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Bete T, Ali T, Misgana T, Negash A, Abraham T, Teshome D, Sirtsu A, Nigussie K, Amano A. Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0300417. [PMID: 38547179 PMCID: PMC10977762 DOI: 10.1371/journal.pone.0300417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation. METHOD A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated. RESULTS The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women. CONCLUSION AND RECOMMENDATION This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.
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Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teklu Abraham
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Dekeba Teshome
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Addisu Sirtsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkerim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Kyei-Arthur F, Agyekum MW, Kyei-Gyamfi S. "You cannot stay with one person once you begin having sex at a young age": the prevalence, correlates and effects of early sexual debut among children in Ghana. Reprod Health 2024; 21:38. [PMID: 38521936 PMCID: PMC10960462 DOI: 10.1186/s12978-024-01775-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/16/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection. METHODS A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data. RESULTS The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners. CONCLUSIONS This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana.
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Affiliation(s)
- Frank Kyei-Arthur
- Department of Environment and Public Health, University of Environment and Sustainable Development, Somanya, Ghana.
| | - Martin Wiredu Agyekum
- Institute for Educational Research and Innovation Studies, University of Education, Winneba, Ghana
| | - Sylvester Kyei-Gyamfi
- Department of Children, Ministry of Gender, Children and Social Protection, Accra, Ghana
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Erato G, Shreffler KM, Ciciolla L, Quigley A, Addante S. Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness. J Reprod Infant Psychol 2024; 42:180-193. [PMID: 35819014 PMCID: PMC9834437 DOI: 10.1080/02646838.2022.2097208] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.
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Affiliation(s)
- Gina Erato
- Department of Psychology, Oklahoma State University
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Özen A, Yerlikaya Şaşmaz O, Çavuş Alan S. Opinions of Turkish veterinarians on the termination of unwanted pregnancies in dogs. Vet Rec 2024; 194:e3408. [PMID: 37729387 DOI: 10.1002/vetr.3408] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND No time constraints exist in Turkish veterinary law regarding the termination of unwanted pregnancies in dogs. Having undergone limited ethical debate, opinions on this issue vary among veterinarians. This study aimed to determine appropriate indications accepted by veterinary practitioners for the termination of unwanted pregnancies in dogs and the cut-off point preferred by these professionals for performing this medical and surgical intervention. METHODS A qualitative methodology was used for the collection of the data. Interviews were conducted with 40 veterinarians (13 practitioners and 27 academics). RESULTS The main reasons for performing pregnancy termination were 'institutional obligations' and 'demand of the animal owner'. Meanwhile, the cut-off points for veterinarians were 'possibility of pregnancy', 'implantation/diagnosability/visibility', 'heartbeat' and 'viability'. LIMITATIONS The inclusion of ethics experts among the authors may have caused bias in the comments of the participants on ethical issues. CONCLUSION The fact that animals are legally relegated to the custody of humans not only adds a unique character to the veterinary ethical debate but also creates a comfort zone for veterinarians not willing to examine compelling ethical issues.
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Affiliation(s)
- Abdullah Özen
- Department of History of Veterinary Medicine and Deontology, Faculty of Veterinary Medicine, Fırat University, Elazig, Turkey
| | - Onur Yerlikaya Şaşmaz
- Department of Political Science and Public Administration, Fırat University, Elazığ, Turkey
| | - Seda Çavuş Alan
- Department of History of Veterinary Medicine and Deontology, Faculty of Veterinary Medicine, Fırat University, Elazig, Turkey
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Dijkstra CI, Dalmijn EW, Bolt SH, Groenhof F, Peters LL, Jansen DEMC. Women with unwanted pregnancies, their psychosocial problems, and contraceptive use in primary care in Northern Netherlands: insights from a primary care registry database. Fam Pract 2023; 40:648-654. [PMID: 37029597 DOI: 10.1093/fampra/cmad036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION Globally an estimated 1 in 16 women per year experience an unwanted pregnancy (UWP). In the Netherlands, general practitioners (GPs) play an important role in providing care for women with UWP; however, it is unknown how many of these women consult their GP about the pregnancy. UWPs are a major life experience with a possible influence on mental health. Data that GPs register about UWPs, psychosocial problems, and contraceptive use could give more insight into care needs. AIMS To create an overview of (i) the prevalence of UWPs in general practice, (ii) the prevalence of psychosocial problems in women with UWP, and (iii) contraceptive use of women with UWP. METHODS GP registration data were analysed from 58 general practices located in Northern Netherlands between 2015 and 2019. Patient files were checked for registration of ICPC and ATC codes concerning pregnancy, psychosocial health, and contraceptive use. Chi-square and Fisher's exact test were used to calculate differences between women with a UWP and women with a wanted pregnancy (WP). An analysis of registration dates was conducted to determine when the psychosocial problems were registered in relation to the pregnancy. RESULTS Of female patients of reproductive age, 1.6% had a UWP and 11.8% had a WP. Women with a UWP reported statistically significantly more psychosocial problems. Furthermore, statistically significantly more contraceptive methods were prescribed to women with UWP compared with both women with WP and women without pregnancy. DISCUSSION AND CONCLUSION The finding that women with UWP experience more psychosocial problems can be used to improve aftercare and can be incorporated into current guidelines for GPs.
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Affiliation(s)
| | - Eline W Dalmijn
- Fiom, Research Department, 's-Hertogenbosch, The Netherlands
| | - Sophie H Bolt
- Fiom, Research Department, 's-Hertogenbosch, The Netherlands
| | - Feikje Groenhof
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Lilian L Peters
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Danielle E M C Jansen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- Department of Sociology and Interuniversity Centre for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
- Accare, University Centre for Child and Adolescent Psychiatry, Groningen, The Netherlands
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Blondel B, Beuzelin M, Bonnet C, Moreau C. Pregnancy intention and preconception contraceptive behaviors and substandard prenatal care in France. J Gynecol Obstet Hum Reprod 2023; 52:102608. [PMID: 37245644 DOI: 10.1016/j.jogoh.2023.102608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Evaluate the association between a combined measure of time-based pregnancy intention and preconception contraceptive behavior and suboptimal prenatal care. POPULATION AND METHOD Women delivering a live birth in all maternity units during one week in March 2016 were interviewed in the postpartum ward (N = 13,132). Multinomial logistic regression models were used to assess the association between the indicator of pregnancy intention and substandard prenatal care (late initiation of care and less than the recommended number of prenatal visits (<60% recommended)). RESULTS 83.6% of women had timed pregnancies, 4.7% had mistimed pregnancies but discontinued contraception to conceive, 8.0% had mistimed pregnancies without discontinuing contraception to conceive and 3.7% had unwanted pregnancies. Women with timed pregnancies or mistimed pregnancies despite discontinuing contraception to conceive were more socially advantaged than those who had an unwanted pregnancy or a mistimed pregnancy without discontinuing contraception to conceive. 3.3% of women had a substandard number of prenatal visits and 2.5% had delayed prenatal care initiation. The adjusted odds ratios (aOR) of substandard prenatal visits were high among women with unwanted pregnancies (aOR=2.78; 95% confidence interval [1.91-4.05]) and women with mistimed pregnancies who had not discontinued contraception to conceive (aOR=1.69; [1.21-2.35]) compared to women with timed pregnancies. No difference was observed for women with mistimed pregnancies who discontinued contraception to conceive (aOR=1.22; [0.70-2.12]). CONCLUSION Using routinely collected information on preconception contraception allows a more nuanced assessment of pregnancy intentions that can help caregivers identify women at greater risk of substandard prenatal care.
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Affiliation(s)
- Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France.
| | - Maxime Beuzelin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Camille Bonnet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team (Epopé), Center of Research in Epidemiology and Statistics, Université Paris Cité, INSERM, 75014 Paris, France
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Primary Care and Prevention, Centre for Research in Epidemiology and Population Health (CESP), U1018, INSERM, 94805 Villejuif, France
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GHASEMI NASAB ZOHREH, MOTAGHI ZAHRA, NAZARI ALIMOHAMMAD, KERAMAT AFSANEH, HADIZADEH-TALASAZ FATEMEH. The effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy in Iran: A randomized clinical Trial. J Prev Med Hyg 2023; 64:E316-E322. [PMID: 38125990 PMCID: PMC10730047 DOI: 10.15167/2421-4248/jpmh2023.64.3.2930] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/15/2023] [Indexed: 12/23/2023]
Abstract
Background Unwanted pregnancy is an important public health concern that can have significant health, social, and economic effects on the mother, the baby and her family. The establishment and enhancement of maternal-fetal attachment (MFA) play a role in the promotion of emotional communication between the mother and the child in the future. This study aimed at investigating the effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy. Methods In this randomized clinical trial, 60 eligible pregnant women with unwanted pregnancy and gestational age of 22-28 weeks who had referred to health centers in Mashhad, a city in the northeast of Iran, were selected and they were through random block assignment divided into two groups of counseling with the cognitive-behavioral approach (n = 30) and the control group (n = 30). In addition to the routine pregnancy care, the cognitive-behavioral counseling group received four group counseling sessions on a weekly basis, while the control group only received the routine pregnancy care from healthcare providers. Maternal-fetal attachment before and after intervention in the two groups was assessed through Cranley's Maternal-Fetal Attachment Scale. Comparison of mean scores within and between the two groups was performed using SPSS 21 through independent and paired t-tests. Results At the end of the study and after the intervention, the mean scores of maternal-fetal attachment in the intervention and control groups were 94.06 ± 11.73 and 80.16 ± 10.09, respectively, and the difference between the groups was significant. Although the difference between the mean scores of each group at the beginning and the end of the study was significant, this difference between the two groups was also noticeable (21.56 ± 12.16 vs 7.40 ± 12.39) and statistically significant. Conclusions Cognitive-behavioral counseling can be effective in enhancing the maternal-fetal attachment in unwanted pregnancies; therefore, it is recommended to be integrated into pregnant women's healthcare programs.
