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Jingran G, Yan D, Xiaoying Y. Risk of teratogenicity in continued pregnancy after gestational exposure to mifepristone and/or misoprostol: a systematic review and meta-analysis. Arch Gynecol Obstet 2024:10.1007/s00404-024-07616-w. [PMID: 38980347 DOI: 10.1007/s00404-024-07616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This meta-analysis aimed to comprehensively assess the teratogenic risk to offspring associated with continuing pregnancy after administering mifepristone and/or misoprostol during gestation. METHODS We conducted a systematic search of multiple databases, including PubMed, Web of Science, Embase, Cochrane, CNKI, and CBM, from their inception to February 2024, with no language restrictions. We included cohort and case-control studies that analyzed the teratogenic effects of mifepristone and/or misoprostol on fetuses and newborns. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The odds ratios (OR) from individual studies were combined using meta-analysis. Sensitivity testing and heterogeneity analysis were conducted. RESULTS A total of 13 studies were eligible for inclusion, comprising 5193 cases of congenital malformations and 12,232 controls. CONCLUSION Our findings indicated that the use of misoprostol during early pregnancy increased the risk of congenital abnormalities in offspring (OR = 2.69; 95% CI: 1.57-4.62). However, the potential teratogenic effect of mifepristone during pregnancy cannot be ruled out. Additionally, the use of mifepristone and/or misoprostol has been linked to a higher risk of certain congenital anomalies, such as hydrocephalus (OR = 3.41; 95% CI: 1.17-9.97), Möbius syndrome (OR = 26.48; 95% CI: 11.30-62.01), and terminal transverse limb defects (OR = 10.75; 95% CI: 3.93-29.41). (PROSPERO, CRD42024522093, 03182024).
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Affiliation(s)
- Gao Jingran
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Du Yan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Yao Xiaoying
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
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Aguemi AK, Torloni MR, Okamura MN, Guazzelli CAF. Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e524-e534. [PMID: 37846185 PMCID: PMC10579915 DOI: 10.1055/s-0043-1772187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. METHODS Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. RESULTS One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. CONCLUSION Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.
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Affiliation(s)
- Adalberto Kiochi Aguemi
- Women's Health Technical Area, Secretaria Municipal da Saúde de São Paulo, SP, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | | | - Mirna Namie Okamura
- Coordination of Epidemiology and Information, Secretaria Municipal da Saúde de São Paulo, SP, Brazil
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Stein RA, Grayon A, Katz A, Chervenak FA. The Zika virus: an opportunity to revisit reproductive health needs and disparities. Germs 2022; 12:519-537. [PMID: 38021183 PMCID: PMC10660223 DOI: 10.18683/germs.2022.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 12/01/2023]
Abstract
First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.
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Affiliation(s)
- Richard A. Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Alexis Grayon
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Adi Katz
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| | - Frank A. Chervenak
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
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4
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Filho ESF, Machado RB. Contraceptive counseling during the pandemic: practical guidelines. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:579-584. [PMID: 34461669 PMCID: PMC10302448 DOI: 10.1055/s-0041-1735185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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5
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Diniz D, Medeiros M, Madeiro A. Abortion after the Zika virus epidemic in Northeast Brazil. Rev Saude Publica 2021; 55:6. [PMID: 33825799 PMCID: PMC8009316 DOI: 10.11606/s1518-8787.2021055003053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Debora Diniz
- Universidade de Brasília. Faculdade de Direito. Brasília, DF, Brasil
| | - Marcelo Medeiros
- Princeton University. Program of Latin American Studies. Princeton. New Jersey, USA
| | - Alberto Madeiro
- Universidade Estadual do Piauí. Núcleo de Pesquisa e Extensão em Saúde da Mulher. Teresina, PI, Brasil
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Trends and inequalities in unplanned pregnancy in three population-based birth cohorts in Pelotas, Brazil. Int J Public Health 2020; 65:1635-1645. [PMID: 33048194 DOI: 10.1007/s00038-020-01505-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/24/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To assess time trends in unplanned pregnancy, stratified by sociodemographic status, reproductive history, and inequalities in family income and women's skin color, in Pelotas, Brazil. METHODS Data from mothers of participants of the 1993 (N = 5264), 2004 (N = 4243), and 2015 (N = 4268) Pelotas birth cohorts were analyzed. Unplanned pregnancy was investigated in the perinatal period, with tests to assess changes over time among different sociodemographic and reproductive history subgroups and inequalities as a function of family income and skin color. RESULTS The prevalence of unplanned pregnancy was 62.7% (3299/ 5264), 65.9% (2794/ 4243), and 52.2% (2226/ 4268) in the 1993, 2004, and 2015 cohorts, respectively. Black or brown women and women of lower socioeconomic status had a higher prevalence of unplanned pregnancy in all cohorts. The overall rate of unplanned pregnancy decreased over time in most subgroups. Inequality as a function of family income and skin color increased during the time frame of assessment. CONCLUSIONS The prevalence of unplanned pregnancies decreased in the period analyzed, but it is still unjustifiably high. Efforts aimed at reducing unplanned pregnancy are vital and will require special attention to the most vulnerable groups.
