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Leon-Larios F, Gutiérrez Ales J, Puente Martínez MJ, Correa Rancel M, Lahoz Pascual I, Silva Reus I, Quílez Conde JC. Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020). J Clin Med 2022; 11:jcm11133777. [PMID: 35807063 PMCID: PMC9267860 DOI: 10.3390/jcm11133777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The National Contraception Survey conducted by Sociedad Española de Contracepción intends to know the sexual and contraceptive habits of Spanish women of reproductive age. Methods: A descriptive and cross-sectional study with random sample selection was conducted with women aged from 14 to 49 years old in July and August 2020. Results: A total of 1801 women participated in the study, of which 78.7% used some contraception method during their sexual relationships. The most frequently used methods were condoms (31.3%) and combined oral contraceptives (18.5%) at their last sexual encounter. A total of 25.7% used both condoms and pills, especially younger women and those who had no steady partners (p < 0.001). Use of Long-acting Reversible Contraceptives continues to be low, although a slight increase in their use is observed, and they are recommended for 50% of the users who need contraception. Counselling on contraception was provided to 64.3% of the women, mainly by their gynaecologists. Regarding the decision to use a contraceptive method, the one suggested by health professionals was more influential, although this was not the case for women aged less than 20 years old (p < 0.001). A total of 38.4% of the women have used emergency oral contraception at least once and 66.8% of those who do not make continuous use of contraception methods do so out of personal choice. Conclusions: It is necessary to deepen work on counselling and awareness among the population towards the use of efficient contraceptive methods that prevent unplanned pregnancies.
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Affiliation(s)
| | | | | | - Marta Correa Rancel
- Hospital Universitario de Canarias, 38320 Tenerife, Spain;
- Departamento de Obstetricia-Ginecología, Pediatría, Preventiva, Medicina Legal y Forense, Microbiología, Parasitología, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
| | | | - Isabel Silva Reus
- Centro de Salud Sexual y Reproductiva de Villena, 03400 Alicante, Spain;
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Association of levonorgestrel intrauterine devices with stress reactivity, mental health, quality of life and sexual functioning: A systematic review. Front Neuroendocrinol 2021; 63:100943. [PMID: 34425187 DOI: 10.1016/j.yfrne.2021.100943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Levonorgestrel-intrauterine-devices (LNG-IUD) are one of the most used contraceptive methods worldwide. While several reviews exist on how LNG-IUDs impact physiology and gynaecological functions, this systematic review focuses on stress, mental health, quality of life, sexual functioning, and effects on brain architecture. While data on stress is scarce, results on mental health are ambiguous. More consistently, LNG-IUD use seems to improve quality of life and sexual functioning. No studies highlighting the consequences of LNG-IUD use on the brain were found. The reviewed studies are characterized by a substantial variation in approaches, participant groups, and study quality. More high-quality research assessing the effects of LNG-IUD on mental health, including response to stressors and brain function and structure, is needed to identify women vulnerable to adverse effects of LNG-IUD, also in comparison to oral contraceptives, and to empower women to make more informed choices concerning hormonal contraception.
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Gashaye KT, Tsegaye AT, Abebe SM, Woldetsadik MA, Ayele TA, Gashaw ZM. Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study. PLoS One 2020; 15:e0240816. [PMID: 33079973 PMCID: PMC7575092 DOI: 10.1371/journal.pone.0240816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Kiros Terefe Gashaye
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris Woldetsadik
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Mengistu Gashaw
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Gondar, Gondar, Ethiopia
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Bastin A, Scanff A, Fraize S, Hild JC, Lous ML, Lavoue V, Ruelle Y, Chaaban S. Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months. EUR J CONTRACEP REPR 2019; 24:399-406. [DOI: 10.1080/13625187.2019.1659951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Alexandre Scanff
- Department of Epidemiology and Public Health, Rennes University Hospital, Rennes, France
| | | | | | - Maela Le Lous
- Department of Gynaecology, Rennes University Hospital, Rennes, France
| | - Vincent Lavoue
- Department of Gynaecology, Rennes University Hospital, Rennes, France
- School of Medicine, University of Rennes 1, Rennes, France
- Inserm U1242, Rennes, France
| | - Yannick Ruelle
- Department of General Practice, UFR SMBH, University of Paris 13, Bobigny, France
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Parra Ribes I, Rascón Poza JJ, Pérez Campos E, Bugella Yudice I, Rodríguez Domingo MJ. Economic Burden of Contraception Management in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2018; 6:63-74. [PMID: 32685572 PMCID: PMC7309956 DOI: 10.36469/9785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. OBJECTIVES This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. METHODS A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. RESULTS Reversible contraception costs in Spain amount to €12.5 billion over a 5-year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women's age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. CONCLUSIONS LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.
