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Edelman N, Whetham J, Cassell J, de Visser R, Mercer C, Jones C, Gersten A, Bremner S. Performance of a tool to identify different types of self-reported sexual risk among women attending a contraception and sexual health clinic: results of a cross-sectional survey. BMJ Sex Reprod Health 2021; 47:117-128. [PMID: 32499381 PMCID: PMC8053341 DOI: 10.1136/bmjsrh-2019-200482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic. METHODS Female patients aged 16-44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity. RESULTS The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%-60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%-91.8%) and specificity of 43.7% (95% CI 39.0%-48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%-86.0%) and specificity of 48.3% (95% CI 43.4%-53.1%). CONCLUSIONS The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
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Affiliation(s)
- Natalie Edelman
- School of Health Sciences, University of Brighton, Brighton & Hove, UK
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Jennifer Whetham
- Claude Nicol Centre, Brighton & Sussex University Hospitals Trust, Brighton and Hove, UK
| | - Jackie Cassell
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Catherine Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Christopher Jones
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | | | - Stephen Bremner
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
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Hawkins KE, Montague-Johnstone E. Contraceptive usage in homeless women accessing a dedicated primary care service in Scotland, UK: a case note review. BMJ Sex Reprod Health 2021; 47:49-54. [PMID: 32414876 DOI: 10.1136/bmjsrh-2019-200541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Of the 70 000 people experiencing homelessness in Scotland, at least 40% are women. Little is known about their contraceptive usage. Most pregnancies in homelessness are unintended and children are usually looked after in the care system. METHODS A case note review of women's current contraceptive usage in a primary care service serving women experiencing homelessness in Edinburgh, Scotland. The service electronic database was searched for keywords relating to contraception to determine current usage, but also reproductive health, wider demographics and previous pregnancies. RESULTS Of 174 women (16-55 years), 75 (43%) were recorded as using a contraceptive method. 49 (28%) were using long-acting reversible contraception (LARC), most of which was the contraceptive implant. However, 6/41 (15%) of the most effective LARC (intrauterine contraception and implant) was being used beyond its' expiry date. 34 (20%) had no mention of contraceptive use in their medical record and 32 (19%) were not using contraception despite being sexually active. 6 (3%) had been hysterectomised/female sterilisation. 26 (15%) were not sexually active. 179 of the 233 (77%) children mentioned in women's electronic records were recorded as being looked after out with their care. 138/174 (79%) had current/previous drug or alcohol misuse. 100/174 (57%) had a history of domestic violence or abuse. 22/174 (13%) were involved/had been involved in sex work. CONCLUSIONS Primary care services need to give greater attention to the contraceptive needs of homeless women to empower them to become pregnant when the time is right for them and prevent the consequences of unintended pregnancy and homelessness.
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Affiliation(s)
- Katie Eirian Hawkins
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Edinburgh Access Practice primary care service, Edinburgh, UK
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Gallimore A, Irshad T, Cooper M, Cameron S. Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study. BMJ Sex Reprod Health 2021; 47:43-48. [PMID: 32299825 DOI: 10.1136/bmjsrh-2019-200497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling. METHODS Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out. RESULTS Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception. CONCLUSIONS Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences.
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Affiliation(s)
| | - Tasneem Irshad
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | | | - Sharon Cameron
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
- Chalmers Sexual Health Clinic, NHS Lothian, Edinburgh, UK
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Rezel-Potts E, Palmer MJ, Free C, Baraitser P. A cohort study of the service-users of online contraception. BMJ Sex Reprod Health 2020; 46:287-293. [PMID: 32371501 PMCID: PMC7569369 DOI: 10.1136/bmjsrh-2020-200610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In January 2017, the first free service providing oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark - ethnically and socioeconomically diverse areas with high rates of unplanned pregnancy. There are concerns that online services can increase health inequalities; therefore, we aimed to describe service-users according to age, ethnicity and Index of Multiple Deprivation (IMD) quintile of area of residence and to examine the association of these with repeated use. METHODS We analysed routinely collected data from January 2017 to April 2018 and described service-users using available sociodemographic factors and information on patterns of use. Logistic regression analysis examined factors associated with repeat ordering of OCPs. RESULTS The service was accessed by 726 individuals; most aged between 20 and 29 years (72.5%); self-identified as being of white ethnic group (58.8%); and residents of the first and second most deprived IMD quintiles (79.2%). Compared with those of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted OR 0.53, 95% CI 0.31 to 0.89; p=0.001), as were those of Asian and mixed ethnic groups. CONCLUSIONS These are the first empirical findings on free, online contraception and suggest that early adopters broadly reflect the population of the local area in terms of ethnic diversity and deprivation as measured by IMD. Ongoing service development should prioritise the identification and removal of barriers which may inhibit repeat use for black and minority ethnic groups.
