Contraceptive Consultations Research Articles

Prevalence and associated risk factors of Mycoplasma genitalium infection in women in Western Cameroon: A cross sectional study.

Background Mycoplasma genitalium is implicated in genitourinary disorders in both men and women as a sexually transmitted infection (STI). This study aimed to ascertain the prevalence of M. genitalium and identify associated risk factors among women. Aim To investigate the prevalence of M. genitalium and identify various risk-factors associated with M. genitalium infection in women attending the clinic in Western Cameroon. Methods A cross-sectional study was conducted in hospitals from five districts of Western Cameroon on sexually active and non-menstruating women attending for antenatal, prenuptial and contraception consultations,between January 2020 and July 2020. Endocervical swabs (n = 680) were collected, and M. genitalium was detected using real-time PCR targeting the MgPa and pdhD genes. Results A total of 680 women, characterised by a mean age of 27.4 ± 7.5 years, were included in this study. The overall prevalence of the M. genitalium infection was 5.2%. Bivariate analysis revealed that having more than one sexual partner was independently associated with three times higher odds of prevalent M. genitalium infection (OR 2.9, 95% CI: 1.03-8.56). Limitation Cross-sectional design limits exploring temporal relationships with other STIs. Freezing specimens for a year until PCR testing may have compromised detection rates of M. genitalium. Conclusion This study contributes valuable data to the limited understanding of M. genitalium epidemiology. The findings may aid in the formulation of national clinical standards for testing and screening strategies, emphasising the importance of addressing associated risk factors in the targeted population.

MHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice

Background A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods’ effectiveness and clarity on how healthcare professionals include them in contraceptive counselling. Objectives To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings. Methods We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis. Results In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods. Conclusion To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception. Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.

Drug interactions and hormonal contraception

There are several classes/types of drugs that interact with hormonal contraception, which can increase or reduce the effectiveness of the contraception. Contraceptive hormones can also increase or decrease the safety and effectiveness of certain drugs the individual is taking. Therefore, it is important for any health professional who provides contraception to take a through drug history and check interactions before prescribing. Health professionals must ensure contraceptive consultations are thorough, and that these drug interactions are avoided to ensure optimum prescribing and unintended pregnancy. The Faculty of Sexual and Reproductive Health has updated its guidance on drug interactions with hormonal contraception, and this article provides a summary of this updated guidance, along with best practice points.

Effects of virtual reality on pain during intrauterine device insertions: A randomized controlled trial

ObjectivesThe trial aimed to compare the pain perceived by women during intrauterine device (IUD) insertion, with or without virtual reality (VR) therapy. Furthermore, anxiety during the insertions, pain after the insertions, and satisfaction with the insertions were compared. MethodsThe trial was designed as a prospective, bi-centric, randomized, open-label interventional trial. All adult women that chose an IUD during a contraceptive consultation, and who provided informed consent were eligible. Women under legal guardianship, not affiliated to a national social security system, and with pre-existing dizziness, severe facial wounds, or epilepsy were not eligible. Eligible women were randomly allocated either standard care without VR therapy (Control group) or with VR therapy (Experimental group). Pain, anxiety, and satisfaction were measured using a 10-cm numerical scale. ResultsBetween September 2020 and April 2022, 100 women were randomized: 50 to each group. The mean pain scores during IUD insertion were 5.4 cm in the Control group versus 5.1 cm in the Experimental group (p = 0.54). Mean anxiety during insertion were 4.8 cm in the Control group versus 4.2 cm in the Experimental group (p = 0.13). While mean pain perceived after insertions were 2.4 cm in the Control Group and 2.4 cm in the Experimental group (p = 0.98). Mean satisfaction with the insertions was 9.6 cm in both groups (p = 0.87). Anxiety before IUD insertion, as well as anticipated pain, were significantly correlated with pain perceived during insertions. ConclusionsVR therapy performed during the procedure did not alleviate perceived pain in women undergoing IUD insertions.

Medication Adherence and Contraceptive Counseling.

Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives' contraceptive counselling.

