Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancy

Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study

OBJECTIVE

To examine the uptake of postnatal contraception (PNC) and experiences of PNC care across a geographical region of England.

DESIGN

Cross-sectional online survey.

SETTING

The North East and North Cumbria Integrated Care System (ICS).

POPULATION

Women who had completed a pregnancy in the previous 3 years.

METHODS

The uptake of PNC by accessed method(s) and the availability of preferred method(s) is described, and adjusted odds ratios are reported for group differences in uptake by characteristics of interest.

MAIN OUTCOME MEASURES

Uptake of medically prescribed/administered contraception and uptake of long-acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods.

RESULTS

Although almost half of respondents (47.1%; n = 1178) reinitiated some form of sexual activity during the postnatal period, only 38.7% (n = 969) of respondents accessed a medically prescribed/administered contraceptive method postnatally, and only 15.5% (n = 389) of respondents accessed a LARC. It is a matter of concern that 18.8% (n = 451) of respondents indicated that they were unable to access their preferred PNC. In multivariate analysis, younger age, lower household income, higher multiparity, operative delivery, unplanned pregnancy and not breastfeeding were significant predictors of higher PNC uptake.

CONCLUSIONS

The uptake of PNC in this cohort was low, with almost a fifth of women unable to access their preferred method. However, there was some evidence that women belonging to groups perceived to be at risk of rapid repeat pregnancy were more likely to access reliable PNC methods.

Psychosocial Stressors and Postpartum Depressive Symptoms Are Linked to Postpartum Contraceptive Use

Background: Postpartum contraception plays a critical role in reducing the occurrence of rapid subsequent pregnancy, offering individuals reproductive choice, and promoting overall reproductive planning and well-being. In this study, we investigated the relationship between psychosocial stress during pregnancy, postpartum depressive symptoms (PDS), and postpartum contraceptive use. Materials and Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System (2012-2019), which included comprehensive information about maternal experiences, views, and needs before, during, and after pregnancy from four states and a large city, with a total sample size of N = 36,356. We conducted descriptive analyses as well as adjusted multivariable logistic regression models. Main Findings: Our findings demonstrate significant negative associations between partner-related (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [95% CI]: 0.76-0.89, p ≤ 0.001) and trauma-related (aOR = 0.83, 95% CI: 0.75-0.92, p ≤ 0.001) stressors and postpartum contraceptive use. Additionally, we observed a negative association between PDS and postpartum contraceptive use (OR = 0.88, 95% CI: 0.80-0.97, p ≤ 0.01), indicating that individuals experiencing PDS are less likely to utilize contraception after giving birth. Furthermore, our study highlights racial/ethnic, socioeconomic, and parity postpartum contraceptive use disparities. Conclusions: Our findings emphasize the importance of incorporating psychosocial stressors and mental health into the promotion of effective postpartum contraception practices. These results have valuable implications for health care providers, policymakers, and researchers as they can guide the development of targeted interventions and support systems to contribute to improved reproductive health outcomes.

Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia

BACKGROUND

Perinatal loss can have long-lasting adverse effects on a woman's psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations.

AIMS

The primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss.

METHOD

This case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy.

RESULTS

Scandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49-1.95) and total depression score (β: 0.90, 95% CI: 0.06-1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating.

CONCLUSION

Women who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.

Assessment of content, behavior change techniques, and quality of unintended pregnancy apps in Spain: Systematic search on app stores

Objective

Unintended pregnancies are a public health problem that represents 48% of global pregnancies. Despite the proliferation of smartphones there is limited data on the app's features on unintended pregnancy. The purpose of this research was to identify free apps available in Spanish, in the iOS Store and Google Play, which can be recommended to prevent unintended pregnancies in adolescents.

Methods

A systematic search to identify apps was performed in the iOS App Store and in Google Play aiming to replicate the way a patient might access an "unintended pregnancy prevention" app. Additionally, the quality, using the Mobile Application Rating Scale, and content were assessed.

Results

A total of 4614 apps were identified, of which 8 were retrieved for assessment (0.17%). The mean for objective and subject quality was 3.39 (standard deviation (SD) = 0.694) and 1.84 (SD = 0.626), respectively. A total of 16 thematic categories were identified. The mean of topics covered in the apps was 5.38 (SD = 2.925) being those related to contraception the more frequent.