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Morgan CR, Liu H. The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:281-288. [DOI: 10.1136/jfprhc-2016-101553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/03/2017] [Accepted: 03/20/2017] [Indexed: 11/04/2022]
Abstract
BackgroundReducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in the most deprived areas. One possible explanation could be contraceptive prescribing inequality. This study examined the relationship between area deprivation measured by the Scottish Index of Multiple Deprivation and LARC prescription.MethodsUsing Scottish electronic prescribing data from primary care and sexual and reproductive health clinics, this study analysed female Lothian residents with a valid postcode aged 16–49 years who received a contraceptive prescription from 1 April 2012 to 31 March 2014. Prescription of LARC (intrauterine, implant or injectable contraceptive) compared with non-LARC (oral pill, patch, ring or diaphragm) was examined. Logistic regression was performed adjusting for age group and prescription location.ResultsA total of 90 150 women were included; 21.1% of prescriptions were LARC and 15.3% vLARC (intrauterine method or implant). Women residing in the most deprived quintile (Q1) and prescribed contraception received a significantly higher proportion of LARC than quintiles 2–5 (Q2–5). Odds ratios compared with Q1 were: Q2 0.86, Q3 0.77, Q4 0.59 and Q5 0.51. Women in quintile 1 were also significantly more likely to receive vLARC than quintiles 2–5.ConclusionWomen in the most deprived quintile in Lothian who are prescribed contraception are significantly more likely to receive LARC and vLARC compared with women in less deprived quintiles.
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Lindh I, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Hognert H, Milsom I, Lidegaard Ø. Contraceptive use in the Nordic countries. Acta Obstet Gynecol Scand 2016; 96:19-28. [DOI: 10.1111/aogs.13055] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Finn E. Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Insitute and Karolinska University Hospital; Stockholm Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Helena Hognert
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology; Faculty of Health Sciences; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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Trends in the use of oral contraceptives among adolescents and young women in Spain. Reprod Health 2016; 13:122. [PMID: 27664123 PMCID: PMC5035482 DOI: 10.1186/s12978-016-0239-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background We aimed to determine the prevalence of consumption of oral contraceptives (OCs) among adolescents and young women living in Spain and to identify the factors associated with this consumption. Methods We performed a cross-sectional study on the consumption of OCs by women aged 15–30 years residing in Spain. We used secondary individualized data from the 2006 (n = 2513) and 2012 (n = 1530) Spanish National Health Surveys. The dependent variable was the use of OCs in the previous 2 weeks. Independent variables included sociodemographic characteristics, comorbidity, lifestyle, and healthcare resource utilization. The prevalence of OC consumption was analysed by investigating the changes observed between 2006 and 2012. We used multivariate logistic regression to identify the independent factors associated with OC use in each year. Results In 2006, 14.42 % of women reported using OCs; this percentage dropped to 10.21 % in 2012 (p < 0.05). Multivariate analysis revealed an association between OC use and visits to the gynaecologist (AOR, 5.60 [95 % CI, 2.93–10.73] in 2006; and AOR, 3.55 [95 % CI, 1.30–9.73] in 2012), Pap smear tests (AOR, 1.8 [95 % CI, 1.23–2.87] in 2006; and AOR, 2.42 [95 % CI, 1.30–4.51] in 2012), and smoking in 2006 (AOR, 1.42 [95 % CI, 1.04–1.93]). Conclusions There was a significant decrease in OC use from 2006 to 2012 among adolescents and young women living in Spain. In the present study, consumers of OCs were women who visited a gynaecologist more often and complied more with preventive measures such as Pap smear testing. Also, women who reported having used OCs were more likely to smoke than the rest of the study population, although the smoking habit is a risk factor for thrombotic events in women who take OCs.
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Stemmler SM, Hall TM, Prokopík P, Shoptaw S. Time-Site Survey of Substance Use, Sexual Behaviours, and HIV-Testing Practices among Women Attending Social Venues in Prague. Cent Eur J Public Health 2016; 23:135-41. [PMID: 26851424 DOI: 10.21101/cejph.a3954] [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: 09/12/2013] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
Abstract
AIM The rates of HIV acquired through heterosexual contact are increasing in the Czech Republic. This study explored potential HIV risk associa-tions with alcohol, illicit drugs and sexual behaviours among adults from a community-based sample attending gay- and non-gay venues in Prague. METHODS Women attending bars, cafes and beer gardens in central Prague responded to the self-administered, time-site survey. Alcohol use was measured by the AUDIT-C and CAGE questionnaires. Sexual network structuring identified number, gender and coital frequency with current and recent sexual partners. Statistical analysis included central tendency, chi-square and logistic regression. Female participants (n=124) ranged from 18 to 67 years of age (mean 29 years); 25% self-identified as non-heterosexual. RESULTS We found alcohol to be the preferred drug of choice. Younger heterosexual women with new and casual sexual partners were more likely to use alcohol excessively. Women with children reported the least alcohol use. Sixty percent of the sample had never used condoms; condom-use was associated with longer relationship duration and discussions about HIV status with a sexual partner; non-use tended to occur among unmarried women with multiple male partners in short, serial sexual relationships. Women who sought HIV testing tended to be younger and more self-identified as non-heterosexual. Protective practices were rarely reported even when HIV transmission increases via heterosexual sexual partnering. CONCLUSION Further research is recommended regarding cultural and contextual influences on HIV risk behaviours among Czech women.
