Contraceptive Choice Research Articles

Contraceptive counselling and uptake of contraception among women with cardiovascular diseases: a systematic review and meta-analysis.

To address the lack of clarity regarding contraceptive counselling and uptake of contraception among women with cardiovascular disease (CVD), this study aimed to conduct a systematic review and meta-analysis on contraceptive counselling and the subsequent uptake of contraception among women with CVD. A search across six databases identified 1228 articles, with 11 studies (2580 participants) included. The pooled prevalence of contraceptive counselling was 63%, varying from 36 to 94% in individual studies. Inconsistent delivery and documentation of counselling were noted, along with a lack of knowledge about pregnancy complications and misconceptions regarding CVD severity. For contraceptive uptake (n = 5), the pooled prevalence was 64% (95% confidence interval, 45 to 82%). Women with CVD were also found to use less effective methods as well as methods not recommended for their condition (e.g., combined hormonal methods among participants with absolute or relative contraindications). Improving contraceptive counselling and choices for women with CVD can not only enhance knowledge and decision-making for women with CVD in line with their reproductive goals and preferences but reduce high-risk unintended pregnancies and adverse pregnancy outcomes.

Contraceptive counseling: Shared decision on contraceptive choices.

The promising results achieved in male hormonal contraceptive trials over the last decades suggest that new male contraceptives could hit the market soon. In shared decision-making counseling, couples and their healthcare provider collaborate to make decisions about contraception choices. This model of contraceptive counseling could aid men in taking responsibility for contraception and women in trusting their partners in family planning. The shared decision-making process in contraceptive counseling requires partners to provide input on their preferences, values, and desires, while healthcare professionals share medical knowledge and evidence-based information.It has been proven that this method leads to higher adherence and satisfaction. To ensure that contraceptive counseling is inclusive, fair, and supportive of different reproductive experiences and needs, it is crucial to incorporate the Reproductive Justice Framework into counseling.

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center.

This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

Contraceptive Utilization and Perceived Spousal Involvement among Female Employees of Child-bearing Age in a Private University in Ogun State, Nigeria

Objective: This study assessed the utilization and perceived spousal involvement in contraceptive use among female employees of child-bearing age in a private university in Nigeria. Methods: This was a descriptive cross-sectional study of 270 women who were selected using a purposive sampling method. A structured interviewer-administered questionnaire was used to elicit data. Contraceptive utilization was assessed as ever or never utilized. Perception of male involvement was graded as good or poor using items on the questionnaire. Data analysis was done using IBM SPSS version 22 and presented as tables. P&lt; 0.05 was taken as statistically significant. Results: Participants' mean age was 35.3± 5.9 years. Most 236 (87.4%) of them had tertiary education. Four-fifths- 219 (81.1%) had ever been counselled on family planning or utilized contraceptives 216 (80.0%). The majority 232 (85.9%) of the women had good perceived spousal involvement scores, while 38 (14.1%) of the women had poor perceived spousal involvement scores. There were statistically significant associations between receiving family planning counselling, spouse involvement in contraceptive choices, fear of side effects, and spousal refusal with the utilization of contraceptives and perception of spousal involvement (p&lt;0.001 in all instances) Conclusion: Receiving family planning counselling and spousal support positively influenced the utilization of contraceptives and the perception of male involvement, while the fear of contraceptive side effects had negative effects on both outcomes. There is a need to improve male engagement and female counselling in contraceptive use. Health education should also focus on debunking exaggerations of contraceptive side effects.

Unhealthy sexual practices among youth in Vhembe District, Limpopo province: A cross-sectional study.

Abstinence from sexual practice among youth not only prevents infections, HIV and AIDS, and unplanned pregnancies but also promotes healthy sexual practices and positive youth development. The study aims to explore and describe interventions to improve healthy sexual practices among youth in Vhembe district, Limpopo province. The study utilized a descriptive cross-sectional design with a sample size of 531 determined by the selected formular through probability, simple random technique. Using structured questionnaires for data collection from the participants. Validity was ensured and content and face validity. Reliability was ensured. Data was analysed using SPSS version 28.0. Ethical consideration was ensured during the study. The study results showed that 57.4% of the respondents indicated that they do not discuss their choice of contraceptive with their sexual partner, 80.6% of the respondents indicated that unplanned pregnancy can be prevented by supplying contraceptives programs at clinics and school while 83.2% of the respondents revealed that programs linked with contraceptive services can help prevent unplanned pregnancy. The study highlights the lack of contraceptive choice discussions among sexual partners, exposing them to risks of STIs, HIV and AIDS, and teen pregnancy, urging for improved healthcare access.

