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Patel PR, Lee J, Abacan A, Vivens M, Smith PB. Psychological factors that may influence use of long-acting reversible contraceptives (LARC): A qualitative study. Bull Menninger Clin 2022; 86:300-315. [DOI: 10.1521/bumc.2022.86.4.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Although long-acting reversible contraceptives (LARC) remain the most effective method of contraception for teenagers, most adolescents continue to use less reliable methods. The purpose of this study was to investigate possible psychological factors that may lead to this low uptake rate by studying the LARC decisionmaking process among teenagers. In-depth, semistructured, open-ended interviews of sexually active teenagers who had LARC devices placed prior to 18 years of age were conducted. Four key themes emerged from the interviews: (a) the influences of peers (friends and family members) on LARC decision-making; (b) the lack of awareness about obtaining LARC devices; (c) the fear of weight gain as a driving force during contraceptive and LARC decision-making; and (d) the disproportional anxiety about pain from LARC insertion. The results suggest that a paradigm shift in contraceptive counseling is necessary in order to tackle these psychological barriers to teenage LARC use.
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Affiliation(s)
- Pooja R. Patel
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Seoul, Korea
| | - Allyssa Abacan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Micah Vivens
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Peggy B. Smith
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Ayorinde AA, Boardman F, McGranahan M, Porter L, Eze NA, Sallis A, Buck R, Hadley A, Ludeke M, Mann S, Oyebode O. Enabling women to access preferred methods of contraception: a rapid review and behavioural analysis. BMC Public Health 2021; 21:2176. [PMID: 34837979 PMCID: PMC8627100 DOI: 10.1186/s12889-021-12212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally. METHODS Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel. RESULTS We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted. CONCLUSIONS This review highlights factors that influence women's choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception. REGISTRATION Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156 .
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Affiliation(s)
| | - Felicity Boardman
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Majel McGranahan
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Lucy Porter
- Public Health England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Nwamaka A Eze
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Anna Sallis
- Public Health England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Rosanna Buck
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Alison Hadley
- Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Melissa Ludeke
- Public Health England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Sue Mann
- Public Health England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Envall N, Emtell Iwarsson K, Bizjak I, Gemzell Danielsson K, Kopp Kallner H. Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial. Acta Obstet Gynecol Scand 2021; 100:2044-2052. [PMID: 34435347 DOI: 10.1111/aogs.14243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intervention trials of structured contraceptive counseling have proved to increase use of long-acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers' and participants' satisfaction with an intervention used in a large trial in Sweden. MATERIAL AND METHODS A cross-sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi-structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. TRIAL REGISTRATION ClinicalTrials.gov (NCT03269357). RESULTS Fourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time-neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package. CONCLUSIONS The intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Isabella Bizjak
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at Danderyd Hospital, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Kaller S, Mays A, Freedman L, Harper CC, Biggs MA. Exploring young women's reasons for adopting intrauterine or oral emergency contraception in the United States: a qualitative study. BMC Womens Health 2020; 20:15. [PMID: 31992295 PMCID: PMC6986082 DOI: 10.1186/s12905-020-0886-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost. METHODS We telephone-interviewed 17 patients seeking EC from three San Francisco Bay Area youth-serving clinics that offered the IUD as EC and ECPs as standard practice, regarding their experiences choosing an EC method. We thematically coded all interview transcripts, then summarized the themes related to reasons for choosing ECPs or the IUD as EC. RESULTS Ten participants left their EC visit with ECPs and seven with the IUD as EC option. Women chose ECPs because they were familiar and easily accessible. Reasons for not adopting the copper IUD included having had prior negative experiences with the IUD, concerns about its side effects and the placement procedure, and lack of awareness about the copper IUD. Women who chose the IUD as EC did so primarily because of its long-term efficacy, invisibility, lack of hormones, longer window of post-coital utility, and a desire to not rely on ECPs. Women who chose the IUD as EC had not had prior negative experiences with the IUD, had already been interested in the IUD, and were ready and able to have it placed that day. CONCLUSIONS This study highlights that women have varied and well-considered reasons for choosing each EC method. Both ECPs and the copper IUD are important and acceptable EC options, each with their own features offering benefits to patients. Efforts to destigmatize repeated use of ECPs and validate women's choice of either EC method are needed to support women in their EC method decision-making.