Conclusion

The results of the present study suggest that only a small percentage of free pregnancy prevention apps in Spanish should be recommended. The contents of the apps retrieved meet the potential necessities of adolescents.

Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

OBJECTIVES

In 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General Practice (GP)-greater community pharmacy provision reduces GP prescribing. This study aimed to examine predictors of GP and pharmacy EHC activity, describing them using path analysis. From this, commissioners and policy-makers may understand ways to influence this.

STUDY DESIGN

Cross-sectional study of routinely recorded data, obtained through freedom of information requests to local authorities.

SETTING

Community pharmacies and general practices in England, UK.

PARTICIPANTS

All local authorities in England were included in the study (147 areas). The study population were all girls, adolescents and women aged 12-55. Of the 147 areas, data from 80 local authorities were obtained covering an eligible female population of 9 380 153.

PRIMARY AND SECONDARY OUTCOME MEASURES

Correlation between community pharmacy and GP EHC activity.

RESULTS

Data from 80 local authorities were analysed, representing 60% of the eligible female population in England. A significant negative correlation was found between rates of community pharmacy provision and GP prescribing (-0.458, p<0.000). Community pharmacy provision and the proportion of pharmacies commissioned were significantly correlated (0.461, p<0.000). A significant correlation was found between increased deprivation and community pharmacy provision (0.287, p=0.010). Standardised total effects on GP prescribing were determined from path analysis including community pharmacy provision (ß=-0.552) and proportion of pharmacies commissioned (ß=-0.299). If all community pharmacies were commissioned to provide EHC, GP EHC prescriptions could decrease by 15%.

CONCLUSION

Community pharmacy EHC provision has a significant influence on GP EHC prescribing. Increasing the proportion of commissioned community pharmacies should have a marked impact on GP workload. The methodology affords the possibility of examining relationships surrounding other commissioned service activity across different settings and their impact on linked care settings.

A 3-year retrospective study of unintended pregnancy in a developed multi-ethnic Asian community: A call for better healthcare system for family planning

Background

Women of childbearing age may face unintended pregnancy (UP). They are usually referred by primary care professionals (PCPs) to gynecologists to manage their UP in countries where abortion is legalized. The study aimed to determine the prevalence, demographic profiles, and associated factors of women in a developed community seeking referrals from PCPs for their UP.

Methods

The sociodemographic and clinical data were extracted from the electronic medical records of pregnant multi-ethnic Asian women at eight Singapore public primary care clinics from July 2017 to June 2020. Their demographic profiles were reviewed and compared among women of different age bands using appropriate statistical tests. Logistic regression was used to identify the factors associated with UP referrals.

Results

Among 9,794 gravid women, 974 of them requested gynecologist referrals to terminate UP over the 3-year period, constituting a prevalence of 9.94%. The mean age of women requesting such referrals was 29.7 ± 7 years. There were 10.7% with more than one prior unintended pregnancy and 15.7% were foreigners. The majority of these women were married, neither required social assistance nor had comorbidities. Only 2.9% of them were known to be prescribed contraceptives. A multivariable logistic regression analysis showed that women of Indian ethnicity, single, aged below 20 years and above 40 years, were more likely to request referrals for UP.

Conclusion

One in 10 gravid women had sought referrals for UP, especially adolescents and older women, and Indian ethnicity. An accessible community-based healthcare service to educate and counsel women on family planning is urgently needed to reduce the incidence of UP.

A Women's Rights-Based Approach to Reducing Child Mortality: Data from 193 Countries Show that Gender Equality does Affect Under-five Child Mortality

OBJECTIVES

Mother's health and wellbeing significantly affects child health. Women's autonomy can improve healthcare-seeking behaviour, utilisation of healthcare services, and planned pregnancy, thereby improving child health. The global under-five mortality rate (U5MR) has seen the fastest decline in the past two decades, but the influence of gender equality on child mortality remains unaddressed. A strategic approach addressing gender equality is needed to reduce the U5MR further. The study aimed to identify and investigate the association between indicators of gender equality and U5MR using a human rights-based approach.

