Contraceptive Methods Research Articles

Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth

ObjectivesSexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth. Study DesignWe conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis. ResultsWhen discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants’ acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants’ conceptualizations of their SGM youth patients’ identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care. ConclusionMany clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.

Contraception Choice for Female Endurance Athletes: What's Sport Got to Do With It? A Cross-Sectional Survey.

While there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport. Study objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes. This was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively. A total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport. This exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.

Women's decision-making power can influence modern contraceptive use: Evidence from Bangladesh.

It is generally believed that gender inequality and women's lack of decision-making power may restrict women's use of modern contraception, leading to high rates of unwanted pregnancies, abortions, and deaths. Evidence shows that empowered women are more likely to use modern contraception methods, but few studies have investigated this across multiple domains of empowerment. This study examined the associations between women's empowerment and modern contraception use in Bangladesh. Data from a sample of 16,834 married women aged 15-49years from the Bangladesh Demographic and Health Survey 2017-2018 were analysed. Complex survey weight adjusted logistic models were fitted to evaluate the associations after adjusting for clusters, strata, and sampling weights. indicate that just over half of the married women (55.7%) had used modern contraception methods. Women's empowerment was associated with contraceptive use, especially decision-making power. Women who had medium or high autonomy of household decision making were likely to have 20% (AOR=1.20; 95% CI: 1.04-1.39) and 27% (AOR=1.27, 95% CI: 1.11-1.45) increased odds of using modern contraceptives compared to those who scored low in the decision-making domain. The findings demonstrated strong evidence of direct influence of women's decision-making power on modern contraception use. The results also found influence of several socio-demographic factors including area of residence, husband's age, wealth index andmobile phone ownership on the use of modern contraceptives. Future interventions can focus on integrating women's empowerment into family planning programming, with a particular focus on enhancing women's autonomy in decision making.

Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention

ObjectivesTo describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use. Study designWe analyzed data from a cross-sectional, online survey of N = 1694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use. ResultsMost respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal intrauterine device (IUD) (24.8%), and abstinence (19.2%). Some reported formerly (n = 55, 6.6%) or currently (n = 30, 3.6%) relying on testosterone for pregnancy prevention. Only four of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%). ConclusionsMost TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence. ImplicationsTGD individuals use a range of birth control methods for pregnancy prevention and clinicians should not assume preferences for certain forms of contraception based on gender identity (e.g., estrogen avoidance). Clinicians should engage in patient-centered counseling and shared decision-making to provide high-quality contraceptive care to patients of all genders.

Contraceptive effect of a gonadotropin-releasing hormone vaccine on captive male brown bears (Ursus arctos).

Fertility control has traditionally been applied in zoos to control captive populations, and reversible contraception is important. However, contraceptive methods for male bears have not been reported. We aimed to establish a reversible contraceptive for male brown bears by investigating the effects of a gonadotropin-releasing hormone (GnRH) vaccine (Improvac®) that was developed for the immune castration of pigs. We vaccinated six bears with two sequential doses of 400 (n = 2) or 600 μg Improvac® (n = 4) with a 1-month interval during the pre-breeding season (February to April). We compared the reproductive parameters (testosterone levels and semen parameters) of the six vaccinated and four non-vaccinated (control) bears once during the breeding season (May or June). To investigate whether the reproductive performance could be restored in the following year of contraception, we also compared the reproductive parameters once during the breeding season in two bears between the year with GnRH vaccination and the following year without vaccination. Vaccination treatments suppressed reproductive parameters in 5 bears, although vaccination with 400 μg of Improvac® was not effective in one bear. Testosterone levels and the rate of progressive sperm motility were significantly lower, and total sperm count and testis size tended to be lower in vaccinated bears, compared with the controls. Blood biochemical findings and direct observations after Improvac® vaccination did not reveal side effects. Moreover, testosterone levels and spermatogenic scores of two bears were restored in the following year. We confirmed that the Improvac® vaccine elicited a reversible contraceptive effect in male brown bears.

Factors Associated with Discontinuation of Using Hormonal Contraceptive Methods in Alexandria Governorate.

Factors Associated with Discontinuation of Using Hormonal Contraceptive Methods in Alexandria Governorate.

