Contraceptive Clients Research Articles

Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods

BackgroundSame-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. Same-day start may be appropriate for all contraceptive methods, but we lack data comparing methods. ObjectivesTo assess the frequency of same-day initiation among six contraceptive methods selected for “same-day start” among new contraceptive users and describe the efficacy of same-day start first cycle pregnancy risk by all contraceptive methods and by each method. Study DesignUsing prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first seven days of their menstrual cycle (same-day start). Enrolled participants at four family planning clinics in Salt Lake County, Utah between September 2015-March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants that received care immediately after or within two weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report frequency of unprotected intercourse within 5 days and 6-14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk by contraceptive method initiated same-day and assessed for simultaneous use of oral emergency contraception. ResultsOf the 3,568 individuals enrolled, we identified the majority as same-day start users (n=2,575/3,568, 72.2%), with one in eight of those reporting unprotected intercourse in the previous 5 days (n=322/2,575, 12.5%) and one in ten reporting unprotected intercourse 6-14 days prior to contraceptive method initiation (n=254/2,575, 9.9%). We identified 11 pregnancies among same-day start users (0.4%, 95% CI 0.2%-0.7%) compared to 1 (0.1%. 95% CI 0.002%-0.6%) among those who initiated contraception within seven days from the last menstral period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest 1st cycle pregnancy rates (1.0 – 1.2%). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Of the same-day user who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. Conclusion(s)Same-day start is common and associated with a low pregnancy risk. Using the “any method, any-time” approach better meets contraceptive clients’ needs and maintains a low risk of pregnancy.

Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015.

To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 ( low-decline counties ) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 ( high-decline counties ). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18-44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services.

Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research.

Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.

Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal

Since 1984, Republican administrations in the US have enacted the global gag rule (GGR), which prohibits non-US-based non-governmental organisations (NGOs) from providing, referring for, or counselling on abortion as a...

Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument

BackgroundPeople's sexual experiences have a strong association with contraceptive satisfaction and continuation, but no measures exist to specifically assess contraceptive-related sexual acceptability. AimThis study developed and examined the psychometric properties of reliability, separation, and item fit of a new Contraceptive Sexual Acceptability (CSA) instrument. MethodsEnrolled participants initiating a new contraceptive method from the HER Salt Lake longitudinal cohort study contributed baseline survey responses for scale development. The study included the Female Sexual Function Index, the New Sexual Satisfaction Scale, measures of physical and mood-related side effects, and self-reported perceptions of contraception's sexual impacts. Items from these measures’ served as the basis for analyses. We analyzed responses using descriptive techniques and modeled using exploratory factor (EFA) and bifactor analyses (BFA). The Masters’ Partial Credit Rasch method modeled reliability, separation, and item fit statistics. Here we evaluate (i) the reproducibility of relative measure location on the modeled linear latent variable, (ii) the number of statistically unique performance levels that can be distinguished by the measure, and (iii) the discrepancy between item responses and expectations of the model. Psychometric findings and theoretical models informed item reduction and final scale development. OutcomesWe developed a 10-item Contraceptive Sexual Acceptability scale that exceeded the thresholds and sufficiently covered domains for use in contraceptive research and clinical settings. ResultsStarting with data on 39-items from 4,387 individuals, we identified 10-items that best measured the CSA latent construct. The Rasch model included a total of 5 calibrations. We reduced items based on bifactor analysis and surpassed unidimensionality thresholds (OH = 0.84, ECV = 0.74) set a priori. The final items included questions with scaled responses about pleasure and orgasm (orgasm quality, orgasm frequency, giving partner pleasure), physical (arousal and function) and psychological (emotional connection, surrender) components, general questions of satisfaction and frequency, and a measure of perceived impact of contraception on sexual experiences in the previous 4 weeks. Clinical ImplicationsThe 10-item CSA instrument covers physical and psychological aspects of contraceptive sexual acceptability and can be used in clinical settings. Strengths & LimitationsThe unidimensional CSA instrument offers a brief, yet comprehensive assessment of sexual acceptability. Given the limited diversity of the sample, implementation of this scale in contraceptive research and clinical interactions should be evaluated and validated in more diverse settings. ConclusionAttuning to sexual acceptability could ultimately help contraceptive clients find methods that better meet their needs and preferences.Sanders JN, Kean J, Zhang C, et al. Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument. J Sex Med 2022;19:507–520.

