Current Contraceptive Use Research Articles

Sociodemographic factors and current contraceptive use among ever-married women of reproductive age: Analysis of the 2017 Indonesia Demographic and Health Survey data

Background and purpose: Globally, the number of new contraceptive users in mid-2017 was only around half of the target. According to the results of the Indonesian Demographic and Health Survey (IDHS), the use of all methods of contraception in Indonesia has increased but is still lower than the target. This study aims to determine the factors associated with the use of contraception in Indonesia.
 Methods: This study uses secondary data from the 2017 IDHS that was carried out in 34 provinces in Indonesia. The total sample was 35,681 of 49,627 women aged 15-49 years. The dependent variable was current contraceptive use. The independent variables consisted of socio-demographic and socio-economic factors, knowledge, discussion with husband, and access to health services. Data analysis was performed through a binary logistic regression test to obtain the adjusted odd ratio of each factor.
 Results: The proportion of current contraceptive use was found to be 63.6% (95%CI: 63.2-64.0%). Factors related to current contraceptive use were family planning information from health workers (AOR=1.67; 95%CI: 1.59-1.77), maternal age of 35-44 years (AOR=1.54; 95%CI: 1.42-1.66), maternal age of 25-34 years (AOR=1.37; 95%CI: 1.27-1.48), maternal age ≥45 years (AOR=0.75; 95%CI: 0.68-0.82), living in the Java-Bali region (AOR=1.28; 95%CI: 1.22-1.35), living in rural areas (AOR=1.07; 95%CI: 1.01-1.12), having more than two living children (AOR=1.52; 95%CI: 1.44-1.60), level of education not attending school until not graduating from high school (AOR=1,46; 95%CI: 1.35-1.59), high school graduation level (AOR=1.25; 95%CI: 1.16-1.35), not working status (AOR=1.08; 95%CI: 1.03-1.13), medium wealth index (AOR=1.07; 95%CI: 1.00-1.14) and good knowledge (AOR=1.17; 95%CI: 1.11-1.23).
 Conclusion: The proportion of current contraceptive use in couples of childbearing age in Indonesia has not reached the government target. Factors that were more likely to increase current contraceptive use were family planning information from health workers, age, region, number of living children, mothers’ education, and knowledge. The family planning program in Indonesia should therefore consider those factors to increase the current contraceptive use.

Sociodemographic factors and current contraceptive use among ever-married women of reproductive age: Analysis of the 2017 Indonesia Demographic and Health Survey data

Background and purpose: Globally, the number of new contraceptive users in mid-2017 was only around half of the target. According to the results of the Indonesian Demographic and Health Survey (IDHS), the use of all methods of contraception in Indonesia has increased but is still lower than the target. This study aims to determine the factors associated with the use of contraception in Indonesia.Methods: This study uses secondary data from the 2017 IDHS that was carried out in 34 provinces in Indonesia. The total sample was 35,681 of 49,627 women aged 15-49 years. The dependent variable was current contraceptive use. The independent variables consisted of socio-demographic and socio-economic factors, knowledge, discussion with husband, and access to health services. Data analysis was performed through a binary logistic regression test to obtain the adjusted odd ratio of each factor. Results: The proportion of current contraceptive use was found to be 63.6% (95%CI: 63.2-64.0%). Factors related to current contraceptive use were family planning information from health workers (AOR=1.67; 95%CI: 1.59-1.77), maternal age of 35-44 years (AOR=1.54; 95%CI: 1.42-1.66), maternal age of 25-34 years (AOR=1.37; 95%CI: 1.27-1.48), maternal age ≥45 years (AOR=0.75; 95%CI: 0.68-0.82), living in the Java-Bali region (AOR=1.28; 95%CI: 1.22-1.35), living in rural areas (AOR=1.07; 95%CI: 1.01-1.12), having more than two living children (AOR=1.52; 95%CI: 1.44-1.60), level of education not attending school until not graduating from high school (AOR=1,46; 95%CI: 1.35-1.59), high school graduation level (AOR=1.25; 95%CI: 1.16-1.35), not working status (AOR=1.08; 95%CI: 1.03-1.13), medium wealth index (AOR=1.07; 95%CI: 1.00-1.14) and good knowledge (AOR=1.17; 95%CI: 1.11-1.23).Conclusion: The proportion of current contraceptive use in couples of childbearing age in Indonesia has not reached the government target. Factors that were more likely to increase current contraceptive use were family planning information from health workers, age, place of residence, region, number of living children, and mothers’ education. The family planning program in Indonesia should therefore consider those factors to increase the current contraceptive use.

