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Elkhateeb RR, Kishk E, Sanad A, Bahaa H, Hagazy AR, Shaheen K, Moustafa E, Fares H, Gomaa K, Mahran A. The acceptability of using IUDs among Egyptian nulliparous women: a cross-sectional study. BMC WOMENS HEALTH 2020; 20:117. [PMID: 32503576 PMCID: PMC7275565 DOI: 10.1186/s12905-020-00977-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
Background Although intrauterine contraceptive device is highly effective, safe, long term and reversible method of contraception, the general population and physicians refuse. IUDs for nulliparous women due to persistent rumors about its side effects and complications. The aim of this study was to assess the acceptability of IUD use in nulliparous women by both women and health care providers in Egypt. Methods Five hundred thirty nulliparous women and 200 physicians were interviewed in 10 family planning clinics in Suez and Minia cities – Egypt. The knowledge and attitudes of women and health care providers towards IUD use in nulliparous women were assessed through a well designed questionnaire over 2 years. Those women who accepted using IUD were then followed up for 6 months. Results Most of nulliparous women sought for contraception reported a negative impression of IUD method (96.2%). 82.5% of physicians had the same attitude. The reasons for refusing IUD among nulliparous women are fear of side effects including infection (52.8%), and bleeding (37.7%).Also, fear of subsequent infertility 51.9% of women. Regarding the providers, increased pelvic inflammatory disease (PID) represented the highest percentage (70%) for non acceptability, followed by difficult insertion (52.5%). Ninety women who accepted use IUD were followed up 6 months later, 94.4% were still using the method and77.8% were happy with the results. Conclusion The main barriers that hinder the use of IUD in nulliparous women are the women insufficient knowledge and attitude of their physicians. Good client counseling. Good training for physician to improve their experience would help increase the use of such effective and safe method.
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Affiliation(s)
- Reham Refaat Elkhateeb
- Obstetrics and Gynecology, Faculty of medicine Minia University, Maternity Hospital Minia University, Minia, Egypt.
| | - Eman Kishk
- Obstetrics and Gynecology, Faculty of Medicine Suez Canal University, Suez, Egypt
| | - Ahmad Sanad
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Haitham Bahaa
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
| | - Abdel Rahman Hagazy
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
| | - Kareem Shaheen
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Enas Moustafa
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Hahem Fares
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Khalid Gomaa
- Obstetrics and Gynecology at Maternity Hospital, Minia University, Minia, Egypt
| | - Ahmad Mahran
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
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Bingham AL, Garrett CC, Bayly C, Kavanagh AM, Keogh LA, Bentley RJ, Hocking JS. The levonorgestrel intrauterine device in Australia: analysis of prescribing data 2008-2012. BMC WOMENS HEALTH 2018; 18:194. [PMID: 30482186 PMCID: PMC6257965 DOI: 10.1186/s12905-018-0680-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/01/2018] [Indexed: 01/25/2023]
Abstract
Background Unplanned pregnancy is a significant problem in Australia. Local data pertaining to use of the levonorgestrel-releasing intra-uterine device (LNG-IUD), and associated factors are limited. The aim of this analysis was to calculate prescribing rates of the LNG-IUD in Australia, including trends in prescribing and associations with socio-demographic factors, in order to increase understanding regarding potential use. Methods We examined prescriptions for the LNG-IUD recorded in the national Pharmaceutical Benefits Scheme (PBS) from 2008 to 2012. Prescribing trends were examined according to patient age, remoteness of residential location, and proximity to relevant specialist health services. Associations between these factors and prescription rates were examined using poisson regression. Analyses were stratified by 5-year age-groups. Results Age-adjusted prescription rates rose from 11.50 per 1000 women aged 15–49 (95% CI: 11.41–11.59) in 2008 to 15.95 (95% CI:15.85–16.01) in 2012. Prescription rates increased most among 15–19-year-olds but remain very low at 2.76 per 1000 women (95% CI: 2.52–3.01). Absolute increases in prescriptions were greatest among 40–44-year-olds, rising from 16.73 per 1000 women in 2008 (95% CI: 16.12–17.34) to 23.77 in 2012 (95% CI: 22.58–24.29). Rates increased significantly within all geographical locations (p < 0.01). Non-metropolitan location was significantly associated with increased prescribing rates, the association diminishing with increasing age groups. Conclusions Prescription of LNG-IUD in Australia is very low, especially among young women and those in major cities. Service providers and young women may benefit from targeted education outlining use of the LNG-IUD, strengthened training and referral pathways. Disparities in prescription according to location require further investigation.