A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time

BACKGROUND:Contraceptives are used to prevent unwanted pregnancies and treat certain gynecologic conditions, but many women report non-use or inconsistent use because of method dissatisfaction. The sexual acceptability of contraception—how birth control methods affect users’ sexual well-being—is likely an important component of contraceptive satisfaction but has yet to be systematically examined.OBJECTIVE:This study aimed to assess contraceptive satisfaction among new-start contraceptive users and examine whether sexual acceptability measures predict contraceptive satisfaction at 3 months while controlling for more commonly measured contraceptive side effects.STUDY DESIGN:This analysis used data derived from the baseline, 1-month, and 3-month surveys of the HER Salt Lake Contraceptive Initiative, a prospective cohort study of new contraceptive clients. From March 2016 to March 2017, enrolled participants received their desired contraceptive method at no cost and could switch or discontinue at any time (up to 3 years). This analysis included individuals who continued their new contraceptive method for at least 1 month and completed all relevant survey measures. We used ordered logistic regression modeling to predict contraceptive satisfaction at 3 months. Primary predictor variables included changes in sexual functioning (6-item Female Sexual Function Index), sexual satisfaction (New Sexual Satisfaction Scale), and perceived impact of the contraceptive method on sex life at 1 month. Covariates included vaginal bleeding changes, physical side effects, and mood-related side effects.RESULTS:Our analytical sample included 1879 individuals. At 3 months, 52.1% of participants were “completely satisfied” with their contraceptive method, 30.7% were “somewhat satisfied,” 4.2% were “neither satisfied nor dissatisfied,” 6.9% were “somewhat dissatisfied,” and 6.2% were “completely dissatisfied.” Compared with patients who said their contraceptive method made their sex life “a lot” worse at 1 month, patients whose method improved their sex life “a lot” had a 7.7 times increased odds of greater satisfaction at 3 months (95% confidence interval, 4.02–14.60; P<.0001) and patients whose method improved their sex life a “little” had a 5.88 times increased odds of greater satisfaction (confidence interval, 3.12–11.11; P<.001). To a much lesser degree, experiencing less or no bleeding was significantly associated with increased satisfaction, whereas worsening of physical side effects was linked to decreased satisfaction. The only other factors significantly associated with satisfaction were changes in bleeding and physical side effects.CONCLUSION:Our findings suggest that patients’ sexual experiences of their contraceptive methods are important correlates of satisfaction. Clinicians may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.

Changing lives, dynamic plans: Prospective assessment of 12-month changes in pregnancy timing intentions and personal circumstances using data from HER Salt Lake.

ObjectivesTo explore the association between changes in personal circumstances and shifts in pregnancy intentions.Study designNew start contraceptive clients, who desired to prevent pregnancy for at least one year enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative (September 2015 –March 2017) and responded to the question “What are your future pregnancy plans?” at enrollment and 12-month follow-up. We estimated multivariable binary logistic fixed-effects regressions to examine the association between changes in personal circumstances and a change from never desiring a pregnancy at enrollment to considering one in the future at 12-month follow-up.ResultsThe majority of the 2825 participants (2246, 79%) maintained their pregnancy timing intention over the 12-month study period. Multivariable analyses of the 208 participants who changed from never desiring a pregnancy to considering pregnancy in the future at 12-month follow-up indicated that entering cohabitation (aOR 3.14, 95% CI 1.30–7.58), increased household income (aOR 1.06, 95% CI 1.00–1.13), and changes from unemployment to full-time employment (aOR 5.94, 95% CI 1.29–27.36) are associated with increased the odds of desiring a future pregnancy after never wanting one a year prior.ConclusionsPregnancy intentions are dynamic over twelve months and covary with partner status, household income, and employment status. Pregnancy intentions are linked to changes in life circumstances. Health care providers need to frequently assess pregnancy intentions and resulting contraceptive or preconception needs.

Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar

Madagascar’s health system is highly dependent on donor funding, especially from the United States (US), and relies on a few nongovernmental organisations (NGOs) to provide contraceptive services in remote areas of the country. The Trump administration reinstated and expanded the Global Gag Rule (GGR) in 2017; this policy requires non-US NGOs receiving US global health funding to certify that neither they nor their sub-grantees will provide, counsel or refer for abortion as a method of family planning. Evidence of the impact of the GGR in a country with restrictive abortion laws, like Madagascar – which has no explicit exception to save the woman’s life – is limited. Researchers conducted semi-structured interviews with 259 representatives of the Ministry of Health and NGOs, public and private health providers, community health workers and contraceptive clients in Antananarivo and eight districts between May 2019 and March 2020. Interviews highlighted the impact of the GGR on NGOs that did not certify the policy and lost their US funding. This reduction in funding led to fewer contraceptive service delivery points, including mobile outreach services, a critical component of care in rural areas. Public and private health providers reported increased contraceptive stockouts and fees charged to clients. Although the GGR is ostensibly about abortion, it has reduced access to contraception for the Malagasy population. This is one of few studies to directly document the impact on women who themselves described their increased difficulties obtaining contraception ultimately resulting in discontinuation of contraceptive use, unintended pregnancies and unsafe abortions.

Contraceptive selection and practice: Associations with self-identified race and socioeconomic disadvantage.

Many researchers and policymakers have linked contraceptive programs to improvements in women's and children's socioeconomic outcomes. However, these studies have overlooked how socioeconomic status may be an initial driver of contraceptive choice and behavior. Here, I examine the relationship between a comprehensive measure of socioeconomic disadvantage, self-identified race, and contraceptive method selection at enrollment in a unique longitudinal study of contraceptive clients who received a new type of method at no cost. I then examine whether socioeconomic disadvantage has an association with contraceptive switching or discontinuation. I demonstrate that socioeconomic disadvantage decreases the chance of selecting any IUD, while Black racial membership increases the chance of selecting the 3-month injectable and Multiracial membership increases the chance of selecting the Vaginal Ring. I then demonstrate that socioeconomic disadvantage and self-identified race have intersectional and variable associations with switching, and, to a lesser extent, discontinuing methods. These findings offer an important insight for implementation in contraceptive programs: eliminating financial barriers to access contraceptive services does not eliminate the socioeconomic contexts that influence method selection and use that occur as part of everyday lived experiences. Taken cumulatively, these results suggest that contraceptive services should be offered to women in ways that ensure access to reproductive justice without obscuring the need for social changes in the institutions that create disadvantage and shape contraceptive use itself.

The effect of a no-cost contraceptive initiative on method selection by women with housing insecurity

ObjectivesTo compare the sociodemographic characteristics of participants in a contraceptive initiative by housing security and determine the association between housing insecurity on contraceptive method selection before and after the removal of cost. Study designThis cross-sectional assessment includes 4,327 reproductive-aged participants in the HER Salt Lake Contraceptive Initiative who sought new contraceptive services and reported housing status at enrollment. HER Salt Lake prospectively explored the impact of improved contraceptive access on socioeconomic outcomes in Salt Lake County (USA). For six months (September 2015–March 2016) we collected control data, which included clinic standard-of-care cost-sharing. The intervention started March 2016, and provided no-cost contraception services and unlimited opportunities for method switching over the subsequent three years. ResultsThere were 964 (22%) housing-insecure participants. Compared to those with stable housing, housing-insecure individuals more commonly identified as a sexual minority, received public assistance and lacked health insurance. Housing-insecure women preferentially selected long-acting reversible contraception during the control period (aOR 1.60; 95%CI 1.01–2.56), but method selection equalized across housing status during the intervention. ConclusionsWhen cost is not a barrier, all women desire a comprehensive selection of contraceptive methods, regardless of housing security. Contraceptive clients in this vulnerable population need interventions which address access barriers to all methods to support reproductive planning. ImplicationsUnintended pregnancy during housing insecurity may result in homelessness. This study found housing-insecure women desire access to all contraceptive methods, not just long acting reversible contraception. Integration of comprehensive family planning initiatives into efforts to address homelessness is essential to support this vulnerable population in their reproductive planning.