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Affiliation(s)
- Susan M Stemmler
- Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.,California State University, Dominguez Hills, Carson, CA, United States
| | - Timothy M Hall
- Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Steven Shoptaw
- Center for Behavioral and Addiction Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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Godfrey EM, Zapata LB, Cox CM, Curtis KM, Marchbanks PA. Unintended pregnancy risk and contraceptive use among women 45-50 years old: Massachusetts, 2006, 2008, and 2010. Am J Obstet Gynecol 2016; 214:712.e1-8. [PMID: 26694134 PMCID: PMC10994517 DOI: 10.1016/j.ajog.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about unintended pregnancy risk and current contraceptive use among women ≥45 years old in the United States. OBJECTIVES The purpose of this study was to describe the prevalence of women ages 45-50 years old at risk for unintended pregnancy and their current contraceptive use, and to compare these findings to those of women in younger age groups. STUDY DESIGN We analyzed 2006, 2008, and 2010 Massachusetts Behavioral Risk Factor Surveillance System data, the only state in the United States to collect contraceptive data routinely from women >44 years old. Women 18-50 years old (n = 4930) were considered to be at risk for unintended pregnancy unless they reported current pregnancy, hysterectomy, not being sexually active in the past year, having a same-sex partner, or wanting to become pregnant. Among women who were considered to be at risk (n = 3605), we estimated the prevalence of current contraceptive use by age group. Among women who were considered to be at risk and who were 45-50 years old (n = 940), we examined characteristics that were associated with current method use. Analyses were conducted on weighted data using SAS-callable SUDAAN (RTI International, Research Triangle Park, NC). RESULTS Among women who were 45-50 years old, 77.6% were at risk for unintended pregnancy, which was similar to other age groups. As age increased, hormonal contraceptive use (shots, pills, patch, or ring) decreased, and permanent contraception (tubal ligation or vasectomy) increased as did non-use of contraception. Of women who were 45-50 years old and at risk for unintended pregnancy, 66.9% reported using some contraceptive method; permanent contraception was the leading method reported by 44.0% and contraceptive non-use was reported by 16.8%. CONCLUSION A substantial proportion of women who were 45-50 years old were considered to be at risk for unintended pregnancy. Permanent contraception was most commonly used by women in this age group. Compared with other age groups, more women who were 45-50 years old were not using any contraception. Population-based surveillance efforts are needed to follow trends among this age group and better meet their family planning needs. Although expanding surveillance systems to include women through 50 years old requires additional resources, fertility trends that show increasingly delayed childbearing, uncertain end of fecundity, and potential adverse consequences of unplanned pregnancy in older age may justify these expenditures.
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Affiliation(s)
- Emily M Godfrey
- Department of Family Medicine, University of Washington, Seattle, WA; Division of Reproductive Health, Centers for Disease Control and Prevention, NCCDPHP/DRH/WHFB, Atlanta, GA.
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, NCCDPHP/DRH/WHFB, Atlanta, GA
| | - Carie M Cox
- Department of Public Health, St. Catherine University, St. Paul, MN
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, NCCDPHP/DRH/WHFB, Atlanta, GA
| | - Polly A Marchbanks
- Division of Reproductive Health, Centers for Disease Control and Prevention, NCCDPHP/DRH/WHFB, Atlanta, GA
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Broecker J, Jurich J, Fuchs R. The relationship between long-acting reversible contraception and insurance coverage: a retrospective analysis. Contraception 2015; 93:266-72. [PMID: 26577755 DOI: 10.1016/j.contraception.2015.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 11/02/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective was to determine if there is a relationship between patients' financial responsibility (out-of-pocket expenses) and placement of long-acting, reversible contraceptive (LARC) methods among girls and women living in Appalachia who expressed interest in LARC device placement. STUDY DESIGN A retrospective chart analysis of patients prescribed an intrauterine device (IUD) or an etonogestrel implant between December 2011 and July 2013 in an Appalachian private practice was performed. Of the 571 identified patients aged 13 to 50, the majority were Caucasian (98.7%) and using Medicaid (53.2%). Outcomes measured the patients' decision regarding whether to use LARC after being informed of out-of-pocket expenses. RESULTS There was a dramatic increase in the proportion of patients who had LARC methods placed if expense was under $200 (p<.001). Placement rate for privately insured patients was 86.6% for those who paid less than $200 compared to 27.8% for those who paid $200 or more. Medicaid patients, for whom the device was free, had a 78.0% placement rate. For every additional $100 patients had to pay out of pocket, the odds of deciding to use the prescribed LARC method decreased. CONCLUSIONS LARC methods are utilized significantly more often when out-of-pocket cost is low. Cost appears to be a significant barrier to device placement for the group of privately insured Appalachian patients with out-of-pocket expenses over $200. Despite the improvements in coverage for many women provided under the Affordable Care Act, cost may remain a barrier for privately insured women who are required to pay some or all of the cost of LARC methods. IMPLICATIONS Unintended pregnancy rates in the United States remain high, especially in Appalachia. One contributing factor is reliance on user-dependent methods which have significantly high typical use failure rates. Placement of LARC methods for more patients could decrease unintended pregnancy, but device costs may be one barrier to utilization, even for those with private insurance.