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Affiliation(s)
- Amie L Bingham
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3010, Australia.
| | - Cameryn C Garrett
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3010, Australia
| | - Christine Bayly
- The Royal Women's Hospital, 20 Flemington Road, Parkville, Melbourne, VIC, Australia
| | - Anne M Kavanagh
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3010, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3010, Australia
| | - Rebecca J Bentley
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3010, Australia
| | - Jane S Hocking
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Melbourne, 3010, Australia
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3
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Foran T, Butcher BE, Kovacs G, Bateson D, O’Connor V. Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review. EUR J CONTRACEP REPR 2018; 23:379-386. [DOI: 10.1080/13625187.2018.1526898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Therese Foran
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
- Royal Hospital for Women, Sydney, NSW, Australia
| | - Belinda E. Butcher
- Biostatistics and Medical Writing, WriteSource Medical Pty Ltd, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Gab Kovacs
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Institute of Obstetrics and Gynaecology, Epworth HealthCare, Melbourne, VIC, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, Australia
| | - Vivienne O’Connor
- Mater Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Chew KT, Salim N, Abu MA, Abdul Karim AK. Knowledge, attitudes and practice regarding copper intrauterine contraceptive devices among doctors in Malaysia. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:jfprhc-2017-101869. [PMID: 29972367 DOI: 10.1136/bmjsrh-2017-101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Intrauterine contraceptive devices (IUDs) are an important method to reduce unmet need for family planning and for prevention of unintended pregnancy. However, IUD use in Malaysia is still low. Doctors play a major role in influencing IUD uptake among women. This study was designed to evaluate doctors' knowledge, attitudes and perceptions towards IUDs and factors associated with their current practice. METHODS A questionnaire was mailed to public and private contraceptive providers who practise in Kuala Lumpur, Malaysia. RESULTS A total of 400 doctors were invited and 240 (60%) of them responded to the survey. Of the respondents, 161 (65.9%) were from the public or government sector and 89 (34.1%) were from the private sector. The knowledge score of doctors was classed as 'average', and correlated well with their previous training level, working position, number of patients seen in a week and number of contraceptive methods available in their facilities. The age, gender, working duration, availability of IUDs in the premises and number of IUD insertions in a month were not statistically associated with the providers' knowledge. The use of IUDs was low, especially among private doctors, and was significantly related to their knowledge of the method. Knowledge scores, perception and practice were significantly lower in the private sector.
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Affiliation(s)
- Kah Teik Chew
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norsaadah Salim
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Abdul Kadir Abdul Karim
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Daniele MAS, Cleland J, Benova L, Ali M. Provider and lay perspectives on intra-uterine contraception: a global review. Reprod Health 2017; 14:119. [PMID: 28950913 PMCID: PMC5615438 DOI: 10.1186/s12978-017-0380-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion. METHODS A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications. RESULTS Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes. CONCLUSION Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries.
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Affiliation(s)
- Marina A. S. Daniele
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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6
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Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: An expert roundtable discussion. Aust N Z J Obstet Gynaecol 2017; 57:206-212. [PMID: 28294293 DOI: 10.1111/ajo.12587] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low. AIM To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers. METHOD A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use. RESULTS Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required. CONCLUSIONS Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | | | | | - Philip Goldstone
- Marie Stopes International Australia, Melbourne, Victoria, Australia
| | - Gab Kovacs
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Rod Baber
