraceptive utilization was non-random (Moran’s I: 0.30, p-value < 0.01). Statistically, clusters with significant low utilization of LACs were found in Somali, Afar, Gambela, northern Amhara, eastern Oromia and western part of Southern Nations Nationalities and Peoples (SNNP) regions. Adjusting for other factors such as being married (AOR = 2.51, 95% CI: 1.29–4.87), having one to two (AOR = 2.14, 95% CI: 1.43–3.22), and three to four children (AOR = 1.68, 95% CI: 1.02–2.76), urban (AOR = 1.59, 95% CI: 1.16–2.19), want no more children (AOR = 1.40, 95% CI: 1.08–1.83), working status of women (AOR = 1.33, 95% CI: 1.07–1.65) increased the odds of LACs utilization. While previous history of abortion (AOR = 0.56, 95% CI: 0.39–0.80), and living in the pastoralist community (AOR = 0.22, 95% CI: 0.14–0.35) reduced the odds of LACs utilization in Ethiopia

Conclusions

Significant geographic variation of LACs utilization was observed in Ethiopia. Spots with Low LACs utilization were found in the eastern, north eastern and western part of the country. Socio-demographic and pregnancy related factors were significant determinants of LACs utilization. Designing intervention programs targeting the identified hot spot clusters, and variables that can hinder the utilization of LACs is very important to increase the utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01171-2.

Lower and middle-income countries such as Ethiopia face a challenge of an ever increasing population with high maternal mortality. In Ethiopia, the population is estimated to be more than 110 million. High fertility rates, unintended pregnancy, maternal and child mortalities are the main concerns of the country. Accordingly, it is required of the country to make a robust intervention to limit these public concerns. In relation to this, LACs utilization happens to be one of the solutions to solving the concerns. Despite their efficacy, availability, and acceptability the utilization of LACs remains low and varies among different geographic areas. However, the reason is still undefined and geographic variation was not assessed before.

In our study, we analyze the Ethiopian demographic and health survey 2016 data to assess the presence of significant geographic variation and associated factors of long-acting contraceptive utilization. Hence, a spatial and multilevel analysis were employed to assess the geographic variation and associated factors of LACs utilization in Ethiopia.

A statistically significant geographic variation was observed among different clusters. Clusters with significantly low utilization of LACs were found in the pastoralist (Afar, Gambela, and Somalia) regions of the country. Thus, more organized efforts need to be made to increase the utilization of LACs. Controlling for others: Marital statuses, occupation, future pregnancy interest, urban residence, previous history of abortion, living in the pastoralist community were statistically significant determinant factors of LACs utilization.

In conclusion, significant geographic variation of LACs utilization was observed among different clusters. Besides, different socio-demographic, pregnancy, and child health-related variables were significant determinants of LACs utilization.

Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan

INTRODUCTION

Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan.

METHODS

In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts.

RESULTS

Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women's experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method's use.

CONCLUSION

This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

Changes in Rates of Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the USA, 2012-2016

OBJECTIVES

To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use.

METHODS

A retrospective cohort study utilizing the 2012-2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL.

RESULTS

Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08-7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91-5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42-7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06-0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06-0.12) were associated with greater use PPTL versus IPP LARC.

CONCLUSIONS

The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access.

Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users

Introduction

The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users.

Methods

A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants.

Results

A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users.

Conclusion

There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Implications. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns.

Assessment of Male Involvement in Long-Acting and Permanent Contraceptive Use of Their Partner in West Badewacho, Southern Ethiopia

BACKGROUND

Male involvement in family planning use particularly in long-acting and permanent contraceptive methods (LAPCM) is a key strategy to reduce fertility, and promote maternal and child health. Despite this, little is known about male involvement in LAPCM use of their partners in Africa, particularly in Ethiopia. This study aimed to assess male involvement in long-acting and permanent contraceptive method use in west Badewacho district, Southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 564 participants from April 1 to 30/2019. A multi-stage sampling technique was used to select eligible participants. A pre-tested, structured, and interviewer-administered questionnaire was used. Binary and multivariable logistic regression analysis was done to identify associated factors. The adjusted odds ratio with 95% CI was estimated to show the direction and strength of the association. Variables with p<0.05 were considered statistically significant.