Contraception consultation and assessment for women over 40

Access to contraception is a basic human right, and one that empowers women to support pregnancy planning. When assessing a woman over the age of 40 for contraception, concerns such as co-morbidity, changes to menstrual pattern, irregular bleeding and the management of additional perimenopausal and menopausal symptoms are essential considerations. While many methods of contraception can be used in menopause, some may need to be changed to safer, alternative methods. Most women will require some form of contraception (often taken alongside hormone replacement therapy) until the age of 55. This article will focus on contraception consultation and assessment, prescribing considerations in relation to age and menopause, contraceptive formulations (hormonal methods and the copper IUD and the potential health implications of using specific forms of contraception.

School, behavior and health-related difficulties in early adolescents with contraceptive consultation: a population-based study in eastern France.

Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behavior and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behavior and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. This cross-sectional study included 1559 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviors. Data were analyzed for each gender separately using logistic regression models. The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on Odds Ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and obesity while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behavior and health-related problems during adolescent contraceptive consultations.

How to complete a safe and effective contraceptive consultation

The contraceptive consultation should focus on the provision of safe, effective contraception that suits the individual’s requirements. It is important to take a comprehensive medical and drug history to ensure that the chosen method is safe for the individual at both initiation and review consultations. A review consultation is a good opportunity to discuss other – often more effective – methods of contraception. Remote contraceptive consultations are suitable for many patients, as long as the same high standards of care are provided as they would be in a face-to-face consultation. Nurses offering contraceptive services should ensure they keep up to date with the latest clinical guidance. Contraceptive consultations are a key part of providing safe and effective contraceptive care. Claire Nicol explains how to conduct these in an efficient way

How to complete a safe and effective contraceptive consultation

The contraceptive consultation should focus on the provision of safe, effective contraception that suits the individual's requirements. It is important to take a comprehensive medical and drug history to ensure that the chosen method is safe for the individual at both initiation and review consultations. A review consultation is a good opportunity to discuss other – often more effective – methods of contraception. Remote contraceptive consultations are suitable for many patients, as long as the same high standards of care are provided as they would be in a face-to-face consultation. Nurses offering contraceptive services should ensure they keep up to date with the latest clinical guidance.

Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes.

IntroductionTo develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians.MethodsA list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice “best-worst scaling” approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined.ResultsFor 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based “most-preferred” method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93.ConclusionsA best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.

Averting neonatal abstinence syndrome and treating addiction among rural, opioid-using young women.

America's opioid epidemic has spawned an epidemic of neonatal abstinence syndrome (NAS). Studies have not tested approaches to promoting contraceptive services for women with opioid use disorder(OUD) along with treatment for this disorder. This pilot study examined the promotion of medication for OUD(MOUD) treatment and contraception use, primarily long-acting reversible contraception (LARC), for women with OUD. In Appalachia, a peer-delivered contraception and MOUD promotion intervention was delivered to a sample of 30 women with OUD. Primary outcomes were attendance of initial appointments to receive MOUD and counseling about contraceptive options. Peer recovery coaches also offered to help the women schedule appointments and attend the appointment with them or give them a ride if necessary and requested by the patients. Two-thirds experienced all seven symptoms of opioid dependence. Within 30 days of a brief counseling session, over one-half of the women (56.7%) were referred to MOUD, with all of them initiating treatment within 30 days. Just under one-half of the women (46.7%) were referred to a contraception consultation, with 85.7% of those receiving a LARC implant. Study findings indicate the potential efficacy of a single-session, peer-delivered counseling intervention for linking women with OUD and at high risk of unintended pregnancy to MOUD and to services that provide women with highly reliable contraceptives. This study isunique inexploring the efficacy of linking high-risk opioid-using women to contraceptive options and treatment for MOUD to prevent NAS.

