Contraception Planning Research Articles

Management of type 2 diabetes in young adults aged 18-30 years: ADS/ADEA/APEG consensus statement.

Type 2 diabetes in young adults (nominally, 18-30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance, directed mainly towards older adults, may not be appropriate or relevant for the young adult population. Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents (aged <18 years). The full statement is available at https://www.diabetessociety.com.au, https://www.adea.com.au and https://www.apeg.org.au. Advice is provided on important aspects of care including screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient-centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. Management recommendations for young adults, which differ from those for adults, include: ▪screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus; ▪more stringent glucose targets (glycated haemoglobin ≤6.5% [≤48mmol/mol]); ▪in the context of obesity or higher cardio-renal risk, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are preferred second line agents; ▪β-cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated; ▪a blood pressure target of <130/80mmHg, as the adult target of ≤140/90mmHg is too high; ▪absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and ▪a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.

Are postpartum adolescents more likely to diverge from their prenatal stated contraceptive plan?

Background: Approximately 1 in 5 teen births is a repeat birth. Only about 1 in 5 teen mothers use the most effective contraceptive methods. The prenatal and postpartum periods provide opportunities to counsel on and provide effective birth control methods respectively. We hypothesized that adolescents were more likely to diverge from contraceptive plans stated prenatally compared to adult patients.

Pregnancy planning and barriers to accessing postnatal contraception in New Zealand

ObjectiveTo estimate rates of pregnancy and contraceptive planning and to identify barriers and enablers to postnatal contraceptive use. Study DesignFace-to-face survey of patients during their immediate postnatal stay at Middlemore Hospital, Auckland, or associated primary birthing units. Patients were approached by study investigators over designated 2-week study periods in 2019 and 2020. The primary outcome was the rate of pregnancy and contraceptive planning. The descriptive analysis explored differences between ethnicities. ResultsWe were able to approach 332 of 497 eligible women (67%), and 313 of 332 (94%) of those who approached completed the survey. Fifty-three percent of pregnancies were reported to have been planned. Pregnancy was more often planned by European (72%), Indian (68%), and Other Asian patients (72%) compared with Māori (33%) and Pacific patients (39%) (p < 0.001). Thirty-seven percent of patients reported an antenatal contraceptive discussion, and these were more commonly reported by Māori and Pacific patients (p < 0.001). A quarter of patients reported never having a conversation about contraception during or immediately after pregnancy, a third of whom said they would have valued one. Fifty-nine percent of patients reported having made a contraceptive plan immediately after birth. Concern about the side effects of contraception was a barrier reported by 51% of patients. Cost, travel, finding time, and family views were less frequent barriers. ConclusionRates of pregnancy planning reported postnatally are consistent with previous NZ research at approximately 50%, and we also found ethnic differences. Concerns about side effects were the most significant barrier for patients accessing contraception and this needs to be addressed in a culturally useful format. ImplicationsPostpartum patients report low rates of pregnancy planning. A significant proportion of postpartum patients report having no conversations about contraception with clinicians, and concerns about side effects are their most common barrier to contraception.

Individual and Community Level Factors Related to Contraceptive Access, Family Planning, and Reproductive Health Challenges Among Women in Kumasi, Ghana: A Field Study

Despite the availability of contraceptives, cultural practices and social factors create barriers that prevent women in Ghana from realizing their reproductive health potential. The purpose of the field study was to examine individual and community level factors related to contraceptive access, family planning, and reproductive health challenges among women in Kumasi, Ghana. Specifically, we conducted a field-based comparison of women’s health-related issues in Kumasi and the US to determine areas of similarities and differences. Since our focus was Kumasi in general and the Suntreso Government Hospital in particular, we used convenience sampling. Thus, study results are not generalizable to the entire population of Ghana. Given the short duration of the entire field study (three weeks), and the fact that information on the women’s health areas of focus in Ghana is available in the US, secondary data from various sources were used for the US comparison. Utilizing a cross-sectional, mixed-methods study design, 100 women of reproductive age were surveyed. Results showed that 69.0% of study participants in Kumasi knew where to go to access birth control services but had little desire to use them. Like the study participants in Kumasi, most women in the US also know where to access reproductive health services but are more desirous and interested in using such services. We also found that while cultural norms and gender roles served as primary barriers to family planning and contraceptive access for women in Kumasi, access to health insurance is the barrier in the US. Copyright © 2022 Gibson et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Fetal Warfarin Syndrome – a case report