RESULTS

About 108 (19.9%, 95% CI: (16.8, 23.2)) participants were involved in LAPCM use. Being urban dweller [AOR=3.13; 95% CI: (1.58, 6.19)], discussion with wives about LAPCM [AOR=2.81; 95% CI: (1.64, 4.8)], having good knowledge about LAPCM [AOR=2.55; 95% CI: (1.42, 4.57)], and positive attitude towards LAPCM [AOR=2.16; 95% CI: (1.16, 4.02)] were significantly associated factors.

CONCLUSION

Overall, the male involvement in LAPCM use was low. Enhancing male involvement in family planning use through creating community awareness, encouraging inter-spousal communication to enhance decision making, and increasing positive attitude towards LAPCM in the community is crucial to decrease the problem.

Heavy menstrual bleeding in women with inherited bleeding disorders

Heavy menstrual bleeding (HMB) is the commonest bleeding symptom among women with inherited bleeding disorders (IBD). Since HMB starts at the very onset of menarche and continues throughout the reproductive life, the health related quality of life of these women is affected and they are at an increased risk of developing iron-deficiency anemia. Because of the entrenched stigma and taboos, women and girls are often reluctant to discuss the problem of HMB within their families and do not seek medical advice. Increased awareness and multidisciplinary management approach for the management of these women are essential in ensuring an optimal outcome. It is important to take a careful history and undertake a thorough gynecological assessment to exclude other underlying/concomitant causes of HMB. Iron supplementation is essential. Strategies for decreasing menstrual blood flow are similar to those used for HMB in general with the addition of desmopressin and replacement therapy and the exclusion of non-steroidal anti-inflammatory drugs. Tranexamic acid and/or hormonal intervention are usually recommended as first-line therapy. Treatment choice should be individualized taking into account whether the woman wishes to preserve her fertility, if she requires contraception, the type of IBD, the severity of bleeding, and her social and religious background as well as acceptability and availability of the treatment options.

The contraceptive efficacy of a self-assembling intra-uterine device in domestic mares

OBJECTIVE

The primary aim of this study was to investigate the contraceptive efficacy of a self-assembling uterine device (iUPOD™) in the mare. In addition, the effects of iUPODs on oestrous cyclicity, uterine health and circulating concentrations of cortisol were evaluated.

METHODS

Domestic mares underwent oestrous monitoring and artificial insemination. After subsequent ovulation, mares underwent either placement (n = 7) or sham placement (n = 7; controls) of an iUPOD device. Devices were left in place for at least 3 months. Pregnancy diagnoses were carried out 14 days post-ovulation, with any pregnancies terminated at 28 days post-ovulation. All mares underwent weekly blood sampling with or without reproductive examinations throughout the study. Towards the end of the study, multiple serum samples collected over three consecutive days were analysed for concentrations of cortisol. Endometrial biopsies were collected before artificial insemination and during the subsequent breeding season. Endometrial cytology and bacterial cultures were performed before device removal (iUPOD mares) or at the end of the study (control mares).

RESULTS

Pregnancies were diagnosed in 0 of 7 iUPOD mares versus 7 of 7 control mares. Placement of iUPODs was associated with extended luteal phases and variable accumulations of intra-uterine fluid. Bacterial culture results suggested that the mild endometritis associated with iUPODs was sterile in six of seven mares. Short-term placement of iUPODs had no detrimental effects on endometrial architecture. Mean serum cortisol concentrations were significantly lower in iUPOD mares than control mares.

CONCLUSION

iUPODs represent a promising means of fertility control in the mare.

Utilization of Long-Acting Reversible Contraceptive (LARC) Methods in a tertiary hospital in southwestern Nigeria: A Mixed Methods Study

Background/Purpose

There is an increasing trend in the utilization of long-acting reversible contraceptive (LARC) methods globally. The study assessed the utilization of LARC methods and its determinants in a tertiary hospital, southwestern Nigeria using a mixed method study.

Methods

A cross-sectional study of women attending the Family Planning Clinic of the tertiary hospital was conducted between November 1, 2018 and October 31, 2019 using both quantitative and qualitative methods. Quantitative data was collected using structured questionnaire while in-depth interviewer topic guide was used to obtain qualitative data from the respondents. The quantitative and qualitative data obtained from the respondents were analyzed using SPSS version 22 and open code version 3.6.2, respectively, and the determinants of utilization of LARC methods were identified using multivariate regression model.