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Affiliation(s)
- Emma Rezel-Potts
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paula Baraitser
- School of Population Health & Environmental Sciences, King's College London, London, UK
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Crow M, Walker V, Braunholtz-Speight J, Singh M. Improving the provision of postnatal contraception within inpatient wards: a UK pilot study. BMJ Sex Reprod Health 2020; 46:313. [PMID: 31948948 DOI: 10.1136/bmjsrh-2019-200518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Madeleine Crow
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Victoria Walker
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
| | | | - Manisha Singh
- Leeds Sexual Health, Leeds Community Healthcare NHS Trust, Leeds, UK
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Lam MT, Li HWR, Wong CYG, Yeung WSB, Ho PC, Ng EHY. Women's age and total motile normal morphology sperm count predict fecundability: a prospective cohort study. BMJ Sex Reprod Health 2020; 46:279-286. [PMID: 32718983 DOI: 10.1136/bmjsrh-2020-200639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study investigated the role of women's age, serum anti-Müllerian hormone (AMH) level and semen parameters in predicting fecundability. METHODS This was a prospective cohort study on couples attending for preconceptional health check. Occurrence of conception at 1 year after ceasing contraception and time to pregnancy were noted by telephone follow-up. The women's age, serum AMH level and total motile normal morphology sperm count (TMNC) were compared between those who conceived and those who did not after 1 year; their independent predictive value on conception at 1 year was analysed by logistic regression. Among those conceiving within 1 year, Spearman's correlations between time to pregnancy and the clinical parameters were studied. RESULTS Of the 100 couples analysed, we found younger age of the women (p=0.008), higher serum AMH level (p=0.038) and higher TMNC (p=0.015) in those that conceived within 1 year. Multivariate logistic regression found that women's age (OR 0.867, 95% CI 0.761 to 0.988, p=0.032) and TMNC (OR 1.089, 95% 1.001-1.185, p=0.047), but not serum AMH level, significantly predicted conception within 1 year. Among those that conceived within 1 year, none of the parameters analysed were correlated with time to pregnancy within 1 year. CONCLUSIONS Women's age and TNMC are significant independent predictors of conception within 1 year. No parameter was shown to predict the time to pregnancy within 1 year. This finding can aid preconceptional counselling of couples who are planning for pregnancy.
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Affiliation(s)
- Mei Ting Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - Ching Yin Grace Wong
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
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Cavallaro FL, Benova L, Owolabi OO, Ali M. A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't? BMJ Sex Reprod Health 2020; 46:254-269. [PMID: 31826883 PMCID: PMC7569400 DOI: 10.1136/bmjsrh-2019-200377] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 05/21/2023]
Abstract
AIM The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. METHODS Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. RESULTS A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. CONCLUSIONS The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.
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Affiliation(s)
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Moazzam Ali
- World Health Organization, Geneva, Switzerland
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Fix L, Seymour JW, Sandhu MV, Melville C, Mazza D, Thompson TA. At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations. BMJ Sex Reprod Health 2020; 46:172-176. [PMID: 32665231 DOI: 10.1136/bmjsrh-2020-200612] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This study aimed to explore patient experiences obtaining a medical abortion using an at-home telemedicine service operated by Marie Stopes Australia. METHODS From July to October 2017, we conducted semistructured in-depth telephone interviews with a convenience sample of medical abortion patients from Marie Stopes Australia. We analysed interview data for themes relating to patient experiences prior to service initiation, during an at-home telemedicine medical abortion visit, and after completing the medical abortion. RESULTS We interviewed 24 patients who obtained care via the at-home telemedicine medical abortion service. Patients selected at-home telemedicine due to convenience, ability to remain at home and manage personal responsibilities, and desires for privacy. A few telemedicine patients reported that a lack of general practitioner knowledge of abortion services impeded their access to care. Most telemedicine patients felt at-home telemedicine was of equal or superior privacy to in-person care and nearly all felt comfortable during the telemedicine visit. Most were satisfied with the home delivery of the abortion medications and would recommend the service. CONCLUSION Patient reports suggest that an at-home telemedicine model for medical abortion is a convenient and acceptable mode of service delivery that may reduce patient travel and out-of-pocket costs. Additional provider education about this model may be necessary in order to improve continuity of patient care. Further study of the impacts of this model on patients is needed to inform patient care and determine whether such a model is appropriate for similar geographical and legal contexts.
