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Niemeyer Hultstrand J, Törnroos E, Tydén T, Larsson M, Makenzius M, Gemzell‐Danielsson K, Sundström‐Poromaa I, Ekstrand Ragnar M. Contraceptive use among women seeking an early induced abortion in Sweden. Acta Obstet Gynecol Scand 2023; 102:1496-1504. [PMID: 37493190 PMCID: PMC10577618 DOI: 10.1111/aogs.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women. MATERIAL AND METHODS Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented. RESULTS In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. CONCLUSION The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.
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Affiliation(s)
| | - Elin Törnroos
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Tanja Tydén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Margareta Larsson
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Marlene Makenzius
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Kristina Gemzell‐Danielsson
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- WHO CenterKarolinska University HospitalStockholmSweden
| | | | - Maria Ekstrand Ragnar
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Department of Health SciencesLund UniversityLundSweden
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Ukoha WC, Mtshali NG. Preconception care practices among primary health care nurses working in public health facilities in KwaZulu-Natal. Glob Health Action 2022; 15:2112395. [PMID: 36161863 PMCID: PMC9542517 DOI: 10.1080/16549716.2022.2112395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Preconception care (PCC) is necessary to identify and deal with all the risk factors before conception. Some aspects of PCC, like folic acid supplementation, would be relevant to people desiring a pregnancy. Alternatively, PCC could provide contraceptive support to those with no pregnancy intention. In South Africa, primary healthcare nurses provide a comprehensive package of essential services in public health facilities to about 90% of the population at no cost. Therefore, they are the key providers of promotive, preventive, and curative services, including PCC. OBJECTIVE This study aimed to determine the level of PCC practice among primary healthcare nurses and identify determinants of effective practice. METHODS This cross-sectional descriptive survey was conducted among 196 nurses undertaking a specialisation Primary HealthCare program in a selected higher education institution. A pretested questionnaire was used to collect data that were analysed with SPSS version 27 software. RESULTS The overall practice of PCC was 87.8%. Older participants were significantly less likely to exhibit good PCC practice than their younger counterparts. Female participants were also less likely to have good PCC practices than their male counterparts. Married participants were significantly more likely to practice PCC than their unmarried counterparts. Participants practicing in rural areas were also less likely to have good PCC practices than their urban counterparts. CONCLUSION The PCC practice of most primary healthcare nurses in the study is relatively high. The study also identified the determinants of good PCC practice that can enhance its practice. There is a need to revisit the PCC training of healthcare workers, as most indicated the need for further training.
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Affiliation(s)
- Winifred Chinyere Ukoha
- School of Nursing and Public Health, Howard College, University of KwaZulu-Natal, Durban, South Africa
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Lardou I, Chatzipapas I, Chouzouris M, Xenos P, Petrogiannis N, Tryfos D, Chandakas S, Grigoriadis T, Michala L. Fertility awareness and intentions among young adults in Greece. Ups J Med Sci 2021; 126:8148. [PMID: 35140872 PMCID: PMC8788655 DOI: 10.48101/ujms.v126.8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Greece has a mean age of first motherhood at 31.5 years, higher than the European average age of 29.4. Delaying conception, however, may be an important non-reversible cause of infertility. The aim of this study was to identify possible knowledge deficits regarding fertility in young adults. METHODS This was an online survey of young adults, regarding information on intention to parenthood and knowledge on issues affecting fertility. This study was conducted from February to December 2020, aiming for a representative sample of Greek men and women aged 18 and 26 years. The questionnaire was designed by a multidisciplinary group based on the Cardiff Fertility Knowledge Scale, which contained 22 multiple-choice or Likert-scale questions. RESULTS We obtained responses from 1875 young adults, whose mean age was 22.1 years. About 91.8% of men and 94.0% of women declared an intention to have children, out of which 44.0% wanted to have two and 29.0% three children. About 52.0 and 50.8% men and women, respectively, aimed to start a family between 31 and 35 years. Residents of rural areas and those with a lower education level more likely aimed to have children before the age of 30. The most prevalent answers for age of ideal parenthood were between 26 and 30 years for a woman and 31-35 years for a man. Smoking, alcohol consumption and sexually transmitted infections were identified as factors affecting both female and male fertility. Half of men and women, respectively, overestimated general success rates of reproductive techniques. CONCLUSION The knowledge of fertility, particularly with regards to assisted reproductive techniques' success rates, may be overestimated as more young adults plan for having children after the age of 30.