Results

The current utilization rate of LARC methods was 65.6% and implants accounted for 75% of LARC used. Higher education (p = 0.035), more than 3 living children (p = 0.030), previous use of LARC (p = 0.028), good knowledge (p = 0.025) and positive attitude of the women about LARC (p = 0.026) were significant determinants of utilization among the women. Limiting size of family was the commonest reason among LARC users, while partner disapproval, fear of procedure and side effects were reasons given by non-users.

Conclusions

The utilization rate of LARC methods are high, and this should be sustained through improved information dissemination, education of women and involvement of male partners in reproductive health matters including family planning.

Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study

BACKGROUND

Though long-acting reversible contraceptives (LARCs) are highly effective, have minimal side effects, require minimal follow-up, and are low cost, only 10% of contraceptives used in Ethiopia are LARCs. The reason for this low uptake is not understood at the country or regional level. Therefore, this study identified determinants of LARC utilization in Northwest Ethiopia.

METHODS

A facility-based unmatched case control study, using LARC users as cases and short- acting reversible contraception (SARC) users as controls, had been conducted at fourteen public health institutions in Northwest Ethiopia. A systematic random sampling technique was used to select participants with a 1:2 case to control ratio (n = 1167). Binary logistic regression analysis was used to identify determinants of LARC utilization among family planning service users.

RESULTS

Wealth status [AOR:1.87, 95%CI (1.08, 3.24)], history of abortion [AOR:2.69, 95%CI (1.41, 5.12)], limiting family size [AOR: 2.38, 95%CI (1.01, 5.62)], good knowledge about LARCs [AOR: 2.52, 95%CI (1.17, 5.41)], method convenience [AOR: 0.23, 95%CI (0.16, 0.34)], good availability of method [AOR:0.10 (0.05, 0.19)], less frequent visits to health facility [AOR:2.95, 95% CI(1.89, 4.62)], health care providers advice [AOR:10.69, 95%CI (3.27, 34.87)], partner approval [AOR:0.66, 95%CI (0.45, 0.97)], and favorable attitude towards LARCs [AOR:13.0, 95%CI (8.60, 19.72)] were significantly associated with LARC utilization.

CONCLUSION

Professional support, favorable attitude towards LARC use, high economic status, history of abortion, advantage of less frequent visits, having good knowledge towards LARC and interest of limiting births were significantly associated with LARC Utilization. On the other hand, perceived method convenience, and contraception availability were inversely associated with it. Family planning education about the benefits of LARC should be done by health providers and media. Male involvement in the counselling and decision making about the advantage of using LARC may improve the negative influence of partners on LARC utilization. It is also recommended that, future qualitative research further explore perceptions of LARC use.

[Differences in contraceptive practice in the city of São Paulo, Brazil: results of the Ouvindo Mulheres population survey]

Contraception is essential for women to be able to regulate their fertility, exercising a key dimension of reproductive rights. However, little is known about how women deal with this challenge in Brazil's largest city, São Paulo. To fill this gap, the population survey Ouvindo Mulheres: Contracepção no Município de São Paulo was conducted with a probabilistic sample of 4,000 women 15 to 44 years of age living in this city in 2015. This article presents the prevalence of contraceptive practice and analyzes factors associated with lack of contraception use and with types of contraceptives. Prevalence of contraception was estimated for women with at least one heterosexual relation in the 12 months prior to the interview and who were not pregnant. Logistic regression was used to verify factors associated with lack of contraception use, and the CHAID model was used to identify associations with the types of contraceptives used. Prevalence of contraception was 84.8% (95%CI: 83.2-86.3). The most prevalent contraceptives were the pill and condoms. Factors associated with lack of contraceptive use were religion (Pentecostal), number of children (fewer than 3), not having used contraceptives in the first sexual relation, not having a partner, and not having had sex in the previous month. Number of children and woman's age were the first two levels of discrimination of the types of contraceptives used. Prevalence of contraception was high, but maintaining a concentration in two methods: historically, female sterilization and the pill prevailed, nowadays, the pill and condoms do. New hormonal contraceptives should be incorporated by the Brazilian Unified National Health System (SUS), besides promoting the use of long-acting methods such as IUDs.

Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review

PURPOSE OF REVIEW

To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC).

RECENT FINDINGS

Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief.