Men’s Involvement in Wives’ Contraceptive Choices: A Comparative Study in Rural and Urban Communities of Akure South Local Government Area

In rural Nigerian communities, men play a crucial role in family planning decisions, often determining if and how their wives can practice contraception. This study aimed to examine the extent of husbands&amp;apos; influence on their wives&amp;apos; contraceptive choices, comparing rural and urban areas in Akure South local government area. The research included a sample of 360 men, using a researcher-developed questionnaire and interview guide for data collection. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to analyze the data, and chi-square inferential statistics tested the hypothesis at a 0.05 significance level using SPSS version 17. Findings revealed that only 46% of rural respondents participated in family planning practices. Men’s engagement in these activities showed low mean values (2.21, 2.11, 2.25), indicating minimal involvement, primarily due to lack of information (40.5%) and limited contraceptive options (34.8%). Most men used condoms (23.8%), a combination of condoms and withdrawal (27.5%), or vasectomy (13.1%). The study concluded that male participation in family planning was low. To improve this, communities need better access to information, education, and communication. Cultural and religious barriers hindering male involvement in family planning should be addressed, and more male contraceptive options should be made available.

(109) AS SEEN ON TIKTOK: PERCEPTIONS AND UNDERSTANDINGS OF HORMONAL CONTRACEPTIVES ON SOCIAL MEDIA

Abstract Introduction Contraception plays an integral role in many women’s lives and is essential for family planning and treatment of myriad health conditions. Between 2017-2019, approximately 65% of women aged 15 to 49 in the United States were actively using a form of birth control. Social media has a significant influence over the contraceptive choices of many reproductive-aged women. TikTok, a platform established in 2017, is one of the fastest growing worldwide social media applications. In 2018, it was recognized in top charts as “Most Downloaded”, and by 2023, approximately 150 million Americans became active users. Beyond its entertainment value, TikTok serves as a communication platform to nearly 5 million businesses, and the healthcare sector is no exception. Objective This study assessed the attitudes and information users share about hormonal contraceptives (HC) on TikTok, to elucidate the type of information women are receiving. Additionally, the potential for healthcare providers to use this platform as a means to educate and reach millions of patients was explored. Methods Apify, a free data-scraping tool, was used to automatically extract and compile 593 TikTok videos. Frequently searched hashtags, such as #birthcontrol, #hormonalcontraceptive, and #pregnancyprevention, were utilized to identify videos. Inclusion criteria included videos from US-based content creators and videos with English audio or text. The number of views and shares, length of video, and location of content creator for each TikTok were populated by the online application and imported onto RedCap for data collection. Demographic data such as gender and what type of content creator was providing the information, along with topics being portrayed and characteristics of each video, were also collected on RedCap. Results 150 TikTok videos met our inclusion criteria. The average length of each TikTok was 47.08 seconds. The average number of views and shares were 4,623,942 and 9,952, respectively. The predominant HCs discussed were intrauterine devices (IUDs), depo-provera injections, and contraceptive implants. Prevalent themes included negative personal anecdotes, general health information, and side effects. Additionally, the most common characteristics of the Tiktoks were humor and education. Most of the content creators were female (91%), and non-medical professionals (62%). Of the videos created by medical professionals, 25% were created by physicians, 26% by nurse practitioners, followed by nurse midwives (19%), physician assistants (14%), and registered nurses (5%). Conclusions Through short and engaging videos, TikTok has the ability to reach a wide and diverse audience. Oftentimes, users create TikToks that reveal their concerns, frustrating encounters, and how side effects impact their lives. Further studies may include determining how personal experiences of HC influence TikTok users’ acceptability, adherence, and attitudes. Given its reach, medical professionals should consider using the platform to engage with patients and provide evidence based education regarding HC. Disclosure No.