A two-month-old male infant presented with history of respiratory difficulty and got admitted with provisional diagnosis of pneumonia. On examination patient was having unilateral nasal hypoplasia and cyanosis with echocardiography showing truncus arteriosus. Detail history revealed that mother had valve replacement and she was taking warfarin during pregnancy. After initial management patient was referred to pediatric cardiac surgery and plastic surgery for further management. Parents were counseled regarding contraception and family planning.

Contraception and family planning: knowledge, attitude, pattern of use, and barriers among females in Gharbia Governorate, Egypt

AimsMost contraceptive methods are designed to be used by women due to the paucity of effective contraceptive options for men. This study aimed to assess knowledge, attitude, and family-planning (FP) practice among women of reproductive-age group in Gharbia Governorate, Egypt.Materials and materialsA self-administered questionnaire was developed and adapted from previous studies. Scores were used to assess the levels of knowledge, attitude, and practice concerning FP.ResultsThe questionnaire was answered by 430 women. Current use of contraceptives was stated by 81.9%. The commonest methods included intrauterine device (44%), oral pills (20.7%), and injectables (8.4%). Knowledge was good, fair, and poor in 34.2%, 60.2%, and 5.6% of participants, respectively. Attitude was positive in 95.3%. Practice of FP was good in 67.9%. The most common barriers included fear of side effects (27.2%), lack of knowledge (23.3%), husband's refusal (13%), and for religious reasons (6.5%). Good knowledge was significantly associated with full-time job of women (P < 0.001), professional job of husband (P = 0.002), and high income (P = 0.004). Attitude was not significantly associated with sociodemographic characteristics (P > 0.05). Good practice was significantly associated with age ≥30 years (P = 0.037) and family size above 4 (P = 0.002). Knowledge and practice scores were significantly and positively, though weakly, correlated with the attitude score (rs < 0.3, P < 0.05).ConclusionThe overall knowledge and attitude of respondents was good, but practice needs to be improved. Future campaigns and FP counseling should address the misconceptions about contraception, particularly side effects. Other barriers should be approached to ensure meeting of FP needs of couples.

Reconsidering the Contralife Argument and the Principle of Double Effect

According to the contralife argument, because both contraception and natural family planning (NFP) entail at least a contralife motivation to have marital intercourse but avoid pregnancy, both should be forbidden—a conclusion rejected by the natural law tradition and Church teaching, which forbid contraception but permit NFP. This paper argues that the principle of double effect (PDE) can be applied to explain why contraception is forbidden but NFP is permissible. This double-effect analysis evaluates the good effect of procreation and unity against the bad effect of lustful sexual pleasure. This paper argues that contraception fails to meet the conditions of the PDE, because it intends sexual pleasure in isolation from procreation and unity and is therefore forbidden. Conversely, NFP meets the conditions of the PDE because, as with all permissible sexual intercourse, it intends sexual pleasure in conjunction with procreation and unity and is therefore itself permissible.

Preferences and Motivations of Women Who Use Traditional Contraceptive Methods to Avoid Pregnancy in Sub-Saharan Africa: A Systematic Review

Introduction: When it comes to family planning, requirements and preferences vary among couples. Because of their mixed effectiveness, traditional contraceptive methods are often associated and accounted as unmet needs. However, interest in these methods is growing significantly. Nevertheless, knowledge of the reasons for the decision and using traditional contraceptive methods remains limited. The purpose of this study was to identify the preferences and motivations of women who use traditional contraceptive methods to avoid pregnancy in Sub-Saharan Africa. Method: A literature search was conducted in three electronic databases (PubMed/Biomed Central/Medline, Embase, CINAHL). Two independent individuals selected the eligible quantitative, qualitative, and mixed studies published between 2011 and 2020. We conducted a narrative synthesis to organize and group preferences and motivations that facilitate traditional contraceptive methods use. Results: Abstinence, withdrawal, breastfeeding, rhythm method were the main preferences to contraceptive planning methods identified. Factors influencing the use of traditional contraceptive methods were the lack of knowledge, the side effects, the bad experience with the modern contraceptive methods, spousal communication around family planning, the husband’s opposition to modern methods, availability, accessibility, and the absence of side effects as well as the character of the traditional methods, the fact of living in an urban environment as well as the age beyond 30 years. Conclusion: This review identified preferences and motivations for using traditional contraceptive methods. These findings could be considered in different family planning programs to understand their role and help to estimate the contraceptive prevalence better.

