Initiation Of Contraception Research Articles

Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department.

The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting. This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception. Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%). Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.

Does access to no-cost contraception change method selection among individuals who report difficulty paying for health-related care?

BackgroundOut-of-pocket costs continue to be a barrier to accessing necessary healthcare services, including contraception. We explored how eliminating out-of-pocket cost affects contraceptive method choice among people reporting difficulty paying for healthcare in the previous year, and whether method satisfaction differed by method choice.MethodsWe used data from the HER Salt Lake Contraceptive Initiative. This prospective cohort study provided participants with no-cost contraception (April 2016–March 2017) following a control period that provided no reduction in cost for the contraceptive implant, a reduced price for the hormonal IUD, and a sliding scale that decreased to no-cost for the copper IUD (September 2015–March 2016). We restricted the study population to those who reported difficulty paying for healthcare in the past 12 months. For our primary outcome assessing changes in method selection between intervention and control periods, we ran simultaneous multivariable logistic regression models for each method, applying test corrections for multiple comparisons. Among participants who continued their method for 1 year, we explored differences in method satisfaction using multivariable logistic regression.ResultsOf the 1,029 participants reporting difficulty paying for healthcare and controlling for other factors, participants more frequently selected the implant (aOR 6.0, 95% CI 2.7, 13.2) and the hormonal IUD (aOR 3.2, 95% CI 1.7, 5.9) during the intervention than control period. Comparing the same periods, participants less frequently chose the injection (aOR 0.5, 95% CI 0.3, 0.8) and the pill (aOR 0.4, 95% CI 0.3, 0.6). We did not observe a difference in uptake of the copper IUD (aOR 2.0, 95% CI 1.0, 4.1).Contraceptive satisfaction scores differed minimally by contraceptive method used among contraceptive continuers (n = 534). Those who selected LNG IUDs were less likely to report low satisfaction with their method (aOR 0.5, 95% CI 0.3, 0.97).ConclusionWith costs removed, participants who reported difficulty paying for healthcare were more likely to select hormonal IUDs and implants and less likely to select the injectable or contraceptive pills. Among continuers, there were few differences in method satisfaction.ClinicalTrials.gov Identifier NCT02734199

Facility-based simulation as a programmatic tool for implementing a statewide contraceptive initiative

BackgroundAssessing implementation fidelity is highly recommended, but successful approaches can be challenging. Family Planning Elevated (FPE) is a statewide contraceptive initiative which partnered with 28 health clinics across Utah. To assess implementation fidelity, we developed in-situ high-fidelity simulation training to both determine clinic adherence to FPE and offer education to implementing teams. This study aimed to develop, pilot, and assess the use of simulation as a tool for measuring implementation fidelity.MethodsWe developed two simulation scenarios to determine implementation fidelity: one scenario wherein a client is seeking a new method of contraception and another in which the same client has returned to discontinue the method. Both simulations contained multiple aspects of program implementation (e.g., determining program eligibility). We then offered simulations to all FPE partner organizations. To assess simulation training as a tool for determining implementation fidelity, we developed strategies aligned with each aspect of an adapted RE-AIM framework, including pre-post surveys, acceptability and self-efficacy testing, a checklist for programmatic adherence, field notes, action planning and analysis of monitoring data.ResultsFifteen clinical sites and 71 team members participated in the in-situ simulations. Assessment of the checklist showed that 90% of the clinics successfully demonstrated key program components, including person-centered counseling techniques such as sitting at the patient’s level (95.8%); asking open-ended questions (100%); and explaining how to use the contraceptive method selected (91.7%). More than half of clinics fell short in programmatic areas including: confirmation that the FPE program covered same-day intrauterine device insertion (54.2%), and education on health risks associated with the selected contraceptive method (58.3%). After simulation, participants reported improved knowledge of how FPE works (p = < 0.001), increased ability to identify FPE-eligible clients (p = 0.02) and heightened self-efficacy in helping clients select a method (p = 0.03). Participants were satisfied with the simulations, with most (84.1%) reporting that the simulation exceeded their expectations.ConclusionsHighly-realistic in-situ family planning simulations are acceptable to participants, positively change knowledge and clinical team confidence, and can identify systems gaps in clinical care and program implementation. Simulation offers a reciprocal way of monitoring implementation fidelity of a family planning access initiative.Trial registrationThis project was determined to be exempt by the IRB of the University of Utah, the larger Family Planning Elevated program under which this pilot study was nested is registered at ClinicalTrials.gov Identifier: NCT03877757.

Associations between contraceptive availability and rate ofsubsequent legal abortions in Colombia: A historical cohortanalysis.