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Affiliation(s)
- Jane Broecker
- Department of Obstetrics and Gynecology, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States.
| | - Joan Jurich
- Department of Social and Public Health, Ohio University, Athens, OH, United States
| | - Robin Fuchs
- Department of Obstetrics and Gynecology, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States
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The new LNG-releasing IUS: a new opportunity to reduce the burden of unintended pregnancy. Eur J Obstet Gynecol Reprod Biol 2015; 190:58-64. [DOI: 10.1016/j.ejogrb.2015.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
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Wildemeersch D, Goldstuck N, Hasskamp T, Jandi S, Pett A. Intrauterine device quo vadis? Why intrauterine device use should be revisited particularly in nulliparous women? Open Access J Contracept 2015; 6:1-12. [PMID: 29386919 PMCID: PMC5683133 DOI: 10.2147/oajc.s72687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs) and the contraceptive implant, are considered the best methods for preventing unintended pregnancies, rapid repeat pregnancy, and abortion in young women. An opinion paper of 2012 by the American College of Obstetricians and Gynecologists recommends Mirena and Paragard for use in nulliparous and adolescent women. However, these IUDs are not designed for young women and are not optimal as they often lead to early discontinuation. Objective This article was written with the objective to respond to the urgent need to improve intrauterine contraception as it is likely that the objectives of LARC will not be met without significant improvement of IUD design. Anatomical variations in size and shape of the uterus are not sufficiently considered, producing harm and suffering, which often lead to early removal of the IUD. Proposed problem solving The article describes why IUDs should be revisited to meet the challenge of LARC and proposes how to solve these problems. The opinion statement presented here may be considered provocative but is based on hundreds of women with IUD problems who consult or are referred to the practices of the authors of this article due to the disproportion between the IUD and their small uterine cavity. The solution is simple but requires a revision of the current design of IUDs. One-dimensional (longitudinal) IUDs are likely to be the first option. Framed devices with shortened transverse arm and IUDs which adapt to the width of the given uterus are viewed as second best. Conclusion One of the reasons of the high unintended pregnancy rate in the USA may be the paucity of suitable IUDs. Also, the legal climate in the USA seems to be a problem for developers as many lawsuits have recently been reported. Clinical studies conducted in young nulliparous and adolescent women suggest that IUDs that fit well in the uterine cavity, like a shoe, result in better tolerance, less side effects, and last but not least, higher use continuation rates.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
| | | | - Sohela Jandi
- Gynecological Outpatient Clinic, Berlin, Germany
| | - Ansgar Pett
- Gynecological Outpatient Clinic, Berlin, Germany
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Douglas NI, Pavlova TU, Burtseva TE, Rad YG, Petrova PG, Odland JØ. Women's reproductive health in the Sakha Republic (Yakutia). Int J Circumpolar Health 2014; 73:25872. [PMID: 25405105 PMCID: PMC4216814 DOI: 10.3402/ijch.v73.25872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Natalia I Douglas
- Department of obstetrics and gynecology, North-Eastern Federal University, Yakutsk, Russia
| | - Tatiana U Pavlova
- The Yakutia research center for Complex medical problems, Yakutsk, Russia
| | - Tatiana E Burtseva
- The Yakutia research center for Complex medical problems, Yakutsk, Russia
| | - Yana G Rad
- Department of obstetrics and gynecology, North-Eastern Federal University, Yakutsk, Russia
| | - Palmira G Petrova
- Department of obstetrics and gynecology, North-Eastern Federal University, Yakutsk, Russia
| | - Jon Ø Odland
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
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Cea Soriano L, Wallander MA, Andersson S, Filonenko A, García Rodríguez LA. Use of long-acting reversible contraceptives in the UK from 2004 to 2010: Analysis using The Health Improvement Network Database. EUR J CONTRACEP REPR 2014; 19:439-47. [DOI: 10.3109/13625187.2014.948613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Buhling KJ, Klovekorn L, Daniels B, Studnitz FSG, Eulenburg C, Mueck AO. Contraceptive counselling and self-prescription of contraceptives of German gynaecologists: Results of a nationwide survey. EUR J CONTRACEP REPR 2014; 19:448-56. [DOI: 10.3109/13625187.2014.945164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Lete I, Pérez-Campos E. Differences in contraceptive use between Spanish female healthcare providers and Spanish women in the general population aged 23 to 49 years: the HABITS Study. EUR J CONTRACEP REPR 2014; 19:161-8. [PMID: 24666213 DOI: 10.3109/13625187.2014.893424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the