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Affiliation(s)
- Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | - Jane W Seymour
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | | | | | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Aristide C, Mwakisole A, Mwakisole N, Emmanuel M, Laizer E, Kihunrwa A, Downs D, Wamoyi J, Downs J. Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study. BMJ Sex Reprod Health 2020; 46:226-233. [PMID: 31937520 PMCID: PMC7392489 DOI: 10.1136/bmjsrh-2019-200505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. METHODS We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. RESULTS Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Post-seminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. CONCLUSIONS Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.
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Affiliation(s)
- Christine Aristide
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | | | | | - Mary Emmanuel
- St Paul College, Mwanza, United Republic of Tanzania
| | | | - Albert Kihunrwa
- Department of Gynecology and Obstetrics, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - David Downs
- Keble College, University of Oxford, Oxford, UK
| | - Joyce Wamoyi
- National Institute for Medical Research Mwanza Research Centre, Mwanza, United Republic of Tanzania
| | - Jennifer Downs
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Internal Medicine, Weill Bugando Medical Centre, Mwanza, United Republic of Tanzania
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Walker S, Piercy H, Shearn K, Acton F. What consultation resources are available to support delivery of integrated sexual and reproductive health services? A scoping review. BMJ Sex Reprod Health 2020; 46:88-99. [PMID: 31678969 DOI: 10.1136/bmjsrh-2019-200414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Contraceptive and sexual healthcare is increasingly delivered in an integrated setting in the UK and worldwide, requiring staff to be competent in differing styles of delivery, and to have a wide knowledge base. OBJECTIVES We did a scoping review of the literature for evidence of the resources that exist for healthcare professionals to guide or structure the process of conducting an integrated sexual and reproductive health (SRH) consultation. ELIGIBILITY CRITERIA Articles were included in the review if (1) their primary focus was a consultation resource related to one or more aspects of an SRH consultation and (2) they provided details of the resource and/or its application including evaluation of use. SOURCES OF EVIDENCE Peer-reviewed articles published in English, published non-peer-reviewed guides, and web-based guidelines addressing the conduct of a contraception or sexual health consultation were included. Date range: 1998-December 2018. Searches were carried out in the databases AMED (Ovid), ASSIA (ProQuest), CINAHL Complete (EBSCO), Cochrane Library (Wiley), HMIC (NHS Evidence), Medline (EBSCO), PsycINFO (Proquest) and Scopus (Elsevier) on 10 February 2017, and incremental searching performed until December 2018. RESULTS A total of 12 peer-reviewed journal articles, two web-published guidelines from the Faculty of Sexual & Reproductive Healthcare and three published, non-peer-reviewed resources were included. CONCLUSION Many resources exist to guide either the contraceptive or sexual health consultations, but there is a lack of a comprehensive consultation resource to guide the conduct of an integrated consultation.
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Affiliation(s)
- Susan Walker
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Hilary Piercy
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Katie Shearn
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Faye Acton
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
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Bongaarts J, Sitruk-Ware R. Authors' response to 'Should the population and climate discussion be limited to the policy space?'. BMJ Sex Reprod Health 2020; 46:157. [PMID: 31871132 DOI: 10.1136/bmjsrh-2019-200546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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12
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Wall KM, Rogers E, Stephenson R. Meeting the mark by 2020: country progress toward FP2020 and UNAIDS HIV targets. BMJ Sex Reprod Health 2020; 46:85-87. [PMID: 32139389 DOI: 10.1136/bmjsrh-2019-200545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Kristin M Wall
- Emory University School of Public Health, Atlanta, Georgia, USA
| | - Erin Rogers
- The Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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13
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Smith C. Should the population and climate discussion be limited to the policy space? BMJ Sex Reprod Health 2020; 46:156-157. [PMID: 31871134 DOI: 10.1136/bmjsrh-2019-200544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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14
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Hawkins KE. Comment on 'Climate change and contraception'. BMJ Sex Reprod Health 2020; 46:156. [PMID: 31948947 DOI: 10.1136/bmjsrh-2019-200554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Katie Eirian Hawkins
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Edinburgh Access Practice, Edinburgh, UK
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15
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Schmidt-Hansen M, Lohr PA, Cameron S, Hasler E. Surgical or medical abortion of pregnancies between 13 +0 and 23 +6 weeks' gestation? A systematic review and new NICE national guidelines. BMJ Sex Reprod Health 2020; 47:bmjsrh-2019-200460. [PMID: 32184291 DOI: 10.1136/bmjsrh-2019-200460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/06/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Abortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13+0 and 23+6 weeks' gestation for a new national guideline. METHODS We searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n≥100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE. RESULTS Two RCTs (n=140) were included. 'Incomplete abortion requiring surgical intervention' was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). 'Abortion completed by the intended method' was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that 'haemorrhage requiring transfusion/≥500 mL blood loss', 'uterine injury', 'cervical injury requiring repair' and 'infection reported within 1 month of abortion' were reported, they did not differ significantly between methods. Depending on measurement method, 'patient satisfaction/acceptability' was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias. CONCLUSION Based on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks' gestation, unless not clinically appropriate.