To describe factors associated with subsequent abortions in Colombia and evaluate whether high-efficacy contraceptive availability (IUD) post-index abortion was associated with higher efficacy contraceptive initiation and fewer subsequent abortions within 2 years. The study population comprised patients aged 15-44 years who underwent index abortion in 2017 at four clinics in Bogotá, Colombia. Using charts, we conducted a retrospective cohort study with 2-year follow-up (2017-2019) after the index abortion for outcomes of contraceptive initiation and subsequent abortion. We evaluated associations between demographic or clinical characteristics and outcomes using Pearson chi-square and multivariate logistic regression. Of 9175 patients with index abortion, 3409 (37.2%) initiated an intrauterine device (IUD) and 467 (5.1%) had a subsequent abortion within the study period (2017-2019). IUD availability (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.39-1.93) and insurance use (aOR, 5.03; 95% CI, 4.37-5.78) were associated with high-efficacy contraceptive initiation; medication abortion was inversely associated (aOR, 0.24; 95% CI, 0.22-0.27). Initiation of no (aOR, 4.94; 95% CI, 3.59-6.80) or moderate-efficacy (injection: aOR, 4.21 [95% CI, 3.14-5.62]; oral contraceptive pill: aOR, 4.60 [95% CI, 3.21-6.59]) methods were associated with subsequent abortion. Subsequent abortion is inversely associated with initiated postabortion contraceptive efficacy, which is modifiable on a systems level by improving access to effective postabortion contraception.

Analysis of Unmarried Adolescents and Modern Contraceptives Initiation in Nigeria: Evidence from 2018 NDHS

Nigeria is one of Africa’s most populous countries. Nigeria’s population is expected to exceed 400 million by 2050, putting it among the top five most populous countries in the world. High birth rates, limited contraception use, and early marriage are the main causes of this rapid increase. In Nigeria, adolescents play a substantial role in these issues, with 117 births per 1000 girls aged 15–19 years. Data for this article comes from the 2018 Nigerian Demographic and Health Survey (NDHS). Our sample consisted of 1014 sexually active unmarried adolescents aged 15–19 years. Kaplan Meier’s curve, Log Rank Test, and Cox proportional hazards model were modeled to estimate the parameters at p &gt; 0.05. Findings show that the average time to the first use of modern contraceptives after sexual initiation is two years. Initiating sex at age 15 or later, belonging to the richest household wealth quintile, and use of the internet is associated with the early initiation of modern contraceptive methods, while residing in the northwest region and being older are associated with a low incidence of modern contraceptive use. Results indicate a deferred initiation of modern contraceptives after first sexual encounter. It has become imperative for tailored interventions to improve the time of initiation of contraceptives, so as to reduce the associated burdens and consequences.

Role of maternal and child health services on the uptake of contraceptive use in India: A reproductive calendar approach.

BackgroundAccording to the latest round of National Family Health Survey—4 (NFHS (2015–16)) maternal and child health care (MCH) services improved drastically compared to NFHS-3. Previous studies have established that the uptake of MCH services increases the likelihood of early adoption of contraceptives among women. So, our study aims to examine if the early initiation of contraceptive has proportionately improved with the recent increase in MCH services.MethodsThis study used the reproductive calendar of NFHS-4, 2015–16, to evaluate contraceptive initiation within 12 months after the last birth among 1,36,962 currently married women in India. A complementary log-log regression model was created to examine the link between the time of initiation of contraception and MCH care at the national level.ResultsIt was found that only a quarter of women within 12 months from last birth have adopted the modern contraceptive method. Among those majority of the females adopted sterilization mostly at the time of birth. The multivariable model identified, that the period of initiation of contraceptive depends on the gender composition of children and access to MCH services. It was found that the odds of early initiation of contraceptive use was higher when a women have only son (AOR = 1.15,95% CI– 1.22, 1.18) compared to women with only daughter. Also, it was found that women who have availed MCH services were more likely to adopt contraceptives earlier.ConclusionThe number of women availing MCH services has increased in India, but it did not result in a proportional increase in initiation of contraception after childbirth. Facilitating family planning services alongside MCH services will be beneficial in low-resource settings. It is a golden opportunity to educate and encourage women for early adoption of contraceptive.

Delaware Contraceptive Access Now and Contraceptive Initiation Among Medicaid Enrollees, 2015‒2020.

Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Delaware between 2015 and 2020. We evaluated the association of the program with contraceptive initiation in Delaware's Medicaid program using a difference-in-differences design that compared changes in Delaware to changes in Maryland. Results suggest that program implementation was associated with increased initiation of long-acting reversible methods, particularly among adolescent patients aged 15 to 18 years. We found less-consistent evidence for changes to any contraceptive method. (Am J Public Health. 2022;112(S5):S537-S540. https://doi.org/10.2105/AJPH.2022.306938).

