Current Contraceptive Use Research Articles

Are rural Malawian women using their preferred contraceptive method and that of their male partners?

ObjectivesTo measure the agreement between women's current contraceptive use and her preferred method, as well as her partner's preferred method. Study DesignWe used the fourth wave of survey data (2017–2018) from the Umoyo wa Thanzi (UTHA) cohort study of sexual and reproductive health decision making. The prevalence of concordance between women's current method and her preferred method was calculated (n = 818). Among partnered women, we calculated prevalence of concordance between women's current method and her partner's preferred method (n = 719). We used multivariate logistic regression analyses to assess the relationship between women's characteristics and the outcomes. ResultsDespite high prevalence of modern contraceptive use (74.4%), many women were using methods that did not match their preferences (62.6%) or those of their partners (62.3%). Fifty-five percent of women with preference-use discordance preferred methods that were more effective than theirs. Satisfaction with current family planning choice (adjusted odds ratio [aOR], > 5.5 each) and pregnancy desires (aOR, >1.5 each) were strong predictors of both concordance between women's current method and her preferred method and her partner's preferred method. Women who reported higher sexual frequency in past month had elevated odds of concordance between her current and preferred method (aOR: 1.97 for 9+times in past months) than women who had not had sex. ConclusionsMany Malawian women are not using methods they or their partners prefer. Women desiring pregnancy, women reporting infrequent sex, and women who are not satisfied with their method are likely to prefer a different method than the one they are currently using. ImplicationsUnderstanding women's preferences can assist with family planning service provision. Health care providers and researchers should consider the specific methods that women and their partners prefer to use, besides whether they are using any method.

Family planning clients at a Tertiary hospital in Niger Delta, Nigeria: Where they on any contraceptive method prior to first visit?

Background: Maternal and child morbidity and mortality in developing countries have been shown to be reduced by effective use of contraceptive methods. Contraceptive use also improves the lives of women and children. Experience with previous use of contraceptives may affect the uptake rate of modern contraceptive methods. Aim and objective: To determine the pattern of previous contraceptive usage, uptake rates of the contraceptives, the continuation and discontinuation rates and the sources of prior contraceptives. The socio-demographic characteristics and sources of information on current contraceptive use at the Rivers State University Teaching Hospital during the study period. Methods: This was a retrospective study of clients’ records in family planning clinic at theRivers State University Teaching (RSUTH) over a period of five years. Their cards were retrieved, reviewed; data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version25.0 (Armonk, NY). Results: There were 874 contraceptive acceptors attending family planning clinic between 1st January, 2015 and 31st December, 2019 in the centre. Of this number, 566 (64.8%) were using one form of contraceptive method or the other while 308 (35.2%) were not on any form of contraception. Of this 566 women who used contraceptive method prior to their visit to the family planning clinic, intrauterine contraceptive device (IUCD) use accounted for 118 (20.8%), others were barrier method, 107 (18.9%), oral contraceptive pills (OCPs), 95 (16.8%), depot medroxyprogesterone acetate (DMPA), 72 (12.7%), implanon, 40 (7.1%), noristerat, 36 (6.4%), postinor, 28 (5.0%), withdrawal method, 26 (4.6%) and calendar method, 24 (4.2%). Most of the previous contraceptives used came from Government hospital accounting for 44.4%. Most women (72%) obtained their information concerning current contraception from clinical personnel. More than half of the clients (64.1%) were within the age range of 30-39 years and 2 (0.2%) were below 20 years. Age range for the study was 19-51years. Majority of the clients (70.7%) were multipara while 162 (18.5%) were grandmultipara. Modal parity was para 3. The women with formal education were 867 (99.2%). Married women and Christians accounted for843 (96.5%) and 867 (99.2%) respectively. Conclusion: Most clients were in their thirties, married, educated and multiparous. Thirty five percent of the women were not using any form of contraceptive method which is quite alarming and definitely would have led to unwanted pregnancies and possibly induced abortions with its sequalae.