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Affiliation(s)
- ZOHREH GHASEMI NASAB
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - ZAHRA MOTAGHI
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - ALI MOHAMMAD NAZARI
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - AFSANEH KERAMAT
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - FATEMEH HADIZADEH-TALASAZ
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Yeatman S, Sennott C. A partner-specific critique of mistimed and unwanted fertility: Results from an analysis of the 2017-2019 United States National Survey of Family Growth. Perspect Sex Reprod Health 2023; 55:122-128. [PMID: 37394765 PMCID: PMC10527745 DOI: 10.1363/psrh.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
CONTEXT Despite substantial critiques of retrospective measures of fertility intentions, researchers widely use the metrics of unwanted and mistimed pregnancies as tools for monitoring patterns and trends in reproductive health. However, in focusing exclusively on the timing and numeric elements of fertility these constructs ignore partner-specific desires, which may lead to considerable measurement error and threaten their validity. METHODOLOGY We use data on births in the last 5 years from the 2017-2019 United States National Survey of Family Growth to compare responses to the standard retrospective measure of fertility intentions with responses to a partner-specific question that asks respondents about whether they had ever desired a child with that partner. RESULTS We find that women's responses to questions on retrospective fertility desires with and without reference to a particular partner vary in ways that suggest that women and researchers interpret these questions differently. DISCUSSION Despite a long history in fertility research, the standard approach to measuring mistimed and unwanted fertility is both conceptually and operationally flawed. In the context of complicated sexual and reproductive lives that do not start and end with a single partner, researchers should reevaluate the usefulness of the constructs of mistimed and unwanted fertility. We conclude by offering recommendations for analysts and survey designers as well as by calling for a move away from the terms entirely to focus instead on the pregnancies that women themselves view as most problematic.
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Affiliation(s)
- Sara Yeatman
- Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
| | - Christie Sennott
- Sociology Department, Purdue University, West Lafayette, Indiana, USA
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Abstract
We examine whether changes in U.S. pregnancy, birth, and abortion rates between 2009 and 2015 reflect underlying change in the incidence of pregnancies classified by retrospectively reported pregnancy desires: pregnancies reported as having occurred at about the right time, later than wanted, too soon, or not wanted at all, and those for which individuals expressed other feelings, including uncertainty, ambivalence, or indifference. We calculate the proportionate distributions of these pregnancies and rates among U.S. women aged 15-44, as well as change over time, overall and among age groups. Characterization of desires for a past pregnancy shifted in a number of ways between 2009 and 2015, and changes across age groups were not uniform. Rates of pregnancies reported as occurring later than wanted increased among older women, while rates of pregnancies reported as occurring too soon decreased among all women. These findings shed light on previous research documenting an increasing age at first birth, increasing rates of pregnancy and childbearing among the oldest age groups, and changes in patterns of contraceptive use, particularly among young women. Our analysis explores limitations and challenges of two major sources of data on pregnancies in the United States and their measures of retrospectively reported pregnancy desires.
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Affiliation(s)
| | - Mia Zolna
- Guttmacher Institute, New York, NY, USA
| | - Rachel Murro
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
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Gupta U. Informal healthcare providers of abortion services among three scheduled tribes of Jharkhand. Indian J Public Health 2023; 67:254-258. [PMID: 37459021 DOI: 10.4103/ijph.ijph_1382_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background There is a dominant role of informal healthcare providers (IHPs) in the current cultural and sociological context of tribal communities. They outnumber formal health-care providers, thus bridging the gap between existing and nonexisting public health facilities despite not having formal training or accreditation. Objectives The study examines the role, relevance, and extent of abortion services provided by IHPs- in Jharkhand among three Scheduled Tribe groups. Materials and Methods Based on in-depth interviews with 15 IHPs and 42 married women among three Scheduled Tribe groups in three districts of Jharkhand, a qualitative study was conducted. Interview guidelines addressed reasons for preferring IHP services, their scope of practice, dissemination, and quality of services. Results The majority of women seeking abortions used traditional contraceptives, which often resulted in unwanted pregnancies. The economic, cultural, social, access to services, and confidence factors encouraged women to seek abortion services from IHPs. There were differences in the nature of access to abortion services among tribal groups. The Chero and Korwa tribes continued to rely heavily on simpler life technologies that shaped their beliefs and practices regarding reproduction. The Ho tribe, however, preferred to use the formal health-care system since they were close to a more complex society. Conclusion IHP plays a significant role in the social structure of Tribes, demonstrating their marginalization in access to formal health-care services. Eventually, they replaced traditional healers with their function as physicians.
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Affiliation(s)
- Ujjwala Gupta
- Assistant Professor, Department of Public Health, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
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Hobby E, Mark NDE, Gemmill A, Cowan SK. Pregnancy intentions' relationship with infant, pregnancy, maternal, and early childhood outcomes: Evidence from births in Alaska, Missouri, and Oklahoma. Perspect Sex Reprod Health 2023; 55:62-76. [PMID: 36947635 DOI: 10.1363/psrh.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Much of reproductive health care policy in the United States focuses on enabling women to have intended pregnancies. Investigating whether the association between pregnancy intention and adverse outcomes for mothers and children in the immediate and longer term is due to intention or a mother's demographics provides valuable context for policy makers aiming to improve maternal and child outcomes. METHODS We investigated relationships between pregnancy intention and pregnancy, infant, early childhood, and maternal outcomes using data from the Pregnancy Risk Assessment Monitoring System survey, conducted 2-8 months after the child's birth, and follow-up surveys from three states (Alaska, Missouri, and Oklahoma), administered at age 2-3 years old. We used logistic regressions with inverse propensity weights to measure associations, accounting for potential confounding factors. RESULTS After inverse propensity weighting, pregnancy intention was associated with adverse maternal pregnancy behaviors but not most infant outcomes. Mothers who reported an unwanted pregnancy were associated with increased odds of the child receiving a developmental delay diagnosis. Among those who did not report depression prior to pregnancy, mothers with unwanted pregnancies were more likely to experience persistent depression, and mothers with pregnancies mistimed by two or more years had a higher likelihood of experiencing depression postpartum or in the follow up period. CONCLUSIONS Our findings suggest that pregnancy intention is less consequential for maternal and child well-being than socio-economic disadvantage, suggesting that re-orienting policy toward social conditions and reproductive autonomy will serve better individual and population health.
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Affiliation(s)
- Erica Hobby
- Cash Transfer Lab, New York University, New York, New York, USA
| | - Nicholas D E Mark
- Department of Sociology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alison Gemmill
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah K Cowan
- Cash Transfer Lab, New York University, New York, New York, USA
- Department of Sociology, New York University, New York, New York, USA
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Lukeme Ayen D, De Brouwere V. Connaissances, attitudes, pratiques des jeunes en matière de VIH et grossesses non désirées à Kinshasa. Sante Publique 2022; 34:717-726. [PMID: 36577670 DOI: 10.3917/spub.225.0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite the efforts made on education about risks linked to sexuality and the implementation of contraception provision strategies in DRC, still too many young people do not use condoms, even though they are confronted with HIV and unwanted pregnancies. PURPOSE OF RESEARCH To explore knowledge and practices of young people (15-24 years) about sexuality and to identify factors associated with the use of condoms and contraception. METHOD Qualitative descriptive study, conducted among 36 young people in three health zones (Biyela, Kalamu 2 and Selembao) in Kinshasa. Data analysis was done with Atlas.ti, a software adapted to the content analysis method. RESULTS 86% of young people know the risks of unprotected sex (unwanted pregnancies and STIs such as HIV-AIDS). However, 44% have incorrect information about HIV, condoms, and other contraceptives. Condom use by young people was favored by their level of knowledge about sexuality, their perception of HIV, knowledge of a distribution point, the cost and the skills of healthcare providers. CONCLUSION Young people’s knowledge of sexuality is not enough to make them use condoms. Several strategies aimed at building the skills of young people, parents, healthcare providers, as well as making contraception available to young people should be combined.
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Upadhyay UD, Foster DG, Gould H, Biggs MA. Intimate relationships after receiving versus being denied an abortion: A 5-year prospective study in the United States. Perspect Sex Reprod Health 2022; 54:156-165. [PMID: 36414233 DOI: 10.1363/psrh.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT When an individual seeking an abortion cannot obtain one, carrying that pregnancy to term may affect both her relationship with the man involved in the pregnancy and her prospects for new intimate relationships. We aimed to assess the impact of receiving versus being denied a wanted abortion on women's intimate relationships, up to 5 years after seeking an abortion in the United States. METHODS Using mixed-effects regression models, we compared relationship outcomes among women who presented for abortion care just under facilities' gestational age limits ("Near-limit abortion patients," n = 452) with those who presented just over, were denied an abortion ("Turnaways," n = 146) at 30 US facilities. RESULTS At 1 week post-abortion seeking, the predicted probability of being in a relationship with the man involved in the pregnancy was 58%, gradually declining to 27% at 5 years with no significant differences between those who received and those who were denied an abortion. However, from 2 to 5 years post-abortion seeking, participants who were denied an abortion had double the odds (aOR = 2.01, 95% CI: 1.09-3.69) of being in a poor intimate relationship, with a predicted probability of being in a poor relationship of 14% among those denied an abortion compared with 9% among those who received one (p < 0.05). CONCLUSIONS Carrying an unwanted pregnancy to term does not increase the chance of being in an intimate relationship with the man involved in the pregnancy but may have negative implications for the quality of future relationships up to 5 years post-abortion seeking.