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Barbieri MM, Juliato CRT, Bahamondes L, Surita FG. ENG-releasing subdermal implants in postpartum teenagers - an open-label trial study protocol. Reprod Health 2020; 17:100. [PMID: 32576199 PMCID: PMC7310555 DOI: 10.1186/s12978-020-00952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Higher than expected adolescent pregnancy high rates continue globally, with repeated unplanned pregnancy (UP) in this age group is a public health problem. In Brazil, 16% of pregnancies occur in adolescents under 18 years old, with high maternal morbidity and mortality rates in this age group. Effective and safe contraception is required to reduce UP rates. The objective of our study is to evaluate acceptance of etonogestrel (ENG)-releasing subdermal contraceptive implant after childbirth, before discharge, as well as clinical performance up to one year after placement. Comparison between teenagers who opt for ENG-implant versus other contraceptive methods after childbirth will be also evaluated, specifically regarding UP, continuation and discontinuation rates and reasons, body composition, pelvic ultrasound characteristics and user satisfaction. Methods A non-randomized open-label trial will be conducted with teenagers after childbirth and followed up to one year at the Women’s Hospital, University of Campinas (UNICAMP), Campinas, Brazil. The study group will consist of patients who accepted to use ENG-implant and placed before discharge. The comparison group will include adolescents who choose to use other contraceptive methods at the first postpartum visit (42 ± 3 days after childbirth). All women will follow-up at 40–60 days postpartum, as well as, at 6 and 12 months post-enrollment. Patient satisfaction, contraceptive effectiveness, reasons of discontinuation, continuation rate and body composition will be evaluated. Transvaginal ultrasound and electric bio impedance tests will be performed at all follow-up appointments. A 5% significance level was assumed, as well as, a sampling error (absolute) for 10% prevalence. The sample size was calculated at n = 100, obtaining an estimate of 50 to 70 adolescents who would accept the method offered, according to the prevalence and sample error assumed. Discussion Long-acting reversible contraceptive (LARC) methods include subdermal implants and intrauterine contraceptives, are considered first line contraception for teenagers. Immediate postpartum use is a safe option, which significantly reduces rates of repeated UP and all the undesirable consequences inherent to this process. Trial registration This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 92869018.5.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC): http://www.ensaiosclinicos.gov.br/rg/RBR-4z7bc6, (number 2.901.752).
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Affiliation(s)
- M M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - C R T Juliato
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - L Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil
| | - F G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP, 101, Brazil.
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Abstract
In late 2015, the Brazilian Ministry of Health and the Pan American Health Organization classified the increase in congenital malformations associated with the Zika virus (ZIKV) as a public health emergency. The risk of ZIKV-related congenital syndrome poses a threat to reproductive outcomes that could result in declining numbers of live births and potentially fertility. Using monthly microdata on live births from the Brazilian Information System on Live Births (SINASC), this study examines live births and fertility trends amid the ZIKV epidemic in Brazil. Findings suggest a decline in live births that is stratified across educational and geographic lines, beginning approximately nine months after the link between ZIKV and microcephaly was publicly announced. Although declines in total fertility rates were small, fertility trends estimated by age and maternal education suggest important differences in how Zika might have impacted Brazil's fertility structure. Further findings confirm the significant declines in live births in mid-2016 even when characteristics of the municipality are controlled for; these results highlight important nuances in the timing and magnitude of the decline. Combined, our findings illustrate the value of understanding how the risk of a health threat directed at fetuses has led to declines in live births and fertility.