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Affiliation(s)
- Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Aisha Mays
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Lori Freedman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Cynthia C. Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 3333 California St, Suite 335, San Francisco, CA 94143 USA
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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Onsuz MF, Hidiroglu S, Karavus M. Knowledge and approaches of married men applying to a primary healthcare center in Istanbul about IUD: A qualitative study. North Clin Istanb 2019; 6:374-378. [PMID: 31909383 PMCID: PMC6936948 DOI: 10.14744/nci.2018.76093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/06/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aims to determine the knowledge and approach of men applying to a primary health care center about IUD by adopting qualitative research methods. METHODS This study was qualitative research realized using an in-depth interview method. The interview was carried with 15 married men in a primary health care center in Umraniye, using 15 semi-structured interview questions. RESULTS Knowledge of the men in this study about IUD and family planning was inadequate. Participants generally determined the advantages of IUD with its superiority over other methods. Adverse effects of IUD on women and men during intercourse were stated. Knowledge of men about IUD, its side effects and disadvantages were generally composed of misinformation and rumours about the subject. CONCLUSION Men do not have adequate information and knowledge on family planning and IUD. Training provided by the health personnel might have a considerable role in demolishing misinformation and rumors and may augment the level of knowledge about IUD.
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Affiliation(s)
- Muhammed Fatih Onsuz
- Department of Public Health, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Seyhan Hidiroglu
- Department of Public Health, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Melda Karavus
- Department of Public Health, Marmara University Faculty of Medicine, Istanbul, Turkey
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Bauzà-Amengual ML, Esteva M, Ingla-Pol M, Font-Oliver MA, March S. Discourses on the postcoital pill in young women. BMC Public Health 2018; 18:803. [PMID: 29945582 PMCID: PMC6020367 DOI: 10.1186/s12889-018-5691-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/11/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Emergency contraception (EC) is an effective postcoital contraceptive method for reducing the risk of unwanted pregnancy after unprotected intercourse. The estimated effectiveness of EC is between 70 and 89% if taken within 72 h following intercourse. Most of the studies carried out in Spain are quantitative and from the perspective of health professionals. In this study, we intend to explore the knowledge of, attitudes towards and discourse regarding the use of EC in women aged 15 to 25 years. METHODS Sample: A qualitative study including in-depth interviews with 19 women between 15 and 25 years of age was performed. INCLUSION CRITERIA Participants were natives of Spain or of a Latin American country. Segmentation criteria: Participants had experience in the use of EC. DATA COLLECTION Participants were selected by health care informants and by the snowball technique among university students. DATA ANALYSIS A thematic analysis was performed. Preliminary analyses were made during the course of the field work to adapt the script and to assess data saturation. A preliminary code tree was developed by two researchers, and the coding of the text was done with the Atlas.ti 5.0 software. RESULTS EC is perceived positively by women. They do not express issues with taking it, although some feel guilty. The reason for taking EC is to avoid unwanted pregnancy and abortion. Women also feel that EC should be used in moderation. False beliefs and misconceptions regarding EC are held: EC delivers an excess of hormones, induces abortion and causes severe side effects. Women mention that the health professionals who provide EC have moral beliefs. Women use it because of condom breakage associated with their first coital relations. CONCLUSIONS The results of this study have public health implications: The sexual-affective health education received by young people should incorporate clear information about the mechanism of action of the EC pill and its side effects together with empowerment strategies addressing guilt and moralistic messages. Programmes and training activities for health professionals must be designed to prevent the communication of inappropriate messages such as those that exaggerate the side effects of EC and those that promote fear and guilt, because they represent a barrier to the responsible use of this medication.
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Affiliation(s)
- M. L. Bauzà-Amengual
- Department of Nursing and Physiotherapy, Universitat Illes Balears, Carretera de Valldemossa, km 7,5, 07122 Palma, Illes Balears Spain
- Research Group, Cancer Preventative Action, Carretera de Valldemossa, km 7,5, 07122 Palma, Illes Balears Spain
- University Research Institute in Health Sciences, Carretera de Valldemossa, km 7,5, 07122 Palma, Illes Balears Spain
| | - M. Esteva
- Balearic Islands Health Research Institute (iDisBA), Hospital Universitari Son Espases, Edifici S. Carretera de Valldemossa 79, 07120 Palma, Illes Balears Spain
- Unit for Research, Primary Health Care Management, Mallorca, IB-Salut, Carrer de la Reina Esclaramunda, 9, 07003 Palma, Illes Balears Spain
| | - M. Ingla-Pol
- Health Promotion Agency, Palma Town Hall, Plaça de Cort, 1, 07001 Palma, Illes Balears Spain
| | - M. A. Font-Oliver
- Unit for Research, Primary Health Care Management, Mallorca, IB-Salut, Carrer de la Reina Esclaramunda, 9, 07003 Palma, Illes Balears Spain
| | - S. March
- Balearic Islands Health Research Institute (iDisBA), Hospital Universitari Son Espases, Edifici S. Carretera de Valldemossa 79, 07120 Palma, Illes Balears Spain
- Unit for Research, Primary Health Care Management, Mallorca, IB-Salut, Carrer de la Reina Esclaramunda, 9, 07003 Palma, Illes Balears Spain
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Royer PA, Turok DK, Sanders JN, Saltzman HM. Choice of Emergency Contraceptive and Decision Making Regarding Subsequent Unintended Pregnancy. J Womens Health (Larchmt) 2016; 25:1038-1043. [PMID: 27032057 PMCID: PMC5069714 DOI: 10.1089/jwh.2015.5625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies. STUDY DESIGN In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, "trying hard not to get pregnant"; 10, "trying hard to get pregnant") and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups. RESULTS Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD ± 1.60; LNG group: 0.68, SD ± 1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80). CONCLUSIONS Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier NCT00966771.