Unusual Case of Vaginal Bleeding in A Teenager Caused by Endometrial Cast: Case Report and Literature Review

Introduction Endometrial cast, a rare occurrence in gynaecology, is the expulsion of the near entirety of the endometrial lining of the uterine cavity, often maintaining the shape of the uterus. Also known as membranous dysmenorrhoea and largely associated with use of a progesterone-containing contraceptive; some cases following oral contraceptive pills (OCP) use in adolescence for the management of heavy menstrual bleeding (HMB), have been reported. Case Report A 16-year-old nulliparous girl presented with a sudden passage of tissue per vagina (PV) following a short duration of PV bleeding and short-lasting crampy abdominal pain, after a 3-month regular use of Rigevidon® (a combined oral contraceptive pill (OCP) containing ethinylestradiol and levonorgestrel): a contraceptive choice. Noted was a previously normal menstrual cycle following menarche at age 12 with an unremarkable past medical history, a negative urine pregnancy test and an empty uterus on ultrasound scan. Histological examination of the 14cm-long flat fleshy mass with an intrauterine outline confirmed an endometrial or decidual cast. Discussion Cast formation, with different underlying mechanisms – inadequate estrogen opposition effect on endometrium from dysfunctional oestrogen-progesterone imbalance +/- dysfunctional progesterone-mediated cellular Tissue inhibitors to- and matrix metallopeptidases (TIMP/MMP) – has been associated with HMB, ectopic gestations, miscarriages and secondary postpartum haemorrhage. Our case had no preceding significant risk factors and inadequate sonographic-evidence- a common occurrence in literature. This led to diagnostic and management challenges, increasing anxiety and treatment morbidity. Management in young women should be expectant +/- hormonal treatment. Reassurance with individualised progestogens type and dose will aid contraceptive-compliance. Conclusion While endometrial/decidual cast is not associated with a deleterious health effect, it can be distressing to patients and a diagnostic challenge to clinicians, unfamiliar with it. More research into underpinning pathways and disease associations is needed.

Post abortion contraception: A follow up study in women undergoing first and second trimester abortion at a tertiary care centre

: Worldwide 75 million women need post abortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. Majority of them do not wish to conceive in near future and are receptive towards using contraception. Contraceptive counselling and basket of choices should be made available to all women undergoing abortion and her right to decline or postpone this care should be respected while recognizing that each woman has a unique unmet need of contraception.: To compare the acceptance and continuation of various contraceptive choices offered after first and second trimester abortion. : A retrospective study was conducted at a tertiary care hospital in which women who underwent first and second trimester abortion over a period of one year were interviewed regarding their acceptance and continuation of the contraceptive method till six months post abortion.: A total of 378 women underwent first and second trimester abortions over one year, of which 61.3% had resulted from failure of contraception. Women were grouped into Group A for those undergoing first trimester and Group B for women undergoing second trimester abortion for study purpose. Average age of women in group A was 28.9 years and in group B was 26.5 years. Mean period of gestation of pregnancy in group A was 7.5weeks and in group B was 19.5 weeks. In group A 96% parous women had conceived as a result of failure of contraception of which 90% were using natural method (Coitus Interruptus). Group B majority (76.3%) women were nulliparous and early parous (P1, P2) and indication for termination of pregnancy in them were gross congenital anamolies (GCA) in fetus while in rest of multiparous were due to failure of contraception. With group A 53.1% nulliparous women did not opt for any contraception whereas 48.6% primiparous and second parous opted for long acting reversible contraception(LARC) –Intrauterine contraceptive device(IUCD) in contrast to 66% multiparous opting for permanent sterilization at the time of abortion. In group B 45.3% nulliparous and early parous opted for depot medroxy progesterone acetate (DMPA) and 64.2% multigravidas underwent permanent sterilization. : Post abortion care must include counselling and choice of contraceptive basket. Women with future reproductive plans preferred LARC after first trimester abortion whereas DMPA was most acceptable method of contraception after second trimester abortion. Women were most satisfied with LARC and permanent methods compared to methods that required daily intake of pills. There is need of effective contraceptive choices according to the reproductive plans of the women to reduce the burden, morbidity and mortality associated with abortions.

Sexual behaviour among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Data from the ECHO randomized trial.

Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments. This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression. We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the '>' and '<' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively. These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study.

Despite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE). Our four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15-24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance. In-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2-4 levels. Identifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.