SUMMARY

Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

Deleterious effect of short-term gavage of an ethanol extract of cogon grass (Imperata cylindrica L.) roots on testis and epididymal sperm quality

BACKGROUND AND AIM

Cogon grass (Imperata cylindrica L.) (CGG) is a herbal medicine that could be developed into a male antifertility agent. The present study aims to determine the effect of an ethanol extract of CGG roots on mice testicular activity, reproductive hormone levels, and epididymal sperm quality.

MATERIALS AND METHODS

This study was designed as completely randomized with three different doses, such as an ethanol extract of CGG roots at 0 (control), 90, and 115 mg/kg body weight. In total, 21 male DDY mice strain were treated with the CGG extract (by gavage) for 14 days, followed by an evaluation of reproductive organs, epididymal sperm quality, testis histology, histomorphometry, and reproductive hormone assays. All quantitative data were analyzed by analysis of variance, followed by Tukey's post hoc test at α=0.05.

RESULTS

The results showed that the administration of the CGG root ethanol extract disrupted the testis interstitial area and seminiferous tubules, resulting in decreased epididymal sperm quality as well as serum testosterone levels in a dose-dependent pattern.

CONCLUSION

Oral administration of a CGG root ethanol extract induced testicular damage, decreased epididymal sperm quality, and impaired testosterone secretion.

Synthesis and characterization of PCL-DA:PEG-DA based polymeric blends grafted with SMA hydrogel as bio-degradable intrauterine contraceptive implant

Presently available long-acting reversible female contraceptive implants are said to be an effective way of preventing unintended pregnancy. Unacceptable side effects attributed by these contraceptive implants act as a major drawback for the practitioners. These problems pave the way for the development of a new form of long-acting non-hormonal female contraceptive implant, especially in the developing countries. PCL-DA: PEG-DA polymeric scaffold is grafted with Styrene Maleic Anhydride (SMA) based hydrogel, and their physicochemical, thermal and biological parameters are being explored for developing a bio-degradable form of the non-hormonal intrauterine contraceptive implant. With the fixed ratio of PEG-DA: PCL-DA polymer, SMA hydrogel was added at four different concentrations to determine the optimum concentration of SMA hydrogel for the development of a promising long-acting biodegradable intrauterine contraceptive implant. Structural elucidation of the polymers was confirmed using ¹H and ¹³C NMR spectroscopic analyses. The physiochemical characterization report suggests that SMA hydrogel interacts with the PCL-DA: PEG-DA polymeric scaffold through intermolecular hydrogen bonding interaction. The in-vitro spermicidal activity of the polymeric scaffold increases when the concentration of SMA based hydrogel in the polymer samples is increased without showing any significant toxicological effects. From the study results, it may be concluded that SMA hydrogel grafted PCL-DA: PEG-DA scaffold can be developed as intra-uterine biodegradable non-hormonal female contraceptive implant due to its excellent bio-compatibility and spermicidal activity.

Trends and factors associated with long-acting reversible contraception in Kenya

Background: Kenya has 12 million female adolescents and youths aged 10-34 years whose reproductive behavior will determine the growth and size of its population for the next decade. The anticipated momentum of births can be slowed by the use of long-acting reversible contraception (LARC) methods as they are more effective, need no user adherence, and hence have no risk of incorrect or inconsistent use. However, in spite of the many health and social benefits, LARC is underutilized because of myths and misconceptions. Kenya is in the ultimate decade towards Vision 2030 and investing in LARC can save costs of health care and accelerate the achievement of the development goal. The objective of this study was to establish factors associated with LARC use, with a view of establishing the potential for increasing demand.

Methods: The study was national and used secondary data from the three waves of the Kenya Demographic Health Survey from 2003, 2008/09 and 2014 in a sample of all women of reproductive age who reported currently using modern contraceptive methods at the time of interview. Descriptive and logistic regression analysis was employed to profile and examine LARC users.

Results: LARC use was low but picking up rapidly, especially among contraceptive users of higher social economic status in a major shift between 2008/09 and 2014. Consistent factors that influenced its use were age, wealth, and number of living children, while education and residence were of influence some of the time.

Conclusions: There is huge unexploited potential for more LARC uptake based on the identified predictors of its use. Scaling up of LARC uptake is critical to deal with issues of poor user adherence, incorrect and inconsistent use, and method failure that characterize short-acting contraception, resulting in increased unintended pregnancies, incidences of unsafe abortions and maternal and infant mortality.