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Affiliation(s)
- Mia Schmidt-Hansen
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Patricia A Lohr
- British Pregnancy Advisory Service (BPAS), Stratford upon Avon, UK
| | - Sharon Cameron
- Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, UK
| | - Elise Hasler
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
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Cooper M. Expanding access to postpartum long-acting reversible contraception (LARC): how can we deliver? BMJ Sex Reprod Health 2019; 46:bmjsrh-2019-200548. [PMID: 31826884 DOI: 10.1136/bmjsrh-2019-200548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Michelle Cooper
- University of Edinburgh MRC Centre for Reproductive Health, Edinburgh EH3 9ES, UK
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Bongaarts J, Sitruk-Ware R. Climate change and contraception. BMJ Sex Reprod Health 2019; 45:233-235. [PMID: 31615904 DOI: 10.1136/bmjsrh-2019-200399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
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Marston C, Francis SC. Neglect of STIs and infertility undermines family planning programmes. BMJ Sex Reprod Health 2019; 46:bmjsrh-2018-200270. [PMID: 31558574 DOI: 10.1136/bmjsrh-2018-200270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Cicely Marston
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Yang JM, Cheney K, Taylor R, Black K. Interpregnancy intervals and women's knowledge of the ideal timing between birth and conception. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200277. [PMID: 31511242 DOI: 10.1136/bmjsrh-2018-200277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Short interpregnancy intervals (IPIs) are associated with adverse obstetric outcomes. However, few studies have explored women's understanding of ideal IPIs or investigated knowledge of the consequences of short IPIs. METHODS We performed a prospective questionnaire-based study at two hospitals in Sydney, Australia. We recruited women attending antenatal clinics and collected demographic data, actual IPI, ideal IPI, contraceptive use, and education provided on birth-spacing and contraception following a previous live birth. We explored associations between an IPI <12 months and a selection of demographic and health variables. RESULTS Data were collected from 467 women, of whom 344 were pregnant following a live birth. Overall, 72 (20.9%) women had an IPI <12 months only 7.5% of whom believed this was ideal, and the remaining stating their ideal IPI was over 12 months (52.3%) or they had no ideal IPI (40.3%). IPI <12 months following a live birth was significantly associated with younger age (p=0.043) but not with ethnicity, relationship status, education, religion, parity nor previous mode of delivery. IPI <12 months was associated with non-use of long-acting reversible contraception (LARC) (p<0.001), breastfeeding <12 months (p=0.041) and shorter ideal IPI (p=0.03). Less than half of the women (43.3%, n=149) reported having received advice about IPI and less than half about postnatal contraception (44.2%, n=147). CONCLUSIONS Younger age and non-use of LARC are significantly associated with IPIs <12 months. A minority of women with a short IPI perceived it to be ideal. Prevention of short IPIs could be achieved with improved access to postnatal contraception.
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Affiliation(s)
- Jenny M Yang
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kate Cheney
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Rebecca Taylor
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten Black
- University of Sydney, Sydney, New South Wales, Australia
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Babra DS, Lyus R, Black B, Roberts C, Dorman EK, Masters T. Development of a national referral centre for surgical abortion at Homerton University Hospital. BMJ Sex Reprod Health 2019; 45:bmjsrh-2019-200368. [PMID: 31434662 DOI: 10.1136/bmjsrh-2019-200368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/16/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Richard Lyus
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Benjamin Black
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Cathy Roberts
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | - Tracey Masters
- Homerton University Hospital NHS Foundation Trust, London, UK
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Gull SE. Let's talk about conscientiousobjection. BMJ Sex Reprod Health 2019; 45:bmjsrh-2019-200361. [PMID: 31151989 DOI: 10.1136/bmjsrh-2019-200361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
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Reynolds-Wright JJ, Heller RL. Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200288. [PMID: 31028168 DOI: 10.1136/bmjsrh-2018-200288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Insertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with 'missing threads' or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common. CASE HISTORY In January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous 'lost' intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been 'lost' and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms. CONCLUSION This case reports an unusual presentation of a delayed and importantly 'silent' perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.