Relationship between classic indicators of health behaviour and contraceptive choices in women in Flanders

BackgroundIn this study we shed light on ongoing trends in contraceptive use in Flanders (Belgium). Building on the fundamental cause theory and social diffusion of innovation theory, we examine socio-economic gradients in contraceptive use and the relationship to health behaviours.MethodsUsing the unique and recently collected (2020) ISALA data, we used multinomial logistic regression to model the uptake of contraceptives and its association to educational level and health behaviour (N:4316 women).ResultsHigher educated women, and women with a healthy lifestyle especially, tend to use non-hormonal contraceptives or perceived lower-dosage hormonal contraceptives that are still trustworthy from a medical point of view. Moreover, we identified a potentially vulnerable group in terms of health as our results indicate that women who do not engage in preventive health behaviours are more likely to use no, or no modern, contraceptive method.DiscussionThe fact that higher educated women and women with a healthy lifestyle are less likely to use hormonal contraceptive methods is in line with patient empowerment, as women no longer necessarily follow recommendations by healthcare professionals, and there is a growing demand for naturalness in Western societies.ConclusionThe results of this study can therefore be used to inform policy makers and reproductive healthcare professionals, since up-to-date understanding of women’s contraceptive choices is clearly needed in order to develop effective strategies to prevent sexually transmitted infections and unplanned pregnancies, and in which women can take control over their sexuality and fertility in a comfortable and pleasurable way.

Contraceptive Attitudes and Beliefs of Women With Sickle Cell Disease: A Qualitative Study

ObjectivesWe aimed to qualitatively explore factors influencing contraceptive use in women living with sickle cell disease (SCD). Study DesignWe conducted a semi-structured qualitative study using data from interviews with reproductive-aged women with SCD. The Theory of Planned Behavior, which describes an individual's attitudes, subjective norms, and perceived behavioral control as drivers of a health behavior, served as a framework for data collection and thematic analysis. ResultsWe analyzed interviews from 20 participants. Attitudes toward contraception showed skepticism regarding hormonal contraception and concern about adverse effects of contraception related to SCD. The role of subjective norms in contraceptive choice depended on whether participants possessed trusted sources of information, such as health care providers, family, and friends, or whether they relied on themselves alone in their contraceptive decision-making. The influence of health care providers was complicated by inconsistent and sometimes conflicting counseling. Finally, with regard to participants’ perceived control in their contraceptive choices, some were motivated to alleviate menstrual pain or prevent SCD-related pregnancy risks, but many reported feeling disempowered in contraceptive decision-making settings because of ways that healthcare providers exerted pressure or responded to participants’ demographic characteristics. ConclusionsWomen living with SCD are influenced by many factors similar to those documented for other populations when making decisions about contraception. However, SCD amplifies both the importance and risks of contraception and may also complicate individuals' autonomy and contraceptive access. Hematology and reproductive health providers should recognize the risk of coercion, maximize patients’ reproductive agency, and coordinate reproductive health counseling for patients with SCD.

Who Is Financially Constrained in Their Choice of Contraceptive Method? Lessons from M-CARES

The Michigan Contraceptive Access, Research, and Evaluation Study (M-CARES) is a randomized control trial that examines how financial constraints affect the choice of contraceptives among uninsured individuals. Although all M-CARES participants are highly financially constrained, these constraints are more binding in some subgroups. Black women, women with less than a high school degree, and women with incomes above 250 percent of the federal poverty line are less financially constrained, whereas married women and those with three or more children are more financially constrained. A mediation analysis shows that attitudes and beliefs about contraception do not explain this heterogeneity across groups.

CONTRACEPTION IN WOMEN WITH CARDIOVASCULAR RISK; UNIVERSITY HOSPITAL CENTER OF TLEMCEN, ALGERIA

Objective: Study the vascular risk in women using oral hormonal contraception. Design and method: Descriptive study, interested in studying the blood pressures of women using contraception compared to women not using it. The data were entered and analyzed by Epi-info 6 software. Results: In total, 122 women were included in our study, 36 of whom were aged between 21 and 55 years, or 29.5% of cases. Women aged over 60 represented 73.7% of cases; 54.1% were married. There were 98 women users of oral contraception (OC), all ages combined, or 80.3%, compared to 25 women who did not use OC, or 20.5%. The prevalence of hypertension was 74.2% among female OC users; and 68% among women who do not use CO. Epidemiological profile and associated risk factors of hypertensive women using oral contraception: In number of 72. Women aged under 50 represented 23.6% and those aged over 60: 76.4%. A low socioeconomic level was noted for 72.2% and medium for 23.6%. Low educational level: 45.8%, Women who did not have a profession represented 70%. Married women represented 60% of cases and widows 38.9% with an average number of children of five. The average duration of hypertension was 12.15 ± 7.75 years, with a length of service ranging from one year to 40 years. The average duration of contraception was 24 ±7.6 years. Associated risk factors: diabetes 44.4%, hypercholesterolemia: 18.1%, migraine 14%, obesity: 12.5% and tobacco 4.2%. Conclusions: Many epidemiological data has investigated the link between oral contraceptive use and elevated blood pressure. In our study, hypertensive women who used oral contraception had significant risk factors; long-standing high blood pressure with an average of more than ten years and taking oral contraception for a long time with an average of more than twenty years. A woman with high blood pressure will be more limited than other women in her choice of contraceptive method.