Effect of the COVID-19 pandemic on contraceptive prescribing in general practice: a retrospective analysis of English prescribing data between 2019 and 2020

ObjectivesThis paper looks at how contraceptive prescribing by General Practices in England was affected by the COVID-19pandemic and lockdown. It compares English prescribing data in April – June 2019, the year before COVID19, and April–June 2020, the first three months of ‘lockdown’.Design & SettingThis paper is based on retrospective analysis of the English Prescribing Dataset which reports monthly on prescribed items from English General Practices. Data on all forms of prescribed contraceptive methods were extracted using BNF codes, and total quantities tabulated by method. To reach the total number of months of contraception provided, total quantities were divided or multiplied according the frequency with which the method is taken per month or the numbers of months of contraception provided.ResultsPrescription of the combined oral contraceptive pill reduced by 22% during the period of lockdown compared to the same three months in 2019. Prescriptions of Progestogen-Only pills remained stable. Prescription of long-acting methods reduced, with the greatest reductions in implants (76% reduction from pre-lockdown levels), intra-uterine systems (79% reduction from pre-lockdown levels) and intrauterine devices (76% reduction from pre-lockdown levels).ConclusionsThe disruption of face-to-face contraceptive consultations in General Practice during a COVID-19 ‘lockdown’ has resulted in a reduction in oestrogen –containing methods compared to progestogen-only methods, which require less face-to-face monitoring.Implant and intrauterine contraceptive device prescription reduced by three quarters over the first three months of lockdown, which has the potential to result in a rise in unintended pregnancies.

"The pill doesn't open the fridge door!". Medical and gynecological violence in contraception consultations

In France, “the pill crisis” has brought into question the centrality of oral contraception within the “contraceptive standard”, as well as the drawbacks associated with its use, and is more widely part of a dynamic of raising awareness about medical and gynecological violence, at work since the early 2010s. This paper intends to question the medical and gynecological violence faced by women seeking medical attention in order to access what is supposed to be a condition for their emancipation : contraception. As part of a sociological research project on the prescriptions and uses of oral contraception, nearly seventy interviews were conducted with seventeen users of oral contraception and thirty-one health professionals authorized to prescribe contraception. Ninety-five medical and gynecological consultations were also observed, in both public and private medical facilities. The use of oral contraception requires regular medical consultation, increasingly exposing users to the risk of medical and gynecological violence, with lack of consent at its core. The case study of a gynecological consultation, as well as the analysis of interviews and observations, reveal various forms of medical violence, with a focus on the patients’ dependence on the medical profession. The interconnectedness of these different forms of medical and gynecological violence encourages us to consider them as part of a continuum of gender violence. An ethical caring stance makes it possible to guard against these situations.

Effect of the Covid pandemic on progestogen-only and oestrogen-containing contraceptive prescribing in general practice: a retrospective analysis of English prescribing data

Objectives This paper looks at how trends in contraceptive prescribing by General Practices in England were affected by the Covid pandemic and lockdown. It compares English prescribing data from May 2014 to May 2021, including the period of ‘lockdown’, from April 20-June 20. Design & Setting A retrospective analysis of the English Prescribing Dataset which reports monthly on prescribed items from English General Practices was carried out. Data on all forms of prescribed contraceptive methods were extracted using British National Formulary (BNF) codes, and total quantities tabulated by method, then transformed into ‘months of contraception provided’ by each method. Results Prescription of the combined oral contraceptive pill reduced by 22% during the period of lockdown compared to the same three months in 2019. Prescriptions of Progestogen-Only pills remained stable. This continued a trend in oral contraceptive prescribing evident from May14. Prescription of long-acting methods reduced during the period of lockdown, with the greatest reductions in implants (76% reduction from pre-lockdown levels), intra-uterine systems (79% reduction from pre-lockdown levels) and intrauterine devices (76% reduction from pre-lockdown levels). These rates of contraceptive provision recovered quickly after the period of lockdown ended. Conclusions The disruption of face-to-face contraceptive consultations in General Practice during a Covid-19 ‘lockdown’ has resulted in a reduction in oestrogen –containing methods compared to progestogen-only methods, which require less face-to-face monitoring. Implant and intrauterine contraceptive device prescription reduced by three quarters over the first three months of lockdown, but rebounded in the next year.