Accessibility to postpartum tubal ligation after a vaginal delivery: When the Medicaid policy is not a limiting factor

To describe rates of postpartum sterilization and indications for unfulfilled requests when Medicaid policy is not a limiting factor. We conducted a single-institution, retrospective review. Women who requested postpartum tubal ligation after vaginal delivery from August 2015 to March 2019 were studied. Select demographic characteristics were compared between those who did and did not undergo the procedure. Reasons for why the procedure was cancelled, alternate contraceptive plans, and subsequent pregnancies were collected. Statistical analysis included the t test and chi-squared test, with p < 0.05 considered significant. A total of 4103 patients requested postpartum tubal ligation following vaginal delivery. About 3670 (89.4%) procedures were performed and 433 (10.6%) were canceled. Of the 433, 423 (98%) were not performed at patient request; 10 (2 %) were cancelled based on physician recommendation. Of these, 3 were due to significant maternal anemia in the setting of refusal of blood products, 1 due to anesthesia concerns, 1 for increased body mass index, and 1 due to delivery events. Alternative contraception methods were offered; 72 (28% of patients not receiving a tubal ligation) received Depo Provera prior to discharge. One-fourth (n=110, 25.4%) did not keep the postpartum follow-up appointment. 83 (19.2%) of the 433 patients had at least one subsequent pregnancy. Although over half expressed interest at the time of discharge in long-acting reversible contraceptives, only 20% obtained this method at the postpartum visit. Postpartum sterilization was predominantly achieved, among women whose requests were unfulfilled, the majority (98%) were at patient request with a minority by physician recommendation. When the availability of postpartum tubal ligation is independent of Medicaid reimbursement and the hospital system and providers are organized to support timely access to permanent postpartum contraception, the majority of tubal ligations requests can be fulfilled following vaginal delivery.

Assessment of the Social Factors Affecting the use of Contraceptives and the Stigma Associated

The factors affecting the use of contraceptives and social stigma associated with it has caused significant uncontrolled growth of population, which is the most important problem with developing countries like India. The only effective way of controlling population explosion is through promotion and practice of contraception and family planning. To assess the social factors affecting the use of contraceptives and the stigma associated with it. To assess basic knowledge about contraceptive methods and relationship between knowledge of contraceptives and formal education; Compare knowledge and use of contraceptives in rural and urban populations, different occupational categories and economic statuses; Determine the major source of information about contraceptives in different age groups and to assess reasons for using and not using contraceptives. The research indicated that, still a significant percentage of population do not have proper knowledge, have hesitancy in buying, hesitancy in discussing contraceptive methods. Significant portion of the study group is not using contraceptive methods to prevent STDs or for practicing birth spacing. Low socioeconomic status was associated with not using any form of contraception among women with unintended pregnancies. We have received maximum responses from females (67.0%); from males (33.0%). We have received maximum response from undergraduates (41.2%) and least from people with no formal schooling (4.6%). Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively. Health education may help overcome the issues related to social stigma on the use of contraceptives and family planning. Keywords: Contraceptives, Family planning, Knowledge, Social stigma

Relationship between Media Access and Social Support with Contraception Plans in East Java, Indonesia