contraceptive modalities used in the general female population with those of female healthcare providers (HCPs) in Spain. METHODS A nationwide survey of a representative sample of Spanish women and female Spanish HCPs aged 23 to 49 years (total sample size: 3200). RESULTS The condom was the most widely used contraceptive method in both groups (30% and 23% in the general population and among HCPs, respectively). The reasons cited for relying on this method were ease of use (19% and 13%, respectively; p = 0.2), effectiveness (16% and 22%, respectively; p = 0.2), absence of side effects (14% and 22%, respectively; p = 0.1), and fear of side effects associated with oral contraception (13% and 2%, respectively; p < 0.0001). After the condom, oral contraceptives, the intrauterine device and the vaginal ring were the most widely used methods among HCPs (13% each). CONCLUSIONS The spectrum of contraceptive methods used by female HCPs differs from that of women in the general Spanish population. HCPs opt more often for long-acting reversible contraceptives because of their effectiveness and safety whereas women in the general population rely more frequently on the condom and surgical methods.
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Affiliation(s)
- Iñaki Lete
- * Servicio de Ginecología, Hospital Universitario Araba, Vitoria, & Facultad de Medicina, Universidad del País Vasco , Vitoria , Spain
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Teunissen AM, Grimm B, Roumen FJME. Continuation rates of the subdermal contraceptive Implanon(®) and associated influencing factors. EUR J CONTRACEP REPR 2013; 19:15-21. [PMID: 24329119 DOI: 10.3109/13625187.2013.862231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the continuation rates of the etonogestrel subdermal contraceptive implant among well-informed women, and the reasons for early discontinuation. STUDY DESIGN Retrospective consecutive cohort design. METHODS Women who had the implant inserted between 1 January 2006 and 1 January 2010 at the Atrium Medical Centre, the Netherlands were followed up for at least three years. The dates of insertion and removal were recorded, as were the reasons for removal. Statistical analysis was performed using the independent samples t-test and the Pearson alpha correlation test. RESULTS The implant was inserted in 230 women. Follow-up was possible in 214 women, with an average age of 26.7 years. Most of them were nulliparous and the majority had used a combined oral contraceptive, Implanon®, or Mirena® previously. The mean overall continuation period was 23.5 months (95% confidence interval: 21.7-25.3), with a median of 25 months. The continuation rate after 12 months was 72%; after 24 months, 53%; and after 36 months, 25%, with all women concerned having a new implant placed. The previously used contraceptive method Implanon® was associated with the highest continuation rates. An erratic bleeding pattern was the main reason for early removal. CONCLUSIONS Despite adequate counselling before insertion, the continuation rate of the etonogestrel implant was rather low compared to those reported by other investigators. The main reason for discontinuation was an irregular bleeding pattern.
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Affiliation(s)
- Anna Maria Teunissen
- * Maastricht University, Faculty of Health, Medicine and Life Sciences , Maastricht , the Netherlands
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Short M, Dallay D, Omokanye S, Stauch K, Inki P. Acceptability of long-acting, progestin-only contraception in Europe: a two-year prospective, non-interventional study. EUR J CONTRACEP REPR 2013; 19:29-38. [PMID: 24289528 DOI: 10.3109/13625187.2013.862230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare two-year continuation rates and user satisfaction with the levonorgestrel releasing-intrauterine system (LNG-IUS) and the etonogestrel releasing-subdermal implant (ENG implant) in women in Europe. METHODS This prospective, non-interventional study was undertaken at 72 sites in France (n = 61), Great Britain (n = 2), Ireland (n = 3) and Slovakia (n = 6). Women opting to switch their method of contraception to the LNG-IUS or the ENG implant were followed-up over 24 months to document continuation and satisfaction with their chosen contraceptive method. Reasons for discontinuation were documented. RESULTS The data analysed were based on 363 women (LNG-IUS [n = 247] and ENG implant [n = 116]), aged 20 to 45 years, with at least one follow-up visit after contraceptive placement. The documented cumulative continuation rate was 82% in the LNG-IUS group and 67% in the ENG implant group at 24 months. The documented discontinuation rates were 13% and 17%, respectively. Bleeding problems were cited as reason for discontinuation in 4% and 11% of women in the LNG-IUS and ENG implant groups, respectively. CONCLUSIONS The LNG-IUS is associated with higher continuation rates and user satisfaction than the ENG implant in this study of women in Europe, though the groups were not similar in all respects. Bleeding problems with the ENG implant account for most of the reasons for discontinuing its use.