Association Between Proximity to Delivery Hospital and Postpartum Contraception Choice [ID 2683622

INTRODUCTION: Proximity to prescribers may present a barrier to postpartum contraceptive care. We examine associations between postpartum contraceptive choice and residential proximity to the prescribing, delivery hospital. METHODS: After IRB approval, we collected electronic medical record data from 2020 to 2022 at an inner-city, academic hospital and used CDXGeoData to determine residential distance to the hospital. Contraceptive choice at delivery, 2 weeks, and 6 weeks postpartum, focusing on long-acting reversible contraception (LARC) versus other contraceptives, was compared across distance to hospital. RESULTS: We identified 3,705 births: 53.5% Black, 30.3% Hispanic, and 73.7% utilizing public health insurance. Residential distance to the hospital was 0–1,724 miles with 74.2% living within 10 or fewer miles. Those residing within 10 miles were more likely to be non-Black (X2 (2)=12.02; P&lt;.01), Hispanic (X2 (2)=83.91; P&lt;.001), single (X2 (3)=33.54; P&lt;.001) and primiparous (X2 (3)=13.09; P&lt;.01). Cesarean section was more frequent (32.5% versus 28.1%; X2 (2)=6.58; P&lt;.01) and gestational age shorter (U=1171108; P&lt;.05) for those living further from the hospital. Postpartum tubal ligation did not differ across groups. LARC uptake at discharge and 2 weeks postpartum trended towards being higher for women who lived further (X2 (1)=3.49; P=.06; aOR 1.15; 95% CI, 0.96–1.39). CONCLUSION: There is a trend towards increased LARC uptake if the patient resides further from their delivery hospital after controlling for confounding factors. Our findings add to understanding of patient preferences and barriers to care.

Association Between Contraceptive Efficacy Knowledge and Method Choice: A Behavioral Economics Lens [ID 2683608

INTRODUCTION: Patients often use less effective contraception despite desire to avoid pregnancy, a decision considered “irrational” by neoclassical economic theory. “Bounded rationality,” a behavioral economics principle encompassing information failure, may underlie such decisions. We assess the role of bounded rationality on contraceptive decision-making by evaluating the relationship between contraceptive efficacy knowledge and contraceptive choice. METHODS: We used the Guttmacher’s publicly available “Continuity and Change in Contraceptive Use” dataset, a survey administered 2012–2014. Contraceptive effectiveness was grouped into Tier 1, Tier 2, “Other,” and “No Method” based on survey options and CDC classification. Contraceptive knowledge was assessed by two questions comparing effectiveness of oral contraceptive pills (OCPs) versus condoms and OCPs versus intrauterine devices (IUDs). We used logistic regression to calculate odds ratios (ORs) for the association between contraceptive tier used and contraceptive knowledge, adjusted for race/ethnicity and age, with each regression restricted to users of the two methods compared. RESULTS: Our sample included 4,634 respondents. 43.8% accurately compared OCPs and condoms; 30.1% accurately compared OCPs and IUDs. Answering that condoms are more effective than OCPs was associated with seven times greater odds of using other methods (OR 7.1; 95% CI, 4.5–11.1). Answering that OCPs are more effective than IUDs was associated with 0.01 odds of using Tier 1 over Tier 2 (95% CI, 0.005–0.05). CONCLUSION: Consistent with bounded rationality, respondents who incorrectly compared contraceptive efficacy were far more likely to use the less effective method. Contraception misconceptions, particularly regarding relative efficacy, should be assessed and addressed when offering patient-centered counseling.