Objectives: The percentage of contraceptive prevalence rate (CPR) and total fertility rate (TFR) of woman were indicators of the 2015-2019 National Medium Term Development Plan (RPJMN). Total fertility rates in East Java had decreased significantly from 1971 to 2018. The achievement of the prevalence of modern contraceptive use (CPR) in East Java was 63.1 percent based on the results of the Program Performance and Accountability Survey (PPAS, 2018). This achievement was far better than the national achievement which only reached 57 percent. However, this target cannot be achieved by all districts and cities in East Java. According to Green’s theory, the factors of predisposing, enabling and reinforcing are factors that can be related to behavior. The purpose of this study was to analyze the relationship between enabling factors (media access) and reinforcing factors (social support) related to contraceptive plans in women of childbearing age in East Java, Indonesia.Study Design: This research was a non-reactive study using data from the IDHS (Indonesia Demographic and Health Survey) 2017. The unit of analysis in this study was all teenage respondents in East Java who met the requirements of the 2017 IDHS respondents.Results: The results showed that the enabling factor associated with contraception selection plans was listening to information about contraception through radio (sig = 0.038), television (sig &lt; 0.001) and newspapers (sig &lt; 0.001). While the reinforcing factor associated with contraceptive selection plans was supports from health facilities (sig = 0.000) and from farmacy (sig = 0.023). The role of health workers was very minimal in providing information access to woman in the process of selecting contraception. It can be seen that almost all of the woman said that they did not get information either from field officers (41.91%), from health facilities (39.45%), from village clinics (42.52%), and from pharmacists (38.00%).Implication to the fields: Based on the results of this study, there is a need for equal distribution of education in the selection of contraceptive methods to woman through optimizing the role of various health facilities, one of them through contraception officers, optimizing the use of mass media, especially television, radio and newspapers and magazines in disseminating information related to family planning.

Profile of abortion seekers in the tertiary center of northern hills with review of medical termination of pregnancy act in India

The aim of the present study was to investigate the socio-demographic and obstetric profile of pregnant women, seeking medical termination of pregnancy in accordance with the Medical Termination of Pregnancy (MTP) Act and the reasons for undergoing termination of pregnancy in the tertiary care center of the hilly region of Northern India and to further review the amendments in the Medical Termination of Pregnancy Act 1971 along with its future implications in legalizing abortions in India.&#x0D; Materials and Methods: A registry-based retrospective study was carried out among pregnant women, attending the gynecologic outpatient department for termination of pregnancy at the tertiary care teaching hospital and the referral center for Himalayan foothills in Northern India. The records of women, seeking termination of pregnancy during a 1-year period between October 2020 and September 2021, were reviewed and information on their demographic and obstetric profile, reason for undergoing termination of pregnancy, and acceptance of contraception, following termination of pregnancy was recorded in the data sheet. The information obtained was analyzed using SPSS version 20 (IBM, Chicago, USA) for descriptive statistics.&#x0D; Results: A total of 400 pregnant women underwent Medical Termination of Pregnancy between October 2020 and September 2021. 30.5 % (122/400) women between 26–30 years of age underwent termination of pregnancy, followed by 27.3 % women aged between 31–35 years. Social reasons for termination of pregnancy were more evident in women aged 26 years and above. 84.09 % pregnancies were terminated in the second trimester (&gt;12 weeks) on eugenic ground, while 65.01 % pregnancies were terminated in the first trimester (6–12 weeks) on social grounds. Only 7.75 % (31/400) women opted for sterilization or family planning after MTP, out of which the majority opted for temporary methods of contraception.&#x0D; Conclusion: We conclude from the results of the present study that women in the peak reproductive age (26–30 years) are more likely to seek pregnancy termination and this group of women needs to be the focus of contraceptive counseling and family planning services. Timely ultrasound scans by an expert sonologist may be a step forward towards lowering the rates of late pregnancy termination. There is a need to educate women to avail and use contraceptive methods in an effective manner and to make them aware of utilizing sterilization services, once they complete their families to avoid unwanted pregnancies.