Family planning counseling and its associations with modern contraceptive use, initiation, and continuation in rural Uttar Pradesh, India

BackgroundWe examine the association between the quality of family planning (FP) counseling received in past 24 months, and current modern contraceptive use, initiation, and continuation, among a sample of women in rural Uttar Pradesh, India.MethodsThis study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15–49 years; the analysis excluded women who were already using a permanent method of contraceptive during the first round of survey and who reported discontinuation because they wanted to be pregnant (N = 1398). We measured quality of FP counseling using four items on whether women were informed of advantages and disadvantages of different methods, were told of method(s) that are appropriate for them, whether their questions were answered, and whether they perceived the counseling to be helpful. Positive responses to every item was categorized as higher quality counseling, vs lower quality counseling for positive response to less than four items. Outcome variables included modern contraceptive use during the second round of survey, and a variable categorizing women based on their contraceptive use behavior during the two rounds: continued-users, new-users, discontinued-users, and non-users.ResultsAround 22% had received any FP counseling; only 4% received higher-quality counseling. Those who received lower-quality FP counseling had 2.42x the odds of reporting current use of any modern contraceptive method (95% CI: 1.56–3.76), and those who received higher quality FP counseling at 4.14x the odds of reporting modern contraceptive use (95% CI: 1.72–9.99), as compared to women reporting no FP counseling. Women receiving higher-quality counseling also had higher likelihood of continued use (ARRR 5.93; 95% CI: 1.97–17.83), as well as new use or initiation (ARRR: 4.2; 95% CI: 1.44–12.35) of modern contraceptives. Receipt of lower-quality counseling also showed statistically significant associations with continued and new use of modern contraceptives, but the effect sizes were smaller than those for higher-quality counseling.ConclusionsFindings suggest the value of FP counseling. With a patient-centered approach to counseling, continued use of modern contraceptives can be supported among married women of reproductive age. Unfortunately, FP counseling, particularly higher-quality FP counseling remains rare.

Determinants of Teenage Pregnancy in Rural Ethiopia

Teenage pregnancy is a major health concern because it associated with higher morbidity and mortality for both mother and child. The general aim was to assess the determinants of teenage pregnancy in rural Ethiopia using 2252 teenagers of EDHS 2016 data. The data was analyzed using descriptiv(percentage and barcchart) and inferential statistics(logistic regression).The descriptive statistics revealed that 16.3% of the teenagers experienced teenage pregnancy and the highest teenage pregnancy were found in the rural area of Harari, Afar, Dire Dawa and Somali regional state of Ethiopia while the lowest was found in Ahmara, SNNPand Tigray regional state of Ethipia. The logistic regression showed that age at first sexual intercourse, marital status, education level, wealth index, knowledge about ovulary cycle, Current contraceptive use and region were signficantly affect teenage pregnancy in Ethiopia. Hence, the government and other cocerned body should work to create awareness and legal restriction on reproductive activity of teenagers to minimize the risk of teenage pregancy across the regional state of Ethiopia. Keywords: Teenage; pregnancy; Logistic Regression DOI : 10.7176/JHMN/68-02 Publication date: November 30 th 2019

Prevalence and determinants of HIV shedding in breast milk during continued breastfeeding among Zambian mothers not on antiretroviral treatment (ART): A cross-sectional study.