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Affiliation(s)
| | - Rebecca L Heller
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Shaw JG, Shaw KA. Improving contraceptive choice for military servicewomen: better provision serves both women and deployment planning. BMJ Sex Reprod Health 2019; 45:86-87. [PMID: 31000570 DOI: 10.1136/bmjsrh-2018-200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jonathan G Shaw
- Division of Primary Care & Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Kate A Shaw
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Reynolds-Wright JJ, Main P, Cameron ST. Accuracy of a point-of-care test for quantifying human chorionic gonadotrophin (hCG) in the management of pregnancy of unknown location in an abortion service. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200166. [PMID: 30636695 DOI: 10.1136/bmjsrh-2018-200166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Women may seek abortion at gestations when there is no visible intrauterine pregnancy on ultrasound scanning. Clinical protocols for pregnancy of unknown location (PUL) require measurement of serum human chorionic gonadotrophin (hCG), with the National Institute for Health and Care Excellence recommending that values above 1500 IU/L be further investigated to exclude ectopic pregnancy. Our aim was to determine whether a point-of-care test (POCT) could be used instead of laboratory serum hCG measurement. METHODS Over 12 months, women who presented to an abortion service with a PUL had a POCT for blood or urine hCG and laboratory serum hCG measurement. The POCT machine used provides a discrete hCG value below 1000 IU/L and above this gives results as a range. The sensitivity and specificity of the POCT in identifying cases where laboratory serum hCG results were above 1500 IU/L were calculated. RESULTS A total of 118 women presented with a PUL, of whom 70 had a POCT on blood (n=49) or urine (n=21) and a corresponding laboratory serum hCG. The sensitivity of the blood POCT was 0.67 (95% CI 0.38 to 0.87) and the specificity was 0.97 (95% CI 0.83 to 0.99). The sensitivity of the urine POCT was 0.25 (CI 0.01 to 0.78) and the specificity was 0.94 (CI 0.69 to 0.99). CONCLUSION Although both the blood and urine POCTs had a high level of specificity, neither test was acceptably sensitive. While promising, this POCT for hCG is not sufficiently reliable to replace laboratory serum hCG testing in the management of women with PUL in an abortion service.
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Affiliation(s)
| | - Peter Main
- Chalmers Centre for Sexual Health, NHS Lothian, Edinburgh, UK
| | - Sharon T Cameron
- Chalmers Centre for Sexual Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
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Whelan I. The effect of United Kingdom immigration policies on migrant access to sexual and reproductive healthcare. BMJ Sex Reprod Health 2018; 45:bmjsrh-2018-200165. [PMID: 30343270 DOI: 10.1136/bmjsrh-2018-200165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
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Affiliation(s)
- Lara Shemtob
- Royal Free London NHS Foundation Trust, London, UK
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Boog K, Heanue J, Kumar V. Implementing integrated sexual and reproductive healthcare in a large sexual health service in England: challenges and opportunities for the provider. BMJ Sex Reprod Health 2018; 45:bmjsrh-2018-200090. [PMID: 30097465 DOI: 10.1136/bmjsrh-2018-200090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/07/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Katie Boog
- Leicestershire Sexual Health Service, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Leicester, UK
| | - Johanna Heanue
- Leicestershire Sexual Health Service, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Leicester, UK
| | - Vinod Kumar
- Leicestershire Sexual Health Service, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Leicester, UK
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Lord J, Regan L, Kasliwal A, Massey L, Cameron S. Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England. BMJ Sex Reprod Health 2018; 44:bmjsrh-2018-200134. [PMID: 29986873 DOI: 10.1136/bmjsrh-2018-200134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jonathan Lord
- Department of Gynaecology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- British Society of Abortion Care Providers (BSACP), London, UK
| | - Lesley Regan
- Royal College of Obstetricians and Gynaecologists, London, UK
- Department of Obstetrics and Gynaecology, Imperial College London, London, UK
| | - Asha Kasliwal
- Faculty of Sexual and Reproductive Healthcare, London, UK
- Community Gynaecology and Reproductive Health, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Louise Massey
- British Society of Abortion Care Providers (BSACP), London, UK
- Sexual and Reproductive Health, Aneurin Bevan University Health Board, Wales, UK
| | - Sharon Cameron