Impacts of a Statewide Effort to Expand Contraceptive Access in New Mexico, 2014‒2020.

Two New Mexico state agencies implemented a statewide contraceptive access initiative in a sizable rural border state through the provision of low- or no-cost contraception, provider training and technical assistance, public awareness campaigns, and policy changes. These interventions resulted in successful expansion of reproductive health services provision and contraceptive use among Medicaid-enrolled adolescents and young women of reproductive age between 2014 and 2020. These findings demonstrate how multilevel interventions can expand contraceptive access, even in rural limited-provider settings. (Am J Public Health. 2022;112(S5):S541-S544. https://doi.org/10.2105/AJPH.2022.306817).

Implementation and Monitoring of the Family Planning Elevated Contraceptive Access Program, Utah, 2018‒2019.

Family Planning Elevated (FPE) is a contraceptive access initiative in Utah. FPE designed and utilized a comprehensive monitoring system to identify and respond to challenges implementing our initiative as they arose. Here, we describe the components of our monitoring system, and highlight how FPE's monitoring system successfully identified that Utah's Medicaid expansion was not widely adopted by eligible individuals. We then describe how FPE adapted to this challenge. (Am J Public Health. 2022;112(S5):S528-S531. https://doi.org/10.2105/AJPH.2022.306935).

The Effect of Family Planning Counseling on Incident Pregnancy in Nepal.

An intervention aimed at institutionalizing postpartum intrauterine device (PPIUD) services was introduced in Nepal between 2015 and 2019. The intervention was evaluated using a cluster-randomized stepped-wedge trial, with data on women being collected immediately after delivery and at one- and two-year postpartum follow-ups. The sample consists of 19,155 women. We used intention-to-treat (ITT) analysis and structural equation model (SEM) to investigate how the intervention affected the occurrence of a new pregnancy (incident pregnancy). The ITT analysis showed that women in the intervention group had a reduced probability, -0.7 percentage points (95 percent CI: -3.0, 1.4), of having an incident pregnancy compared to women in the control group. The SEM analysis showed that the intervention increased the probability of receiving antenatal family planning counseling and PPIUD-specific counseling by 22.2 percentage points (95 percent CI: 20.0, 24.4) and 26.5 percentage points (95 percent CI: 24.8, 28.3), respectively. The intervention had an unintended spillover effect, increasing the probability of receiving postnatal family planning counseling by 11.4 percentage points (95 percent CI: 7.3, 15.5). In the SEM, we find the expected impact of the intervention on increased counseling and induced effects on contraceptive method initiation, lowering the probability of an incident pregnancy by 0.3 percentage points (95 percent CI: -0.5, -0.1).

036 What to do when it fails? Termination

Teenage unplanned pregnancy is a worldwide concern. It is associated with poor medical, social, and economic outcomes for both mother and child. The negative outcomes are further compounded by the fact that there are chances of repeat pregnancy within 24 months of giving birth among teenage mothers because they struggle with contraceptive method initiation and continuation.

An early return to fertility resulting in ectopic pregnancy 10 weeks post vaginal birth: A case report

Background: There exists an unmet need for timely initiation of reliable postpartum contraception among mothers. This could result in unplanned and closely spaced pregnancies that may endanger the lives of the mother and the unborn baby.&#x0D; Case presentation: A 22-year-old para 1+0 presented to the emergency department with gradual onset of lower abdominal pains, per vaginal spotting, and bloating 10 weeks after childbirth. She reported full-time breastfeeding and regular and consistent use of male condoms for contraception. A diagnosis of ectopic pregnancy was established following a positive urine pregnancy test and a transabdominal ultrasound that revealed features of right tubal pregnancy. Exploratory laparotomy and partial salpingectomy were performed. The patient was stable and was discharged on the second postoperative day.&#x0D; Conclusion: Early return of fertility in exclusively breastfeeding mothers is possible; hence, an effective family planning method is needed during the postpartum period to minimize the complications of short interpregnancy intervals.