The risk of postnatal HIV transmission exists throughout the breastfeeding period. HIV shedding in breast milk beyond six months has not been studied extensively. The aim of this study was to determine prevalence and determinants of HIV shedding in breast milk during continued breastfeedingA cross-sectional study was nested in the PROMISE-PEP trial in Lusaka, Zambia to analyze breast milk samples collected from both breasts at week 38 post-partum (mid-way during continued breastfeeding). We measured concurrent HIV deoxyribonucleic acid (DNA) and HIV ribonucleic acid (RNA) as proxies for cell-associated HIV (CAV) and cell-free HIV (CFV) shedding in breast milk respectively. Participants’ socio-demographic date, concurrent blood test results, sub clinical mastitis test results and contraceptive use data were available. Logistic regression models were used to identify determinants of HIV shedding in breast milk (detecting either CAV or CFV).The prevalence of HIV shedding in breast milk at 9 months post-partum was 79.4% (95%CI: 74.0 – 84.0). CAV only, CFV only and both CAV and CFV were detectable in 13.7%, 17.3% and 48.4% mothers, respectively. The odds of shedding HIV in breast milk decreased significantly with current use of combined oral contraceptives (AOR: 0.37; 95%CI: 0.17 – 0.83) and increased significantly with low CD4 count (AOR: 3.47; 95%CI: 1.23 – 9.80), unsuppressed plasma viral load (AOR: 6.27; 95%CI: 2.47 – 15.96) and severe sub-clinical mastitis (AOR: 12.56; 95%CI: 2.48 – 63.58).This study estimated that about 80% of HIV infected mothers not on ART shed HIV in breast milk during continued breastfeeding. Major factors driving this shedding were low CD4 count, unsuppressed plasma viral load and severe sub-clinical mastitis. The inverse relationship between breast milk HIV and use of combined oral contraceptives needs further clarification. Continued shedding of CAV may contribute to residual postnatal transmission of HIV in mothers on successful ART.

Projecting the fiscal impact of South Africa's contraceptive needs: Scaling up family planning post 2020.

Evidence-informed priority setting is vital to improved investment in public health interventions. This is particularly important as South Africa (SA) makes the shift to universal health coverage and institution of National Health Insurance. To measure the financial impact of increasing the demand for modern contraceptive methods in the SA public health sector. We estimated the total cost of providing contraceptives, and specifically the budgetary impact of premature removals of long-acting reversible contraceptives. We created a deterministic model in Microsoft Excel to estimate the costs of contraception provision over a 5-year time horizon (2018 - 2023) from a healthcare provider perspective. Only direct costs of service provision were considered, including drugs, supplies and personnel time. Costs were not discounted owing to the short time horizon. Scenario analyses were conducted to test uncertainty. The base-case cost of current contraceptive use in 2018 was estimated to be ZAR1.64 billion (ZAR29 per capita). Injectable contraceptives accounted for ~47% of total costs. To meet the total demand for family planning, SA would have to spend ~30% more than the estimate for current contraceptive use. In the year 2023, the 'current use' of modern contraceptives would increase to ZAR2.2billion, and fulfilling the total demand for family planning would require ZAR2.9 billion. The base-case cost of implantable contraceptives was estimated at ZAR54 million. Assuming a normal removal rate, the use of implants is projected to increase by 20% during the 5-year period between 2019 and 2023, with an estimated 46% increase in costs. The cost of early removal of Implanon NXT is estimated at ZAR75million, with total contraception costs estimated at ZAR102 million in 2019, compared with ZAR56 million when a normal removal rate is applied. The costs of scaling up modern contraceptives in SA are substantial. Early and premature removals of implantable contraceptives are costly to the nation and must be minimised. The government should consider conducting appropriate health technology assessments to inform the introduction of new public health interventions as SA makes the shift to universal health coverage by means of National Health Insurance.

The role of decision-making pattern on the use of long-acting and permanent contraceptive methods among married women in Indonesia