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Affiliation(s)
- Letícia J Marteleto
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA.
| | - Gilvan Guedes
- Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil
| | - Raquel Z Coutinho
- Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil
| | - Abigail Weitzman
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA
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Teshale AB, Tesema GA. Magnitude and associated factors of unintended pregnancy in Ethiopia: a multilevel analysis using 2016 EDHS data. BMC Pregnancy Childbirth 2020; 20:329. [PMID: 32471381 PMCID: PMC7260812 DOI: 10.1186/s12884-020-03024-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Unintended pregnancy has become a significant public health and reproductive health problem that has had a substantial and appreciable adverse impact on mother, child, and the general public. Despite the paramount negative effects of unintended pregnancy, many pregnancies are unintended in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of unintended pregnancy in Ethiopia. Methods This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 7590 reproductive-aged women who gave birth in the 5 years preceding the survey. A multi-level logistic regression analysis was used to account for the hierarchal nature of the DHS data. In the multivariable multilevel analysis, those variables with p-value < 0.05 were considered to be significantly associated with unintended pregnancy. Result The prevalence of unintended pregnancy was 26.6% [95%CI: 25.6, 27.6]. In the multivariable multilevel logistic regression analysis; individual level variables such as being in the age group 20 to 34 [adjusted odds ratio (AOR) = 0.57; 95%CI: 0.41, 0.79] and 35 to 49 [AOR = 0.68; 95%CI: 0.47, 0.97], being follower of Muslim religion [AOR = 0.73; 95%CI: 0.60, 0.88], being married [AOR = 0.46; 95%CI: 0.37–0.58], household size of four to six [AOR = 1.38; 95%CI: 1.10, 1.69] and seven and above [AOR = 1.54; 95%CI: 1.20, 1.99], and being multiparous [AOR = 1.36; 95%CI: 1.10, 1.69] and grand multiparous [AOR = 1.92; 95%CI: 1.47, 2.52] were significantly associated with unintended pregnancy. Among community level variables; being living in large central [AOR = 2.56; 95%CI: 2.06, 3.17] and metropolitan regions [AOR = 1.91; 95%CI: 1.44, 2.53] were significantly associated with unintended pregnancy. Conclusion In this study the prevalence of unintended pregnancy was high. Maternal age, religion, marital status, household size, parity, and region were the most important factors associated with unintended pregnancy. Special attention should, therefore, be given to younger, single, multiparous and grand multiparous women, and not follower of Muslim religion as well as mothers from large central and metropolitan regions in terms of increasing accessibility and affordability of maternal health services, which could minimize unintended pregnancy.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Diniz D, Ali M, Ambrogi I, Brito L. Understanding sexual and reproductive health needs of young women living in Zika affected regions: a qualitative study in northeastern Brazil. Reprod Health 2020; 17:22. [PMID: 32028969 PMCID: PMC7006063 DOI: 10.1186/s12978-020-0869-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika’s association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. Methods Individual semi-structured interviews were conducted with 22 young women, aged 14–24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. Results Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika’s sexual transmission. Conclusions The young women’s knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.
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Affiliation(s)
- Debora Diniz
- Rights and Justice Regional Deputy Director - International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), Caixa Postal 8011, Brasília, DF, 70094-971, Brazil
| | - Moazzam Ali
- Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
| | - Ilana Ambrogi
- Researcher at Anis - Institute of Bioethics, Caixa Postal 8011, Brasília, DF, 70094-971, Brazil
| | - Luciana Brito
- Director of Research at Anis - Institute of Bioethics, Caixa Postal 8011, Brasília, DF, 70094-971, Brazil.