METHODS

We analysed open-source secondary data from international agencies comprising 521 gender-sensitive variables for 193 countries. Nine variables were included for the final Structural Equation Model based on the theoretical model. Model 1 consisted of 193 countries, and Model 2 comprised a subgroup analysis of 11 variables for 158 countries. Gender equality was a latent variable, and the U5MR was the outcome variable.

RESULTS

Gender equality was significantly associated with U5MR (Z = - 7.47, 95% CI = - 754.67 to - 440.98, p < 0‧001, n = 193 for Model 1, and Z = - 7.71, 95% CI = - 808.26 to - 480.72, p < 0‧001, n = 158 for Model 2). Female education, women's waged and salaried employment, women as employers, and women's representation in leadership and parliament enhanced gender equality, whereas the prevalence of child marriage and intimate partner violence (IPV) negatively affected gender equality. Improvement in gender equality significantly reduced U5MR. CONCLUSIONS FOR PRACTICE: Improving women's economic, educational, and social position and increasing female representation in higher leadership and policymaking positions is the key to reducing child mortality. Notably, eliminating child marriage and IPV is the key to achieving gender equality and is needed at the forefront of national policies. Gender equality can significantly improve women's reproductive autonomy, a critical factor in improving healthcare utilisation for women and their children.

A Pregnant Pause: Rethinking Economic Evaluation in Contraception and Pregnancy

Pregnancy presents a unique challenge to economic evaluation, requiring methods that can account for both maternal and fetal outcomes. The ethical challenges to healthcare presented by pregnancy are well understood, but these have not yet been incorporated into cost-effectiveness approaches. Economic evaluations of pregnancy currently take an ad hoc approach to outcome valuation, opening the door to biased estimates and inconsistent resource allocation. We summarize the limitations of current economic evaluation methods and outline key areas for future work.

Association of husbands' education status with unintended pregnancy in their wives in southern Ethiopia: A cross-sectional study

Background

Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands’ education status and their wives unintended pregnancy in southern Ethiopia.

Methods

The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands’ education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy.

Results

The proportion of unintended pregnancy in this sample was 20.6%. Husbands’ education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]).

Conclusion

Unintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.

GP prescribing in Northern Ireland by deprivation index: retrospective analysis

Objective

In the present study, we sought to explore the relationship between socioeconomic status and prescribing magnitude and cost in primary care throughout Northern Ireland.

Design

We performed a retrospective data analysis of general practitioner (GP) prescribing using open-source databases with data collected from May to October 2019 to determine the number of prescriptions and cost of drugs and drug classes by area, ranking these by deprivation index. We used Kendall’s tau to quantify the relationship between prescribing and deprivation.

Setting

We analysed open-source data collected from 325 GP practices in Northern Ireland during the period from May to October 2019.

Participants

We analysed a total of 2 764 303 prescriptions signed during our study period.

Results

Our study indicates a clear trend of increased overall spending per patient (r=−0.1232, p=0.02) and number of prescriptions per patient (r=−0.3440, p<0.001) in areas of higher deprivation. The mean cost per item was higher in less deprived areas (r=0.3809, p<0.001). Overall, £13.79 more was spent and 3.5 more items were prescribed per patient in the most compared with the least deprived decile, although more expensive items tended to be prescribed in areas with lower socioeconomic deprivation (£11.27 per item vs £9.20 per item). We found a statistically significant correlation of prescribing of key drug classes, such as bronchodilators, antidepressants and drugs used to treat diabetes, among others, with greater deprivation. Prescribing of vaccines and drugs used in the treatment of glaucoma was correlated with lower deprivation.

Conclusion

We provide an exploration of the correlation of prescribing with deprivation by analysing all prescriptions signed within a 6-month period in Northern Ireland. Our study broadly agrees with published literature, although a few notable exceptions are highlighted. We provide evidence of discrepancies in medication cost between areas of differing deprivation and suggest possible explanations for these trends. This information will be valuable for future investigation of disease prevalence, as well as targeting of patient education and future funding.

Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception

OBJECTIVE

The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant.

STUDY DESIGN

We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use.

RESULTS

A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36-0.96], 1.06 for copper IUD (95% CI 0.72-1.50) and 0.63 for LNG implants (95% CI 0.39-0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58-1.25), 1.11 for copper IUD (95% CI 0.77-1.54) and 0.63 for LNG implants (95% CI 0.39-0.96).