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Mazza D, Black K, Taft A, Lucke J, McGeechan K, Haas M, McKay H, Peipert JF. Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial protocol. BMJ Open 2016; 6:e012491. [PMID: 27855100 PMCID: PMC5073472 DOI: 10.1136/bmjopen-2016-012491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The increased use of long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, has the potential to reduce unintended pregnancy and abortion rates. However, use of LARCs in Australia is very low, despite clinical practice guidance and statements by national and international peak bodies advocating their increased use. This protocol paper describes the Australian Contraceptive ChOice pRojet (ACCORd), a cluster randomised control trial that aims to test whether an educational intervention targeting general practitioners (GPs) and establishing a rapid referral service are a cost-effective means of increasing LARC uptake. METHODS AND ANALYSIS The ACCORd intervention is adapted from the successful US Contraceptive CHOICE study and involves training GPs to provide 'LARC First' structured contraceptive counselling to women seeking contraception, and implementing rapid referral pathways for LARC insertion. Letters of invitation will be sent to 600 GPs in South-Eastern Melbourne. Using randomisation stratified by whether the GP inserts LARCs or not, a total of 54 groups will be allocated to the intervention (online 'LARC First' training and rapid referral pathways) or control arm (usual care). We aim to recruit 729 women from each arm. The primary outcome will be the number of LARCs inserted; secondary outcomes include the women's choice of contraceptive method and quality of life (Short Form Health Survey, SF-36). The costs and outcomes of the intervention and control will be compared in a cost-effectiveness analysis. ETHICS AND DISSEMINATION The ACCORd study has been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080. Any protocol modifications will be communicated to Ethics Committee and Trial Registration registry. The authors plan to disseminate trial outcomes through formal academic pathways comprising journal articles, nation and international conferences and reports, as well as using more 'popular' strategies including seminars, workshops and media engagements. TRIAL REGISTRATION NUMBER ACTRN12615001346561.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Kirsten Black
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Central Clinical School, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jayne Lucke
- Australian Research Centre for Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Victoria, Australia
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney, New South Wales, Australia
| | - Heather McKay
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jeffery F Peipert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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Bateson D, Harvey C, Trinh L, Stewart M, Black KI. User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women. Aust N Z J Obstet Gynaecol 2016; 56:655-661. [PMID: 27704541 DOI: 10.1111/ajo.12534] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception. AIMS To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation. METHODS Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation. RESULTS Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred. CONCLUSIONS Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.
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Affiliation(s)
- Deborah Bateson
- Family Planning NSW, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Harvey
- Family Planning Queensland (now called True Relationships and Reproductive Choice), Brisbane, Queensland, Australia
| | - Lieu Trinh
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Mary Stewart
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Boupha B, Shi G, Turdaliyeva BS. Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico. Reprod Health 2016; 13:70. [PMID: 27283191 PMCID: PMC4901518 DOI: 10.1186/s12978-016-0185-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. METHODS A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. RESULTS Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. CONCLUSIONS This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.
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Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada.
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - G Emmanuel Guindon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | | | - Boungnong Boupha
- Foreign Affairs Committee and Women's Caucus, Laos National Assembly, Vientiane, Lao PDR
| | - Guang Shi
- Democratic Party of Peasants & Workers in China, Beijing, China
| | - Botagoz S Turdaliyeva
- Department of Health Policy & Management, Kazakh National Medical University, Almaty, Kazakhstan
- Evidence-Based Health Centre, Almaty, Kazakhstan
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Black KI, Day CA. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders. Subst Abuse 2016; 10:27-33. [PMID: 27199563 PMCID: PMC4869602 DOI: 10.4137/sart.s34555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 01/10/2023]
Abstract
Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area.
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Affiliation(s)
- Kirsten I. Black
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Carolyn A. Day
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
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Kelly M, Inoue K, Black KI, Barratt A, Bateson D, Rutherford A, Stewart M, Richters J. Doctors’ experience of the contraceptive consultation: a qualitative study in Australia. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 43:119-125. [DOI: 10.1136/jfprhc-2015-101356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 03/03/2016] [Accepted: 03/29/2016] [Indexed: 01/24/2023]
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12
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Goldsmith C, Nelson AL. Urgent need to change clinical practices about postpartum contraception. World J Obstet Gynecol 2015; 4:52-57. [DOI: 10.5317/wjog.v4.i3.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 02/05/2023] Open
Abstract
In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device - has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.