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Affiliation(s)
- Pamela A Royer
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - Hanna M Saltzman
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
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Envall N, Groes Kofoed N, Kopp-Kallner H. Use of effective contraception 6 months after emergency contraception with a copper intrauterine device or ulipristal acetate - a prospective observational cohort study. Acta Obstet Gynecol Scand 2016; 95:887-93. [DOI: 10.1111/aogs.12916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/19/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Niklas Envall
- Swedish Association for Sexuality Education; Stockholm Sweden
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
| | - Nina Groes Kofoed
- Department of Obstetrics and Gynecology; Danderyd Hospital; Stockholm Sweden
| | - Helena Kopp-Kallner
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
- Department of Obstetrics and Gynecology; Danderyd Hospital; Stockholm Sweden
- Department of Clinical Sciences at Danderyd Hospital; Division of Obstetrics and Gynecology; Karolinska Institute; Stockholm Sweden
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Wright RL, Fawson PR, Frost CJ, Turok DK. U.S. Men's Perceptions and Experiences of Emergency Contraceptives. Am J Mens Health 2015; 11:469-478. [PMID: 26186949 DOI: 10.1177/1557988315595857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research suggests that men should be included in reproductive health decision making to help enhance positive health outcomes for their partners. Men affect the use of contraception and what method is used. Men's decisions may be affected by different factors such as gender, education, and the nature of their sexual relationship. A qualitative study was conducted to explore males' experiences and perceptions about emergency contraception (EC), and the meanings males assign to EC. Semistructured in-depth focus groups were held with 15 men who engage in heterosexual activity recruited from a university setting in the United States. Participants expressed egalitarian views of the contraception decision-making processes, a sense of responsibility regarding reproductive decision making, and that society has a negative stigma toward those who use EC. However, there was a lack of knowledge regarding the copper intrauterine device, which was not viewed as a method of EC. Exploring the role and needs of men in reproductive health care discussions and research is an important and growing area. Recommendations are provided for health care practitioners, policy, and future research around men and EC.
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Pichardo M, Arribas L, Coccio E, Heredia G, Jagroep S, Palermo T. IUDs as EC? Limited awareness and high reported acceptability: evidence from Argentina. Contraception 2014; 90:522-8. [PMID: 24973905 DOI: 10.1016/j.contraception.2014.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 05/06/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We explored knowledge and attitudes regarding the copper intrauterine device (IUD) as emergency contraception (EC) among women in Buenos Aires, Argentina. STUDY DESIGN We interviewed a convenience sample of women attending a family planning center at a public hospital. Participants were asked about knowledge and use of contraceptives, including EC (pre-script). Then they were given information about the IUD as EC and subsequently asked about acceptability of using the copper IUD as EC (post-script), the primary outcome in this analysis. RESULTS We analyzed data on 273 women. While only 1.83% of participants knew the IUD served as EC at baseline, 79.85% said they would be willing to use the device as such if the need arose after given relevant information. Multivariate results from a pre-script revealed that women with low levels of education and those born outside of Argentina were less knowledgeable about EC pills. Only previous use of the IUD was associated with high levels of IUD knowledge. Post-script, results indicated that being Argentine [odds ratio (OR)=2.15, 95% confidence interval (CI) 1.21, 3.81] and previous IUD use (OR=2.12, 95% CI=1.07, 4.19) were positively associated with considering the IUD as EC. Nulliparity was negatively associated with willingness to use the IUD as EC (OR=0.44, 95% CI 0.22, 0.86). CONCLUSION We examined acceptability of the copper IUD as EC in a Latin American setting and found that, while prior levels of knowledg'e were low, acceptability of the IUD as EC was high. Implications for programming and policy include outreach and education regarding this highly effective method and advocacy to change existing regulations in Argentina prohibiting the use of IUD as EC. IMPLICATIONS After given information about the IUD as a method of EC, women interviewed said they would be willing to use the IUD EC despite their limited prior knowledge of this method. With more widespread information and availability of the IUD as EC, more women may opt for this highly effective method, which can provide additional protection against unwanted pregnancy for up to 10 years.