Objectives: This study aimed to analyse the association between the decision-making pattern and the use of long-acting and permanent methods of contraception (LAPMs) among married and cohabiting women in Indonesia, by controlling for variables at the individual and community or regional level, and geographical area (province).Methods: A cross-sectional survey was conducted using secondary data from Performance Monitoring and Accountability 2020 (PMA2020) which involved 4724 married or cohabitating women aged 15–49 years. Data were analysed using bivariate and multivariate analysis. Multilevel logistic regression was performed to investigate the determinants by taking geographical area into account.Results: The majority of women (63.8%) had made their own decision on current contraceptive use, 30.1% had made a joint decision with their partner or health care provider, and 6.1% had not been involved in the decision-making process. Multilevel analysis showed that the decision-making pattern and individual level factors were significantly associated with LAPM use, and variables at community or regional level were not significant predictors. Compared with women who had made their own decision on contraceptive use, LAPM use was 2.3 times higher in women who had made a joint decision with their partner or health care provider (odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0, 2.7; p < .001) and more than three times higher in women not involved in the decision-making process (OR 3.1; 95% CI 2.3, 4.1; p < .001).Conclusion: Coercion potentially occurs in the contraceptive decision-making process. Our findings suggest that LAPM use may be increased by encouraging joint contraceptive decision making. Increasing women’s participation in the decision-making process is an integral part of respecting women’s reproductive autonomy.

Predictors of modern contraceptive use and fertility preferences among men in Myanmar: further analysis of the 2015-16 demographic and health survey

Background: Men’s opposition to contraception and men’s fertility preferences can affect women’s unmet need for family planning. In Myanmar, there is limited research on men's reproductive health while women’s fertility, fertility preferences, and use of reproductive health services were well understood. A better understanding of men’s perceptions and preferences can support evidence-based male sexual and reproductive health programs and improve their effectiveness. This study focused on predictors of modern contraceptive use and fertility preferences among men age 15-49 years in Myanmar.Methods: A secondary data analysis was conducted using the 2015-16 Myanmar Demographic and Health Survey. Among 4,737 men age 15-49 years in the selected households, 3,248 men who ever had sex and 2,831 currently married men were selected as the sample for contraceptive use and fertility preferences respectively. Multiple logistic regression analysis was used with two separate models.Results: Among men who ever had sex, 39% were currently using modern contraception and 60% married men said they would like to have more than two children. Men from the coastal, and plain regions were more likely to use modern contraception and had higher fertility preferences compared with men living in the hilly region. The working men had higher levels of modern contraceptive use than jobless men and men from middle wealth index were significant current contraceptive users.Conclusions: The geographic region was a predictor of both current contraceptive use and fertility preferences, while occupation showed a significant correlation with contraceptive use.

Is There a Relationship between Repeat Induced Abortion and Current Use of Contraception among Women in the Reproductive Age? A Study in Ghana

Is There a Relationship between Repeat Induced Abortion and Current Use of Contraception among Women in the Reproductive Age? A Study in Ghana

Mobile Helpline and Reversible Contraception: Lessons From a Controlled Before-and-After Study in Rural India.

BackgroundResearchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India.ObjectiveThis study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India.MethodsWe implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed.ResultsThe current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents’ mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline.ConclusionsA mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India.

The contraceptive and reproductive history and planning goals of trans-masculine adults: a mixed-methods study

ObjectivesThis study aims to identify factors associated with the reproductive planning of trans-masculine adults. Study designBetween 2015 and 2016, providers enrolled 150 trans-masculine adults in a sexual health study assessing sociodemographics, social support, gender affirmation, sexual partnering, and reproductive history and planning. A brief clinical interview assessed contraceptive use and concerns. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and three outcomes: current contraceptive use, lifetime pregnancy history and reproductive planning. ResultsOverall, 37.3% are currently using contraceptives; 5.3% have been pregnant; and 20.0% plan to have biological children (9.3% plan to become pregnant; 12.0% plan to use their oocytes with a surrogate). Participants are less likely to use contraceptives if they are students vs. not, have socially affirmed their gender vs. not and have a partner vs. are single. Greater number of sexual partners is associated with the increased odds of contraceptive use. Further, as social support increases, the odds of having been pregnant decreases. Participants with a nonbinary gender identity are more likely to want to become pregnant than those with a binary gender identity, whereas those who have socially affirmed their gender are less likely to want to become pregnant than those who had not. Finally, participants of color more commonly planned to use their oocytes with a surrogate than white participants. ConclusionSociodemographic, gender affirmation, social support and sexual partner factors are associated with contraceptive use and reproductive history among trans-masculine patients. ImplicationsHealthcare providers must be aware of the diverse reproductive histories and pregnancy goals of trans-masculine individuals in order to provide comprehensive reproductive healthcare counseling and provision. More research is needed to better understand contraception and reproduction desires in trans-masculine individuals.