- British Society of Abortion Care Providers (BSACP), London, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Aziz MM, El-Gazzar AF, Elgibaly O. Factors associated with first-year discontinuation of Implanon in Upper Egypt: clients' and providers' perspectives. BMJ Sex Reprod Health 2018; 44:jfprhc-2017-101860. [PMID: 29954878 DOI: 10.1136/bmjsrh-2017-101860] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The etonogestrel implant Implanon is a favourable and cost-effective contraceptive method for women in developing countries, and expansion of its use represents a priority for the family planning (FP) programme in Egypt. We studied the factors affecting first-year Implanon discontinuation from clients' and providers' perspectives. METHODS We used a mixed quantitative-qualitative methodology. We conducted a household survey of Implanon clients and three focus group discussions with FP physicians and directors. RESULTS We found that 13.5% of Implanon users discontinued its use in the first year. Survival analysis found that clients who had previously used Implanon (HR 0.36, 95% CI 0.15 to 0.88) and whose husbands had secondary or a higher level of education (HR 0.36,95% CI 0.19 to 0.69) were less likely to discontinue Implanon use after the first year, while clients who experienced side effects of Implanon use were more likely to discontinue it (HR 3.6,95% CI 1.60 to 8.11). Other causes of discontinuation which emerged in the qualitative analysis were the unjustified advice for Implanon removal by non-gynaecologists, due to unrelated users' complaints, and deficient pre-insertion counselling. CONCLUSIONS Implanon has a low first-year discontinuation rate as compared with other contraceptive methods. FP clients should be given sufficient pre-insertion counselling about side effects of Implanon and duration of protection. Physicians should offer Implanon mainly to clients seeking long-term contraception in order to decrease its discontinuation rate and increase its cost effectiveness.
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Affiliation(s)
- Mirette M Aziz
- Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Amira F El-Gazzar
- Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Omaima Elgibaly
- Public Health and Community Medicine, Assiut University, Assiut, Egypt
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Brammeier K, Cutter J, Cook S, Scherf C. The Cardiff postpartum family planning initiative: improving provision of postpartum contraception. BMJ Sex Reprod Health 2018; 45:jfprhc-2017-101924. [PMID: 29972359 DOI: 10.1136/bmjsrh-2017-101924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Sinead Cook
- Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Caroline Scherf
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
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Bush J. Sayana Press and a case of likely lipoatrophy. BMJ Sex Reprod Health 2018; 44:bmjsrh-2018-200120. [PMID: 29972355 DOI: 10.1136/bmjsrh-2018-200120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jane Bush
- The Centre for Contraception, GU Medicine and HIV Services, North Devon Healthcare Trust, 31 Sidwell St., Exeter EX4 6NN, UK
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Cooper M, Boydell N, Heller R, Cameron S. Community sexual health providers' views on immediate postpartum provision of intrauterine contraception. BMJ Sex Reprod Health 2018; 44:97-102. [PMID: 29921631 DOI: 10.1136/bmjsrh-2017-101905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Increasing access to effective postpartum contraceptive methods can reduce the risk of unintended pregnancy and short inter-birth intervals. The need for an additional postpartum visit can be a barrier to women accessing intrauterine contraception after childbirth. Immediate postpartum intrauterine contraception (PPIUC) provision is known to be safe, but is not routinely available in the UK. Establishing this service requires multidisciplinary support, including from community and maternity stakeholders. The aim of this study was to determine the views of community sexual health providers towards PPIUC implementation. METHODS A questionnaire was distributed to attendees at two UK sexual health conferences. Research questions focused on (1) views on PPIUC (2) perceived role of the sexual health provider in PPIUC service and (3) potential challenges anticipated in providing PPIUC aftercare. Free-text boxes were provided for further comment. Analysis was by a mixed methods approach. RESULTS A total of 240 questionnaires were distributed with 156 completed (response rate 65%). Some 128 respondents (82%) felt 'positive' towards the PPIUC implementation. Most respondents (67.9%) indicated they would be happy to promote PPIUC and provide thread checks. Perceived challenges in providing PPIUC aftercare included staff time, experience in managing clinical issues, and access to ultrasound. CONCLUSIONS Community sexual health providers were positive towards PPIUC implementation, and perceived their role predominantly in the aftercare of women. Several clinical and practical challenges were identified, some of which differ from those previously expressed by other groups. Stakeholder involvement is key to successful implementation of PPIUC, and wider recognition of potential barriers can assist in developing strategies to overcome these.