English

This study was conducted in Muk-Lami town located at 498 km from Addis Ababa and 54 km far from the Western Wollega zonal city, Ghimbi. The study was concerned with reproductive health and contraception where females in the study area have less exposure to contraceptives, choice and proper utilization of methods. This study attempted to investigate major determinants of contraceptive choice, use and side effects on female clients attending family planning services at Muk-Lami Governmental Health Center. The data was collected from women clients selected by simple random method for further information concerning choice and side effects of contraceptives among women attending family planning services. The data had been collected from 182 women between age categories of 20-49 years. The data was analyzed using SPSS version 20. Among contraceptive clients, 39.56% of women have not been informed about contraceptives. Obtained results showed that each contraception method had its own side effects that ranged from mild to severe health complications and reproductive risks on mothers. The majority (61.54%) of clients responded that they feel at least a minimum discomfort whenever using one of the modern birth control methods. Findings of this study also revealed that educated and non-educated women did not have similar and adequate knowledge on contraception. Therefore, educational experts, medical sectors and other concerned bodies including NGOs should empower women through special sex education for successful implementation of family planning programs. Key words: Birth control, contraceptive, clients, pregnancy, side effect, women

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

ObjectivesTo explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. Study designThe HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. ResultsBased on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05–1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07–1.26) or those who were uncertain (PR=1.19; 95% CI 1.09–1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96–0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice. ConclusionsPregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants. ImplicationsPregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.

Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar

ObjectivesTo improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs. Study designWe implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. A total of 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least-squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome. ResultsWe find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95% confidence interval 0.13–1.18; p=.014) represents a 26% increase. ConclusionsGiving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs’ services. ImplicationsNo study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs’ services.

Weight and body mass index among female contraceptive clients

ObjectivesAs obesity may affect the efficacy of some contraceptives, we examined weight, body mass index (BMI) and prevalence of obesity among female contraceptive clients at 231 U.S. health centers. A secondary aim was to analyze differences in contraceptive method use by obesity status. Study designCross-sectional study using de-identified electronic health record data from family planning centers. We analyzed contraceptive visits made by 147,336 females aged 15–44years in 2013. ResultsA total of 46.1% of clients had BMI ≥25. Mean body weight was 154.4lb (S.D.=41.9); mean BMI was 26.1 (S.D.=6.6). A total of 40% had BMI ≥26, when levonorgestrel emergency contraception may become less effective. Obese clients had higher odds of using a tier 1 or tier 3 contraceptive method and had lower odds of using a tier 2 or hormonal method than non-obese clients. ConclusionsAbout half of contraceptive clients would be categorized as overweight or obese. Contraceptive method choices differed by obesity status. ImplicationsAbout half of contraceptive clients in this study population were overweight or obese. Contraceptive method choices differed by obesity status. All women — regardless of body size — should receive unbiased, evidence-based counseling on the full range of contraceptive options so that they can make informed choices.

Intrauterine contraceptive device acceptors in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeastern Nigeria - A 5-year review

Background: Unsafe abortions of unintended pregnancies contribute significantly to maternal deaths in Nigeria. The intrauterine device (IUD) is a widely used method of contraception. Objectives: This study aimed to determine the contraceptive prevalence at this center, the proportion of the acceptors adopting the IUD method, and the sociodemographic characteristics and other parameters among the IUD clients. Findings from this study and the analysis of similar studies elsewhere will help improve contraceptive services, especially counseling and acceptance. Materials and Methods: This was a retrospective study of the period January 2004-Dec. 2008. The family planning register was used to trace the case records of the clients who had accepted IUDs over the 5-year period. Labor ward registers were used to calculate the number of deliveries over the same period. EPI Info Version 6 (2002) for Windows was used to analyze the data. Chi-squared tests were used and differences were considered significant if P < 0.05. Results: The total number of deliveries at our center in the studied period was 2,791, while the total number of contraceptive clients (for all methods) was 607, giving a contraceptive prevalence rate of 21.75%. IUD was the most accepted method, used by 344 (56.67%) women, followed by injectable progestogens, used by 172 (28.34%). Among IUD acceptors, most were multiparous women (para 2-5), numbering 168 (50.91%); most were in the age group of 26-30 years 100 (30.30%); male sterilization was not done at all (0%). Conclusion: IUD is a preferred contraceptive option among our women; however, the prevalence rate of modern contraceptive use at our center is still unacceptably low. More aggressive health education using the mass media, nongovernmental organizations (NGOs), religious and community leaders, and easy access to the commodities are required to reverse the trend.

Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure

ObjectivesUse of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors. Study designUsing data from the 2006–2010 National Survey of Family Growth, we assessed reports of any and only withdrawal use at last sexual episode in the last month from 3517 sexually active 15 to 24 year-old women and men at risk of unintended pregnancy. Logistic regression documented associations with withdrawal. ResultsFourteen percent of young women and 17% of young men reported any use of withdrawal at last sex; 7% and 6%, respectively, reported only use of withdrawal. Though associated with few sociodemographic factors, withdrawal was significantly linked with pregnancy- and condom attitudes. In regression models, compared to those who said they would be upset if they discovered they were pregnant, young women who said they would be pleased about a pregnancy were 2.2–2.6 times as likely to have used any/only withdrawal (p<.01). For both women and men, those who felt that condoms were likely to diminish sexual pleasure were more likely to have used any/only withdrawal (odds ratio=1.8–2.6, p<.05). ConclusionsAt their last sexual episode, a greater proportion of young adults used withdrawal in conjunction with other methods than by itself. The psychological and sexual variables of orientation toward pregnancy and attitudes about condoms and pleasure were more strongly linked with withdrawal practices than most sociodemographic variables. Implications statementSince a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.

Trends and variation in LARC use among Planned Parenthood affiliates

Objectives: Utilization of long-acting reversible contraceptives (LARCs) — including intrauterine contraceptives (IUCs) and implants — is increasing among U.S. women. National data show that 8.5% of women using contraceptives used LARCs in 2009. Given their high efficacy and ease of use, LARCs have great potential to reduce unintended pregnancy. The research objective was to examine trends in LARC use among Planned Parenthood contraceptive clients and variation among Planned Parenthood affiliates.

Better than nothing or savvy risk-reduction practice? The importance of withdrawal

This commentary discusses the causes and consequences of the family planning fields lack of enthusiasm for withdrawal use despite its comparative effectiveness. It also includes possible ways to improve measurement and understanding of withdrawal use and how to discuss it with contraceptive clients after the review of new data on the prevalence and practices of withdrawal.

Public and private providers' involvement in improving their patients' contraceptive use

BackgroundThis study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use. Study DesignA nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys. ResultsA total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of “other public” clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important. ConclusionsStrategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.

T10-P-13 Contraceptive clients’ experiences of the services received

The objective of this study was to describe contraceptive clients’experiences of the services they received at a family planning clinic in the centre of Jyvaskyla, Central Finland. The data was collected with a questionnaire from the clients visiting family planning clinic from January to April 2007. Public health nurses delivered the questionnaire form to the clients at the beginning of the consultation (n=71). The response rate was 97%. The majority of the clients were aged between 20 and 29 years. Contraceptive pills (37%) were the most popular birth control method. Most of them were content with the contraceptive method they used. One third of the clients said that they had been afraid of getting pregnant while using the present contraceptive method. More than half of them clients said they would prefer a public health nurse visit instead of a doctor. Most of the respondents had used the Internet to find more information on the services. According to nearly 40% of them, making an appointment was difficult. 36% of the respondents had received counselling for STI prevention from a doctor and 56% from a public health nurse. Only 38% had received sexual counselling, but 42% could not express their opinion on this question In general, the clients were very satisfied with the family planning services provide. However, more attention should be paid to STI prevention and sexual counselling during the consultations. The division of tasks between doctors and public health nurses should be closely considered in the future.