PD36-10 THE MAMMALIAN REPRODUCTIVE GENETICS DATABASE, VERSION 2 (MRGDv2)

You have accessJournal of UrologyCME1 May 2022PD36-10 THE MAMMALIAN REPRODUCTIVE GENETICS DATABASE, VERSION 2 (MRGDv2) Ricardo Deras, Vivek Ramanathan, Xingquan Lu, Uma Ramamurthy, Martin Matzuk, Larry Lipshultz, and Thomas Garcia Ricardo DerasRicardo Deras More articles by this author , Vivek RamanathanVivek Ramanathan More articles by this author , Xingquan LuXingquan Lu More articles by this author , Uma RamamurthyUma Ramamurthy More articles by this author , Martin MatzukMartin Matzuk More articles by this author , Larry LipshultzLarry Lipshultz More articles by this author , and Thomas GarciaThomas Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002594.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mammalian Reproductive Genetics Database (MRGD; currently http://mrgd.org), established by Dr Robert E. Braun at the University of Washington in 1997, has had a long historical presence in the reproductive biology community as a research resource designed to disseminate highly relevant male and female reproductive tissue and cell gene expression data from many publications. Highly visited and highly cited, the website provided users a one-stop shop to quickly determine a gene expression profile for their gene or tissue of interest from an aggregate of many microarray data sources, all published between 2004 and 2008. Although of unquestionable significance in advancing the fields of male and female reproduction, with the advent of sequencing-based gene expression analyses, and the plethora of new published datasets available, the MRGD has been in dire need of presenting results from these newest advances in technology. METHODS: In the present work, we have established a new web portal, the Mammalian Reproductive Genetics Database, version 2 (MRGDv2). This new portal hosts interactive visualizations (customizable heatmaps and bar graphs) of male and female reproductive and non-reproductive tissue. Cell gene expression data from our recent reanalysis of 988 published human and mouse RNA-seq datasets was also present. RESULTS: We have generated a new and innovative database with a comprehensive assortment of additional human and mouse tissues and cells. The data is presented to users on a refreshed and modern web interface with most data hosted on the former MRGD re-included and referenced on the new website, with all gene IDs updated to the current version. Further, users are able to display the orthologous species' expression result side-by-side through one search. CONCLUSIONS: The former MRGD was highly utilized by biologists and researchers across the fields of reproductive biology and contraceptive development. It is anticipated that the MRGDv2 will be as impactful, if not more impactful, due the added datasets, functionality and features that have been added. With gene expression data at your fingertips, clinicians can make a more informed decision as to whether a mutated gene is likely to cause a reproductive phenotype-only, or cause disorders that extend to non-reproductive systems, and which systems are likely to be affected. Source of Funding: This work has been supported by the Male Contraceptive Initiative and the Eunice Kennedy Shriver National Institute of Child Health & Human Development grant R01HD095341 (to TXG) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e636 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Deras More articles by this author Vivek Ramanathan More articles by this author Xingquan Lu More articles by this author Uma Ramamurthy More articles by this author Martin Matzuk More articles by this author Larry Lipshultz More articles by this author Thomas Garcia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Genital inflammatory status and the innate immune response to contraceptive initiation.

Data on the effects of contraceptives on female genital tract (FGT) immune mediators are inconsistent, possibly in part due to pre-existing conditions that influence immune mediator changes in response to contraceptive initiation. This study included 161 South African women randomised to injectable depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (IUD), or levonorgestrel (LNG) implant in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial. We measured thirteen cytokines and antimicrobial peptides previously associated with HIV acquisition in vaginal swabs using Luminex and ELISA, before, and at 1 and 3 months after contraceptive initiation. Women were grouped according to an overall baseline inflammatory profile. We evaluated modification of the relationships between contraceptives and immune mediators by baseline inflammation, demographic, and clinical factors. Overall, LNG implant and copper IUD initiation were associated with increases in inflammatory cytokines, while no changes were observed following DMPA-IM initiation. However, when stratifying by baseline inflammatory profile, women with low baseline inflammation in all groups experienced significant increases in inflammatory cytokines, while those with a high baseline inflammatory profile experienced no change or decreases in inflammatory cytokines. We conclude that pre-contraceptive initiation immune profile modifies the effect of contraceptives on the FGT innate immune response.

Case Report of the Successful Use of Two Skyla Levonorgestrel Intrauterine Devices in a Patient with a Uterine Didelphys

Background: Little is known about contraceptive desires in women with uterine anomalies. Only limited case reports exist regarding the use of intrauterine devices (IUD) in such patients. According to the United States Medical Eligibility Criteria (US MEC) for Contraceptive Use, any abnormally shaped uterine cavity, which includes congenital or acquired uterine abnormalities, are Category 4 for initiation of IUD contraception. We present the case of a young woman with uterine didelphys who desired IUD placement despite significant counseling of other contraceptive options.

The Effect of Contraception on Genital Cytokines in Women Randomized to Copper Intrauterine Device, Depot Medroxyprogesterone Acetate, or Levonorgestrel Implant.