Pengembangan Aplikasi Konsultasi Alat Kontrasepsi Berbasis Android Sebagai Antisipasi Baby Boom Masa Pandemi Covid-19

The COVID-19 pandemic caused a drastic decrease in all users of contraceptives, causing the birth rate (baby boom) to increase by 10% during the COVID-19 pandemic. Several factors have contributed to the increasing decline in contraceptive use, including the lack of health facilities with COVID-19 standardized personal protective equipment, causing concern for couples of childbearing age (EFA) thus delaying visits to health facilities to consult or use family planning, and a small number of health facilities in particular. Contraceptive services do not open a practice because they do not have the means to prevent the spread of COVID-19. This study aims to develop an android-based contraceptive consultation application in anticipation of the baby boom during the COVID-19 pandemic. This research on the development of an android-based contraceptive consultation application during the COVID-19 pandemic was developed to facilitate between family planning acceptors and health workers so that the family planning service program continues to run well. This type of research uses quantitative research with a research design using a combined method (combination method) between Research and Development (R&D) and Pre Experiment methods with One group Pre-test and Post-test designs which will be carried out in the working area of Tiumang Health Center, Tiumang District, Dharmasraya Regency, Province West Sumatra. The research instrument used is a questionnaire and informed consent which will be given to respondents at the time of pre-test and post-test with the tool used is an android-based contraceptive consultation application. The steps of this application design model include needs analysis, development design, contraceptive consultation application development, expert validation test, large-small group trial, and android-based contraceptive consulting application product. The results obtained in this study are an application designed and the features needed by EFA in collaboration with experts in the field of information technology (IT). The calculation of application observations carried out by design experts overall reached 84% meaning valid, while content observations / materials in applications carried out by content experts overall reached 80% meaning valid.

Molecular detection and genotyping of Chlamydia trachomatis circulating in women of Western Cameroon: a cross-sectional study

Background: In Cameroon, C. trachomatis screening is not routinely practiced, and its epidemiology is still unexplored. The present study aimed to determine the prevalence of C. trachomatis infection, its risk factors and the genotypes circulating in the West Cameroon region.Methods: A cross-sectional study was carried out amongst patients in five district hospitals in the West region of Cameroon. Endocervical samples were collected from women visiting the hospitals forantenatal, prenuptial and contraception consultations and at least 18 years old, sexually active, and non-menstruating. The molecular detection of C. trachomatis was performed using conventional polymerase chain reaction (PCR) followed by sequencing of the ompA gene.Results: The prevalence of C. trachomatis infection was determined to be 11.47%. Having sex for the first time between the ages of 15 and 17 (OR=1.683, 95% CI: 1.1-2.5), non-usage of condom (OR=1.622, 95% CI: 1.2-2.1), being single (OR=1.263, 95% CI: 1.0-1.5) and age range 18-30 years (OR=1.426, 95% CI: 1.1-1.8) were risk factors for C. trachomatis infection. Three genotypes of C. trachomatis circulated in West Cameroon viz. D (49%), E (29.4%) and G (21.6%).Conclusions: This study revealed that, three genotypes; D (dominant), E and G were identified circulating in the population of the study area. This information may be important for controlling the dissemination of C. trachomatis infection in West Cameroon as well as strategizing the therapeutic approach.

Talen en spiralen: kennis en besluitvorming in anticonceptieconsultaties met een taalbarrière

Abstract Misconception and contraception: knowledge and decision-making in contraceptive consultations with a language barrier Just like in general medical consultations, different domains of knowledge come together and are negotiated in contraceptive consultations, followed by decision-making on the contraceptive method. Research shows that a language barrier can hamper knowledge negotiation and decision-making in medical consultations. Our paper contributes to those findings by focussing on contraceptive counselling as a specific and underexplored consultation type. We gathered our data in a Belgian abortion clinic, where contraception is discussed during the consultations, and where an important part of the consultations are characterised by a language barrier. We adopt a Bourdieusian view on language as capital, and use a linguistic ethnographic and interactional sociolinguistic approach, complemented with analytical tools from conversation analysis on epistemics and deontics. The analysis of data fragments, ranging from a limited to a double language barrier, shows that this barrier is connected in various ways with how, and how much, knowledge is negotiated. Incomplete renditions, interruptions, epistemic and deontic claims from non-professional interpreters, along with a lack of shared contextualisation, impede clients to gather information and therefore influence decision-making. We conclude that a language barrier involves a potential risk for knowledge negotiation and decision-making in contraceptive consultations. More attention from healthcare professionals to language barriers could empower women in their sexual and reproductive health choices.