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Affiliation(s)
- Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - Heather Gould
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California, United States
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Khan MN, Harris ML, Huda MN, Loxton D. A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh. Sci Rep 2022; 12:15165. [PMID: 36071170 PMCID: PMC9452522 DOI: 10.1038/s41598-022-19559-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women's homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women's intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women's homes.The availability of health facilities near women's homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia.
| | - Melissa L Harris
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Md Nazmul Huda
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbeltown, NSW, 2560, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, Australia
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Khan MN, Harris ML, Loxton D. Low utilisation of postnatal care among women with unwanted pregnancy: A challenge for Bangladesh to achieve Sustainable Development Goal targets to reduce maternal and newborn deaths. Health Soc Care Community 2022; 30:e524-e536. [PMID: 33225479 DOI: 10.1111/hsc.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
Pregnancy complications are the major cause of maternal and newborn deaths in low- and middle-income countries that are more frequently associated with unintended pregnancy. The World Health Organization (WHO) recommends postnatal care (PNC) for women and their newborns within 24 hr of birth to prevent pregnancy complications and associated adverse outcomes. We, therefore, examined the relationship between unintended pregnancy and PNC use in Bangladesh. Data from 4,493 women and newborn dyads were extracted from the 2014 Bangladesh Demographic and Health Survey and analysed. PNC was classified as: no PNC; some level of PNC (either the woman or her newborn missed PNC within 24 hr of birth but had at least one PNC visit within 42 days of birth); and WHO's recommended level of PNC (at least one PNC use for both the woman and her child within 24 hr of birth). Pregnancy intention at conception for the last live birth was categorised as wanted, mistimed or unwanted. Multilevel multinomial logistic regression modelling was used to assess the association between pregnancy intention and PNC use, adjusting for possible confounders. We found around 27% of participants had adhered to WHO's PNC use recommendations. Around 26% of pregnancies that resulted in live births were unintended at conception, including 15% of which were classified as mistimed and 11% as unwanted. Following adjustment of confounders, a 37% (OR = 0.63, 95% CI: 0.47-0.85) lower odds of using WHO's recommended level of PNC and a 33% (OR, 95% CI, 0.49-0.93) lower odds of some level of PNC were found for pregnancies that were unwanted relative to those that were wanted. No association was found between mistimed pregnancy and PNC use. Strengthening healthcare facilities and improving the linkage between women and existing healthcare facilities are important to ensure WHO's PNC recommendations are met for women experiencing an unwanted pregnancy.
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Affiliation(s)
- Md Nuruzzaman Khan
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Melissa L Harris
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW, Australia
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
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Jang M, Molino AR, Ribeiro MV, Mariano M, Martins SS, Caetano SC, Surkan PJ. Maternal Pregnancy Intention and Developmental Outcomes in Brazilian Preschool-Aged Children. J Dev Behav Pediatr 2021; 42:e15-e23. [PMID: 33859123 DOI: 10.1097/dbp.0000000000000951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged children. METHODS Data from children aged 4 to 5 years and their primary caregivers in Embu das Artes, a Brazilian municipality in the state of São Paulo, were collected in 2016. Maternal pregnancy intention was defined as intended or unintended, which was then further stratified as mistimed or unwanted. Outcomes included socioemotional developmental delay, internalizing and externalizing behaviors, and school readiness. We estimated risk ratios (RRs) for unadjusted and inverse-probability-weighted regression adjustment (IPWRA) analyses using 2-level (intended vs unintended) and 3-level (intended vs mistimed vs unwanted) exposure definitions. RESULTS Of 1,034 total mothers, 40.7% reported their pregnancy as intended, 46.0% as mistimed, and 13.4% as unwanted. In both unadjusted and IPWRA analyses comparing intended and unintended pregnancies, all associations failed to reach statistical significance. In the IPWRA analysis using the 3-level exposure definition, unwanted pregnancies were associated with higher risk of socioemotional developmental delay (RR = 1.14; 95% confidence interval [CI], 1.01-1.28) and co-occurring internalizing and externalizing behaviors (RR = 1.11, 95% CI, 1.00-1.22), compared with intended pregnancies. CONCLUSION There was higher risk of poor child outcomes among unwanted compared with intended pregnancies, whereas mistimed pregnancies were not associated with poor outcomes. Further research using standardized definitions of pregnancy intention along with targeted interventions that increase access to family planning services and counseling for parents of children born after unintended pregnancies is needed.
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Affiliation(s)
- Minyoung Jang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea R Molino
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marcos V Ribeiro
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marília Mariano
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Sheila C Caetano
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Adomako EB, Darkwa Baffour F. Suffering in the Hands of a Loved One: The Endemic to Intimate Partner Violence and Consequences on Migrant Female Head-Load Carriers in Ghana. J Interpers Violence 2021; 36:NP11940-NP11967. [PMID: 31789080 DOI: 10.1177/0886260519888547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The study contributed to filling a knowledge gap in the area of intimate partner violence (IPV). Previous studies conducted in Ghana have investigated the causes and types of IPV, leaving a gap on the consequences the violence had on the victims. Using a population of local economic migrants (hereafter, head-load carriers), a qualitative design with emphasis on phenomenology was employed to investigate the effects of IPV on 20 head-load carriers in two major cities in Ghana (Kumasi and Accra). The analysis performed on the data, using interpretive phenomenological analysis, revealed that IPV affected the head-load carriers' health, employment, and human relationships. Each of the participants spoke of one or more health complications, which they attributed to IPV. Among the health-related effects reported by the head-load carriers were body pains, wounds, depression, suicide ideation, headache, and abdominal pains that resulted from the termination of an unwanted pregnancy. All the head-load carriers recounted the detrimental outcomes of IPV on their job and human relationships. After they had experienced IPV, some of the victims could not go to work due to fear of stigmatization and those who were able to could not work as they usually do due to severe pain. At their workplace, some of the IPV victims became aggressive toward customers and coworkers, whereas others remained isolated. These negatively impacted on their human relationship skills and earnings. Based on the findings, there is the need for policies that seek to address IPV to consider the effects on victims' employment, earning, and behavior.
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BakenRa A, Gero A, Sanders J, Simmons R, Fay K, Turok DK. Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception. Obstet Gynecol 2021; 138:79-84. [PMID: 34259467 PMCID: PMC8216596 DOI: 10.1097/aog.0000000000004433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days. METHODS This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before). RESULTS Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0-1.3%) or with any unprotected intercourse episode 6-14 days before IUD placement (0.0%, 97.5% CI 0.0-3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI -0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI -0.2% to 0.5%). CONCLUSION With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02175030.
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Affiliation(s)
- Abena BakenRa
- University of California Berkeley School of Public Health, Berkeley, California; and the University of Utah School of Medicine, Salt Lake City, Utah
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Mihretie GN, Muche Liyeh T, Ayalew Goshu Y, Gebrehana Belay H, Abe Tasew H, Belay Ayalew A. Young-parent communication on sexual and reproductive health issues among young female night students in Amhara region, Ethiopia: Community-based cross-sectional study. PLoS One 2021; 16:e0253271. [PMID: 34143828 PMCID: PMC8213161 DOI: 10.1371/journal.pone.0253271] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Young is a key stage in rapid biological and psychosocial changes affecting every aspect of the lives and an important time to set the foundation for good health in adulthood. Adolescent-parent communication is a potential path for improving sexual and reproductive health outcomes for adolescents, most of parents did not teach their adolescents about sexual and reproductive health. Even though, some researches have been done on day time students, there is no study conducted focusing on young girls attending night school in Ethiopia. OBJECTIVE This study aimed to assess young-parent communication on sexual and reproductive health issues and associated factors among night female students in Amhara Region, Ethiopia, 2018. METHOD School based quantitative cross-sectional study was employed in Amhara region among 1640 young female night students from September 15 to November 15/2018. Face-to-face interview-administered questionnaires were used to collect the data. Bi-variable and multi-variable logistic regression model were used. Odds ratio (OR) with 95% confidence interval (CI) were computed to determine the strength of association between predictor and outcome variables. P-values less than 0.05 considered as level of significance. RESULTS One hundred ten (37.5%) of the students had communication with their parents on at least two issues of sexual and reproductive health (SRH) issues in the last 6 months. Grade level (adjusted odd ratio (AOR) = 2.61, 95% CI (2.04, 3.34)), marital status (AOR = 1.29, 95% CI (1.03, 1.63), living arrangement (AOR = 1.50(1.13, 2.00)), utilization of youth friendly sexual and reproductive health services (AOR = 1.80, 95% CI (1.41, 2.30)), students ever had sexual intercourse (AOR = 1.50, 95% CI (1.23, 1.96)), Information about sexual and reproductive health services (AOR = 1.45(1.16, 1.80)) were associated young-parents communication on sexual and reproductive health issues. CONCLUSION In this study young-parent communications on sexual and reproductive health (SRH) issues was found to be limited. Therefore, teachers, health extension workers, and health professionals should strengthen comprehensive SRH education for students in school, churches, mosques, health facilities and encouraging them to participate in different health clubs in school. Parent should give education for their children sexual and reproductive health during the era of young age.
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Affiliation(s)
- Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Tewachew Muche Liyeh
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yitayal Ayalew Goshu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habitamu Abe Tasew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abeba Belay Ayalew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Zaki SA, Naous J, Ghanem A, Abou Abbas D, Tomb R, Ghosn J, Assi A. Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon. Sci Rep 2021; 11:9855. [PMID: 33972604 PMCID: PMC8110545 DOI: 10.1038/s41598-021-89258-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.