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Grentzer JM, Peipert JF, Zhao Q, McNicholas C, Secura GM, Madden T. Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion. Contraception 2015; 92:313-8. [PMID: 26093189 DOI: 10.1016/j.contraception.2015.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 05/08/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective was to compare three strategies for Chlamydia trachomatis and Neisseria gonorrhoeae screening prior to intrauterine device (IUD) insertion. STUDY DESIGN This was a secondary analysis of the Contraceptive CHOICE Project. We measured the prevalence of C. trachomatis and/or N. gonorrhoeae at the time of IUD insertion. We then compared sensitivity, specificity, negative and positive predictive values, and likelihood ratios for three screening strategies for C. trachomatis and N. gonorrhoeae prior to IUD insertion: (a) "age-based" — age ≤25 years alone; (b) "age/partner-based" — age ≤25 and/or multiple sexual partners; and (c) "risk-based" — age ≤25, multiple sexual partners, inconsistent condom use and/or history of prior sexually transmitted infection (STI). RESULTS Among 5087 IUD users, 140 (2.8%) tested positive for C. trachomatis, 16 (0.3%) tested positive for N. gonorrhoeae, and 6 (0.1%) were positive for both at the time of IUD insertion. The "risk-based" screening strategy had the highest sensitivity (99.3%) compared to "age-based" and "age/partner-based" screening (80.7% and 84.7%, respectively.) Only one (0.7%) woman with a chlamydia or gonorrhea infection would not have been screened using "risk-based" screening. CONCLUSION A risk-based strategy to screen for C. trachomatis and N. gonorrhoeae prior to IUD insertion has higher sensitivity than screening based on age alone or age and multiple sexual partners. IMPLICATIONS Using a risk-based screening strategy (age≤25, multiple sexual partners, inconsistent condom use and/or history of an STI) to determine who should be screened for C. trachomatis and N. gonorrhoeae prior to IUD insertion will miss very few cases of infection and obviates the need for universal screening.
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Affiliation(s)
- Jaclyn M Grentzer
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
| | - Jeffrey F Peipert
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110
| | - Qiuhong Zhao
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110
| | - Colleen McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110
| | - Gina M Secura
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110
| | - Tessa Madden
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110
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Chakraborty NM, Murphy C, Paudel M, Sharma S. Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. BMC Health Serv Res 2015; 15:39. [PMID: 25627578 PMCID: PMC4322443 DOI: 10.1186/s12913-015-0701-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/07/2015] [Indexed: 12/29/2022] Open
Abstract
Background Nepal has high unmet need for family planning and low use of intrauterine devices (IUDs). While clients’ attitudes toward the IUD are known in a variety of contexts, little is known about providers’ knowledge and perceptions of the IUD in developing countries. Nepal’s liberal IUD service provision policies allow the opportunity to explore provider knowledge and perceptions across cadres and sectors. This research contributes to an understanding of providers’ IUD perceptions in low-resource environments, and increases evidence for IUD task-sharing and private sector involvement. Methods A questionnaire was administered to 345 nurses and auxiliary nurse midwives (ANMs) affiliated with the private Mahila Swastha Sewa (MSS) franchise, public sector, or private non-franchise sector. All providers had been trained in TCu 380A IUD insertion and removal. The questionnaire captured providers’ IUD experience, knowledge, and perceived barriers to recommendation. Descriptive, multivariate linear, and multinomial logistic regression was conducted, comparing providers between cadre and sector. Results On average, providers answered 21.5 of 35 questions correctly, for a score of 61.4%. Providers scored the lowest on IUD medical eligibility, answering 5.9 of 14 questions correctly. Over 50% of providers were able to name the four side effects most frequently associated with the IUD; however, one-third of all providers found at least one of these side effects unacceptable. Adjusted results show that cadre does not significantly impact provider’s IUD knowledge scores or side effect perceptions. Public sector affiliation was associated with higher knowledge scores regarding personal characteristic eligibility and more negative perceptions of two normal IUD side effects. IUD knowledge is significantly associated with provider’s recent training and employment at multiple facilities, and side effect perceptions are significantly associated with client volume, range of family planning methods, and region. Conclusions Provider knowledge and attitudes towards IUD provision are similar across cadre and sector, supporting WHO task-sharing guidelines and validating Nepal’s family planning policies. However, overall provider knowledge is low. We recommend that providers need to receive further training and support to improve knowledge, manage side effects, and recognize women in periods of high unmet need - such as post-partum or post-abortion women - as suitable candidates for IUDs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0701-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Mahesh Paudel
- Population Services International, Kathmandu, Nepal.
| | - Sriju Sharma
- Helen Keller International Nepal, Lalitpur, Nepal.
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Intrauterine contraception: attitudes, practice, and knowledge among Swedish health care providers. Contraception 2014; 89:407-12. [DOI: 10.1016/j.contraception.2013.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/10/2013] [Accepted: 12/23/2013] [Indexed: 11/21/2022]
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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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Black KI, Bateson D, Harvey C. Australian women need increased access to long-acting reversible contraception. Med J Aust 2013; 199:317-8. [PMID: 23992177 DOI: 10.5694/mja12.11832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Kirsten I Black
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia.