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Affiliation(s)
- Michelle Cooper
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Nicola Boydell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rebecca Heller
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK
| | - Sharon Cameron
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Bull L, Jones R, Rayment M, Cohen C. Patients at a London integrated sexual health clinic are concerned at redirection of contraceptive prescriptions. BMJ Sex Reprod Health 2018; 44:146-147. [PMID: 29921642 DOI: 10.1136/bmjsrh-2018-200083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lauren Bull
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Rachael Jones
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Michael Rayment
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
| | - Charlotte Cohen
- Department of Genitourinary Medicine, Chelsea and Westminster Hospital Foundation Trust, London, UK
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Sauer U, Mann S, Stephenson JM. Moving towards same-day provision of Level 3 care in sexual and reproductive health services. BMJ Sex Reprod Health 2018; 44:jfprhc-2017-101817. [PMID: 29972365 DOI: 10.1136/bmjsrh-2017-101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ulrike Sauer
- Central and North West London NHS Foundation Trust, Margaret Pyke Centres, London, UK
| | - Susan Mann
- Homerton University Hospital NHS Foundation Trust, Sexual and Reproductive Health (SRH), London, UK
| | - Judith M Stephenson
- Research Department of Reproductive Health, Institute for Women's Health, London, UK
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Pereira G, Gerson-Sofer N. Improving access to specialist care for adolescent girls with disabilities. BMJ Sex Reprod Health 2018; 44:15-16. [PMID: 29921593 DOI: 10.1136/bmjsrh-2017-200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 06/08/2023]
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Bentley J. Two women with extended use of contraceptive implants. BMJ Sex Reprod Health 2018; 44:73. [PMID: 29203500 DOI: 10.1136/bmjsrh-2017-200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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A patient's mother's perspective. Early puberty - questions answered and an ongoing relationship established. BMJ Sex Reprod Health 2018; 44:14. [PMID: 29921592 DOI: 10.1136/bmjsrh-2017-200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/07/2017] [Indexed: 06/08/2023]
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Sundaram K, Oakeshott P, Moore M. Use and opinions of contraceptive services: survey of socially disadvantaged young adults. BMJ Sex Reprod Health 2018; 44:68. [PMID: 29921595 DOI: 10.1136/bmjsrh-2017-101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Pippa Oakeshott
- Population Health Sciences and Education, St George's, University of London, London, UK
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Edouard L. Resources for service provision: policies and politics. J Fam Plann Reprod Health Care 2017; 43:339-341. [PMID: 29018109 DOI: 10.1136/jfprhc-2017-101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 08/09/2017] [Indexed: 11/03/2022]
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O'Brien PA, Pillai S. Uterine perforation by intrauterine devices: a 16-year review. ACTA ACUST UNITED AC 2017; 43:289-295. [PMID: 28739631 DOI: 10.1136/jfprhc-2016-101684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/27/2017] [Accepted: 06/11/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION One of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period. METHODS We prospectively collected data on uterine perforations for the years 2000-2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding. RESULTS We identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel. CONCLUSION Our perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3 months postpartum as that may be a time when a high proportion of insertions are done.
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Affiliation(s)
- Paul A O'Brien
- Raymede Clinic, Sexual & Reproductive Health Service, Central North West London NHS Foundation Trust, London, UK
| | - Sarah Pillai
- Contraception and Sexual Health Service, Central London Community Healthcare NHS Trust, London, UK
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Cassidy SR, Cohen C, Forbes K, Nwokolo N, Day S. Access to contraception: why patient choice matters. J Fam Plann Reprod Health Care 2017; 43:239. [PMID: 28676543 DOI: 10.1136/jfprhc-2017-101775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/08/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Seán Richard Cassidy
- Directorate of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Charlotte Cohen
- Directorate of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kimberley Forbes
- Directorate of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nneka Nwokolo
- Directorate of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sara Day
- Directorate of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Heller R, Cameron S, Briggs R, Forson N, Glasier A. Authors' response to comment on 'Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals'. J Fam Plann Reprod Health Care 2017; 43:164-165. [PMID: 28400453 DOI: 10.1136/jfprhc-2017-101759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rominski SD, Lori JR, Morhe ES. "My friend who bought it for me, she has had an abortion before." The influence of Ghanaian women's social networks in determining the pathway to induced abortion. ACTA ACUST UNITED AC 2017; 43:216-221. [PMID: 28330856 DOI: 10.1136/jfprhc-2016-101502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 01/20/2017] [Accepted: 03/06/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Even given the liberal abortion law in Ghana, abortion complications are a large contributor to maternal morbidity and mortality. This study sought to understand why young women seeking an abortion in a legally enabling environment chose to do this outside the formal healthcare system. METHODS Women being treated for complications arising from a self-induced abortion as well as for elective abortions at three hospitals in Ghana were interviewed. Community-based focus groups were held with women as well as men, separately. Interviews and focus group discussions were conducted until saturation was reached. RESULTS A total of 18 women seeking care for complications from a self-induced abortion and 11 seeking care for an elective abortion interviewed. The women ranged in age from 13 to 35 years. There were eight focus groups; two with men and six with women. The reasons women self-induce are: (1) abortion is illegal; (2) attitudes of the healthcare workers; (3) keeping the pregnancy a secret; and (4) social network influence. The meta-theme of normalisation of self-inducing' an abortion was identified. DISCUSSION When women are faced with an unplanned and unwanted pregnancy, they consult individuals in their social network whom they know have dealt with a similar situation. Misoprostol is widely available in Ghanaian cities and is successful at inducing an abortion for many women. In this way, self-inducing abortions using medication procured from pharmacists and chemical sellers has become normalised for women in Kumasi, Ghana.