CONCLUSIONS

In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women.

IMPLICATIONS STATEMENT

Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.

Prevalence and determinants of unintended pregnancy in Ethiopia: A systematic review and meta-analysis of observational studies

BACKGROUND

Unintended pregnancy has significant consequences for the health and welfare of women and children. Despite this, a number of studies with inconsistent findings were conducted to reduce unintended pregnancy in Ethiopia; unavailability of a nationwide study that determines the prevalence of unintended pregnancy and its determinants is an important research gap. Thus, this study was conducted to determine the overall prevalence of unintended pregnancy and its determinants in Ethiopia.

METHODS

We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias of observational studies. The heterogeneity of studies was also assessed using I2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the overall prevalence of unintended pregnancy and its determinants in Ethiopia. In addition, the subgroup analyses were performed to investigate how the prevalence of unintended pregnancy varies across different groups of studies.

RESULTS

Twenty-eight studies that satisfy the eligibility criteria were included. We found that the overall prevalence of unintended pregnancy in Ethiopia was 28% (95% CI: 26-31). The subgroup analyses showed that the highest prevalence of unintended pregnancy was observed from the Oromiya region (33.8%) followed by Southern Nations Nationalities and Peoples' region (30.6%) and the lowest was in Harar. In addition, the pooled prevalence of unintended pregnancy was 26.4% (20.8-32.4) and 30.0% (26.6-33.6) for community-based cross-sectional and institution-based cross-sectional studies respectively. The pooled analysis showed that not communicating with one's husband about family planning was more likely to lead to unintended pregnancy (OR: 3.56, 95%CI: 1.68-7.53). The pooled odds ratio also showed that unintended pregnancy is more likely among women who never use family planning methods (OR: 2.08, 95%CI: 1.18-3.69). Furthermore, the narrative review of this study showed that maternal education, age, and household wealth index are strongly associated with an unintended pregnancy.

CONCLUSIONS

In this study, the prevalence of unintended pregnancy was high. Lack of spousal communication, never using family planning, maternal education, and household wealth level were significantly associated with an unintended pregnancy. This study implies the need to develop plans and policies to improve the awareness of contraceptive utilization and strengthen spousal communication related to pregnancy.

Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009-2010 and 2013-2014)

BACKGROUND

Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada.

METHODS

Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives).

RESULTS

Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50).

INTERPRETATION

We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.

Assessment of the awareness and usages of family planning methods in the Lebanese community

BACKGROUND

Worldwide, one in three women has unmet family planning (FP) needs because of difficulties in accessing or using contraceptives. In Lebanon, information from the scientific literature on the national prevalence of contraceptive use appears scarce.

OBJECTIVE

In view of this, we measured the current Lebanese national prevalence of FP methods' uptake among women and men of reproductive age, and we assessed barriers for potential unmet need.

METHODS

We conducted a cross-sectional survey on a nationally representative sample of 825 married women (aged 15-49 years) and men of reproductive age (aged 18+ years). We used the validated Demographic & Health Survey (DHS) data collection tool and analysed data with SPSS Version 22.0 with p values <0.05 considered statistically significant.

RESULTS

We found that the current prevalence of contraceptive use is 55.6%, the unmet need is 11.4%, the total demand for FP is 67% and the percentage of satisfied demand for FP is 83%. Despite favourable knowledge of and access to FP methods as well as positive attitudes towards FP; there is a clear stagnation in the rate of contraception use over the past four decades. The identified major factors hindering the use of FP methods in Lebanon appear to be religion, age and lower educational levels.

CONCLUSION

We suggest the implementation of effective interventions at the national level to promote and encourage the uptake of modern FP methods among couples. The latter will further promote maternal and child health, as well as empower women to fulfil their equal function in society.