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Affiliation(s)
| | - Jihane Naous
- Marsa Sexual Health Center, Beirut, Lebanon
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Antoine Ghanem
- Marsa Sexual Health Center, Beirut, Lebanon
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Roland Tomb
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Jade Ghosn
- Service des Maladies Infectieuses et Tropicales, AP-HP Nord, Hôpital Bichat - Claude Bernard, Paris, France
- INSERM IAME - UMR 1137, Université de Paris, Paris, France
- Faculté de Médecine Site Paris Nord, Université de Paris, Paris, France
| | - Ayman Assi
- Marsa Sexual Health Center, Beirut, Lebanon.
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
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Ojo IE, Ojo TO, Orji EO. Why do married women procure abortion? Experiences from Ile-Ife, south western Nigeria. Afr Health Sci 2021; 21:327-337. [PMID: 34394314 PMCID: PMC8356588 DOI: 10.4314/ahs.v21i1.42] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Nigeria, about 1.25million induced abortions occur annually and the country accounts for one-fifth of abortion-related deaths globally. Objectives The study aimed to assess the determinants of induced abortion among married women. Methods A mixed methods study was conducted in Ile-Ife, Nigeria. The quantitative component employed a cross-sectional study design while the qualitative aspect comprised focus group discussions. Information on contraceptives use, unintended pregnancy and induced abortion were obtained from 402 married women (with at least one child) aged 18–49 years using a semi-structured questionnaire. Four focus group discussion sessions were conducted among women of reproductive age. Results Majority (67.2%) of respondents had ever used a contraceptive method. However, 34.3% of the women have had unintended pregnancies and 14.2% had induced abortion. FGD findings revealed that non-use of contraceptives and contraceptive failure were major reasons for unintended pregnancies and induced abortion. The significant predictors of induced abortion were non-use of contraceptives, age≥ 40 years and multiparity. Conclusion Induced abortion still occur among married women particularly those not using contraceptives, aged ≥40 years and those with high parity. More emphasis should be placed on making contraceptives more accessible to married women.
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Affiliation(s)
| | | | - Ernest Okechukwu Orji
- Obafemi Awolowo University College of Health Sciences, Department of Obstetrics, Gynaecology and Perinatology
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Sato R, Elewonibi B, Msuya S, Manongi R, Canning D, Shah I. Why do women discontinue contraception and what are the post-discontinuation outcomes? Evidence from the Arusha Region, Tanzania. Sex Reprod Health Matters 2020; 28:1723321. [PMID: 32178594 PMCID: PMC7888019 DOI: 10.1080/26410397.2020.1723321] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In Africa, high discontinuation of contraceptive use is thwarting goals for healthy birth spacing or limiting childbearing. This paper investigates how well the contraception program is addressing the needs of women and couples in the Arusha region, Tanzania by studying contraceptive use continuation. We measured the overall and method-specific discontinuation rate, reasons for discontinuation, post-discontinuation reproductive behaviours/outcomes, and examined the determinants of contraceptive discontinuation. We used data from a household survey conducted in Arusha from January to May 2018. Information on contraceptive use during the 31 months preceding the survey was recorded in a monthly calendar. Using the single- and multiple-decrement life-table approach, we calculated the overall and cause-specific discontinuation of contraceptive methods. Logistic regression was used to evaluate the determinants of discontinuation. The 12-month overall discontinuation of contraceptive use was 44.6%. Discontinuation was lowest for implants (12.3%) and highest for male condoms (60.1%), the most common reason being side effects (11.7%). 59.8% of women who discontinued did not switch to another method within 3 months following discontinuation and 20.9% experienced pregnancy. Longer distance to a health facility is associated with higher discontinuation of hormonal methods such as injectables, but lower discontinuation of non-hormonal methods such as condoms. Discontinuation due to side effects is not explained by most of the women's background characteristics other than the method they used. Discontinuation of contraception is high among Arusha women. Effective contraception programs, especially improved counselling, need to address the reasons for the discontinuation of contraceptive use.
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Affiliation(s)
- Ryoko Sato
- Research Associate, Harvard TH Chan School of Public Health, Boston, MA, USA. Correspondence: ,
| | - Bilikisu Elewonibi
- Research Associate, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sia Msuya
- Associate Professor, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rachel Manongi
- Associate Professor, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David Canning
- Professor, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Iqbal Shah
- Principal Research Scientist, Harvard TH Chan School of Public Health, Boston, MA, USA
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Ahinkorah BO. Individual and contextual factors associated with mistimed and unwanted pregnancies among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis. PLoS One 2020; 15:e0241050. [PMID: 33091050 PMCID: PMC7580885 DOI: 10.1371/journal.pone.0241050] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Unintended pregnancies are associated with a number of risk factors such as malnutrition, mental illness, unsafe abortion, maternal mortality and horizontal transmission of HIV to children. These risks are predominant among adolescent girls and young women compared to older women. This study examined the individual and contextual factors associated with unintended pregnancy among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa. Materials and methods Data for this study was obtained from recent Demographic and Health Surveys carried out between 2010 and 2018 in 10 countries in sub-Sahara Africa. The sample size for this study was made up of 6,791 adolescent girls and young women (aged 15–24), who were pregnant during the surveys and had complete responses on all the variables considered in the study. Unintended pregnancy was the outcome variable in this study. Descriptive and multilevel logistic regression analyses were performed and the fixed effect results of the multilevel logistic regression analysis were reported as adjusted odds ratios at 95% confidence interval. Results Unintended pregnancy in the selected countries was 22.4%, with Angola, recording the highest prevalence of 46.6% while Gambia had the lowest prevalence of 10.2%. The likelihood of unintended pregnancy was high among adolescent girls and young women aged 15–19 [aOR = 1.48; 95% CI = 1.26–1.73], those with primary [aOR = 1.99; 95% CI = 1.69–2.33] and secondary/higher [aOR = 2.30; 95% CI = 1.90–2.78] levels of education, single (never married/separated/divorced/widowed) adolescent girls and young women [aOR = 9.23; 95% CI = 7.55–11.28] and those who were cohabiting [aOR = 2.53; 95% CI = 2.16–2.96]. The odds of unintended pregnancy also increased with increasing birth order, with adolescent girls and young women having three or more births more likely to have unintended pregnancies compared to those with one birth [aOR = 1.99; 95% CI = 1.59–2.48]. Adolescent girls and young women who had ever used contraceptives (modern or traditional), had higher odds of unintended pregnancies compared to those who had never used contraceptives [aOR = 1.32; 95% CI = 1.12–1.54]. Finally, adolescent girls and young women who belonged to the rich wealth quintile were more likely to have unintended pregnancy compared to those in the poor wealth quintile [1.28; 95% CI = 1.08–1.51]. Conclusion The study found that age, marital status, level of education, parity, use of contraceptives and wealth quintile are associated with unintended pregnancy among adolescent girls and young women in high fertility sub-Saharan African countries. These findings call for the need for government and non-governmental organisations in high fertility sub-Saharan African countries to restructure sexual and reproductive health services, taking into consideration these individual and contextual level characteristics of adolescent girls and young women.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Liverpool, Australia
- * E-mail:
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Orthmann Bless D, Hofmann V. Abortion in women with Down syndrome. J Intellect Disabil Res 2020; 64:690-699. [PMID: 32643815 DOI: 10.1111/jir.12761] [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: 03/03/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nearly two-thirds of pregnancies in women with Down syndrome (DS) end in abortion. The aim of the present study was to determine if these high abortion rates might relate to specific characteristics of women with DS, their life situation and the course of pregnancy. METHODS In a sample of 351 pregnancies in Switzerland (1998 to 2009), women with DS were compared with women with other forms of intellectual disability (ID) and women without ID, regarding the type of abortion, personal characteristics and pregnancy complications that might increase the probability of abortion. RESULTS All abortions among women with DS were medically induced. In women with DS and ID, abortions were more likely to occur due to unwanted pregnancy than in women without ID. In addition, women with DS and ID were more often diagnosed with fetal complications and maternal health problems. However, no correlation between fetal complications or maternal health problems and pregnancy outcome was found. CONCLUSIONS The group differences found do not directly explain the high abortion rates among women with DS. Maternal diagnosis of DS appears to be the most important predictor of abortion. Possible explanations for this finding are discussed.
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Affiliation(s)
- D Orthmann Bless
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
| | - V Hofmann
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
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Vivanti AJ, Deruelle P, Picone O, Guillaume S, Roze JC, Mulin B, Kochert F, De Beco I, Mahut S, Gantois A, Barasinski C, Petitprez K, Pauchet-Traversat AF, Droy A, Benachi A. Follow-up for pregnant women during the COVID-19 pandemic: French national authority for health recommendations. J Gynecol Obstet Hum Reprod 2020; 49:101804. [PMID: 32407897 PMCID: PMC7212959 DOI: 10.1016/j.jogoh.2020.101804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations concerning follow-up of pregnant women during the COVID-19 outbreak. METHODS A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France.