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Affiliation(s)
- Mary Short
- * Rock Court Medical Centre, Blackrock , Co. Dublin , Ireland
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Weisberg E, Bateson D, McGeechan K, Mohapatra L. A three-year comparative study of continuation rates, bleeding patterns and satisfaction in Australian women using a subdermal contraceptive implant or progestogen releasing-intrauterine system. EUR J CONTRACEP REPR 2013; 19:5-14. [PMID: 24229367 DOI: 10.3109/13625187.2013.853034] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-acting reversible contraceptive methods (LARCs) are safe, highly effective, readily reversible, and require no action on the part of the user following insertion. Early discontinuation may put women at increased risk of unintended pregnancy. METHODS Following insertion of a progestogen-only subdermal implant or intrauterine system (IUS) at Family Planning NSW, women 18 years and older completed a questionnaire about their choice. At 6 weeks, 6, 12, 24 and 36 months by telephone or online they completed a questionnaire about bleeding patterns, side effects, satisfaction, and reasons for discontinuation. RESULTS Two hundred IUS users and 149 implant users were enrolled. The former were generally older, married or in a de-facto relationship, and had children. Forty-seven percent of implant users discontinued within three years compared to 27% of IUS users (p = 0.002). In the first two years amenorrhoea was more frequent in implant users. Frequent bleeding/spotting was more prevalent in the first year of IUS use but over time was twice as prevalent in implant users. Infrequent bleeding/spotting was more common in IUS users. CONCLUSION Both devices are highly effective and acceptable cost-effective methods. While LARCs should be promoted to women of all ages seeking contraception, early discontinuation due to unacceptable bleeding highlights the need for pre-insertion counselling.
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Affiliation(s)
- Edith Weisberg
- * Sydney Centre for Reproductive Health Research , FPNSW, Sydney , Australia
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Black KI, Lotke P, Lira J, Peers T, Zite NB. Global survey of healthcare practitioners’ beliefs and practices around intrauterine contraceptive method use in nulliparous women. Contraception 2013; 88:650-6. [DOI: 10.1016/j.contraception.2013.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
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Dassah ET, Odoi AT, Owusu-Asubonteng G. Prevalence and factors predictive of long-acting reversible contraceptive use in a tertiary hospital in urban Ghana. EUR J CONTRACEP REPR 2013; 18:293-9. [PMID: 23650905 DOI: 10.3109/13625187.2013.790951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence, socio-demographic and reproductive factors associated with long-acting reversible contraceptive (LARC) use among clients resorting to reversible birth control methods in a tertiary hospital in Ghana. METHODS Retrospective review of records of clients who opted for reversible family planning (FP) methods at Komfo Anokye Teaching Hospital, Kumasi, Ghana, from 1 July 2003 to 30 June 2008. We recorded data on their contraceptive history, and socio-demographic- and reproductive characteristics. Categorical variables were compared using the χ(2) test and factors associated with LARC uptake examined by binomial regression with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Of 5946 clients who opted for reversible contraception, 71% chose LARCs, and the remaining 29% chose shorter-acting contraceptives. LARCs were employed mainly by women with more living children (p trend < 0.001) who had previously used LARCs (adjusted RR: 1.49; 95% CI: 1.39-1.60). Over half of non-contraceptive users started with LARCs while 27% of women switched from shorter-acting contraceptives to LARCs. CONCLUSION The prevalence of LARC uptake was much higher than the national average. Significant factors associated with current LARC use were the number of surviving children and previous LARC use.