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Moreira LR, Ewerling F, Barros AJD, Silveira MF. Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys. Reprod Health 2019; 16:148. [PMID: 31601246 PMCID: PMC6788119 DOI: 10.1186/s12978-019-0805-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). Methods We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman’s age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. Results On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were “health concerns” and “infrequent sex,” but the prevalence of each reason varied substantially across countries. Nonuse due to “opposition from others” was higher among married than unmarried women; in turn, the prevalence of nonuse due to “lack of access” or “lack of knowledge” was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to “lack of access.” Pro-rich inequality was detected for reasons “health concerns,” “infrequent sex,” and “method-related”, while the reasons “other opposed,” “fatalistic,” “lack of access,” and “lack of knowledge” were linked to patterns of pro-poor inequality. Conclusions Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).
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Affiliation(s)
- Laísa Rodrigues Moreira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160 - 3rd floor. Centro, Pelotas, 96020-220, Brazil
| | - Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160 - 3rd floor. Centro, Pelotas, 96020-220, Brazil.,International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Mariangela Freitas Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro, 1160 - 3rd floor. Centro, Pelotas, 96020-220, Brazil.
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Divakar H, Bhardwaj A, Purandare CN, Sequeira T, Sanghvi P. Critical Factors Influencing the Acceptability of Post-placental Insertion of Intrauterine Contraceptive Device: A Study in Six Public/Private Institutes in India. J Obstet Gynaecol India 2019; 69:344-349. [PMID: 31391742 PMCID: PMC6661034 DOI: 10.1007/s13224-019-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/09/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine critical factors and barriers to postpartum intrauterine contraceptive device (PPIUCD) use in India in order to guide programs aimed at reducing maternal and child mortality. METHODS All pregnant women were enrolled for contraception counseling during their visit to the antenatal outpatient clinic. Women who opted for PPIUCDs were enrolled in the study and offered PPIUCD insertion, irrespective of mode of delivery. Those who withdrew consent when in labor or soon after delivery, experienced severe bleeding, or exhibited unstable vital signs were excluded, as were febrile women and those diagnosed with chorioamnionitis. RESULTS A total of 66,508 women were enrolled in the study. 86.1% indicated they discussed family planning options with their partners/husbands before making a decision. 178 respondents (0.3%) could not mention one advantage of PPIUCDs, while 23.1% could not mention one disadvantage. 13.9% of the women withdrew consent. Family member objections (43.44%), husband/partner objection (27.94%), and deciding on another method (15.59%) were the main reasons for consent withdrawal. CONCLUSIONS Awareness of PPIUCDs is not a limiting factor in women's consent to PPIUCD insertion. As a woman's decision to use a PPIUCD is significantly influenced by family members and her partner/husband, awareness initiatives that target these populations should be considered.
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Affiliation(s)
- Hema Divakar
- Federation of Obstetric and Gynaecological Societies of India, Mumbai, 400013 India
- Divakar’s Speciality Hospital, 220, 2nd Phase, JP Nagar, Bengaluru, 560078 India
| | - Ajey Bhardwaj
- Avni Health Foundation, 2nd Floor, Amarsons Bhavan, 68 Misquitta St, Vile Parle East, Mumbai, 400057 India
| | | | - Thelma Sequeira
- Avni Health Foundation, 2nd Floor, Amarsons Bhavan, 68 Misquitta St, Vile Parle East, Mumbai, 400057 India
| | - Pooja Sanghvi
- Avni Health Foundation, 2nd Floor, Amarsons Bhavan, 68 Misquitta St, Vile Parle East, Mumbai, 400057 India
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Naveed S, Lashari UG, Waqas A, Bhuiyan M, Meraj H. Gender of children and social provisions as predictors of unplanned pregnancies in Pakistan: a cross-sectional survey. BMC Res Notes 2018; 11:587. [PMID: 30107823 PMCID: PMC6092811 DOI: 10.1186/s13104-018-3696-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous research indicates that attitudes to pregnancy and motherhood are influenced by social values, culture and religion. This study explores the relationship between social support and unwanted pregnancy among Pakistani women. This cross-sectional study was conducted at four teaching hospitals in Lahore in 2014. RESULTS A total of 500 pregnant women who visited the hospitals' obstetrics and gynecology departments were asked to respond to a questionnaire consisting of respondents' characteristics and the Social Provisions Scale (SPS). Logistic regression analyzed the predictors of unplanned pregnancy. Unwanted pregnancies were more likely to occur among pregnant women from rural areas, with low scores on the SPS 'reassurance of worth' sub-scale, no history of contraceptive use, and who already had at least one son than those with no sons.