Disparities in Long-Acting Reversible Contraceptive Utilization among Married Women in Ethiopia: Findings of the Ethiopian Demographic and Health Survey

Background

Long-acting contraceptive methods, subdermal implants, and intrauterine devices are reliable, safe, and cost-effective family planning methods. However, these methods are not widely used in Ethiopia despite government effort to increase access. The study is aimed at assessing the rate of utilization of long-acting contraceptive methods among married women and associated factors.

Method

We analyzed the 2016 Ethiopian Demographic and Health Survey dataset. A total of 2045 married women of reproductive age group, who were using any modern contraceptive method at the time of the survey, were included in the study. Descriptive statistics were computed to characterize the study participants. Bivariate and multivariable logistic regression analyses were performed to identify associated factors, reporting odds ratios (ORs) and 95% confidence intervals (95% CIs).

Result

The multivariable analyses showed that women educational status, parity, religion, previous history of abortion, desire for more child, and region where the respondents reside were significantly the factors that determine the utilization of long-acting contraceptive. There is a significant regional disparity in long-acting contraceptive utilization. Compared to women residing in Tigray region, those who live in other regions (Afar-Somali, Oromia, Amhara, Benishangul Gumz-Gambela, and Southern Nations Nationalities and People) have low likelihood of using long-acting contraceptive methods.

Conclusion

Utilization of long-acting family planning method is low in Ethiopia. There is a significant regional disparity in utilizing these methods. Policy makers should promote culture-sensitive and tailored interventions to improve the utilization of long-acting family planning methods.

The influence of birth cohort and calendar period on global trends in ovarian cancer incidence

Ovarian cancer is the eighth most common cancer in women worldwide and incidence rates vary markedly by world region. Our study provides a comprehensive overview of ovarian cancer incidence trends globally, examining the influence of birth cohort and period of diagnosis on changing risk. We presented current patterns and trends of ovarian cancer incidence until 2012 using data from successive volumes of Cancer Incidence in Five Contents. The incidence of ovarian cancer is highest in northern and eastern European countries and in northern America. Declining trends were observed in most countries with the exception of a few central and eastern Asian countries. Marked declines were seen in Europe and North America for women aged 50-74 where rates have declined up to 2.4% (95% CI: -3.9, -0.9) annually in Denmark (DNK) over the last decade. Additionally, declines in the incidence rate ratio (IRR) were observed for generations born after the 1930s, with an additional strong period effect seen around 2000 in United States and DNK. In contrast, IRRs increased among younger generations born after the 1950s in Japan and Belarus. Overall, the favorable trends in ovarian cancer incidence is likely due to the increase use of oral contraceptive pills, and changes in the prevalence of other reproductive risk and protective factors for ovarian cancer over the years studied. Changes in disease classifications and cancer registry practices may also partially contribute to the variation in ovarian cancer incidence rates. Thus, continuous cancer surveillance is essential to detect the shifting patterns of ovarian cancer.

Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey

Background

There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia.

Methods

Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis.

Result

From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman’s occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change.

Conclusion

The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.

How do women and health care professionals view hormonal long-acting reversible contraception? Results from an international survey

Purpose: Evidence from real-world settings is important to provide an accurate picture of health care delivery. We investigated use of long-acting reversible contraception (LARC) in women aged 15-49 years.Materials and methods: Two surveys, one of women and one of health care professionals (HCPs), were conducted in parallel across seven countries. Participating women completed an online survey to assess contraceptive awareness, current method of contraception, age, and experience with current contraceptive method. HCPs participated in an online survey to provide practice-level information and three anonymous charts of hormonal LARC users.Results: Of 6903 women who completed the survey, 3225 provided information about their current primary contraception method. Overall, 16% used LARC methods, while 52% used oral contraceptives (OCs). Of hormonal intrauterine system users, 72% described their experience as 'very favourable', compared with only 53% of women using OCs. Anonymous patient records (n = 1605) were provided by 550 HCPs who completed the online survey. Most women (64%) had used short-acting reversible contraception before switching to LARC. Physicians perceived 56-84% of LARC users to be highly satisfied with their current form of contraception.Conclusions: Although usage of LARC was low, most women using LARC were highly satisfied with their method of contraception.