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Affiliation(s)
- Edward T Dassah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Wildemeersch D, Pett A, Jandi S, Hasskamp T, Rowe P, Vrijens M. Precision intrauterine contraception may significantly increase continuation of use: a review of long-term clinical experience with frameless copper-releasing intrauterine contraception devices. Int J Womens Health 2013; 5:215-25. [PMID: 23658502 PMCID: PMC3645905 DOI: 10.2147/ijwh.s42784] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this paper is to review the experience with the frameless, anchored, GyneFix copper-releasing intrauterine contraceptive devices (IUCDs/IUDs) (Contrel Europe, Belgium), and to demonstrate their high acceptability and low rate of discontinuation of use, which could contribute to current efforts that aim to reduce radically the high number of unintended pregnancies and induced abortions, particularly in young women. Materials and methods This paper is based on studies that examined the differences in uterine volume and cavity size, related to age and parity, and on original clinical research data and practical experience with frameless copper IUDs, as well as on literature data on the IUD–endometrial cavity relationship of conventional IUDs, with special reference to side effects and user discontinuation. Results The mean transverse diameter in nulliparous and parous women is significantly less than the length of the transverse arm of the TCu380A IUD (ParaGard, Duramed, NY, USA) or the levonorgestrel intrauterine system (Mirena, Bayer, Germany). Small, frameless, flexible, and unidimensional copper IUDs appear to be well tolerated, with less impact on menstrual bleeding, resulting in low discontinuation rates when compared with standard-size conventional IUDs, which often result in increased expulsion rates, complaints of pain and erratic or increased menstrual bleeding, and subsequent high rates of discontinuation, particularly in young women. Conclusion The unidimensional GyneFix IUDs fit the majority of uterine cavities. An IUD that fits is likely to result in increased tolerance and continued use of the method. As this would appeal to women, the logical result should be greater use of the method and fewer unintended pregnancies and induced abortions. Recommending the standard TCu380A (ParaGard) IUD or the Mirena levonorgestrel intrauterine system, primarily developed for use in parous women, for general use in nulliparous and adolescent women should be done with caution in the light of current scientific evidence, except if 3-D sonography indicates that the uterine cavity is sufficiently large.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
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24
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Interventions for increasing uptake of copper intrauterine devices: systematic review and meta-analysis. Contraception 2012; 86:600-5. [DOI: 10.1016/j.contraception.2012.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/09/2012] [Accepted: 05/18/2012] [Indexed: 11/19/2022]
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25
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Baird DT, Evers JLH, Gemzell-Danielsson K, Glasier A, Killick SR, Van Look PFA, Vercellini P, Yildiz BO, Benagiano G, Cibula D, Crosignani PG, Gianaroli L, La Vecchia C, Negri E, Volpe A. Family planning 2011: better use of existing methods, new strategies and more informed choices for female contraception. Hum Reprod Update 2012; 18:670-81. [DOI: 10.1093/humupd/dms021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Arrowsmith ME, Aicken CRH, Saxena S, Majeed A. Strategies for improving the acceptability and acceptance of the copper intrauterine device. Cochrane Database Syst Rev 2012:CD008896. [PMID: 22419340 DOI: 10.1002/14651858.cd008896.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) are highly effective and are the most widely used reversible contraceptive method in the world. However, in developed countries IUDs are among the least common methods of contraception used. We evaluated the effect of interventions to increase uptake of the copper IUD, a long-acting, reversible contraceptive method. OBJECTIVES To determine effectiveness of interventions to improve uptake and continuation of the copper IUD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, PsycINFO, PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP) and OpenSIGLE. We also handsearched references of relevant reviews and included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled before and after studies of interventions which measured use and uptake of contraception including copper IUD as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results for relevant studies and extracted data from included studies. We used RevMan 5.1 to calculate Peto odd ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes. We conducted meta-analysis by pooling data for similar types of intervention where possible. We used the GRADE system to evaluate the quality of evidence. MAIN RESULTS Nine studies representing 7960 women met our inclusion criteria, including seven randomised controlled trials and two controlled before and after studies that reported IUD uptake postintervention. We evaluated the quality of evidence as moderate to low. Three studies on contraceptive counselling and referrals by community workers showed an increase in uptake of the IUD among intervention groups (Peto OR 2.00; 95% CI 1.40 to 2.85). Two studies on antenatal contraceptive counselling also favoured the intervention groups (Peto OR 2.33; 95% CI 1.39 to 3.91). One study on postnatal couple contraceptive counselling also showed an increase in IUD uptake compared to control (Peto OR 5.73; 95% CI 3.59 to 9.15). The results of one study evaluating postnatal home visits and two studies on enhanced postabortion contraceptive counselling did not reach statistical significance. AUTHORS' CONCLUSIONS Community-based interventions and antenatal contraceptive counselling improved uptake of copper IUD contraception. Since the copper IUD is one of the most effective reversible contraceptive methods, primary care and family planning and practitioners could consider adopting these interventions. Although our review suggests these interventions are clinically effective, a cost-benefit analysis may be required to evaluate applicability.
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Affiliation(s)
- Myat E Arrowsmith
- 1Department of Primary Care and Public Health, Imperial College London, London, UK. 2University College London, Centre forSexual Health & HIV Research, London, UK.