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Affiliation(s)
- Sadiq Naveed
- KVC Prairie Ridge Hospital, 4300 Brenner Drive, Kansas, KS, 66104, USA
| | | | - Ahmed Waqas
- CMH Lahore Medical College & Institute of Dentistry, Lahore Cantt, Pakistan.
- Human Development Research Foundation, Rawalpindi, Pakistan.
| | - Mariam Bhuiyan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hafsa Meraj
- Sharif Medical and Dental College, Jati Umra, Lahore, Pakistan
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Marteleto LJ, Weitzman A, Coutinho RZ, Alves SV. Women's Reproductive Intentions and Behaviors during the Zika Epidemic in Brazil. POPULATION AND DEVELOPMENT REVIEW 2017; 43:199-227. [PMID: 31359895 PMCID: PMC6663086 DOI: 10.1111/padr.12074] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Letícia J Marteleto
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX 78712-1699
| | - Abigail Weitzman
- University of Michigan, Population Studies Center, 426 Thompson Ave
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Bahamondes L, Ali M, Monteiro I, Fernandes A. Contraceptive sales in the setting of the Zika virus epidemic. Hum Reprod 2017; 32:88-93. [PMID: 27932442 PMCID: PMC5165082 DOI: 10.1093/humrep/dew310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil? SUMMARY ANSWER Contraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak. WHAT IS KNOWN ALREADY Transmission of ZIKV is primarily by Aedes aegypti mosquitoes; however, sexual transmission has also been described. The association of several birth defects and the ZIKV infection during pregnancy has been established, and it was estimated in Bahia, Brazil that the infection rate could range from 10% to 80%. The World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February 2016. The Brazilian government also made recommendations for women who were planning to become pregnant and who reside in ZIKV-affected areas to reconsider or postpone pregnancy. STUDY DESIGN, SIZE, DURATION The objective of this study was to assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak. We obtained information from all pharmaceutical companies based in Brazil and from the manufacturers of long-acting reversible contraceptives (LARCs), including the copper-intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants, about contraceptives sales in the public and private sectors between September 2014 and August 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS We analyzed the data for: (i) oral contraceptives, i.e. combined oral contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives, (ii) injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate, (iii) LARCs and (iv) emergency contraceptive (EC) pills. MAIN RESULTS AND THE ROLE OF CHANCE Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7-13.8 million cycles/units per month (90%). The second largest group of sales was injectables, representing 0.8-1.5 million ampoules per month (9.5%). Following this, are LARC methods with sales of 37 000-41 000 devices per month (0.5%). It is important to note that although the peak months of sales were different for each group of contraceptives, there were no significant differences overall between the months of observation. The EC pill sales were between 1.0 million and 1.3 million of pills per month. LIMITATIONS, REASONS FOR CAUTION Although the use of contraceptive methods was already high and no change was noted, the ZIKV outbreak may have changed the pregnancy intentions of Brazilian women. Consequently, the number of women planning pregnancy may be lower than that recorded. The contraceptive sales figures did not include condoms. Since condoms might not only prevent pregnancies, but also sexual transmission of ZIKV, this lack of information is a limitation. WIDER IMPLICATIONS OF THE FINDINGS The results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil. Furthermore, it is possible that access to LARC methods was limited. Although we did not investigate the reason for low LARC uptake, we suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women. Projections estimate millions of additional cases of ZIKV transmission. Thus, a coordinated response is needed to ensure access to a wide range of contraceptive methods for women during the ZIKV outbreak. In conclusion, this assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and represents an alternative source of data to help us understand the trends in demand for contraception in ZIKV-affected areas. STUDY FUNDING/COMPETING INTERESTS This study received partial financial support from Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504-9 and from an anonymous donor. The funding sources did not play a role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The authors declare no conflict of interest associated with this study. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Luis Bahamondes
- Family Planning Clinic, Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971 Campinas, SP, Brazil
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organisation, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Ilza Monteiro
- Family Planning Clinic, Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971 Campinas, SP, Brazil