Contraceptive Behaviors in Polish Women Aged 18-35-a Cross-Sectional Study

The aim was to evaluate contraceptive behaviors, and factors affecting them, in the population of Polish-speaking women. A cross-sectional study was performed on 6763 women, current contraceptive users, aged 18 to 35. An anonymous and voluntary questionnaire written in Polish, containing 33 questions, was distributed online from January to February 2017. The Internet and doctors were the most popular sources of information about contraception (82% and 73%, respectively). Upon choosing contraception, women paid the most attention to its efficacy (85%) and its impact on health (59%). The most common methods were combined oral contraceptives (38%) and condoms (24%). In total, 51% had chosen hormonal contraception, of which 68% experienced side effects. The most frequent were decreased libido (39%) and weight gain (22%). Factors associated with the usage of hormonal or non-hormonal contraception were: education, relationship status, parenthood, number of sexual partners, frequency of intercourses, sources of information about contraception, and factors considered most important when choosing a contraceptive method. The choice between short-acting and long-acting reversible contraception was influenced by age, relationship status, parenthood, smoking, sources of information about contraception, and factors considered most important when choosing a contraceptive method. Wide access to contraception, high-quality education, and counselling should become priorities in family planning healthcare.

Causes and consequences of unintended pregnancies in the Gaza Strip: a qualitative study

BACKGROUND

Little is known about unintended pregnancies in the Gaza Strip. This study explored causes and consequences of unintended pregnancies among women in the Gaza Strip.

METHODS

This was a qualitative study, and included 21 women who had experienced unintended pregnancies previously. Data collection took place in three focus groups of 5-12 participants, which were facilitated by one female researcher. Structured questions on reasons for, causes and impact of unintended pregnancies were answered by all participants. Sessions were audiotaped and responses were transcribed and read by all the researchers to extract themes.

RESULTS

The mean age of participants was 34.2±6.0 years, parity was 2.7±0.6 and 16 participants (76.2%) had benefitted from secondary level education or above.Five main themes were identified: (1) economic hardship was the main reason for pregnancies to be unwanted; (2) high pressure was exerted on women for male babies, exposing women to gender-based violence; (3) advanced maternal age was perceived as a social stigma; (4) complete lack of support for women facing unintended pregnancy led to self-management of terminations including attempts of unsafe methods; and (5) changes of methods and incorrect use leading to contraceptive failure was the most frequent cause.

CONCLUSIONS

Unintended pregnancies in the Gaza Strip are a common cause of distress for women. The most effective way of preventing unintended pregnancies remains access to reliable contraception. However, a service designated to support women facing unintended pregnancies is needed in the Gaza Strip. Local policymakers have to address this when planning healthcare services.

Prevalence, determinants, and outcomes of unintended pregnancy in Sohag district, Egypt

Background

Unintended pregnancies may be mistimed or unwanted. It represents 40% of all pregnancies, and it had multiple risky health outcomes. It is essential to understand the factors affecting unintended pregnancies and their consequences to develop strategies that help prevent them. The present study is conducted to identify the prevalence, determinants, and outcomes of unintended pregnancies in Sohag district, Egypt.

Methods

A cross-sectional study was conducted in Sohag district, 2016. Five hundred fifty-four ever married women aged 18–49 years whose last pregnancy was in the 3 years preceding the data collection date were randomly selected from rural and urban localities. Data were collected through home visits using a validated questionnaire. In this study, Sohag city represents the urban place, while Tunis and El-Sheikh Makram villages represent the rural places.

Results

Nearly one third (30.7%) of the study sample had an unintended pregnancy within the last 3 years from the time of interview. Regression analysis showed that young women < 30 (OR = 2.24, 95% CI 1.12–4.48, p = 0.02), young husbands ≤ 30 (OR = 5.44, 95% CI 1.14–26.11, p = 0.03), women working for cash (OR = 6.16, 95% CI 3.15–13.92, p < 0.0001), monthly income ≤ 1200 LE (OR = 34, 95% CI 6.41–187.52, p < 0.0001), and spacing < 24 months (OR = 8.79, 95% CI 4.33–17.80, p < 0.0001) were risk factors for mistimed pregnancy. On the other hand, women working for cash (OR = 11.43, 95% CI 3.22–40.62, p < 0.0001), living children ≥ 5 (OR = 11.45, 95% CI 2.84–46.07, p = 0.001), and the woman’s perception of her family size as higher than the ideal (OR = 394.8, 95% CI 97.36–1601.17, p < 0.0001) were risk factors for unwanted pregnancy. Mistimed and unwanted pregnancies were significantly associated with late start of antenatal care (ANC), low birth weight (LBW), and no breastfeeding. In addition, unwanted pregnancies were associated with more pregnancy complications.