Factors influencing modern contraceptive usage among women aged 15-49 years: a cross-sectional study

Introduction: This study aimed to examine the factors that influence modern contraceptive use among married women of reproductive age in Kirkuk City, Iraq. Methods: A cross-sectional study was conducted to gather data from a convenience sample of 500 married women of reproductive age attending family planning units at 10 healthcare facilities, Azadi, Kirkuk Teaching Hospital, and private gynecological and obstetric clinics. Data were collected using a structured questionnaire from October 1st, 2023, to February 1st, 2024. The statistical analysis involved descriptive and inferential techniques. Results: The prevalence of contraceptive use among participants was 74.6%, with about (21%) reporting condom use and (16.0%) withdrawal usage. However, intrauterine devices were reported in (12.6%). Side effects were significantly (p<0.001) associated with contraceptive method choices, with 52% of the users experiencing adverse effects. External pressures to have additional children or become pregnant significantly (p=0.037) influenced contraceptive method choices. There were fewer modern contraceptive methods due to unsafety (30.9%), discomfort (23.6%), and side effects, such as headache (18%), weight gain (16%), and irregular bleeding (14%). Conclusions: Modern contraceptive use is affected by healthcare, safety, side effects, reproductive health, and personal choices. Providing complete knowledge and access to modern contraceptives helps couples make informed reproductive health decisions, empowers women to regulate their fertility, supports their personal and reproductive objectives, and promotes their health and well-being. Keywords: birth control, childbearing age, Iraq, modern contraceptive, side effects

Factors associated with contraceptive use among adolescents in three regions of Senegal.

The study aimed to evaluate the use of contraception by adolescents aged 10 to 19 years in three municipalities of Senegal, as well as the associated factors. The study was conducted in 2022 and used a cross-sectional approach. The sample size was 940 participants. Sampling was done using a multistage stratified random sampling method. The chi-square test and logistic regression using R software version 4.2.1 were used to analyze the data. Only 2.2% of adolescents had ever used a contraceptive method. Adolescents aged 15 to 19 years, those residing in Kolda, married adolescents, and those who were aware of family planning were more likely to use family planning methods. We conclude that policymakers in Senegal should implement policies and programmes for improving the reproductive health needs of adolescents in Senegal.

ПРИОРИТЕТЫ ВЫБОРА СРЕДСТВ КОНТРАЦЕПЦИИ СТУДЕНТКАМИ МЕДИЦИНСКОГО УНИВЕРСИТЕТА

Purpose: To determine the priorities of contraceptive choices of medical students depending on various factors. Materials and methods: 75 female students of North-Western State Medical University named after I.I. Mechnikov participated in the study; mean age was 20,5 years, 77% were sexually active. Information was collected using a specially designed questionnaire that included questions about the characteristics of sexual life (duration, number of partners, frequency of partner changes, regularity of sex), methods of contraception and the reasons for their choice, diagnosis and prevention of STIs, the effect of contraception on the menstrual cycle and its characteristics, and sexual life. Pearson criterion at p≤0.05 was applied in data analysis. Female Sexuality Index (FSI) was assessed using The Female Sexual Function Index (FSFI) questionnaire. Results: the predominant method of contraception choice among the respondents depending on sexual experience was the barrier method. With increasing sexual experience, the proportion of girls using interrupted intercourse increased and the proportion using hormonal contraception decreased. The predominant contraceptive method among girls who rarely change sexual partners was the condom, while girls with frequent changes in sexual partners preferred to use the standard day method. The reasons for choosing a contraceptive method were the fear of unwanted pregnancy, simplicity and ease of use of the method, and the lack of impact on sexual pleasure. The vast majority of all respondents were primarily afraid of HIV infection, syphilis, and the development of acquired immunodeficiency syndrome (AIDS). Girls using hormonal contraception were primarily guided by a doctor's prescription when choosing a method. The majority in this group had a positive effect of the method on the menstrual cycle and a decrease in pain in the mammary glands was observed with the start of contraception. The maximum index of female sexuality was found in the groups of girls using spermicides and the standard days method, and the lowest - in female students not using contraception. Conclusion: barrier and natural methods of contraception were the priority of choice for most of the respondents.

Assessment of intention to use modern contraceptives among women of reproductive age in Benin: evidence from a national population-based survey