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Affiliation(s)
- Ioanna Lardou
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Michail Chouzouris
- Department of Statistics and Insurance Science, University of Piraeus, Athens, Greece
| | - Panos Xenos
- Department of Statistics and Insurance Science, University of Piraeus, Athens, Greece
| | | | | | | | - Themos Grigoriadis
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Lina Michala
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
- CONTACT Lina Michala
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Niemeyer Hultstrand J, Engström E, Målqvist M, Tydén T, Maseko N, Jonsson M. Evaluating the implementation of the Reproductive Life Plan in disadvantaged communities: A mixed-methods study using the i-PARIHS framework. PLoS One 2020; 15:e0236712. [PMID: 32915798 PMCID: PMC7485818 DOI: 10.1371/journal.pone.0236712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. Methodology MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. Results The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients’ ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women’s limited reproductive health and rights. Discussion The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.
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Affiliation(s)
| | - Ellinor Engström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ferreira-Filho ES, de Melo NR, Sorpreso ICE, Bahamondes L, Simões RDS, Soares-Júnior JM, Baracat EC. Contraception and reproductive planning during the COVID-19 pandemic. Expert Rev Clin Pharmacol 2020; 13:615-622. [DOI: 10.1080/17512433.2020.1782738] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Edson Santos Ferreira-Filho
- Gynecology Division, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil
| | - Nilson Roberto de Melo
- Gynecology Division, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil
| | | | - Luis Bahamondes
- Family Planning Clinic, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Ricardo Dos Santos Simões
- Gynecology Division, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil
| | - José Maria Soares-Júnior
- Gynecology Division, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Gynecology Division, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo, Brazil
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Adachi T, Endo M, Ohashi K. Regret over the delay in childbearing decision negatively associates with life satisfaction among Japanese women and men seeking fertility treatment: a cross-sectional study. BMC Public Health 2020; 20:886. [PMID: 32513145 PMCID: PMC7282077 DOI: 10.1186/s12889-020-09025-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/01/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Currently, in developed countries, increasing numbers of women and men are delaying childbearing but begin seeking fertility treatment later in life. Some women undergoing infertility treatment develop negative feelings such as depression associated with low life satisfaction and regret over the delay in childbearing. We therefore examine the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors among Japanese women and men seeking fertility treatment. METHODS This cross-sectional study included 253 women and 196 men referred to fertility facilities in Japan from July to December 2018. Participants completed a questionnaire on life satisfaction, regret over the delay in childbearing decision, infertility-related factors and sociodemographic characteristics. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS), and the degree of regret over delay in childbearing decision was measured on a 7-point Likert scale. Multiple linear regressions, conducted separately by sex, were used to analyze the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors. RESULTS Of the 253 women and 196 men, 102 (40.3%) women and 43 (21.9%) men answered "strongly agree" regarding their regret over the delay in childbearing decision. Among women, life satisfaction was negatively associated with regret (β = - 0.155, 95% CI [- 0.938, - 0.093], p = 0.017), use of assisted reproduction technology (ART) (β = - 0.135, 95% CI [- 2.977, - 0.020], p = 0.047). In contrast, previous live birth was positively associated with life satisfaction (β = 0.134, 95% CI [0.122, 3.739], p = 0.037). In men, we found no significant association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors. CONCLUSIONS Regret over the delay in childbearing decision is negatively associated with life satisfaction among Japanese women seeking fertility treatment. It may be important for women to make better informed decision regarding the timing of childbearing to not regret later in life. Health professionals should address regret over the delay in childbearing decision during fertility treatment and explore ways to spread information on fertility awareness.
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Affiliation(s)
- Tomoko Adachi
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan.
| | - Masayuki Endo
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan
| | - Kazutomo Ohashi
- Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Suita, Osaka, 565-0871, Japan
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Abstract
Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.
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Affiliation(s)
- Ilse Delbaere
- Midwifery Education, VIVES University of Applied Sciences, Kortrijk, Belgium
- CONTACT Ilse Delbaere Midwifery Education, VIVES University of Applied Sciences, Doorniksesteenweg 145, Kortrijk, 8500, Belgium
| | - Sarah Verbiest
- Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Tydén
- Department of Women’s and Children’s Heath, Akademiska Sjukhuset Uppsala University, Uppsala, Sweden
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