The Spectrum, Severity and Outcomes of Rheumatic Mitral Valve Disease in Pregnant Women in Australia and New Zealand

Rheumatic heart disease (RHD) poses significant perinatal risks. We aimed to describe the spectrum, severity and outcomes of rheumatic mitral valve disease in pregnancy in Australia and New Zealand. A prospective, population-based cohort study of pregnant women with RHD recruited 2013-14 through the hospital-based Australasian Maternity Outcomes Surveillance System. Outcome measures included maternal and perinatal morbidity and mortality. Univariable and multivariable logistic regression analyses were undertaken to test for predictors of adverse maternal and perinatal outcomes. Of 274 pregnant women identified with RHD, 124 (45.3%) had mitral stenosis (MS) and 150 (54.7%) had isolated mitral regurgitation (MR). One woman with mild MS/moderate MR died. There were six (2.2%) stillbirths and two (0.7%) neonatal deaths. Babies born to women with MS were twice as likely to be small-for-gestational-age (22.7% vs 11.4%, p=0.013). In women with MS, use of cardiac medication (AOR 7.42) and having severe stenosis (AOR 16.35) were independently associated with adverse cardiac outcomes, while New York Heart Association (NYHA) class >1 (AOR 3.94) was an independent predictor of adverse perinatal events. In women with isolated MR, use of cardiac medications (AOR 7.03) and use of anticoagulants (AOR 6.05) were independently associated with adverse cardiac outcomes. Careful monitoring and specialist care for women with RHD in pregnancy is required, particularly for women with severe MS, those on cardiac medication, and those on anticoagulation, as these are associated with increased risk of adverse maternal cardiac outcomes. In the context of pregnancy, contraception and preconception planning are important for young women diagnosed with RHD.

Contraceptive plans before preoperative assessment and at procedure in surgical abortion patients

To describe changes in contraceptive method plans pre-appointment, after counseling, and post-procedure in patients having an abortion. We reviewed electronic medical records of University of California, Davis Health patients who had an operating room abortion from January 2015 to December 2016. We excluded persons with procedures for fetal anomaly or demise. We extracted patient demographics and contraceptive plans reported at each encounter (telephone intake, pre-operative appointment, and day of abortion). We evaluated individual contraceptive plans across the encounters, identified patient characteristics that contributed to plan change, and created a multivariable logistic regression model for predictors of contraception method plan change from telephone intake to post-procedure. The 747 patients had a mean gestational age of 16 4/7 ± 5 0/7 weeks with 244 (32.7%) <15 weeks and 235 (31.5%) ≥20 weeks. At telephone intake, 273 (36.4%) wanted a long-acting method (139 [50.9%] intrauterine device [IUD]; 99 [36.3%] implant; 35 [12.3%] unspecified), 11 (3.9%) permanent contraception, and 248 (33.2%) a less effective or no method; 215 (28.8%) stated they were undecided. Most (357/433 [82.4%]) patients who planned a reversible method based on the telephone intake obtained that or a similar method. Of the 273 patients planning a long-acting method, 258 (94.5%) received an IUD (158 [40.9%]) or implant (100 [36.6%]). Of the 215 undecided patients, 88 (40.9%) received an IUD and 55 (25.6%) an implant. No demographic factors predicted a change in method plan. Most patients will receive the method they initially identified at the telephone intake after an abortion, especially those planning an IUD or implant. Undecided patients are commonly open to discussing options.

Differences in postpartum contraceptive choices and patterns following low- and high-risk pregnancy

ObjectiveTo assess the impact of a high-risk pregnancy on postpartum contraceptive planning and use. MethodsWe conducted a retrospective cohort study of women who gave birth in a teaching hospital in 2020. We classified women into 2 groups based on their risk status according to the Society for Maternal-Fetal Medicine. The World Health Organization (WHO) tiers of contraceptive efficacy were used to categorize contraceptive planning and administration. The primary outcome was the utilization rate of Tier 1contraceptive methods at their postpartum visit in women with prior high-risk pregnancy. Univariate and multivariate analyses were carried out to determine the relationships between risk status, characteristics, contraceptive preference, and actual utilization. ResultsThis study included 788 low-risk and 482 high-risk postpartum women. High risk women indicated greater interest in (43.5% low-risk vs 52.2% high-risk, p < 0.01) and usage rates of (45.7% low-risk vs 54.3% high-risk, p = 0.01) Tier 1 contraception. The most commonly chosen contraceptive methods among low- and high-risk women were progestin-only pills (30.6%) and tubal ligation (36.4%), respectively. Uptake rates of immediate postpartum contraceptive implants did not differ between low (9.3%) and high-risk (11%) women (p = 0.32). Few patients adopted intrauterine devices (1.1%). ConclusionHigh-risk status was associated with intention to use and uptake of effective contraceptive methods, which persisted through the postpartum period. ImplicationsTo assist women in achieving the recommended interpregnancy intervals, counseling tailored to their individual risks and needs should be provided. Reasons for low intrauterine devices uptake should be explored. Postnatal care should include immediate postpartum long-acting reversible contraception (LARC) services.