BackgroundWomen’s intentions to use any contraceptive method are critical for better understanding their future needs and making them more likely to act on that intention. This study assessed the factors associated with the intention to use modern contraceptives among women of reproductive age in Benin.MethodsThis was a cross-sectional study that used the 2017–2018 Benin Demographic and Health Survey (BDHS). The study analyzed a weighted sample of 13, 582 women of reproductive age who were non-users of contraceptives. The intention to use contraceptives was the outcome variable. Multivariate logistic regression analysis was conducted to determine the factors associated with the intention to use contraceptives among women of reproductive age. The results were estimated using an adjusted odds ratios (aOR) with a 95% confidence interval (CI) and statistical significance set at p < 0.05. ResultsApproximately 35.0% of the women had the intention to use modern contraception. We found that women aged between 30 and 34 (aOR = 0.70, 95%CI: 0.57, 0.86), 35–39 (aOR = 0.52, 95%CI: 0.42, 0.66), 40–44(aOR = 0.30, 95%CI: 0.22, 0.39) and 45–49 (aOR = 0.10, 95%CI: 0.07, 0.14), Muslim women (aOR = 0.68, 95%CI: 0.53, 0.85) and those who perceived the distance to a health facility not to be a big problem (aOR = 0.75, 95%CI: 0.67, 0.84) were less likely to have the intention to use modern contraceptives compared with their counterparts. On the other hand, women who attained primary (aOR = 1.21, 95%CI: 1.07, 1.36), secondary (aOR = 1.39, 95%CI: 1.21, 1.59), and higher education (aOR = 1.60, 95%CI: 1.13, 2.26), women who were employed (aOR = 1.39, 95%CI: 1.23, 1.57), women with no religion (aOR = 1.32, 95%CI: 1.04, 1.69), women whose partners were working (aOR = 1.69, 95%CI: 1.16, 2.44), women who heard about family planning in the media (aOR = 1.51, 95%CI: 1.16, 2.44), and women in the poorer (aOR = 1.31, 95%CI: 1.10, 1.54), middle (aOR = 1.42, 95%CI: 1.20, 1.67]), richer (aOR = 1.23, 95%CI: 1.03, 1.47), and richest households (aOR = 1.42, 95%CI: 1.15, 1.75) were more likely to have the intention to use contraceptives than their counterparts.ConclusionThe study provides valuable insights into the intention to use contraceptives among women of reproductive age in Benin. The findings indicate that the proportion of women who have intention to use contraceptives remains low. The findings of this study could inform the development of targeted interventions and policies to increase access to and uptake of contraceptives in Benin, with the ultimate aim of improving the reproductive health and well-being of women and their families.

Family Planning and Men's Condom from the Perspective of Women and Men in Turkey: A Qualitative Study

Objective: In this study, it was aimed to examine the opinions of men and women who use male condoms as a contraceptive method, regarding the method and family planning. Methods: The sample of the study, which was carried out in a qualitative design, was chosen by the purposeful sampling method and consisted of 12 women and 13 men, categorized according to their genders. Results: As a result of this study, the findings of men and women using the male condom method were grouped under five themes. Themes are male condom decision making process, the effect of male condom on sexual life, disadvantages perceived by the male condom, gender in the use of family planning, beliefs in the use of family planning. Conclusion: This study was found that men decided to use male condoms by hearing from the environment, reduced sexual sensation, had a feeling of plastic / substance and found it costly. It was determined that women preferred it because they were clean and heard from the environment, reduced pleasure, was costly and negatively affected their sexual life.

Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review

BackgroundWe report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures.Case presentationA 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications.ConclusionThis case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it’s the transuterovesical migration, before concluding wrongly to its expulsion. It’s a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

Pregnancy after Tubal Sterilization in the United States, 2002 to 2015

BackgroundTubal sterilization is the most commonly used method of contraception in the United States. Because contraceptive effectiveness influences contraceptive selection, we examined typical use failure rates after tubal sterilization in the United States.MethodsWe estimated rates of pregnancy after tubal sterilization using data from four waves of the National Survey of Family Growth (NSFG), representative samples of U.S. women aged 15 to 44 years, collected in 2002, 2006 to 2010, 2011 to 2013, and 2013 to 2015. Survey weighting was used in survival analysis to examine time to first pregnancy after tubal sterilization. Data from these participants were censored after a tubal reversal procedure, infertility treatment, hysterectomy, or bilateral oophorectomy. Reported pregnancy rates after tubal sterilization procedures were examined by using Kaplan–Meier curves and then multivariable Cox proportional-hazards models to examine the effects of age at tubal sterilization, race/ethnicity, education, Medicaid funding, and postpartum versus interval procedures.ResultsPregnancy after tubal sterilization was reported by 2.9 to 5.2% of participants across NSFG waves. In the most recent survey wave (2013 to 2015), the estimated percentage of participants with pregnancies within the first 12 months after a tubal sterilization procedure was 2.9%; at 120 months after tubal sterilization, the estimated percentage with a pregnancy was 8.4%. At all the time points examined, pregnancy after tubal sterilization was less common after postpartum procedures than after interval procedures; however, this difference was not evident in multivariable models. In multivariable models, chance of pregnancy decreased with age at time of tubal sterilization. Race/ethnicity, education, and Medicaid funding were not consistently associated with pregnancy after tubal sterilization.ConclusionsThese data suggest that there may be nontrivial rates of pregnancy after tubal sterilization.