| | - Philippe Deruelle
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Service de Gynécologie Obstétrique, Hôpital de Hautepierre, Faculté de Médecine de Strasbourg, 67000 Strasbourg, France
| | - Olivier Picone
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris University, IAME INSERM U1137, APHP (Paris, France) GRIG (Groupe de Recherche sur les Infections pendant la Grossesse), 92700 Colombes
| | - Sophie Guillaume
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | | | - Blandine Mulin
- French Federation of Perinatal Health Networks, 31000 Toulouse, France
| | - Fabienne Kochert
- French Association of Ambulatory Paediatrics, 33400 Talence, France
| | | | - Sophie Mahut
- College of General Medicine, 75017 Paris 8, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | - Chloé Barasinski
- Collège National des Sages-Femmes de France, 75015 Paris, France; Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F63000 ClermontFerrand, France
| | - Karine Petitprez
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | | | - Alcyone Droy
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | - Alexandra Benachi
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France; Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France
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Vayngortin T, Bachrach L, Patel S, Tebb K. Adolescents' Acceptance of Long-Acting Reversible Contraception After an Educational Intervention in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2020; 21:640-646. [PMID: 32421513 PMCID: PMC7234691 DOI: 10.5811/westjem.2020.2.45433] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adolescents who seek care in the emergency department (ED) are a cohort at increased risk of unintended pregnancy. Although adolescents are interested in learning about pregnancy prevention in the ED, there is a lack of effective educational interventions in this setting. Long-acting reversible contraceptives (LARC) are highly effective and safe in teens, yet are underutilized. This study assessed contraception use among adolescents in the ED and evaluated the impact of an educational video on their interest in and uptake of LARCs. METHODS We conducted a two-arm randomized controlled trial on a convenience sample of sexually active females 14 to 21 years old in an urban pediatric ED. Participants were randomized to an educational video or standard care. All participants completed a survey and were given an informational card about affiliated teen clinics with the option to schedule an appointment. We assessed pre-post mean differences between control and intervention participants and pre-post differences among intervention participants. Participants were followed three months after their ED visit to examine use of contraception. RESULTS A total of 79 females were enrolled (42 control and 37 intervention). The mean age was 17 years, and most were youth of color. The proportion of participants with a prior pregnancy was 18%. Almost all participants reported wanting to avoid pregnancy, yet 18% reported not using contraception at last intercourse. At baseline, 17.7% of participants were somewhat or very interested in the intrauterine device (IUD) or implant. After watching the video, 42.3% were somewhat or very interested in the IUD and 35.7% in the implant. Among those who watched the video, there were significant increases in interest in using an IUD or implant (p<.001). Compared to controls, adolescents who watched the video were also significantly more likely to report wanting an IUD (p<0.001) or implant (p=0.002). A total of 46% were reached for follow-up. Of these, 16% had initiated a LARC method after their ED visit (p=NS). CONCLUSION Most adolescent females in the ED want to avoid pregnancy, but are using ineffective methods of contraception. A brief educational video on LARCs was acceptable to adolescents and feasible to implement in a busy urban ED setting. Adolescents who watched the video had significantly greater interest in using LARCs, but no demonstrated change in actual adoption of contraception.
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Affiliation(s)
- Tatyana Vayngortin
- Rady Children’s Hospital, University of California San Diego, Division of Emergency Medicine, San Diego, California
| | - Lela Bachrach
- University of California San Francisco Benioff Children’s Hospital Oakland, Department of Adolescent Medicine, Oakland, California
| | - Sima Patel
- University of California San Francisco Benioff Children’s Hospital Oakland, Department of Emergency Medicine, Oakland, California
| | - Kathleen Tebb
- University of California San Francisco, Department of Adolescent Medicine, San Francisco, California
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Sayehmiri K, Ebtekar F, Zarei M, Gheshlagh RG. Prevalence of unwanted pregnancy among Iranian women: an updated meta-analysis. BMC Pregnancy Childbirth 2019; 19:491. [PMID: 31829158 PMCID: PMC6907188 DOI: 10.1186/s12884-019-2640-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/27/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Unwanted pregnancy is a global issue with adverse outcomes for the mother, child, family, and society. Previous studies in Iran have reported different prevalence rates for unwanted pregnancy. This meta-analysis was aimed at estimating the overall prevalence of unwanted pregnancy among Iranian women. METHODS A total of 20 articles in English or Persian, published between 2012 and December 2018, were collected. The search was conducted in national and international databases, including Scientific Information Database (SID), MagIran, PubMed, Scopus, and Web of Science, using the following keywords: 'Unplanned pregnancy', 'Unintended pregnancy', 'Unwanted pregnancy', and 'Mistimed pregnancy'. The data were analyzed using the meta-analysis method and the random effects model. Heterogeneity among studies was assessed using the I2 statistic. All analyses were performed using Stata, version 12. RESULTS Analysis of 20 studies with a total sample size of 16,298 showed that the prevalence of unwanted pregnancy among Iranian women was 26% (95% Confidence Interval [CI]: 23-28). This prevalence was higher in the regions 5 and 2 of Iran (27%) than the other regions, and had no significant decrease between 2012 and 2018 (p = 0. 937). CONCLUSION More than one-fourth of pregnancies among Iranian women are unwanted. Providing training programs for couples who do not plan to have children along with the support policies aimed at stimulating population growth, can be an important step in overcoming the issue of unwanted pregnancy and reducing the illegal abortions related to it.
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Affiliation(s)
- Kourosh Sayehmiri
- Prevention Center of Social-Mental Injuries, Ilam University of Medical Sciences, Ilam, Iran
| | - Fariba Ebtekar
- Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mozhdeh Zarei
- Department of Health in Emergencies and Disasters, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghanei Gheshlagh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Abstract
OBJECTIVE Unplanned and poorly timed pregnancies are associated with adverse maternal and neonatal outcomes. Further understanding of preconception substance use with unplanned and poorly timed pregnancy is warranted. METHODS Data were analyzed from a prospective study enrolling women early in pregnancy. Preconception tobacco, alcohol, marijuana, opioid, and cocaine use was ascertained. Participants reported whether their current pregnancy was planned and whether it was a good time to be pregnant. Multivariable logistic regression modeling generated risk estimates for preconception substance use, and pregnancy planning and timing, adjusting for confounders. RESULTS Overall, 37.2% reported unplanned pregnancy, 13.0% poorly timed pregnancy, and 39.0% reported either unplanned and/or poorly timed pregnancy. Within 6 months preconception, one-fifth (20.2%) reported nicotine cigarette use. In the month before conception, 71.8% reported alcohol use, 6.5% marijuana, and approximately 1% opioid or cocaine use. Multivariable analysis demonstrated preconception opioid use was associated with increased odds of poorly timed pregnancy (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.03-7.99). Binge drinking the month before conception was associated with increased odds of poorly timed pregnancy and unplanned pregnancy (OR 1.75, 95% CI 1.01-3.05; and OR 1.68, 95% CI 1.01-2.79, respectively). Marijuana use 2 to 3 times in the month preconception was associated with increased risk of unplanned pregnancy, and unplanned and/or poorly timed pregnancy compared with nonuse (OR 1.78, 95% CI 1.03-3.08; and OR 1.79, 95% CI 1.01-3.17, respectively). Preconception tobacco or cocaine use was not associated with unplanned or poorly timed pregnancy following adjustment. CONCLUSIONS We demonstrate increased odds of unplanned or poorly timed pregnancy among women with preconception binge drinking, marijuana use, and opioid use; however, no association is observed with other substances after multivariable adjustment, including tobacco. Further research to evaluate high-level preconception substance use and substance disorders with pregnancy planning and timing is warranted. Focused efforts optimizing preconception health behaviors and reducing risk of unplanned or poorly timed pregnancy are needed.
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Affiliation(s)
- Lisbet S. Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
| | - Stephanie Peglow
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA 23507
| | - Neena Qasba
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
| | - Kimberly A. Yonkers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520
| | - Aileen M. Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520
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Abstract
Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.
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Affiliation(s)
| | - Bernadette Mazurek Melnyk
- Department of Pediatrics & Psychiatry, College of Nursing and College of Medicine, The Helene Fuld Health Trust National Institute for EBP, The Ohio State University , Columbus , OH , USA
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Robles-Bykbaev Y, Oyola-Flores C, Robles-Bykbaev VE, López-Nores M, Ingavélez-Guerra P, Pazos-Arias JJ, Pesántez-Avilés F, Ramos-Cabrer M. A Bespoke Social Network for Deaf Women in Ecuador to Access Information on Sexual and Reproductive Health. Int J Environ Res Public Health 2019; 16:E3962. [PMID: 31627417 PMCID: PMC6843236 DOI: 10.3390/ijerph16203962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
Many deaf women face the lack of numerous resources related to their personal development. The unavailability of proper information on Sexual and Reproductive Health (SRH), in particular, causes problems of sexually transmitted infections, unwanted pregnancy in adolescence, sexual violence, complications during pregnancy, etc. In response to this, we have created a social network that delivers SRH content (verified and validated by experts) to women with different degrees of hearing loss. The site features a recommender system that selects the most relevant pieces of content to deliver to each woman, driven by her individual preferences, needs and levels of knowledge on the different subjects. We report experiments conducted in Cuenca, Ecuador, between 2017 and 2018 with 98 volunteers from low- and middle-income settings, aiming to evaluate the quality and appeal of the contents, the coherence of the methodology followed to create them, and the effectiveness of the content recommendations. The positive results encourage the frequent creation of new content and the refinement of the recommendation logic as the cohort of users expands over time.
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Affiliation(s)
- Yaroslava Robles-Bykbaev
- GI-IATa, UNESCO Chair on Support Technologies for Educational Inclusion, Universidad Politécnica Salesiana, 010102 Cuenca, Ecuador.
| | - Christian Oyola-Flores
- GI-IATa, UNESCO Chair on Support Technologies for Educational Inclusion, Universidad Politécnica Salesiana, 010102 Cuenca, Ecuador.
| | | | - Martín López-Nores
- AtlantTIC Research Center, Department of Telematics Engineering, University of Vigo, 36310 Vigo, Spain.
| | - Paola Ingavélez-Guerra
- GI-IATa, UNESCO Chair on Support Technologies for Educational Inclusion, Universidad Politécnica Salesiana, 010102 Cuenca, Ecuador.
| | - José Juan Pazos-Arias
- AtlantTIC Research Center, Department of Telematics Engineering, University of Vigo, 36310 Vigo, Spain.
| | - Fernando Pesántez-Avilés
- GI-IATa, UNESCO Chair on Support Technologies for Educational Inclusion, Universidad Politécnica Salesiana, 010102 Cuenca, Ecuador.
| | - Manuel Ramos-Cabrer
- AtlantTIC Research Center, Department of Telematics Engineering, University of Vigo, 36310 Vigo, Spain.