Contraceptive methods continuation and its determinants among acceptors on repeat visits to a Nigerian University Teaching Hospital: a 10-year review

Background: Family planning is a known reproductive health modality for reducing the high maternal mortality in Nigeria. Contraceptive use and continuation is thus necessary to achieve its benefits. The study aimed to determine the contraceptive options and the factors associated with the continuation of contraceptive choices among women on repeat visits. Methods: This was a 10-year retrospective study of the family planning clinic register of all clients who presented for a repeat visit for contraceptive method continuation at the University of Uyo Teaching Hospital. Results: There were 6939 contraceptive acceptors on repeat visits aged between 14 and 50 years (mean 31.6 years, SD 5.4). The majority were 26 to 30 years (32.9%), had secondary education (54.6%), were multiparous (90.9%) and chose the subdermal implant (34.9%) and the intrauterine contraceptive devices (27.7%) for continuation. There was a significant association between the women`s age (Df=3, F=10.81, p&lt;0.0001), their educational status (Df=6, Χ2=38.5583, p&lt;0.0001), their parity (Df= 15, Χ2 =76.8644, p&lt;0.0001) and the contraceptive method continued. Conclusions: An interest in long-acting reversible contraceptives for continuation was found, and this is significantly associated with their sociodemographic and obstetric characteristics; however, we recommend cross-sectional and focus-group inquiries among clients in the different contraceptive-specific categories for further information on the reasons for their choices at subsequent visits.

Creating Lasting Love: An Ethnographic Study of Sexual Pleasure, Intimacy and Contraception

Sexual pleasure and intimacy are key reasons why people have sex, yet it remains underexamined in our understanding of how people make decisions about contraception. This paper draws on ethnographic research of the intersections between sexual pleasure, intimacy and contraception among women using specialist contraceptive services in central London. I describe how contraceptive use and choices are intertwined with how women assess intimacy in their sexual relationship, and not solely a desire to avoid pregnancy. How and when women use contraceptives relays their concerns about creating and maintaining pleasure and intimacy in their sexual relationships. Moreover, this ethnographic account illustrates how women draw on various contraceptive methods in their decision making and use them to increase communication and trust, distinguish relationships and potentially enhance sexual pleasure, which is indexical and necessary for enduring intimate connections. Considering intimacy alongside sexual pleasure also allows us to consider the relational dimensions of contraceptive choice and how these are far from static, one-off decisions. These empirical insights into intimacy illustrate that contraceptive choice is both a reflection of the perceived intimacy in a relationship and is also a “practice of intimacy”, particularly when people are navigating the various forms of intimacies available.

Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs

ObjectivesImmediately following the Dobbs decision, Ohio prohibited abortion after the detection of fetal cardiac activity. We aimed to characterize changes in the uptake of long-acting reversible contraception (LARC) and permanent contraception following the abrupt enactment of restrictive abortion legislation. Study designWe conducted a retrospective cohort study using electronic medical record data of patients aged 15 to 55 who underwent permanent contraception (tubal ligation, vasectomy) or LARC placement (intrauterine device, contraceptive implant) at a multihospital system in northeast Ohio from January 1, 2022 to Decemeber 31, 2022, 6 months before and after Dobbs. We compared procedure volumes and patient characteristics. ResultsWe identified 4247 tubal ligation and LARC procedures pre-Dobbs, including 725 (17.1%) permanent contraception and 3522 (82.9%) LARC. Post-Dobbs, the total number of tubal ligation and LARC procedures increased by 15.8% (4916), and there was a significant increase in the proportion of permanent contraception, (p < 0.001). Vasectomy volume increased by 33.3% post-Dobbs, from 1193 to 1590 procedures. Compared to pre-Dobbs, patients undergoing contraceptive procedures post-Dobbs were younger (tubal ligation and LARC, 30.9 median years [24.5, 36.8] vs 31.5 [25.2, 36.9], p = 0.011; vasectomy, median 36.6 years [32.9, 39.6] vs 37.2 [34.2, 40.4], p < 0.001) and more likely to report single relationship status (57.4% vs 55.9% for tubal ligation and LARC, p = 0.028% and 23.0% vs 18.1% for vasectomy, p = 0.002). ConclusionsThis study demonstrates increased uptake of contraceptive procedures following the Dobbs decision. This rise in permanent contraception suggests a relationship between abortion policy and contraceptive decision-making, especially among younger patients. ImplicationsIncreased permanent and long-acting reversible contraception procedures following Dobbs reveal shifting contraceptive choices, particularly among younger individuals, indicating a connection between abortion policy and reproductive decisions.