A biphasic sessile mass of the buccal mucosa

During a routine dental hygiene appointment, a 20-year-old Asian American female was noted to have an asymptomatic, 1.5-cm, sessile nodule of unknown duration on the left buccal mucosa. The patient had been aware of the lesion for several months. It had a biphasic clinical appearance: The inferior aspect had an erythematous, slightly lobular appearance, with intact surface epithelium, whereas the superior aspect was slightly cyanotic, with prominent overlying superficial vessels (Figure 1). The lesion was nontender to palpation. The patient's medical history included current use of oral contraceptives. Dental history included past orthodontic treatment. The patient denied use of tobacco products or history of trauma to the affected area.

The Impact of Education and Residence on Current Use of Contraception in Ethiopian Women

BACKGROUND: Maternal and infant mortality is high in Ethiopia. An underlying cause of maternal and infant mortality is unintended pregnancy, which is inversely associated with contraceptive use. Hence, the use of contraception can necessarily be increased to reduce the mortality rate of mother and infant.&#x0D; &#x0D; OBJECTIVES: This study aims to examine the effect of educational attainment and place of residence on contraceptive use among Ethiopian women of childbearing ages.&#x0D; &#x0D; METHODS: Data are obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS) and total 10 223 women aged 15&amp;ndash;49 years are analyzed in this study. Both unadjusted and adjusted multivariate logistic regression models are employed to examine the effect of exposure variables on contraceptive use. &#x0D; &#x0D; RESULTS: It can be seen that only around 36% of Ethiopian women used any of the contraceptive methods. In the case of contraceptive use, a significantly higher odds is observed for women with secondary or higher education with respect to those who were illiterate (e.g., OR=1.51, 95% CI: 1.19&amp;ndash;1.93 after adjusting for total children ever born, number of living children, desire of more children, wealth index, respondent currently working, region and religion; and OR=2.53, 95% CI: 2.05&amp;ndash;3.13 for unadjusted model). Urban women had also a significantly higher odds for contraceptive use than their rural counterparts (OR=1.89, 95% CI: 1.42&amp;ndash;2.51 by adjusted model for the above confounders, and OR=2.22, 95% CI: 1.81&amp;ndash;2.73 by unadjusted model). &#x0D; &#x0D; CONCLUSION: The findings reveal that both educational improvement and urbanization may increase the use of contraception among women in Ethiopia.

A high resolution LC–MS targeted method for the concomitant analysis of 11 contraceptive progestins and 4 steroids

In the context of hormonal contraception and hormone replacement therapy (HRT), many women are exposed to exogenous hormones. Current use of hormonal contraception with combined ethinyl estradiol and different progestins bestows a breast cancer relative risk (RR) of 1.2- while combined HRT has a RR of 2. Although these exposures present an important public health issue, little is known about the effects of individual progestins on the breast and other tissues. Increasing availability of large scale biobanks, high throughput analyses and data management tools enable ever expanding, sophisticated population studies. In order to address the impact of distinct progestins on various health indicators, it is desirable to accurately quantify progestins in clinical samples.Here we have developed and validated a high resolution liquid chromatography mass spectrometry (LC–MS) targeted method for the simultaneous quantification of 11 synthetic progestins widely used in oral contraceptives, gestodene, levonorgestrel, etonogestrel, chlormadinone acetate, cyproterone acetate, drospirenone, desacetyl norgestimate, medroxyprogesterone acetate, norethindrone, dienogest, nomegestrol acetate, and 4 endogenous steroid hormones, progesterone, testosterone, androstenedione, and cortisol in blood samples. This highly specific quantitative analysis with high resolution Orbitrap technology detects and quantifies 15 compounds using their internal standard counterparts in a single 12 min LC–MS run. Sensitivity is attained by the use of the instrument in targeted selected ion monitoring mode. Lower limit of quantitation ranges from 2.4 pg/ml for drospirenone to 78.1 pg/ml for chlormadinone acetate. The method provides comprehensive progestin panel measurements with as little as 50 μl of murine or human plasma.