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Affiliation(s)
- Margaret Pichardo
- Program in Public Health, Stony Brook University (State University of New York), Stony Brook, NY 11790, USA
| | - Lia Arribas
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Elina Coccio
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Graciela Heredia
- Department of Gynecology, Rivadavia Hospital, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Sherani Jagroep
- Physicians for Reproductive Health (work was conducted while at Stony Brook University), New York, NY 10018-3889, USA
| | - Tia Palermo
- Program in Public Health, Department of Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY 11790, USA.
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Dermish AI, Turok DK. The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception. Expert Rev Med Devices 2013; 10:477-88. [PMID: 23895075 DOI: 10.1586/17434440.2013.811865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.
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Affiliation(s)
- Amna I Dermish
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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12
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Cogswell C, Lipetz C. Comment on ‘An emergency contraception algorithm based on risk assessment: changes in clinicians’ practice and patients’ choices’. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 39:230-1. [DOI: 10.1136/jfprhc-2013-100663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McKay RJ, Gilbert L. An emergency contraception algorithm based on risk assessment: changes in clinicians' practice and patients' choices. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 39:201-6. [PMID: 23430815 DOI: 10.1136/jfprhc-2012-100495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES When ulipristal acetate (UPA) was introduced into the Contraceptive and Sexual Health Services service in June 2011 an algorithm was developed to guide method selection. The aim was to encourage clinicians to assess risk and to offer a copper intrauterine device (IUD) as first-line choice with hormonal methods as second-line choice. METHODS UPA was the second-line choice for presentations up to 120 hours after high-risk episodes (i.e. around the time of ovulation). Women at lower risk were also offered UPA if presentation was between 72 and 120 hours after unprotected intercourse unless the risk was very low, in which case levonorgestrel 1.5 mg was the second-line choice. RESULTS Prior to the protocol only 49% of women were offered an IUD compared with 61.6% afterwards. This improved further in the subgroup of women at high risk where 93.3% were offered an IUD compared with 59% initially. After the introduction of UPA the percentage of women accepting the IUD fell from 30% to 14.1%. Overall 14.5% of women received UPA compared to 7.8% receiving an IUD. CONCLUSIONS Introduction of a standardised protocol for the provision of emergency contraception has significantly increased the proportion of women offered an IUD as postcoital contraception, particularly in women at high risk of conception. Introduction of UPA has seen a halving of the number of women accepting the IUD. This is cause for concern. Further investigation into the reasons behind this decrease in IUD uptake needs to be undertaken.
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Affiliation(s)
- Rebecca Jayne McKay
- Department of Reproductive Medicine, Cambridge Universities Hospitals NHS Foundation Trust, Cambridge, UK.
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Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012; 27:1994-2000. [PMID: 22570193 DOI: 10.1093/humrep/des140] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception. METHODS The reference list for this study was generated from hand searching the reference lists of relevant articles and our own article archives, and electronic searches of several databases: Medline, Global Health, Clinicaltrials.gov, Popline, Wanfang Data (Chinese) and Weipu Data (Chinese). We included studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in which the number of pregnancies was ascertained and loss to follow-up was clearly defined. Data from each article were abstracted independently by two reviewers. RESULTS The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate (excluding one outlier study) was 0.09%. CONCLUSIONS IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day of intercourse or IUD type to allow analysis by any of these variables.
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Affiliation(s)
- Kelly Cleland
- Office of Population Research, Princeton University, 218 Wallace Hall, Princeton, NJ 08544, USA.
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Harper CC, Speidel JJ, Drey EA, Trussell J, Blum M, Darney PD. Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers. Obstet Gynecol 2012; 119:220-6. [PMID: 22270272 PMCID: PMC3266549 DOI: 10.1097/aog.0b013e3182429e0d] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles. METHODS We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception. RESULTS The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians. CONCLUSION Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA.
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