Factors associated with long acting and permanent contraceptive methods use in Ethiopia

Background

Long acting and permanent contraceptives methods are more effective, save cost and enable women to control their reproductive lives better. Although the Ethiopian government is promoting its use through various mechanisms, the level of use is low. Therefore, this study was designed to identify factors associated with long acting and permanent contraceptive methods use in Ethiopia.

Methods

Four Ethiopian demographic and health survey data were used to examine trends of long acting and permanent contraceptive methods use. To identify factors associated with long acting and permanent contraceptive methods use, the 2016 Ethiopian demographic and health survey data was used. The data was accessed from the demographic and health survey program data base. Data analysis was done using Stata 15.1. Descriptive analysis was used to describe socio-economic and other variables of the study participants. Data were weighted and design effect was considered during analysis. Multicollinearity was assessed using variance inflation factor. Finally, multinomial logistic regression model was used to identify factors associated with long acting and permanent contraceptive methods use.

Results

Long acting and permanent contraceptive methods use increased significantly from 0.6% in 2000 to 11.6% in 2016. The odds of long acting and permanent contraceptive methods use was higher among richer women (AOR 2.6; 95%CI 1.2–5.4), women who were sales workers (AOR 2.1; 95%CI 1.1–3.9) and women whose ideal number of children was high (AOR; 4.2, 95%CI 1.4–13.0). But the odds of long acting and permanent contraceptive methods use was lower among female headed households (AOR 0.2: 95%CI 0.1–0.5) and women who had history of abortion (AOR 0.2: 95%CI 0.1–0.5).

Conclusion

Long acting and permanent contraceptive methods use increased significantly in Ethiopia. Wealth index, women’s occupation, ideal number of children, sex of head of the household and history of abortion were factors associated with long acting and permanent contraceptive methods use in Ethiopia. Improving economic status of women may help improve long acting and permanent contraceptive methods use in Ethiopia.

Assessment of need for limiting family after two children: A cross-sectional study from a Northern State of India

Background:

Success of a programme of free-choice participation, like Family Planning Programme, can be envisaged only when focus is on the needs of the people. Although India was the first country to introduce Family Planning Programme, total fertility rate of 2.1 has not yet been achieved, highlighting that the need of limiting family after two children is not yet felt by the people of India. Therefore, the study was undertaken to assess need for limiting family and permanent methods, and factors influencing it among couples with two or more living children.

Materials and Methods:

A community-based cross-sectional study was conducted in rural and urban areas of Haldwani Tehsil, Uttarakhand. Multistage sampling technique was used for selection of study sample. Data were collected using a pretested questionnaire. Statistical analysis was done using Epi Info version 7.2.2.6.

Results:

Out of 221 women interviewed, only one-third had adopted permanent methods of contraception for limiting family, one-third were using temporary methods, and remaining were not using any contraception. Merely one-third participants were willing to adopt permanent contraception in future. Unmet need for permanent methods was higher among women of younger age, literate woman, and/or husband and joint families. It was lower in women with three or more living children in comparison with women with two children. Unfelt need for limiting the family was 8.6%.

Conclusion:

Acceptance of permanent methods of contraception was low with temporary methods being equally preferred for limiting family. Unfelt need for limiting still remains in the community despite promotion of small family norm.

The Trend, Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization

STUDY OBJECTIVE

To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL).

DESIGN

A retrospective cohort study.

SETTING

Four university-affiliated hospitals in Houston, TX, and New York, NY.

PATIENTS

All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016.

INTERVENTIONS

Sterilization by bilateral salpingectomy or conventional tubal ligation.

MEASUREMENTS AND MAIN RESULTS

There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001).

CONCLUSIONS

The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries

BACKGROUND

The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys.

METHODS

Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied.

FINDINGS

We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives.

INTERPRETATION

Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis.

FUNDING

Wellcome Trust, Pan American Health Organization.

Contextual influences on the choice of long-acting reversible and permanent contraception in Ethiopia: A multilevel analysis

BACKGROUND

Long acting reversible and permanent contraception (LARPs) offer promising opportunities for addressing the high and growing unmet need for modern contraception and helps to reduce unintended pregnancies and abortion rates in sub-Saharan Africa (SSA). This study examines the contextual factors that influence the use of long acting reversible and permanent contraception among married and fecund women in Ethiopia.