A Qualitative Assessment of Healthcare Providers’ Insights towards Utilization of Symptothermal Method to Ameliorate Unmet Need for Family Planning among Women in Kisumu County, Kenya

Purpose: To attain the Sustainable Development Goals (SDGS) 3- target 3.7, that highlights the need to improve women’s sexual and reproductive health status through means including family planning, information and education, a safer family planning method that could ameliorate unmet need for family planning, is urgently required. Healthcare providers’ knowledge and perception of natural family planning might influence decision of women interested in Symptothermal method (STM). We investigated healthcare providers’ factors influencing utilization of STM as a strategy to ameliorate unmet need for family planning among women in Kisumu County, Kenya. Methodology: Focus group discussion technique was used involving 14 healthcare providers and 8 STM users purposively selected. Phenomenology approach to enquiry which aims to investigate experiences from the perspective of the participants was adopted. Reflexive Thematic analysis was used. Data were transcribed and the thematic codes categorized were applied to assess all focus group transcripts. Dedoose 9.2.005 software was used for the analysis. Findings: Three themes were identified. Disclosure of untapped demand emerged as a significant insight, with healthcare providers admitting their previous oversight of the role of STM as part of other family planning methods. To ensure the successful integration of STM in healthcare facilities, healthcare providers identified training and community awareness as primary strategies. A major challenge identified was limited dissemination of information to clients, with healthcare providers often prioritizing and promoting contraceptive methods in which they are more confident. Unique contribution to theory, practice and policy: Comprehensive training would play a pivotal role in fostering a thorough understanding of STM among service providers. This understanding would instill confidence in healthcare providers, empowering them to effectively convey information to clients with assurance and clarity.

Higher Learning Female Scholars’ Knowledge and Usage of Emergency Contraceptive Pills in Dodoma Tanzania

Background An emergency contraceptive pill (ECP) is one of the contraceptive methods that provide the last chance of preventing unplanned and unintended pregnancy once there is unsafe sexual intercourse. Higher learning scholars are at danger of getting an unwanted and unplanned pregnancy which poses a major public health concern and needs to be addressed. Therefore study examines higher-learning female scholars’ the level of knowledge and usage of Emergency Contraceptive pills in Dodoma Tanzania.  Methodology A Quantitative descriptive cross-sectional study and a multi-stage sampling technique were used to obtain 909 higher learning female scholars’ aged between 18 to 35 years old residing at Dodoma University, St. John, and College of Business Education in Dodoma, Tanzania. Data was collected using a self-administered questionnaire and analyzed using SPSS version 20  Results The Respondent rate was 99.7%. Among 906 respondents only 30.6% knew emergency contraceptive pills (ECP), 27.7% had never heard about emergency contraceptive pills and 19.5% had ever used ECPs. Among those with knowledge, 33.7% reported using emergency contraceptive pills while for those with no previous knowledge, 21.8% had used ECP. At CI of 95% and p&lt;0.05, the use of ECPs had statistical significance with age, level of education, marital status, ever heard of ECPs, level of knowledge, and sexual relationship.  Conclusion The results of the analysis of this study show that the level of knowledge and usage of emergency contraceptive pills among higher-learning female scholars’ in Dodoma Tanzania was low. At CI of 95, the use of ECPs had a statistical relationship with age, level of education, marital status, ever heard of ECPs, level of knowledge, and sexual relationship.

Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data.

The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

Postpartum contraception provision across Europe: preliminary findings from a multi country survey

Introduction Looking after a baby and recovering from birth pose barriers to accessing and initiating effective contraception in the postpartum period. Another pregnancy at this time can end in abortion or a short interbirth interval. These are preventable if contraception is provided immediately from maternity settings. Our aim was to survey contraceptive experts across Europe about provision of postpartum contraception (PPC) in their country to develop a greater understanding of availability of and delivery of PPC services within the region. Materials and Methods Contraceptive experts across Europe were invited to participate in an anonymous mixed-methods online survey consisting of free text and fixed-response questions focusing on: (1) national guidelines/policy (2) antenatal contraceptive discussion and (3) immediate postpartum provision of methods. Respondents were asked to rate PPC provision in their region and detail perceived facilitators or barriers. Results Experts from 28 countries completed the survey. Fifteen (40%) reported their country had national guidelines for PPC provision, 40% reported that some antenatal contraceptive counselling was offered and 51% reported that contraceptive methods were provided in some (43%) or all (8%) maternity settings. Country-level PPC provision was reported as ‘poor’ or ‘very poor’ by 54% of respondents. Reported barriers to PPC provision included: cost, lack of policy/government support, awareness and training of maternity staff. Conclusions There is significant variation in PPC provision across Europe. Few countries offer antenatal contraceptive counselling or provide contraception from maternity settings. Introduction of supportive PPC policies, funding and training for staff could improve outcomes for mothers and babies.