The ECHO trial randomized women to intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG-implant), or copper intrauterine device (Cu-IUD). In a substudy of the ECHO trial, we tested the hypothesis that contraceptives influence genital inflammation by comparing cervicovaginal cytokine changes following contraception initiation. In addition, we compared cytokine profiles in women who acquired HIV (cases) versus those remaining HIV negative (controls). Women (n = 251) from South Africa and Kenya were included. Twenty-seven cervicovaginal cytokines were measured by Luminex at baseline, and 1 and 6 months after contraceptive iTanko et alnitiation. In addition, cytokines were measured preseroconversion in HIV cases (n = 25) and controls (n = 100). At 6 months after contraceptive initiation, women using Cu-IUD had increased concentrations of 25/27 cytokines compared to their respective baseline concentrations. In contrast, women initiating DMPA-IM and LNG-implant did not experience changes in cervicovaginal cytokines. Preseroconversion concentrations of IL-1β, IL-6, and TNF-α, previously associated with HIV risk, correlated with increased HIV risk in a logistic regression analysis, although not significantly after correcting for multiple comparisons. Adjusting for contraceptive arm did not alter these results. Although Cu-IUD use broadly increased cervicovaginal cytokine concentrations at 6 months postinsertion, these inflammatory changes were found not to be a significant driver of HIV risk. NCT02550067.

Bleeding Complications Associated With Intrauterine Contraception in Women Receiving Anticoagulation Therapy

ObjectiveTo determine whether anticoagulation therapy is associated with an increased risk of complications after initiation of intrauterine contraception (IUC). Patients and MethodsWe retrospectively reviewed records of women receiving anticoagulation therapy at the time of IUC placement from 2000 to 2017 and records of controls (no anticoagulation), matched by race, age, and body mass index. The primary outcome was the cumulative incidence of bleeding (more than spotting [World Health Organization bleeding grades 2 to 4]), IUC expulsion, and IUC removal. Secondary outcomes included treatment for bleeding and bleeding patterns stratified by medication and IUC type. Outcomes were assessed at 24 hours, 30 days, and 6 months after IUC placement. ResultsWe matched 208 women taking anticoagulants with 421 controls. The most common anti-coagulant agents were aspirin (60.1%) and warfarin (36.1%). Most women received the levonorgestrel IUC. No complications occurred within 24 hours. Patients receiving anticoagulants had higher rates of the primary composite outcome at 30 days (odds ratio, 1.77 [95% CI, 1.04 to 3.04]; P=.04) and at 6 months (odds ratio, 2.05 [95% CI, 1.29 to 3.26]; P=.002). Primary complications did not differ by IUC type among control patients, but among women receiving anticoagulants, nonhormonal IUC was associated with an increased rate of complications (P=.04). ConclusionAnticoagulation therapy was associated with higher rates of bleeding at 30 days and 6 months, and nonhormonal IUC plus anticoagulation therapy was associated with higher rates of primary complications. Our findings support current periprocedural anticoagulation guidelines, which state that anticoagulation and antiplatelet therapy can be continued at the time of IUC insertion.

MHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review

ABSTRACT Ensuring people have access to their preferred method of contraception can be key for meeting their reproductive goals. A growing number of mHealth interventions show promise for improving access to contraception, but no literature review has identified the effects of mHealth interventions among both adolescents and adults in the United States. The purpose of this systematic review was to describe the format, theoretical basis, and impact of mHealth interventions for contraceptive behavior change (contraceptive initiation and continuation) among people of all ages in the US. A systematic review of the literature was conducted using six electronic databases guided by Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data on study design, frequency, duration, mHealth modality, contraceptive method, behavior change theory, and behavioral outcome were extracted to facilitate comparison. Eighteen studies met eligibility criteria. The majority (11; 61%) used SMS (short message service). Twelve studies focused on contraceptive initiation, most (n = 8) of which also measured continued use over time. The remaining six interventions focused on continuation alone, generally through appointment reminders. Very little contraceptive behavior change was identified across studies. Current mHealth interventions may hold promise for some health areas but there is little evidence that they change contraceptive behavior. Future mHealth interventions should focus on assessing person-centered outcomes, including satisfaction, side effects, and reasons for discontinuation, to best support people to use their preferred contraceptive method.

Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden

ObjectiveThis trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.MethodsA cluster randomised controlled trial was conducted in 2017–2019 at abortion, youth and maternal...

Does early initiation of progestin-only contraception after delivery influence breast milk production and duration of breastfeeding?

Robbins, Esther MD, MPH; Banks, Haley MD; Dunbar, Azrael MD; Walker, Kelsey MD Author Information