| | - Arlete Fernandes
- Family Planning Clinic, Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971 Campinas, SP, Brazil
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Theme-Filha MM, Baldisserotto ML, Fraga ACSA, Ayers S, da Gama SGN, Leal MDC. Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012. Reprod Health 2016; 13:118. [PMID: 27766945 PMCID: PMC5073899 DOI: 10.1186/s12978-016-0227-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Unintended pregnancy, a pregnancy that have been either unwanted or mistimed, is a serious public health issue in Brazil. It is reported for more than half of women who gave birth in the country, but the characteristics of women who conceive unintentionally are rarely documented. The aim of this study is to analyse the prevalence and the association between unintended pregnancy and a set of sociodemographic characteristics, individual-level variables and history of obstetric outcomes. METHODS Birth in Brazil is a cross-sectional study with countrywide representation that interviewed 23,894 women after birth. The information about intendedness of pregnancy was obtained after birth at the hospital and classified into three categories: intended, mistimed or unwanted. Multinomial regression analysis was used to estimate the associations between intendedness of a pregnancy, and sociodemographic and obstetric variables, calculating odds ratios and 95 % confidence intervals. All significant variables in the bivariate analysis were included in the multinomial multivariate model and the final model retaining variables that remained significant at the 5 % level. RESULTS Unintended pregnancy was reported by 55.4 % of postpartum women. The following variables maintained positive and significant statistical associations with mistimed pregnancy: maternal age < 20 years (OR = 1.89, 95 % CI: 1.68-2.14); brown (OR = 1.15, 95 % CI: 1.04-1.27) or yellow skin color (OR = 1.56, 95 % CI: 1.05-2.32); having no partner (OR = 2.32, 95 % CI: 1.99-2.71); having no paid job (OR = 1.15, 95 % CI: 1.04-1.27); alcohol abuse with risk of alcoholism (OR = 1.25, 95 % CI: 1.04-1.50) and having had three or more births (OR = 2.01, 95 % CI: 1.63-2.47). The same factors were associated with unwanted pregnancy, though the strength of the associations was generally stronger. Women with three or more births were 14 times more likely to have an unwanted pregnancy, and complication in the previous pregnancies and preterm birth were 40 % and 19 % higher, respectively. Previous neonatal death was a protective factor for both mistimed (OR = 0.61, 95 % CI: 0.44-0.85) and unwanted pregnancy (OR = 0.44, 95 % CI: 0.34-0.57). CONCLUSIONS This study confirms findings from previous research about the influence of socioeconomic and individual risk factors on unintended pregnancy. It takes a new approach to the problem by showing the importance of previous neonatal death, preterm birth and complication during pregnancy as risk factors for unintended pregnancy.
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Affiliation(s)
- Mariza Miranda Theme-Filha
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcia Leonardi Baldisserotto
- Epidemiology in Public Health, Auxiliar Researcher National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Susan Ayers
- Psychology, Centre for Maternal and Child Health Research, City University, London, UK
| | - Silvana Granado Nogueira da Gama
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Campanharo FF, Cecatti JG, Haddad SM, Parpinelli MA, Born D, Costa ML, Mattar R. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil. PLoS One 2015; 10:e0144385. [PMID: 26650684 PMCID: PMC4674155 DOI: 10.1371/journal.pone.0144385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/17/2015] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity.
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Affiliation(s)
- Felipe F. Campanharo
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- * E-mail:
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Samira M. Haddad
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Mary A. Parpinelli
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Daniel Born
- Discipline of Cardiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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YAZDKHASTI M, POURREZA A, PIRAK A, ABDI F. Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:12-21. [PMID: 26060771 PMCID: PMC4449999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/23/2014] [Indexed: 11/28/2022]
Abstract
Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.
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Affiliation(s)
- Mansureh YAZDKHASTI
- 1. Dept. of Reproductive Health, School of Nursing & Midwifery, Tehran University, Tehran, Iran
| | - Abolghasem POURREZA
- 2. Dept. of Health Management & Economics, School of Public Health, Tehran University, Tehran, Iran
| | - Arezoo PIRAK
- 1. Dept. of Reproductive Health, School of Nursing & Midwifery, Tehran University, Tehran, Iran
| | - Fatemeh ABDI
- 3. Dept. of Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University, Tehran, Iran
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