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Jalali R, Mohammadi M, Vaisi-Raygani A, Ghobadi A, Salari N. Prevalence of unwanted pregnancy in Iranian women: a systematic review and meta-analysis. Reprod Health 2019; 16:133. [PMID: 31484563 PMCID: PMC6727578 DOI: 10.1186/s12978-019-0804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unwanted pregnancies are considered as one of the most important public health risks. Regarding the importance of the unwanted pregnancy in the country and helping health policy-makers obtain more accurate information on this issue, this study aims to provide a systematic review and meta-analytical on the prevalence of unwanted pregnancies in Iran. METHODS The present study was carried out using meta-analysis. Articles related to the topic were obtained through SID, Magiran, Scopus, PubMed, and ScienceDirect and Google Scholar databases from 2001 to 2017, Articles written based on cross-sectional studies were included in the study and other overviews, case-control, cohort, and interventional studies were excluded from the list of articles. Heterogeneity of studies was investigated using I2 index and data analysis was performed in Comprehensive Meta-Analysis software (Version 3). RESULTS In 23 articles, the prevalence of unwanted pregnancy in Iranian women was 27.9% (95%CI: 24-32.1%). The meta-regression analysis was used in two sample sizes and years of study. It was reported that as the sample size and Years increases, the prevalence of the unwanted pregnancy decrease, this difference was also statistically significant (P = 0.000). CONCLUSION Considering that the prevalence of unwanted pregnancy is high in Iran, it is necessary that health policy makers take effective measures to enhance the awareness of couples and public information about the risks of the unwanted pregnancy.
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Affiliation(s)
- Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aliakbar Vaisi-Raygani
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akram Ghobadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Ups J Med Sci 2019; 124:203-212. [PMID: 31495254 PMCID: PMC6758707 DOI: 10.1080/03009734.2019.1653407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
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Affiliation(s)
- Yvonne Skogsdal
- Maternal Health Care Unit, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- CONTACT Yvonne Skogsdal Maternal Health Care Unit, Region Örebro County, Box 1613, SE-701 16, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala, Sweden
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Orozco-Olvera V, Shen F, Cluver L. The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth: A meta-analysis, 1985-2017. PLoS One 2019; 14:e0209969. [PMID: 30753185 PMCID: PMC6372167 DOI: 10.1371/journal.pone.0209969] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022] Open
Abstract
Background Risky sexual behaviors are associated with the transmission of sexually transmitted infections (STIs) and unwanted pregnancies, both major health concerns for youth worldwide. This review studies the effectiveness of narrated mass media programs in promoting safer sexual practices among youth in developed and developing countries. Methods Electronic and manual searches were conducted to identify experimental and quasi-experimental studies with robust counterfactual designs published between 1985 and the first quarter of 2017. Effect sizes were meta-analyzed using mixed-effects models. Results Eight experimental and two quasi-experimental studies met our inclusion criteria. The aggregated sample size was 23,476 participants, with a median of 902 participants per study. Entertainment education narratives had small but significant effects for three sexual behaviors. It reduced the number of sexual partners [standardized mean difference, (SMD) = 0.17, 95% confidence interval (CI) = 0.02–0.33, three effect sizes], reduced unprotected sex (SMD = 0.08, 95% CI = 0.03–0.12, nine effect sizes), and increased testing and management for STIs (SMD = 0.29, 95% CI = 0.11–0.46, two effect sizes). The interventions were not effective in reducing inter-generational sex, measured through the age-gap with sexual partners (SMD = 0.06, 95% CI = -0.06–0.19, four effect sizes). Entertainment education had medium-size effects on knowledge outcomes (SMD = 0.67, 95% CI = 0.32–1.02, seven effect sizes), where a time-decay relationship is observed. No effects were found on attitudes. Conclusion Although mass media entertainment had small effects in promoting safer sexual practices, its economies of scales over face-to-face interventions suggest its potential to be a cost-effective tool above an audience threshold. The use of study participants from the general youth population and the use of mostly effectiveness trials mitigate concerns regarding its scalability. The overall paucity of high-quality studies affirms the need for strengthening the evidence base of entertainment education. Future research should be undertaken to understand the moderator effects for different subgroups and intervention characteristics.
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Affiliation(s)
- Victor Orozco-Olvera
- Development Research Group, The World Bank, Washington DC, United States of America
- * E-mail:
| | - Fuyuan Shen
- Bellisario College of Communications, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Yaya S, Ghose B. Prevalence of unmet need for contraception and its association with unwanted pregnancy among married women in Angola. PLoS One 2018; 13:e0209801. [PMID: 30596733 PMCID: PMC6312300 DOI: 10.1371/journal.pone.0209801] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background Unmet need for contraception and unwanted pregnancy are recognised as significant barriers to promoting women’s reproductive health and well-being. Currently there is no research evidence on these two crucial indicators of reproductive care in Angola. Therefore, we conducted this study with the objectives of exploring the current prevalence of unmet need for contraception and unintended pregnancy as well as their relationship among married women in Angola. Methods This study was based on cross-sectional data from Angola Demographic and Health Survey (DHS) conducted in 2015–16. Participants were 7,808 married women aged 15–49 years. Unwanted pregnancy was measured in terms of the mistimed and unintended conception for the last-born child. Unmet need for contraception included those who reported unmet need for spacing and limiting. Data were analysed using bivariate and multivariable techniques. Results The combined prevalence of mistimed and unwanted pregnancy was 38.3% (95%CI = 35.9–40.7), and that of unmet need for contraception for spacing and limiting was 51.7% (49.9–53.5). Among the 18 regions, Luanda had the highest prevalence of unmet need for contraception and of unwanted pregnancy with the prevalence being higher than more than one-third of the women. Multivariable analysis significantly revealed a significantly positive association between unmet need and unwanted pregnancy. In all the models, the odds of unwanted pregnancy were found to be as high as four times among women with unmet need compared with those had no unmet need. Compared to women who had no unmet need, those who had unmet need had respectively four (OR = 4.380; 95%CI = 3.690–5.198) and seven (OR = 6.951; 95%CI = 4.642–10.410) times higher odds of experiencing unwanted pregnancy. Conclusion This study concludes that the prevalence of unmet need for contraception and unwanted pregnancy are high with significant disparities across the regions. Women in the capital city had the highest prevalence of both unmet need for contraception and unwanted pregnancy. Although the data were cross-sectional and do not indicate causal relationships, the findings showed a strong positive association between unmet need for contraception and unwanted pregnancy. However, it is recommended to conduct further studies to replicate the findings and to explore the influence behavioural and cultural practices on unwanted pregnancy.
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Affiliation(s)
- Sanni Yaya
- Faculté de médecine, Université de Parakou, Parakou, Benin
| | - Bishwajit Ghose
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
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Yi S, Te V, Pengpid S, Peltzer K. Social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries: a multi-country cross-sectional study. SAHARA J 2018; 15:71-79. [PMID: 30058474 PMCID: PMC6070966 DOI: 10.1080/17290376.2018.1503967] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chi-square test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD = 2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p < 0.001). Female students were significantly more likely to report unprotected sex compared to male students (50.5% vs. 58.8%, p = 0.01). Results of multivariable logistic regression analyses showed that students who reported having two or more partners in the past 12 months were significantly more likely to be male, be aged between 20-30, be current tobacco smokers, be binge drinkers, have severe depressive symptoms, and have been in a physical fight in the past 12 months, compared to students who reported having less than two sexual partners in the past 12 months. Health intervention programmes to prevent and control STIs, especially HIV infection, should focus on university students having the social and behavioural characteristics that are associated with risky sexual behaviours.
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Affiliation(s)
- Siyan Yi
- Senior Research Fellow, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health, Touro University California, Vallejo, CA, USA
| | - Vannarath Te
- Health Systems Research and Policy Support Unit, Ministry of Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Bangkok, Thailand
- Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
| | - Karl Peltzer
- Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
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Affiliation(s)
- Rachel Burton
- Liverpool Medical School, London School of Hygiene and Tropical Medicine, Liverpool L69 3GE, UK
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Abstract
The purpose of the study was to examine the association between women's experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ2 tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample-5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p < .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p < .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed.
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Affiliation(s)
- Gretchen E Ely
- University at Buffalo, The State University of New York, Buffalo, New York
| | - Nadine S Murshid
- University at Buffalo, The State University of New York, Buffalo, New York
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Aztlan EA, Foster DG, Upadhyay U. Subsequent Unintended Pregnancy Among US Women Who Receive or Are Denied a Wanted Abortion. J Midwifery Womens Health 2018; 63:45-52. [PMID: 29377521 DOI: 10.1111/jmwh.12723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Seventeen percent of women in the United States experience more than one unintended pregnancy in their lifetimes. However, few studies examine how the resolution of unintended pregnancy, whether in birth or abortion, affects the likelihood of a subsequent unintended pregnancy. Our objective was to determine whether receiving or being denied a wanted abortion is associated with subsequent unintended pregnancy. METHODS The Turnaway Study, a 5-year, prospective cohort study, followed women who sought an abortion at one of 30 abortion facilities across the United States between 2008 and 2010. Secondary analysis of the Turnaway data analyzed the effects of various factors on time to subsequent unintended pregnancy. RESULTS By 5 years, the rate of unintended pregnancy was 42 per 100 women with no difference between those who received and those who were denied a wanted abortion. Women aged 35 to 46 years (vs those aged 20-24 years), women with a college degree (vs women who had completed high school or obtained a general education diploma), and foreign-born (vs native-born) women had a reduced rate of a subsequent unplanned pregnancy (adjusted hazard ratio [AHR], 0.30; 95% confidence interval [CI], 0.16-0.57; AHR, 0.54, 95% CI, 0.30-0.97; AHR, 0.44; 95% CI, 0.25-0.77, respectively). Higher parity and a history of depression were positively associated with a higher rate of subsequent unintended pregnancy. There was no difference in the outcomes of these unintended pregnancies by study group; approximately one-sixth ended in miscarriage and one-quarter of subsequent unintended pregnancies ended in abortion. DISCUSSION Neither receiving nor being denied abortion is associated with subsequent unintended pregnancy risk. Other factors such as nativity, parity, age, and mental health history are associated with multiple unintended pregnancies. Ensuring access to abortion services will not increase the likelihood that women will experience subsequent unintended pregnancies.