Social networks and their effects on the choice of contraceptive use and method in Bangladesh

Purpose The purpose of this paper is to examine the effects of social networks on contraceptive adoption in Bangladesh. Design/methodology/approach Data were collected from 430 couples; the age of men was between 15 and 49 years. χ2 test was applied to test the association between independent variables and current contraceptive use. Binary logistic regression was applied to examine the effects of social network on contraceptive use, and multinomial logistic regression was applied to examine the effect of social network on the choice of method. Findings Results from binary logistic regression reveal that social networks of both men (OR=2.71, 95% CI=1.371−5.354) and women (OR= 3.597, 95% CI=1.754−7.380) had a strong positive effect on current contraceptive use. The result from multinomial logistic regression also shows that men’s social network (OR= 2.74, 95% CI= 1.356−5.548) and women’s social network (OR=4.165,95% CI=1.958−8.860) were also associated with choosing a modern contraceptive method. Originality/value Social networks have a significant effect on current contraceptive use and modern method choice in Bangladesh. A social network approach should be included in family planning program in Bangladesh.

Women’s empowerment and contraceptive use: a community-based survey in peri-urban Kumasi, Ghana

Background: Many reasons have been used to explain why contraceptive uptake in Ghana has not been as impressive as desired. One area that has not received enough attention is that of women’s empowerment. This study sought a better understanding of how women’s empowerment influences contraceptive uptake. Methods: A structured questionnaire was used to interview 761 currently married or cohabiting women aged 15-49 years who were residents of Asawasi and Oforikrom for at least two years and consented to be part of the study. Bivariate and multivariate analyses were used to link the exposure variables: the three measures of empowerment and other variables such as age, marital status, religion, education, ethnicity, income and number of living children with the outcome variable (current or future contraceptive use). Excel was used for data entry and STATA for analyses. Results: In total, 29% of respondents were empowered in all the three categories used to measure empowerment in this study; 34% were empowered in two of the three categories, 29% were empowered in only one category while 9% of the women were not empowered in any of the categories. In multivariate logistic regression analysis, the odds of empowered women using contraceptives was significantly higher than the odds of women who were not empowered. Conclusions: Provision of economic interventions to empower and uplift conditions of women is needed to bring change in the economic status of their families and remove their dependence upon family members. This would make women in peri-urban Kumasi economically independent in making contraceptive choices and decisions, which would help in the realization of the Sustainable Development Goals: One (to end poverty in all its forms everywhere) and Five (to achieve gender equality and empower all women and girls).

Healthcare Access, Pregnancy Intention, and Contraceptive Practices Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee.

Women with substance use disorders often experience unique challenges to obtaining contraception and adhering to user-dependent methods. As a result, this at-risk population of women tends to have higher than average rates of unintended pregnancy. The objective of this study was to describe contraceptive use, pregnancy intentions, and adequacy of access to reproductive healthcare among women receiving opioid agonist therapy in northeast Tennessee. A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. Descriptive analyses were conducted using logistic regression to evaluate the statistical significance of bivariate associations. Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to health care. More than half had a history of unwanted pregnancy (53%), among whom few (23.1%) reported the consistent use of contraception at time of conception. Although most desired to avoid pregnancy (90%), only 59% of women reported the current use of regular contraception. Most of those not using regular contraception believed that they were not at risk for pregnancy (54.3%). Although most participants reported adequate access to health care and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Research is needed to identify barriers to contraceptive acceptance and causes of pregnancy risk misperceptions in this population of women at increased risk of unintended pregnancy.

Intimate partner violence and contraceptive use among married women in Nepal.

To examine relationships between lifetime experience of intimate partner violence (IPV), and current contraceptive use and method among married women of reproductive age in Nepal. A cross-sectional analysis of 2016 Nepal Demographic Health Survey data on contraceptive use and IPV experience among ever-married women of reproductive age. Weighted percentages were reported and multinomial logistic regression was used to assess associations between IPV (physical, sexual, emotional, or any form) and contraception use (modern reversible, sterilization, or traditional). Among 3562 women who responded to the violence module, 26% reported experiencing any form (physical, sexual or emotional) of IPV in their lifetime. Lifetime exposure to any form of IPV was associated with sterilization (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.12-2.00) and lifetime exposure to physical violence only was significantly associated with having been sterilized (aOR, 1.59; 95%CI, 1.17-2.16). Experience of violence, particularly physical violence, was found to be associated with sterilization in Nepal. Research is needed to understand the causes of this association, and the decision-making power dynamics related to contraceptive use, husbands' attitudes toward sterilization, and the reasons why sterilization-relative to other contraceptive options-was the contraceptive method of choice.

Complement and its environmental determinants in the progression of human rheumatoid arthritis

Rheumatoid arthritis (RA) is a complex autoimmune disease with an etiology that is not yet well understood, disproportionally affects women and also varies in incidence and prevalence by population. The presence of anti-citrullinated protein antibodies (ACPA) is a highly specific biomarker for the diagnosis of clinically apparent RA. ACPA are also present in the serum for an average of 3–5 years prior to the onset of RA during an asymptomatic period characterized by mucosal inflammation and local ACPA production at these sites. We hypothesized that systemic complement activation products might be generated during the pre-clinical initiation of RA and/or provide a second hit that promotes subsequent arthritis development in the joints. In addition, we evaluated which demographic and genetic features and environmental exposures could influence the complement activation process. We analyzed plasma from healthy subjects, subjects at-risk for the development of RA based on serum ACPA positivity in absence of inflammatory arthritis (IA), and ACPA positive RA subjects by Multiplex Assay and ELISA for eighteen complement system components, factors and activation products belonging to the classical, lectin and alternative pathways. By using regression models, associations between complement proteins and various demographic, genetic, and environmental factors previously found to be associated with RA, including sex, smoking, shared epitope, and oral contraceptive use, were examined. We found no evidence of systemic complement activation in ACPA positive subjects without IA, but in contrast found evidence of systemic involvement of the both classical and alternative pathways during the stage of the disease where classified RA is present, (i.e. during joint inflammation and damage). With regard to the demographic, genetic, and environmental variables, females who reported current or past oral contraceptive use and subjects with current tobacco exposure demonstrated alterations of the alternative pathway of complement. Furthermore, RA subjects with established disease who have a body mass index categorized as obese demonstrated higher levels of C2 compared to RA subjects who are not considered obese. In sum, the complement system may be involved in the pathogenesis of RA, with only localized mucosal effects during the preclinical period in those at-risk for RA but in the joint as well as systemically in those who have developed clinically apparent arthritis.

Prevalence and predictors of contraceptive use among women of reproductive age in 17 sub-Saharan African countries: A large population-based study

ObjectiveTo measure the prevalence of contraceptive use among women of reproductive age in 17 sub-Saharan Africa countries and identify factors associated with contraceptive use in these countries. Study designWe conducted a population-based cross-sectional study using data on contraceptive use from the Demographic and Health Surveys (DHS) for 17 sub-Saharan Africa countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, Congo, Gambia, Ghana, Guinea, Ivory Coast, Liberia, Mali, Niger, Nigeria, Senegal, Togo, and Uganda). We restricted our sample to women aged 15–49 years and used generalized estimating equations to identify factors associated with contraceptive use while controlling for other covariates. ResultsThe overall prevalence of current contraceptive use among women of reproductive age was only 17%, with rates ranging from 7% in Gambia to 29% in Uganda. After adjusting for potential confounders, we found that women were more likely to use a method of contraception if they were sexually active (adjusted prevalence ratio (aPR) 2.17 [95% confidence interval (CI) 2.11, 2.24]); had 5–7 living children (aPR 2.19 [95% CI 1.89, 2.55] compared to no children); had secondary or higher education (aPR 1.71 [95% CI 1.63, 1.78] compared to no education); and were wealthy (aPR 1.34 [95% CI 1.29, 1.40] compared to poor). ConclusionThe use of contraceptives is low in sub-Saharan Africa, but varies substantially across countries. Use of contraception is associated with both personal and socioeconomic factors.