Factors influencing contraceptive uptake among women of reproductive age in Kenya

Background Modern Contraceptive Methods (MCM) use is among the interventions preventing unplanned pregnancies and unsafe abortions globally. Nevertheless, MCM uptake is still low. We aimed at determining factors influencing contraceptive uptake among women of reproductive age 15 to 49 years, in Kenya. Methods We used secondary data collected by Performance Monitoring for Action (PMA). PMA used cross sectional multi-stage cluster survey design and collected the data between November and December 2019. The study was approved by NACOSTI/202974 and KNERC KNH/ERC/R/192. Results The study obtained a sample size of 9477 women of reproductive age (WRA) from 11 counties in Kenya. Both descriptive and inferential statistical analysis with a P value of 0.05 was done using Stata 16.1. The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. The prevalence was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55). More than half (53.4%) of the married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Women affiliated with the Islam religion were less likely to use modern contraceptive (aPOR 0.6, 95% CI 0.42, 0.89 p=0.010) as compared to the Catholics. Family planning (FP) services were found to be lower (aPOR 0.535(95% CI 0.29,0.98 p=0.043) in National Hospital Insurance Fund (NHIF)-covered facilities than in non-NHIF-covered ones. Adolescent FP service provision and prescription was 4 times higher (aPOR 4.0 95% CI; 1.05,15.41, p=0.42) as compared to either the prescribed or provided. Conclusion Low uptake for MCM is influenced by sociodemographic factors and Health system factors. Efforts to increase MCM uptake should focus on rural residents, unmarried women, Islamic religion women and accreditation of NHIF services in all facilities.

A comprehensive analysis of contraceptive safety: Implications for gynecological health and education levels

The use of contraceptives is essential for lowering the net reproduction rate and stabilizing population growth. Developing countries are characterized by high birth rates and rapid population growth. With lower contraceptive usage rates among eligible couples and resistance towards family planning methods, achieving population stabilization seems challenging. Therefore, this study aims to study the effects of various contraceptive methods on gynecological health and their safety profiles, The present observational study, was conducted in Department Obstetrics and Gynaecology at tertiary health care centre, Panjab, India. A total of 450 women were evaluated with the help of a pre-designed and pre-tested questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Punjab. The data were collected and analysed.All the participants were known to the traditional contraception and only few were aware about the modern contraception. Participants preferred tubal ligation (43.78%) over vasectomy (75.78%) and rarely considered hysterectomy (1.11%). Most knew about male condoms (99.56%) but fewer about female condoms (0.44%). Among the participants, 59.78% were aware of contraception side effects. Regarding condom use, opinions were divided, with 48.67% in favor and 51.33% against. Educated individuals were aware of contraception but not its major side effects. Therefore, we suggest investigating social, cultural, and knowledge aspects to improve understanding.

Understanding factors affecting the acceptance of post-abortion contraception: A comprehensive analysis

To assess the proportion of post-abortion contraceptive acceptance and the determinant factors in the utilization of contraception. It is a prospective observational study done on 468 women who presented for abortion care in a tertiary care centre. Data were collected using a pre-structured questionnaire, counselled for contraceptive usage. The family planning method accepted was noted and followed up after one month. Data were analysed using descriptive statistics and expressed in the form of frequency and percentages. In the present study, the magnitude of acceptance of post-abortion contraception was 73.08%. Most women were in the age group 21-30 years (62.82%), the majority belonged to lower socioeconomic status (43.16%), 78.62% were homemakers. Age of the women, education status, and history of the previous usage of contraception showed a positive association with acceptance of post-abortion contraception. The most accepted method was tubectomy (24.35%) followed by barrier contraception (20.51%). During follow-up after 1 month, 69.24% were willing to continue the same method and 5.1% opted for a change in the contraceptive method. The common determinant factors for not opting for post-abortion contraception were due to religious belief, partner opposition, fear of side effects of contraceptive methods and willingness to concieve again shortly. The proportion of post-abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion strongly influenced the usage of family planning services especially in rural areas where the accessibility is comparatively low. Family planning counseling during the time of abortion plays an important role in accepting post-abortion family planning services. At all levels of health care, family planning counseling and services should be provided to those who come for abortion to reduce maternal morbidity and mortality.