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Abstract
BACKGROUND Twenty states currently require that women seeking abortion be counseled on possible psychological responses, with six states stressing negative responses. The majority of research finds that women whose unwanted pregnancies end in abortion do not subsequently have adverse mental health outcomes; scant research examines this relationship for young women. METHODS Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed. Population-averaged lagged logistic and linear regression models were employed to test the relationship between pregnancy resolution outcome and subsequent depressive symptoms, adjusting for prior depressive symptoms, history of traumatic experiences, and sociodemographic covariates. Depressive symptoms were measured using a nine-item version of the Center for Epidemiologic Studies Depression scale. Analyses were conducted among two subsamples of women whose unwanted first pregnancies were resolved in either abortion or live birth: (1) 856 women with an unwanted first pregnancy between Waves 2 and 3; and (2) 438 women with an unwanted first pregnancy between Waves 3 and 4 (unweighted n's). RESULTS In unadjusted and adjusted linear and logistic regression analyses for both subsamples, there was no association between having an abortion after an unwanted first pregnancy and subsequent depressive symptoms. In fully adjusted models, the most recent measure of prior depressive symptoms was consistently associated with subsequent depressive symptoms. CONCLUSIONS In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.
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Affiliation(s)
- A M Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California,Berkeley, Berkeley, CA,USA
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van Ditzhuijzen J, Ten Have M, de Graaf R, van Nijnatten CHCJ, Vollebergh WAM. [Abortion and the risk of mental disorders]. Tijdschr Psychiatr 2018; 60:527-535. [PMID: 30132581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research into the potential mental health consequences of abortion yields inconsistent results and is characterized by methodological limitations.<br /> AIM: To offer a more conclusive insight into women's mental health after an abortion by stringently taking both pre-abortion mental health and confounding covariates into account.<br /> METHOD: A prospective longitudinal cohort study, the Dutch Abortion and Mental Health Study (DAMHS), through which women with and without abortion experiences could be compared. The study was designed in a similar way to the large scale Dutch population study into mental health of the Trimbos Institute, the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2).<br /> RESULTS: Women who had an abortion were significantly more likely to have had previous DSM-IV mental disorders. Psychiatric history appeared to be associated with how women experienced and handled the unwanted pregnancy and abortion. A prior history of mental disorders, averse recent life events or an unstable partner relationship increased the risk of developing post abortion mental disorders, while experiencing an abortion did not.<br /> CONCLUSION: Women who have had an abortion more often have a history of mental disorders, yet there is no evidence that an abortion in itself would increase the risk of developing a mental disorder.
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Aké-Tano SOP, Kpebo DO, Konan YE, Tetchi EO, Sable SP, Ekou FK, Attoh TH, Aka LN, Diarassouba B, Dagnan NCS. [Abortion practices in high school students in Yamoussoukro, Côte d'Ivoire]. Sante Publique 2017; 29:711-717. [PMID: 29384305 DOI: 10.3917/spub.175.0711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Induced abortion is illegal in Cote d'Ivoire, except when the mother's life is in danger. The primary objective of this study was to describe abortion practices among Yamoussoukro high school students. More specifically, this study estimated the prevalence of induced abortion, described the pathway and the methods used for abortion and determined any abortion-related complications. MATERIAL AND METHODS This cross-sectional study was conducted in July 2011 on 312 randomly selected girls attending the Lycée Jeunes Filles in Yamoussoukro. RESULTS These girls had a mean age (SD) of 16.1 (4.7) years; 258 (82.7%) of them had already had sexual intercourse and 81 (31.4%) had already been pregnant. Fifty (61.7% [56.3-67.1%]) of these 81 girls had already had an abortion. The abortion pathway was as follows: the main method was self-prescribed medication (70%) as first attempt, followed, in case of failure, by traditional healers (56.4%). Healthcare practitioners were usually consulted at the third attempt (85.7%). The most commonly used methods of abortion were drugs (91.9%), ingestion of plants/beverages (68.5%) and introduction of devices into the uterine cavity (62.3%). Twenty-two (44%) out of 50 induced abortions resulted in complications, mostly infectious complications (81.8%), and bleeding (68.2%). Complications were significantly associated with self-induced abortions or abortions performed by traditional healers (p < 0.001). CONCLUSION More intensive sexual education, access to modern methods of contraception, awareness campaigns concerning the risks related to unwanted pregnancies and abortions performed by non-medical personnel need to be implemented to prevent school abortions. The quality and accessibility of post-abortion services also need to be reinforced.
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Averbach S, Kakaire O, Kayiga H, Lester F, Sokoloff A, Byamugisha J, Dehlendorf C, Steinauer J. Immediate versus delayed postpartum use of levonorgestrel contraceptive implants: a randomized controlled trial in Uganda. Am J Obstet Gynecol 2017; 217:568.e1-568.e7. [PMID: 28610898 DOI: 10.1016/j.ajog.2017.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/12/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Use of long-acting, highly effective contraception has the potential to improve women's ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period. OBJECTIVE The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion. STUDY DESIGN This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum. RESULTS From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group. CONCLUSION Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals.
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Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Department of Reproductive Medicine, University of California, San Diego, San Diego, CA.
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Herbert Kayiga
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Abby Sokoloff
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine Dehlendorf
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Jody Steinauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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Kraus C, Hooper-Lane C. Are oral emergency contraceptives a safe and effective form of long-term birth control? J Fam Pract 2017; 66:632-634. [PMID: 28991943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Yes, but not as effective as some other methods. Annual pregnancy rates in women using pericoital levonorgestrel 150 mcg to 1 mg range from 4.9% to 8.9%; menstrual irregularity is the most common adverse effect (strength of recommendation [SOR]: B, Cochrane review of lower-quality trials). In women younger than 35 years who have sexual intercourse 6 or fewer times per month, correct and consistent use of pericoital levonorgestrel 1.5 mg results in an annual pregnancy rate of 11% (SOR: B, one large prospective, open-label trial). Pericoital contraception is less effective than long-acting reversible contraceptives (annual pregnancy rates of 0.05%-0.8%) or perfect use of combined oral contraceptives (0.3% annual pregnancy rate), but similar to, or better than, typical use of combined oral contraception (9%) and condoms (18%).
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Affiliation(s)
- Connie Kraus
- University of Wisconsin-Madison School of Pharmacy and Department of Family Medicine and Community Health, Madison, WI, USA
| | - Christopher Hooper-Lane
- University of Wisconsin-Madison School of Medicine and Public Health, Ebling Library, Madison, WI, USA
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Habib MA, Raynes-Greenow C, Nausheen S, Soofi SB, Sajid M, Bhutta ZA, Black KI. Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan. BMC Pregnancy Childbirth 2017; 17:156. [PMID: 28558671 PMCID: PMC5450067 DOI: 10.1186/s12884-017-1339-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/22/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). METHODS We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. RESULTS Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age < 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = < 12 months (AOR 1.7 1.4-2.2), having a parity of >2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85. CONCLUSIONS This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan.
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Affiliation(s)
- Muhammad Atif Habib
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, 2006, Australia.
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
| | | | - Sidrah Nausheen
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Sajid
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Kirsten I Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, NSW, 2006, Australia
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Teixeira LB, Pilecco FB, Vigo Á, Drachler MDL, Leite JCDC, Knauth DR. Factors associated with post-diagnosis pregnancies in women living with HIV in the south of Brazil. PLoS One 2017; 12:e0172514. [PMID: 28222175 PMCID: PMC5319676 DOI: 10.1371/journal.pone.0172514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To analyze the factors associated with the occurrence of pregnancies after the diagnosis of infection by HIV. Methods Cross-sectional study with women of a reproductive age living with HIV/AIDS cared for in the public services of the city of Porto Alegre, in southern Brazil. The data was analyzed from a comparison between two groups: women with and women without pregnancies after the diagnosis of HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). Results The occurrence of pregnancies after the diagnosis of HIV is associated with a lower level of education (RP adjusted = 1.31; IC95%: 1.03–1.66), non-use of condoms in the first sexual intercourse (RP = 1.32; IC95%: 1.02–1.70), being 20 years old or less when diagnosed with HIV (RP = 3.48; IC95%: 2.02–6.01), and experience of violence related to the diagnosis of HIV (RP = 1.28; IC95%: 1.06–1.56). Conclusions The occurrence of pregnancies after the diagnosis of infection by HIV does not indicate the exercise of the reproductive rights of the women living with HIV/AIDS because these pregnancies occurred in contexts of great vulnerability.