Conclusions and recommendations

Unintended pregnancy represents a public health problem in Sohag. Therefore, improving services in rural areas and improving the economic level and effective use of family planning methods could reduce the risks associated with the unintended pregnancy.

Financial Strain and Contraceptive Use Among Women in the United States: Differential Effects by Age

INTRODUCTION

Low-income and young women experience disproportionately high rates of unintended pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators of financial status, particularly during emerging adulthood. This study investigates the relationship between financial strain and contraceptive use, focusing on the differential effects by age group.

METHODS

Multinomial logistic regression analyses assessed the relationship between financial strain and contraceptive use in a national sample of U.S. women ages 18-39 years (N = 932). Models were adjusted for income, employment status, and other sociodemographic characteristics and tested the interaction of financial strain and age group.

RESULTS

Women with high financial strain were less likely to use short-acting methods (compared with using no method) in the adjusted model; when the age and financial strain interaction was included, associations held only for women ages 18-24 and 25-29 years of age. Relative to contraceptive nonuse, women ages 18-24 years with high financial strain were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95% confidence interval [CI], 0.01-0.99) and short-acting hormonal (RRR, 0.03; 95% CI, 0.00-0.18) methods. Women ages 25-29 with high financial strain were less likely to use short-acting hormonal (RRR, 0.20; 95% CI, 0.05-0.87) and coital-specific (RRR, 0.11; 95% CI, 0.02-0.51) methods.

IMPLICATIONS FOR PRACTICE AND/OR POLICY

Young women may be vulnerable to the effect of high financial strain on contraceptive nonuse. Providers working with this group should consider incorporating financial strain into screening tools to identify patients who may need extra attention in contraceptive decision-making conversations. Antipoverty programs could also have a positive effect on effective contraceptive use.

Unintended pregnancy and associated factors among pregnant women in Arsi Negele Woreda, West Arsi Zone, Ethiopia

Objective

The study was aimed at determining the prevalence of unintended pregnancy and associated factors in Arsi Negele Woreda from May 01, 2017 to July 30, 2017.

Results

Unintended pregnancy was found to be 41.5%. The multivariable logistic regression revealed that 35 and above age group (AOR; 2.343, 95% CI 1.374, 3.997), single marital status (AOR; 6.492, 95% CI 1.299, 32.455), parity of 2 (AOR; 53.419, 95% CI 21.453, 133.014), parity of 3 and above (AOR; 20.219, 95% CI 7.915, 51.655), having abortion history (AOR; 1.962, 95% CI 1.025, 3.755), having health professional visit (AOR; 2.004, 95% CI 1.218, 3.298) and having autonomy to use contraceptive method (AOR; 2.925, 95% CI 1.648, 5.190) were significantly associated with unintended pregnancy. Therefore, reproductive health advocacy, counseling and access of modern contraceptive methods are recommended.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3778-7) contains supplementary material, which is available to authorized users.

Contraceptive method use among women and its association with age, relationship status and duration: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

BACKGROUND

One in six pregnancies in Britain are unplanned. An understanding of influences on contraceptive method choice is essential to provision compatible with users' lifestyles. This study describes contraceptive method use by age, and relationship status and duration, among women in Britain.

METHODS

Data from women participating in the third British National Survey of Sexual Attitudes and Lifestyles were used to describe contraceptive use grouped as: unreliable method or none; barrier methods; oral/injectable hormonal methods; and long-acting reversible contraception. A total of 4456 women at risk of pregnancy were used to examine associations between contraception use, age, relationship type and duration. Age-stratified odds ratios for contraceptive use by relationship type and duration were estimated using binary logistic regression.

RESULTS

Some 26.0% of 16-49-year-olds used hormonal contraception as their usual method. Use of hormonal and barrier methods was highest in the youngest age group and decreased with age; the reverse was true for use of unreliable methods or none. Barrier method use was higher in short-term relationships among younger participants; this was not seen among older respondents. Duration was more strongly associated with usual contraceptive method than relationship type; this pattern was more marked among younger participants.

CONCLUSIONS

Asking about relationship status and duration may help providers support women's contraceptive use by considering their priorities and preferences at different life stages. Interactions between relationship characteristics, age and contraception are complex, and bear closer scrutiny both in research and in policy and practice.