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Santos ARG, Bahamondes MV, Hidalgo MM, Atti A, Bahamondes L, Monteiro I. Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section. Contraception 2013; 88:164-8. [PMID: 23507169 DOI: 10.1016/j.contraception.2012.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/11/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the high contraceptive effectiveness and noncontraceptive benefits of the levonorgestrel-releasing intrauterine system (LNG-IUS) in nulligravidas, there are still concerns related to the use of this device. Pain at insertion is one of the limitations to the increased use of intrauterine contraceptives. The aim of the study was to evaluate the ease of insertion and occurrence of pain at insertion of the LNG-IUS in nulligravidas (women who never became pregnant) compared to parous women with and without cesarean section (c-section). We also assessed the difficulty at insertion in each group. METHODS Three groups of new acceptors of the LNG-IUS were studied: one with 23 nulligravida women, one with 28 parous women who had undergone at least one c-section and one with 23 parous women who had no previous c-section. Pain at insertion was evaluated by using a pain visual analogue score (VAS). The ease of insertion was defined as easy or difficult by health care providers (HCPs) and classified according to the cause of difficulty: tight cervix, anatomically distorted uterus or pain. RESULTS Almost all women reported pain at insertion, regardless of parity and form of delivery. The mean VAS was 6.6 for nulligravida women, 5.2 for parous women with c-section and 5.9 for parous women with no c-section. Although 93% of the women reported pain at insertion, they also reported a willingness to insert a new LNG-IUS again if needed. The most common difficulties were a tight cervix in nulligravidas, an anatomically distorted uterus in parous women with c-section and pain in parous women without c-section. There was no failure of insertion in any group. HCPs reported that it was easier to perform insertion in parous women who had undergone only vaginal deliveries than nulligravid women or parous women with a prior c-section. CONCLUSIONS Although almost all women reported pain at insertion, they also reported a willingness to insert a new LNG-IUS if needed. This attitude reflects high satisfaction with the LNG-IUS. The type of difficulty at insertion was related to parity and type of delivery. The LNG-IUS was able to be inserted in all women; however, it was easier to do in parous women without c-section than nulligravid women or those with a prior C-section.
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Affiliation(s)
- Ana Raquel Gouvea Santos
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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Harvey C, Bateson D, Wattimena J, Black KI. Ease of intrauterine contraceptive device insertion in family planning settings. Aust N Z J Obstet Gynaecol 2012; 52:534-9. [DOI: 10.1111/ajo.12007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Jeany Wattimena
- Discipline of Obstetrics, Gynaecology and Neonatology; The University of Sydney; Sydney; Australia
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Bahamondes L, Bahamondes MV. Assessment of the use of two new low-dose levonorgestrel-releasing intrauterine systems as contraceptives. WOMENS HEALTH 2012; 8:235-8. [PMID: 22554171 DOI: 10.2217/whe.12.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, Phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil. Steril. 97(3), 616-622.e3 (2012). A randomized, open-label, Phase II study was conducted in 37 centers in five European countries to assess the optimal dose for a new contraceptive levonorgestrel intrauterine system (LNG-IUS). Overall, 742 parous or nulliparous women aged 21-40 years were allocated to receive a LNG-IUS that initially releases 12 µg/day (LNG-IUS(12)) or 16 µg/day (LNG-IUS(16)) in vitro or the currently available device that releases 20 µg/day (LNG-IUS(20)). The two new devices are shorter than the current one. Pearl Indices of 0.17, 0.82 and 0.00 for the LNG-IUS(12), LNG-IUS(16) and LNG-IUS(20), respectively, reflect the contraceptive efficacy of these devices. The mean number of bleeding and spotting days decreased in all three groups; however, this decrease was more significant in LNG-IUS(20) users. Placement of the new shorter devices was considered simple by providers, while patients reported significantly less pain with the two new devices compared with the current one. This study provided further insight into the development of two new LNG-IUS devices as contraceptives, with the additional possibility of using them to treat heavy menstrual bleeding or as endometrial protection during estrogen therapy.
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Affiliation(s)
- Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics & Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, 13084-971 Campinas, SP, Brazil.
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Bahamondes MV, Hidalgo MM, Bahamondes L, Monteiro I. Ease of insertion and clinical performance of the levonorgestrel-releasing intrauterine system in nulligravidas. Contraception 2011; 84:e11-6. [DOI: 10.1016/j.contraception.2011.05.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/08/2011] [Accepted: 05/19/2011] [Indexed: 11/27/2022]
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