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Affiliation(s)
- Luciana Barcellos Teixeira
- Department of Professional Assistance and Guidance, Nursing School, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Flávia Bulegon Pilecco
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Álvaro Vigo
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Department of Statistics, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria de Lourdes Drachler
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Daniela Riva Knauth
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
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Zhang XD, Myers S, Yang HJ, Li Y, Li JH, Luo W, Luchters S. Prevalence and correlates of sexual and gender-based violence against Chinese adolescent women who are involved in commercial sex: a cross-sectional study. BMJ Open 2016; 6:e013409. [PMID: 27993907 PMCID: PMC5168686 DOI: 10.1136/bmjopen-2016-013409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Despite the vast quantity of research among Chinese female sex workers (FSWs) to address concerns regarding HIV/sexually transmitted infection (STI) risk, there is a paucity of research on issues of sexual and gender-based violence (SGBV) and the missed opportunity for sexual and reproductive health (SRH) promotion among young FSWs. Our research aimed to assess the prevalence and correlates of SGBV among Chinese adolescent FSWs, and to explore SRH service utilisation. DESIGN AND METHODS A cross-sectional study using a one-stage cluster sampling method was employed. A semistructured questionnaire was administered by trained peer educators or health workers. Multivariable logistic regression was conducted to determine individual and structural correlates of SGBV. SETTING AND PARTICIPANTS Between July and September 2012, 310 adolescent women aged 15-20 years, and who self-reported having received money or gifts in exchange for sex in the past 6 months were recruited and completed their interview in Kunming, Yunnan Province, China. RESULTS Findings confirm the high prevalence of SGBV against adolescent FSWs in China, with 38% (118/310) of participants affected in the past year. Moreover, our study demonstrated the low uptake of public health services and high rates of prior unwanted pregnancy (52%; 61/118), abortion (53%; 63/118) and self-reported STI symptoms (84%; 99/118) in participants who were exposed to SGBV. Forced sexual debut was reported by nearly a quarter of FSWs (23%; 70/310) and was independently associated with having had a drug-using intimate partner and younger age (<17 years old) at first abortion. When controlling for potential confounders, having experienced SGBV was associated with frequent alcohol use, having self-reported symptoms of STI, having an intimate partner and having an intimate partner with illicit drug use. CONCLUSIONS This study calls for effective and integrated interventions addressing adolescent FSWs' vulnerability to SGBV and broader SRH consequences.
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Affiliation(s)
- Xu-Dong Zhang
- Yunnan Research Centre for Hygiene and Health Management, School of Management and Economics, Kunming University of Science and Technology, Kunming, China
| | - Sierra Myers
- Burnet Institute, Melbourne, Victoria, Australia
| | - Hong-Juan Yang
- Yunnan Research Centre for Hygiene and Health Management, School of Management and Economics, Kunming University of Science and Technology, Kunming, China
| | - Yun Li
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China
| | - Ji-Hong Li
- Kunming Maternal and Child Health Care Centre, Kunming, China
| | - Wei Luo
- Sexually Transmitted Disease Unit, Kunming Centre for Disease Control, Kunming, China
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Mittal S. Emergency contraception: which is the best? Minerva Ginecol 2016; 68:687-699. [PMID: 27082029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Emergency contraception is a safe and effective method to prevent an unwanted pregnancy after an unprotected or inadequately protected sexual intercourse. Several methods for emergency contraception (EC) are currently registered in many countries for use in an emergency to prevent a pregnancy following an unprotected, possibly fertile intercourse or after a contraceptive accident like condom rupture. Different methods have varying modes of action, time frame of efficacy, dosage schedule and unwanted effects. Since several methods are available it is important to decide the best method. EVIDENCE ACQUISITION In this article the available literature on emergency contraception has been reviewed and an attempt has been made to discuss the need for emergency contraception and compare different options for emergency contraception in terms of their efficacy in pregnancy prevention, their safety profile and unwanted side effects. EC repeated use and initiating a regular method after EC use are also discussed. EVIDENCE SYNTHESIS Emergency contraceptive methods include copper Intra-uterine devices (IUD) and different types of pills like estrogen progestin combination pill (Yuzpe Regimen), Progestin only pill (LNG), antiprogestin pill (Mifepristone), and progesterone modulator Uripristal Acetate (UPA). There is a marginal difference in the mechanism of action, efficacy including time frame and ability to protect from pregnancy with regular doses in obese women, drug interactions and side effects. These are discussed in detail. CONCLUSIONS Copper IUD is the most effective emergency contraceptive with advantage of providing continued contraception. However, it cannot be used universally due to lack of infrastructure and a trained provider as well as not being suitable option for women at risk of sexually transmitted infections. Amongst different pills LNG is more effective with fewer side effects than Yuzpe regimen. LNG and UPA are comparable with similar efficacy and side effect profile. UPA has a wider window of efficacy, in LNG efficacy declines after 72 hours. UPA is more suitable for obese women. Mifepristone is effective but is registered as EC pill only in few countries and use is limited as it is also used as an abortion pill. Yuzpe regimen is the least effective of all contraceptive pills as EC, and works only till 72 hours of unprotected sex, but is useful in places where dedicated methods are not available, as it is easily accessible. Any combined pill can be used in this regimen except triphasic pill.
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Affiliation(s)
- Suneeta Mittal
- Department of Obstetrics and Gynecology, Fortis Memorial Research Institute, Gurgaon, India -
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Bonfrer I, Breebaart L, Van de Poel E. The Effects of Ghana's National Health Insurance Scheme on Maternal and Infant Health Care Utilization. PLoS One 2016; 11:e0165623. [PMID: 27835639 PMCID: PMC5106190 DOI: 10.1371/journal.pone.0165623] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
Increasing equitable access to health care is a main challenge African policy makers are facing. The Ghanaian government implemented the National Health Insurance Scheme in 2004 and the aim of this study is to evaluate its early effects on maternal and infant healthcare use. We exploit data on births before and after the intervention and apply propensity score matching to limit the bias arising from self-selection into the health insurance. About forty percent of children had a mother who is enrolled in this insurance. The scheme significantly increased the proportion of pregnancies with at least four antenatal care visits with 7 percentage points and had a significant effect on attended deliveries (10 percentage points). Caesarean sections increased (6 percentage points) and the number of children born from an unwanted pregnancy decreased (7 percentage points). Insurance enrollment had almost no effect on child vaccinations. Among the poorest forty percent of the sample, the effects of the scheme on antenatal care and attended deliveries were similar. However, the effects of the scheme on caesarean sections were about half the size (3 percentage points) and the reduction in unwanted pregnancies was larger (10 percentage points) compared to the effects in the full sample. We conclude that in the first years of operation, the National Health Insurance Scheme had a modest impact on the use of antenatal and delivery care. This is important for other African countries currently introducing or considering a national health insurance as a means towards universal health coverage.
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Affiliation(s)
- Igna Bonfrer
- Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands
- Harvard University, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Lyn Breebaart
- Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands
| | - Ellen Van de Poel
- Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands
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Hall JA, Barrett G, Phiri T, Copas A, Malata A, Stephenson J. Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis. PLoS One 2016; 11:e0165621. [PMID: 27798710 PMCID: PMC5087885 DOI: 10.1371/journal.pone.0165621] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies. METHODS 4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies. RESULTS 44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father's age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner's age and mother's education level. The effect of mother's education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies. CONCLUSION A simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This information can be used to target family planning services to those most at risk of unplanned pregnancies, particularly women with a history of depression or who are experiencing intimate partner violence.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
- * E-mail:
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
| | | | - Andrew Copas
- Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, United Kingdom
| | - Address Malata
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Judith Stephenson
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
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Theme-Filha MM, Baldisserotto ML, Fraga ACSA, Ayers S, da Gama SGN, Leal MDC. Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012. Reprod Health 2016; 13:118. [PMID: 27766945 PMCID: PMC5073899 DOI: 10.1186/s12978-016-0227-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Unintended pregnancy, a pregnancy that have been either unwanted or mistimed, is a serious public health issue in Brazil. It is reported for more than half of women who gave birth in the country, but the characteristics of women who conceive unintentionally are rarely documented. The aim of this study is to analyse the prevalence and the association between unintended pregnancy and a set of sociodemographic characteristics, individual-level variables and history of obstetric outcomes. METHODS Birth in Brazil is a cross-sectional study with countrywide representation that interviewed 23,894 women after birth. The information about intendedness of pregnancy was obtained after birth at the hospital and classified into three categories: intended, mistimed or unwanted. Multinomial regression analysis was used to estimate the associations between intendedness of a pregnancy, and sociodemographic and obstetric variables, calculating odds ratios and 95 % confidence intervals. All significant variables in the bivariate analysis were included in the multinomial multivariate model and the final model retaining variables that remained significant at the 5 % level. RESULTS Unintended pregnancy was reported by 55.4 % of postpartum women. The following variables maintained positive and significant statistical associations with mistimed pregnancy: maternal age < 20 years (OR = 1.89, 95 % CI: 1.68-2.14); brown (OR = 1.15, 95 % CI: 1.04-1.27) or yellow skin color (OR = 1.56, 95 % CI: 1.05-2.32); having no partner (OR = 2.32, 95 % CI: 1.99-2.71); having no paid job (OR = 1.15, 95 % CI: 1.04-1.27); alcohol abuse with risk of alcoholism (OR = 1.25, 95 % CI: 1.04-1.50) and having had three or more births (OR = 2.01, 95 % CI: 1.63-2.47). The same factors were associated with unwanted pregnancy, though the strength of the associations was generally stronger. Women with three or more births were 14 times more likely to have an unwanted pregnancy, and complication in the previous pregnancies and preterm birth were 40 % and 19 % higher, respectively. Previous neonatal death was a protective factor for both mistimed (OR = 0.61, 95 % CI: 0.44-0.85) and unwanted pregnancy (OR = 0.44, 95 % CI: 0.34-0.57). CONCLUSIONS This study confirms findings from previous research about the influence of socioeconomic and individual risk factors on unintended pregnancy. It takes a new approach to the problem by showing the importance of previous neonatal death, preterm birth and complication during pregnancy as risk factors for unintended pregnancy.
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Affiliation(s)
- Mariza Miranda Theme-Filha
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcia Leonardi Baldisserotto
- Epidemiology in Public Health, Auxiliar Researcher National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Susan Ayers
- Psychology, Centre for Maternal and Child Health Research, City University, London, UK
| | - Silvana Granado Nogueira da Gama
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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