P–047 Knowledge, professional attitudes and training of health professionals on male contraceptive methods

Abstract Study question Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods? Summary answer The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more. What is known already The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC). Study design, size, duration Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France. Participants/materials, setting, methods The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception. Main results and the role of chance The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p < 0.001). More than half (55%) of the population never or infrequently offered MC during a couple’s contraceptive request consultation. Female practitioners offered MC significantly more often than male practitioners (48% vs. 26%; p = 0.033). Only 14% of the population had ever participated in training on MC, 96% wished to be better trained on MC, and 86% expressed a willingness to participate in such a training. Limitations, reasons for caution The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives. Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception. Trial registration number 2020–01–23–03

Telehealth for Addressing Sexual and Reproductive Health and Rights Needs During the COVID-19 Pandemic and Beyond: A Hybrid Telemedicine-Community Accompaniment Model for Abortion and Contraception Services in Pakistan.

The COVID-19 pandemic led overburdened health care systems to deprioritize essential sexual and reproductive healthcare, including abortion and contraception care, while accelerating shifts in healthcare delivery to digital technologies. However, in many countries, including Pakistan, inequalities in access to digital technologies remain, presenting an opportunity for interventions that both increase access to deprioritized sexual and reproductive health and rights (SRHR) services and overcome the digital divide in delivering digital solutions to those in need of SRHR services. In June 2020, Ipas Pakistan partnered with Sehat Kahani (SK), a local health care NGO and telehealth service, and an existing network of Lady Health Workers (LHWs) to launch a novel hybrid telemedicine-community accompaniment pilot. The model linked women via LHWs with mobile devices to online providers for telemedicine consultations for SRH, including abortion services, contraception, and other gynecological consultations. In June 2020, we trained 98 LHWs and 22 telehealth doctors. Between June 2020 and March 2021, a total of 176 women were referred by LHWs for telehealth consultations. Among women who received abortion services, nearly all (90%) reported complete uterine evacuation. No serious adverse events were reported. Overall satisfaction was high; 81% reported being satisfied, and 86% said it is likely they would recommend the telehealth service to others. Data show that the provision of SRHR services via a telehealth-accompaniment model can be successfully implemented in Pakistan. Outcome data show high satisfaction and good clinical outcomes for women accessing care through this model. However, more data are needed to understand the full potential of this model. Barriers to digital health models, such as poor or inconsistent internet access, remain in places like Pakistan, especially in rural settings. This approach has its limitations but should be considered as an option in settings with similarly established community health networks and inequitable access to digital health.

Contraceptive Prevalence and Consulting Service in Women with Systemic Lupus Erythematosus: A Cross-Sectional Study.

Systemic lupus erythematosus (SLE), often affects women of childbearing age. Family planning consultation is a major aspect of medical care in these patients because of the risk of disease activation and poor pregnancy and fetal outcomes. The aim of the present study was to evaluate contraceptive prevalence and consulting service in women with SLE. In a cross-sectional study, a total of 144 female patients with SLE, ages 15-50, who were presented to rheumatology clinics in Sari, north of Iran, were evaluated. The study was conducted between March 2019 and May 2020. Patients' clinico-demographic profile and fertility information were obtained. Disease activity and damage were assessed by the systemic lupus erythematosus disease activity (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI). One hundred and forty-four SLE patients of childbearing age participated in this study. From 102 patients with the possibility of pregnancy, 36(35.2%) received contraceptive consultations in last year. Withdrawal was the most prevalent contraceptive method (41.7%), followed by permanent (11.8%), and barrier methods (9%). There were no significant differences in age, disease duration, marriage duration, SDI or SLEDAI scores between the women who received or not received contraceptive counseling (P>0.05). Many SLE patients did not receive adequate information about contraception, and it may be associated with many adverse effects on disease activity and pregnancy outcomes. Therefore, contraceptive consultation as an important aspect of patient's management is strongly suggested.