Attitudes and Practices of Healthcare Professionals and Clinical Medical Students on Contraception: A Cross-Sectional Study in Cape Coast, Ghana.

Background Healthcare providers play a major role in the implementation of family planning policies. In Ghana, there has been a conscious effort to improve the knowledge of preservice and practicing health professionals on family planning. However, there have been concerns about the appropriateness of the attitudes and practices of these health cadres and, hence, their propensity to become barriers to the uptake of contraception in the general population. This study is aimed at assessing the attitudes and practices of healthcare workers and clinical-year medical students in contraceptives use, advocacy, and service provision. Methods A cross-sectional survey was conducted among health workers and clinical-year medical students from January 1 to June 30, 2018. Variables assessed included sexual activity status, previous and current contraceptive use, and satisfaction with contraceptive use among others. Data from 400 self-administered, structured questionnaires comprising close- and open-ended questions was entered in SPSS version 22 and analysed using same. The variables assessed were presented as means, frequencies, and percentages. Results About 58% of the respondents were sexually active. Half of the participants (50.2%) had used a form of contraception before, with condoms and other barrier methods being the most preferred (67.7%). However, only 18% of respondents were on a form of contraceptive at the time of the survey. Four out of five (82.6%) of the users of these contraceptives were satisfied with their past use. A little over half of the participants had discussed contraception with their partners. Over four-fifths of participants thought family planning was beneficial and were willing to encourage others to use a method of family planning. Majority (63.7%) of the participants had had formal training in family planning, but only 72 (18%) were actively involved in the provision of family planning services. Conclusions Although the attitudes of the health workers and trainees toward family planning were excellent generally, only a few were using a method of contraception at the time of the survey despite the fact that most of them were sexually active. There is a need to intensify communication on behaviour change towards contraception among health professionals and clinical-year medical students in order to strengthen their role as change agents in an effort to improve community uptake.

Postpartum contraceptive uptake and fertility desires following obstetric anal sphincter injury.

Our primary objective was to compare rates of contraceptive use among postpartum heterosexual primiparous women with and without obstetric anal sphincter injury (OASIS). The secondary objective was to compare fertility desires among women with and without OASIS. This was a planned secondary analysis of a prospective cohort study of postpartum sexual function among primiparous postpartum women. Women with a history of vaginal delivery with and without OASIS completed online surveys at baseline and 3months postpartum. Sixty-nine women completed baseline and 3-month surveys. Forty-one percent of women with OASIS and 36% without OASIS were not using contraception at 3months postpartum. One-third of women in either group reported using at least moderately effective contraception (P = 0.9), defined as using hormonal contraception or an intrauterine contraceptive device, and excluding condoms. Most women with OASIS (54%) desired to wait 1 to 2years before attempting another pregnancy. One fifth of women with and without OASIS desired another pregnancy within the next year (P = 0.4). A minority of postpartum primiparous women in the present cohort reported using moderately effective contraception 3months postpartum, regardless of whether they sustained OASIS. The discrepancy between current contraceptive use and desired birth spacing suggests an unmet contraceptive need within our population and an opportunity for improved contraceptive counseling consistent with patients' family planning goals, as well as national and international guidelines on birth spacing. Larger prospective studies are needed to further understand the unmet contraceptive need among women with OASIS.

The past, present and future of hormonal contraceptive use in managed captive female tiger populations with a focus on the current use of deslorelin acetate.

Tigers (Panthera tigris spp.) are endangered in the wild; ensuring sustainable insurance populations requires careful planning within zoological collections. In captive situations, contraceptives are often used to control breeding and ensure genetically viable populations that contain manageable numbers of animals; reversible contraceptives are ideal because they offer flexibility for breeding management. Historically, synthetic progestins, such as melengestrol acetate implants, were used in female tigers, but these are associated with an increased risk of reproductive pathology and subsequent infertility. