1
|
Choo BV, Vostrcil LA, Plummer EL, Fairley CK, Bradshaw CS, McNamee K, Henzell H, Chen MY, Chow EPF, Phillips TR. Trends in different contraception methods among women attending the Melbourne Sexual Health Centre from 2011 to 2020. Public Health 2024; 233:130-136. [PMID: 38875732 DOI: 10.1016/j.puhe.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN Repeated cross-sectional study. METHODS Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.
Collapse
Affiliation(s)
- B V Choo
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - L A Vostrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - E L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - C S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - K McNamee
- Sexual Health Victoria, Melbourne 3000, Australia.
| | - H Henzell
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
| | - M Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - E P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - T R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
2
|
Frutos-Balibrea I, Sánchez-Núñez MI, Pedrero-Pérez EJ, Haro-León A, Benítez-Robredo MT. [Long-acting reversible contraception methods in women under 26 years of age]. Semergen 2021; 47:457-464. [PMID: 34148782 DOI: 10.1016/j.semerg.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Long-acting reversible contraception (LARC) methods have proven their high safety and efficacy for pregnancy prevention and they are specially indicated in young and vulnerable population, but their use encounter barriers both between providers and users due to lack of information or to the economic cost. The aim of this study was to assess the use of two LARC methods, intrauterine device (IUD) and implant, in minors under 26 years old after giving an adequate contraceptive advice and subsidizing them in vulnerability situations. To analyze the population that chooses them, the side effects, the reasons for abandoning and the permanence time. MATERIAL AND METHODS Retrospective descriptive study of IUD and implants inserted to minors under 26 years old from January 2016 to December 2019 at the Municipal Health Center of Usera belonging to Madrid Salud. Data is collected from n=266 women who started using IUD or implant. 87 copper IUD, 37 medicated IUD and 142 implants have been placed. RESULTS Increased prescription of both methods, with significant implant use in the last year of the study. There has been vulnerability in 91.7% of women. The average age of IUD users is about 21.4 years, almost 2 years older than that of the implant and they have more children. The side effects frequency has been similar with both methods, being abnormal bleeding as the most frequent side effect. 31% of copper IUD, 32% of medicated IUD and 12% of implants have been removed early. The average permanence time was 19.3 months (SD=13.3), 89.1% remained at the end of the first year, 81.2% at two years and 77.4% at three years. CONCLUSIONS An adequate contraceptive advice and free access are essential keys for increasing the LARC methods use in this particularly vulnerable population. Few and minor side effects and high continuity rate have been found, especially for the implant.
Collapse
Affiliation(s)
- I Frutos-Balibrea
- Centro Municipal de Salud Comunitaria de Usera (Organismo Autónomo Madrid Salud, Ayuntamiento de Madrid), Madrid, España
| | - M I Sánchez-Núñez
- Centro Municipal de Salud Comunitaria de Usera (Organismo Autónomo Madrid Salud, Ayuntamiento de Madrid), Madrid, España
| | | | - A Haro-León
- Departamento de Evaluación y Calidad, Madrid Salud, Madrid, España
| | | |
Collapse
|
3
|
Alonso Moreno FJ, Micó Pérez RM, Segura Fragoso A, Ahmed de Prado H, Guerrero Muñoz M, Palomino Cobo I, Leiva-Cepas F, Llisterri Caro JL. [Skills perceived by general practitioners for providing care to immigrant patients]. Semergen 2020; 46:448-456. [PMID: 32178934 DOI: 10.1016/j.semerg.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/29/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the skills perceived by general practitioners for providing competent care to immigrants MATERIAL AND METHODS: Observational, descriptive and cross-sectional study with data collection using a 21-item questionnaire completed electronically by the general practitioners and validated by the National Validation Commission of SEMERGEN. It was structured with closed-ended, multiple-choice test questions, including variables related to the doctor and variables related to the immigrant patient. The level of professional competence was assessed using a 1 to 10 Likert scale. RESULTS A total 610 family physicians with a mean age of 47.5±12.3 years responded and 64.1% were women. Of these, 112 (18.4%) were residents. The response rate was 4.9%. A large majority (72.6%) had not taken part in continuing education courses on caring for immigrants in the last 5years. Participants reported difficulties in the clinic: 73% of the cases with the language, 38.7% with the allotted time, and 32.3% due to knowledge of the culture. Most (96.9%) of patients attended the clinic due to a common illness. The cause in 14.4% was related to the migratory process (infectious disease acquired in the country of origin), and in 26.4% with the health conditions in the host country (lack of stable housing, overcrowding, and conditions of work). The perceived level of competence was 6.2±1.9. CONCLUSIONS The competence perceived by general practitioners in providing care to immigrants is moderate. The most important barriers for these professionals are ignorance of the language, lack of time allocated for consultation, and ignorance of the patient's culture.
Collapse
Affiliation(s)
| | - R M Micó Pérez
- Medicina Familiar, Centro de Salud Fontanars dels Alforins, EAP Ontinyent, Ontinyent, Valencia, España
| | - A Segura Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud, Talavera de la Reina, España
| | - H Ahmed de Prado
- R3 de Medicina Familiar y Comunitaria, C. Salud Dobra, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - M Guerrero Muñoz
- R4 año de Medicina Familiar y Comunitaria, Centro de Atención Primaria Santa Eulalia Sud. Hospital de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - I Palomino Cobo
- Medicina Familiar, Centro de Salud Mijas, Fuengirola, Málaga, España
| | - F Leiva-Cepas
- Medicina Familiar, Departamento de Ciencias Morfológicas, Facultad de Medicina y Enfermería, Universidad de Córdoba, Grupo de Investigación Epidemiológica en Atención Primaria, Instituto Maimónides de Investigación Biomédica Traslacional (IMIBIC), Córdoba, España
| | | | | | | |
Collapse
|
4
|
David M, Brenne S, Breckenkamp J, Razum O, Borde T. Postpartum Contraception: a Comparative Study of Berlin Women with and without Immigration Background. Geburtshilfe Frauenheilkd 2015; 75:915-922. [PMID: 26500367 DOI: 10.1055/s-0035-1557906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Research Questions: Are there differences in postpartum contraceptive use between women with and without immigration background? Do women more commonly use contraception following a high-risk pregnancy or caesarean section? What role does current breastfeeding play and, amongst immigrants, what is the effect of acculturation level on the frequency of contraceptive use? Study Population and Methods: Data collection was carried out as part of a larger study in three Berlin delivery units using standardised interviews (questionnaires covering e.g. sociodemographics, immigration history/acculturation and use of antenatal care); telephone interviews comprising 6 questions on postpartum contraception, breastfeeding and postpartum complications were conducted on a sample of the study population six months after delivery. Results: 247 women with, and 358 women without a background of immigration were included in the study (total study population n = 605, response rate 81.1 %). 68 % of 1st generation immigrants, 87 % of 2nd/3rd generation women and 73 % of women without immigration background (non-immigrants) used contraception. In the logistical regression analysis 1st generation immigrants were less likely than non-immigrants to be using contraception six months postpartum, and 1st generation immigrants with low acculturation level were significantly less likely to use contraception than 2nd/3rd generation women with low acculturation level. Conclusion: In the extended postpartum period there was no major difference in contraceptive use between immigrants in general and non-immigrants. It remains unclear whether the differing contraceptive behaviour of 1st generation immigrants is the result of less access to information, sociocultural factors or differing contraceptive requirements and further targeted, qualitative study is required.
Collapse
Affiliation(s)
- M David
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin
| | - S Brenne
- Alice Salomon Hochschule Berlin, Berlin
| | - J Breckenkamp
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International Public Health, Bielefeld
| | - O Razum
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International Public Health, Bielefeld
| | - T Borde
- Alice Salomon Hochschule Berlin, Berlin
| |
Collapse
|
5
|
Alvarez-Nieto C, Pastor-Moreno G, Grande-Gascón ML, Linares-Abad M. Sexual and reproductive health beliefs and practices of female immigrants in Spain: a qualitative study. Reprod Health 2015; 12:79. [PMID: 26329808 PMCID: PMC4557225 DOI: 10.1186/s12978-015-0071-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/17/2015] [Indexed: 11/12/2022] Open
Abstract
Background Sexuality and reproduction are two areas that have been dealt with differently over time and across cultures. Immigrant women resident in Spain, are largely of childbearing age and have some specific needs. Female immigrants have specific beliefs and behaviors which may influence how they approach to the Spanish sexual and reproductive health services. There is less visibility of the health problems presented by women immigrants. This article aims to shed light on the sexual and reproductive health beliefs and experiences of female immigrants in a region of southern Spain. Methods A descriptive study design with qualitative data collection and analysis methods were used. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception and beliefs about their sexual and reproductive health. Thirteen interviews were conducted in 2013 with a multi-ethnic sample of female immigrants, currently all are residing in Andalusia. Interview topics included questions about awareness and beliefs about sexuality and reproduction. Content analysis was used. Results We have found that female immigrant brings along all of her beliefs, opinions, attitudes and behaviors regarding sexuality, contraceptives, what is “correct” and what is not, etc. The sexual behavior is conditioned by the prevailing social rules of country of origin, and these rules act ambivalently. In general, knowledge of contraceptive methods was big, but there were perceptions that reproductive health was woman’s domain, due to gender norms and traditional family planning geared exclusively towards women. Conclusion Results suggest that women’s behavior is influenced by the precepts of their origin societies. Therefore, sexual and reproductive health processes should be adapted and incorporated into our society, with special attention being paid to the immigrant population.
Collapse
Affiliation(s)
- Carmen Alvarez-Nieto
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - Guadalupe Pastor-Moreno
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - María Luisa Grande-Gascón
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - Manuel Linares-Abad
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| |
Collapse
|