Dyadic support across contraceptive decision-making among young adult breast cancer survivors and their partners

Objective: The purpose of this study is to explore the role of dyadic support across the contraceptive decision-making process between young adult breast cancer (YABC) survivors and their partners. Research Approach: Semi-structured interviews with YABC survivors and their partners. Participants: Twenty-five young adult breast cancer survivors and their partners (n = 50). Survivors reported an average age of 36.9 years (SD = 4.30) and the majority self-identified as white (86.2%). Methodological Approach: Thematic analysis approach with dyads as the primary unit of analysis, guided by the dyadic decision-making framework and the Theory of Gender and Power. Results: Perceived lack of contraceptive options due to a history of hormone-sensitive cancer, perceived infertility, and contraception as a result of cancer treatment (e.g., hysterectomy) contributed to the contraceptive decision context for survivors and their partners. Contraceptive support varied across couples depending on the cancer-specific context, where communication, sharing responsibility, and respecting bodily autonomy revealed as supportive behaviors. Other social influences including survivors’ desire to conceive biologically and family planning desires also related to partner supportive behaviors. Interpretations: YABC survivors face specific challenges to contraceptive decision-making where partners can offer supportive behaviors. Health care providers can also support couples by engaging in triadic communication about contraception and family planning. Implications for Psychosocial Providers or Policy: Psychosocial providers can support couples by encouraging them to talk together about contraception and highlighting the importance of triadic communication with a healthcare provider to support shared decision-making and alignment of contraceptive decisions with family planning desires.

Trends and Factors Associated with Oral Contraceptive Use among Korean Women.

Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in Korea. We used secondary data from the 2010–2019 National Health and Nutrition Examination Survey to examine trends in the annual prevalence of OC use between 2010 and 2019, and factors influencing OC use. Based on data from 14,386 premenopausal women, the average annual prevalence of OC use was 8.2–10.7% between 2010 and 2014; it increased to 12.6–14.4% during 2015–2019. The prevalence of OC use was significantly higher in women with higher (≥5) than lower gravidity (<5). In addition, among sociodemographic factors, education level, household income, cigarette smoking, and alcohol drinking were significantly associated with OC use in Korean women. As OC use is affected by sociodemographic factors, a contraceptive plan that considers sociodemographic factors is needed to establish an effective family planning policy.

Postpartum permanent contraception: updates on policy and access.

To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.

Sexual and reproductive health education: Midwives’ confidence and practices

ProblemThere is limited evidence regarding midwives’ confidence and practices in providing sexual and reproductive health care in Australia. BackgroundMidwives provide important public health education to women regarding sexual and reproductive health care. AimThe aim of this study was to explore midwives’ confidence and practices around providing education to women on three key areas of sexual and reproductive health: contraception and family planning; sexual activity; and sexual health. MethodsA cross-sectional exploratory study was conducted with responses from n = 164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data. FindingsThere was a significant association between age, years of clinical experience (p = 0.001) and work setting (p = 0.032) on the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education. Lack of time, knowledge and language barriers were key factors preventing education. DiscussionMidwives’ provision of education to women is essential for improving health literacy and health outcomes. Results reveal the necessity to include sexual and reproductive health education in entry to registration courses and the importance of continuing professional development. ConclusionEvidence of midwives’ confidence and current practices in the provision of sexual and reproductive health care offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important public health role.

The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease

ObjectiveTo evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease. Study DesignRetrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum. ResultsOf 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred. ConclusionLARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality. ImplicationsAccess to immediate postpartum IUDs and implants should be a public health priority for women with heart disease – as well as all people with high-risk health conditions – to reduce their disproportionate burden of maternal morbidity and mortality.