METHOD

We use data from the 2016 Ethiopian Demographic and Health Survey to examine the contextual factors that influence choice of long acting reversible and permanent contraception among married, non-pregnant and fecund women. The DHS collects detailed information on individual and household characteristics, contraception, and related reproductive behaviors from women of reproductive age. In addition, we created cluster level variables by aggregating individual level data to the cluster level. Analysis was done using a two-level multilevel logistic regression with data from 6994 married (weighted = 7352) women residing in 642 clusters (communities).

RESULTS

In 2016, 12% of married, non-pregnant and 'fecund' women were using long-acting reversible and permanent methods of contraception in Ethiopia. A higher proportion of women with secondary and above education (17.6%), urban residents (19.7%), in the richest wealth quintile (18.3%) and in paid employment (18.3%) were using LARP methods compared to their counterparts. Regression analysis showed that community level variables such as women's empowerment, access to family planning information and services, region of residence and knowledge of methods were significantly associated with use of LARP methods. Age, wealth status, employment status and women's fertility preferences were among the individual and household level variables associated with choice of LARP methods. With regards to age, the odds of using LARP methods was significantly lower among adolescents (OR, 0.53; 95% CI, 0.32-0.85) and women over the age of 40 (OR, 0.63; 95% CI, 0.44-0.90) compared to women in their 20's.

CONCLUSION

The findings of this study indicate that the demand for long-acting reversible and permanent contraception is influenced not only by women's individual and household characteristics but also by the community's level of women's empowerment, socio-economic development, as well as access and exposure to family planning information and services. Thus, improving knowledge of long-acting reversible and permanent methods, improving women's decision making autonomy and upgrading the capacity and skills of health workers particularly the midlevel providers and community health extension workers on the provision of LARP methods and rights-based approach is important to improve the uptake of LARP methods.

INFORMED CHOICE AND FEMALE STERILIZATION IN SOUTH ASIA AND LATIN AMERICA

Globally, female sterilization is one of the most popular contraceptive methods despite concerns about quality of care for women who report being sterilized. In this study, informed choice among sterilized women was quantified using Demographic and Health Survey (DHS) data from 2000 to 2012 for countries in South Asia and Latin America. Three responses measured informed choice and knowledge about whether women were informed by a health worker or provider: that sterilization is permanent, the potential side-effects of sterilization and other methods of contraception. An ascending composite Method Information Index with scores ranging from 0 (women received no information) to 3 (women received information across all three indicators) was used. Using ordinal logistic regression analysis, the results indicated that women younger than 25 and older than 35 at the time of sterilization, and those at high parities, had lower odds of a high score on the index, while the opposite was true for women sterilized in the private sector in Latin America. Educated women in India had higher odds of a high score on the index, while the same was true for educated and wealthy women in Colombia. These findings indicate that not enough health care providers spend time informing women in South Asia and Latin America about different aspects of sterilization, and that there are specific groups of women that are more affected. There is an urgent need to improve quality of care within health systems providing sterilization for this very important and effective type of contraception.

Tracing long-term trajectories of contraceptive practice across 185 countries

BACKGROUND

Globally the trajectories of approaches in adoption and implementation of family planning programmes have varied subjecting to variation in cultural and political philosophies across the countries. Accordingly, the progress in family planning has varied over the time across the countries.

OBJECTIVE

This study investigates long-term trajectories of demand for family planning and contraceptive prevalence rates and tests the hypothesis of convergence across the world countries.

METHODS

This study used data from United Nations Population Prospects for 185 countries and regions during 1970-2015. Standard graphical, parametric and nonparametric convergence metrics have been used for testing of the convergence hypothesis.

RESULTS

The results suggest a substantial increase in the global average of both demand and actual prevalence of contraceptive practice across the countries, but the actual contraceptive use is yet to catch up with the demand. Our findings suggest that there is a convergence in contraceptive use across the countries, particularly since the mid-1990s.

CONCLUSION

A major part of the convergence in demand for family planning and contraceptive prevalence rate is due to its stalling in both developed and many developing countries and its increase in several developing and least developed countries. Family planning has a greater role in human wellbeing particularly enhancing reproductive, maternal and child health outcomes than being a mere tool for fertility reduction. Therefore, the emphasis is needed on family planning efforts in the lagged behind countries for global convergence of family planning.