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Affiliation(s)
- Sarah D Rominski
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Jody R Lori
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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46
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de Silva S. Contraception Today (8th edn). J Fam Plann Reprod Health Care 2017; 43:167. [PMID: 28270428 DOI: 10.1136/jfprhc-2017-101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Shamela de Silva
- Consultant in Genitourinary Medicine and HIV, West Middlesex Hospital, London, UK;
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48
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Sheldon S, Fletcher J. Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives. ACTA ACUST UNITED AC 2017; 43:260-264. [PMID: 28100470 PMCID: PMC5749305 DOI: 10.1136/jfprhc-2016-101542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/01/2016] [Accepted: 12/05/2016] [Indexed: 11/30/2022]
Abstract
Background Some 40% of abortions carried out in England and Wales are done by vacuum aspiration. It is widely assumed that, in order to be lawful, these procedures must be performed by doctors. Aim and design This study aimed to provide a detailed reassessment of the relevant law and the clinical evidence that supports this assumption. Conclusions A close reading of relevant law reveals that this assumption is unfounded. On the contrary, it would be lawful for appropriately trained nurses or midwives, acting as part of a multidisciplinary team, to carry out vacuum aspiration procedures. This interpretation of the law offers the potential for developing more streamlined, cost-effective abortion services, which would be both safe and highly acceptable to patients.
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Affiliation(s)
- Sally Sheldon
- Professor of Law Kent Law School, Eliot College, Kent University, Canterbury, UK
| | - Joanne Fletcher
- Consultant Nurse in Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Reed E, Erausquin JT, Biradavolu M, Servin AE, Blankenship KM. Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India. J Fam Plann Reprod Health Care 2017; 43:60-66. [PMID: 26699872 PMCID: PMC5284462 DOI: 10.1136/jfprhc-2014-100918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners. METHODS FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients. RESULTS Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) [adjusted odds ratio (AOR) 2.2, 95% confidence interval (CI) 1.2-4.0] and with an occasional client (past week) (AOR 2.6, 95% CI 1.6-5.3), as well as accepting more money for sex without a condom (past 30 days) (AOR 2.5, 95% CI 1.5-4.3). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners. CONCLUSIONS Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.
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Affiliation(s)
- Elizabeth Reed
- Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Jennifer Toller Erausquin
- Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Monica Biradavolu
- Scholar in Residence, Department of Sociology, American University, Washington, DC, USA
| | - Argentina E Servin
- Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA,USA
| | - Kim M Blankenship
- Professor and Chair, Department of Sociology, American University, Washington, DC, USA
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Abstract
While the medical abortion (MA) drugs, mifepristone and misoprostol, have radically altered reproductive health practices around the world, there has been little field research on the sales and use of these drugs, especially in developing countries. This leaves the family planning community with many unanswered questions. While good profiles of contraceptive use are available for many countries and we have good technical data on the MA drugs' efficacy, dosages and regimens such as home dosage of misoprostol versus clinic dosage, we have very little information about the quantities of MA drugs sold, how they are used, where they are used, and, in the case of misoprostol, for what purposes. Sales data are available from one excellent commercial survey and from social marketing sales of mifepristone and misoprostol and these are presented. Acknowledging the sensitivity of the issue, especially in countries where abortion is severely restricted, the author makes a plea for careful additional research to shed light on an important and growing part of the international reproductive health picture.
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Affiliation(s)
- Phil Harvey
- Chairman, DKT International, Washington DC, USA
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