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Short M, Dallay D, Omokanye S, Hanisch JU, Inki P. Acceptability of the levonorgestrel releasing-intrauterine system and etonogestrel implant: One-year results of an observational study. EUR J CONTRACEP REPR 2011; 17:79-88. [DOI: 10.3109/13625187.2011.636088] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sköld A, Larsson M. Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2011; 3:43-7. [PMID: 22325801 DOI: 10.1016/j.srhc.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/20/2011] [Accepted: 11/25/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice. STUDY DESIGN The design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%. RESULTS The women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women's fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential. CONCLUSIONS 46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.
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Affiliation(s)
- Annelie Sköld
- Department of Women's and Children's Health, Uppsala University, Sweden.
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GEMZELL-DANIELSSON KRISTINA, INKI PIRJO, HEIKINHEIMO OSKARI. Recent developments in the clinical use of the levonorgestrel-releasing intrauterine system. Acta Obstet Gynecol Scand 2011; 90:1177-88. [DOI: 10.1111/j.1600-0412.2011.01256.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leval A, Sundström K, Ploner A, Dahlström LA, Widmark C, Sparén P. Assessing perceived risk and STI prevention behavior: a national population-based study with special reference to HPV. PLoS One 2011; 6:e20624. [PMID: 21674050 PMCID: PMC3107227 DOI: 10.1371/journal.pone.0020624] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To better understand trends in sexually transmitted infection (STI) prevention, specifically low prevalence of condom use with temporary partners, the aim of this study was to examine factors associated with condom use and perceptions of STI risk amongst individuals at risk, with the underlying assumption that STI risk perceptions and STI prevention behaviors are correlated. METHODS A national population-based survey on human papillomavirus (HPV) and sexual habits of young adults aged 18-30 was conducted in Sweden in 2007, with 1712 men and 8855 women participating. Regression analyses stratified by gender were performed to measure condom use with temporary partners and STI risk perception. RESULTS Men's condom use was not associated with STI risk perception while women's was. Awareness of and disease severity perceptions were not associated with either condom use or risk perception though education level correlated with condom use. Women's young age at sexual debut was associated with a higher risk of non-condom use later in life (OR 1.95 95% CI: 1.46-2.60). Women with immigrant mothers were less likely to report seldom/never use of condoms with temporary partners compared to women with Swedish-born mothers (OR 0.53 95% CI: 0.37-0.77). Correlates to STI risk perception differ substantially between sexes. Number of reported temporary partners was the only factor associated for both men and women with condom use and STI risk perception. CONCLUSIONS Public health interventions advocating condom use with new partners could consider employing tactics besides those which primarily aim to increase knowledge or self-perceived risk if they are to be more effective in STI reduction. Gender-specific prevention strategies could be effective considering the differences found in this study.
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Affiliation(s)
- Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Middleton AJ, Naish J, Singer N. General practitioners' views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK. EUR J CONTRACEP REPR 2011; 16:311-8. [DOI: 10.3109/13625187.2011.580864] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Heikinheimo O, Inki P, Kunz M, Gemzell-Danielsson K. Predictors of bleeding and user satisfaction during consecutive use of the levonorgestrel-releasing intrauterine system. Hum Reprod 2010; 25:1423-7. [DOI: 10.1093/humrep/deq079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Römer T, Linsberger D. User satisfaction with a levonorgestrel-releasing intrauterine system (LNG-IUS): data from an international survey. EUR J CONTRACEP REPR 2010; 14:391-8. [PMID: 19929641 DOI: 10.3109/13625180903203154] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify the characteristics of an international population of women using the levonorgestrel-releasing intrauterine system (LNG-IUS) and their experiences with this contraceptive. METHODS Women who had used the LNG-IUS for six months or more completed a standardised questionnaire on reasons for use, user satisfaction and other aspects. RESULTS A total of 8680 questionnaires were completed by survey participants in 18 countries across Europe and the Near East. The average woman using the LNG-IUS was 38 years old, was married or lived with her partner, and had two children. Overall, 95% of patients were satisfied with the LNG-IUS; the percentage rose to 99% among those using their second LNG-IUS. Reasons mentioned for using the LNG-IUS included the need for contraception (68%), its high efficacy (59%) and the shorter/lighter menstrual bleeding (55%). Of the women with prior bleeding problems, 93% reported an improvement in their symptoms with the LNG-IUS. Participants also rated the reliability, tolerability and convenience of the method highly. CONCLUSIONS This survey provides insight into the profiles of LNG-IUS users. High levels of satisfaction with this method of contraception were reported by both first and second-time users. Our data suggest that the LNG-IUS is well accepted and that it provides considerable benefits beyond contraception alone.
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Affiliation(s)
- Thomas Römer
- Evangelisches Krankenhaus Köln-Weyertal GmbH, Köln, Germany.
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