Reviewing the cost-effectiveness of long-acting reversible contraceptive methods in an Australian context

BACKGROUND

Relative to the oral contraceptive pill, uptake of long-acting reversible contraceptive methods (LARCs) in Australia continues to be lower than might be suggested by the evidence on their clinical and economic benefits.

AIM

To undertake a critical appraisal of published economic evaluations of LARCs to assess the generalisability of their results to the Australian healthcare context.

MATERIALS AND METHODS

A search of the literature was conducted to identify studies of economic evaluations of LARCs using the Medline, Embase and PubMed databases. The quality of the studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

A total of 1009 citations were screened, from which 20 papers, typically reporting the cost per pregnancy avoided, were reviewed. The overall quality of the studies varied but was generally poor (average score of 62/100). To aid comparisons, results have been grouped under the headings IUS (all hormonal intrauterine systems), IUDs (all non-hormonal intrauterine devices), injectables (all contraceptive injections) and implants (all subdermal contraceptive implants). Overall, the results indicated that LARCs were more effective and less costly than oral contraceptives.

CONCLUSIONS

Despite evidence that LARCs represent value for money, limitations in study quality and approaches must be taken into account when applying these results to Australia. Differences in healthcare settings aside, LARCs may also have benefits beyond their effect on pregnancy that might be captured in broader analyses, such as cost-benefit analyses using willingness to pay methods. These would capture benefits beyond health, which seem to be particularly relevant to contraception.

Experiences with the levonorgestrel-releasing intrauterine system in Kenya: qualitative interviews with users and their partners

Objectives: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an underused contraceptive method in sub-Saharan Africa. A recent market assessment in Kenya found that if a more affordable version of the method were available it may increase demand and uptake of the method. We therefore aimed to examine attitudes and perceptions around the LNG-IUS and experiences of method use, including exploring attributes such as bleeding changes, contraceptive-related amenorrhoea and perceived non-contraceptive benefits.

Methods: Qualitative interviews were conducted among 29 women who were current or recent users of the LNG-IUS, and among a subset (n = 9) of their husbands/partners.

Results: Our findings indicate that women’s main reason for choosing the LNG-IUS for contraception was their perception that the method had fewer side effects compared with other contraceptive methods. Women had favourable attitudes towards using the LNG-IUS. Husbands were also very positive about their partner’s use of the method.

Conclusion: Understanding the motivations and experiences of early adopters of the LNG-IUS can help inform the development of demand creation and communication strategies to influence uptake and continuation of the LNG-IUS both in Kenya and perhaps more broadly. Communication efforts that emphasise the positive attributes of the LNG-IUS could help promote wider use of the method, especially if new, more affordable product(s) become available.

Contraceptive use and preferences of young married women in Kerala, India

Background

As in other states of India, female sterilization is the most widely used contraceptive method in Kerala where women have higher levels of education compared to most other states in India. This paper describes the use and preferences of contraceptive methods among young married women in Trivandrum district, Kerala, India.

Subjects and methods

A community-based cross-sectional survey was carried out among 203 young married women (18–28 years) during January–March 2015 using multistage cluster sampling method. Statistical analysis was mainly descriptive, and chi-squared test was used to test the statistical significance of the relationship between sociodemographic factors and contraceptive use.

Results

The average age at marriage for women was 21.3 years, and 23% of women had more than one child. Current use of any contraceptive methods was 58%. Female sterilization was preferred by 13% and it was significantly higher among women aged 25–28 years than in those aged 18–24 years (20% vs 2.6%, p<0.001). Female sterilization was significantly lower among women with higher levels of education than in women with an education level of plus two or below (5.8% vs 19%, p=0.006). Women were mostly in favor of female sterilization (91%), and a significantly lower proportion of highly educated women preferred female sterilization than women with an education of 12 years or below (85% vs 95.7%, p=0.008).

Conclusion

A considerable number of females in the age group 25–28-years opting for sterilization and the unique preference for female sterilization when the family size is complete show the predominant reliance on female sterilization among young women. Higher education delays sterilization in young women due to delayed marriage and childbirth. Women empowerment, proper information and assuring availability and accessibility to different methods can gradually change the dominant preference for female-oriented permanent method of contraception.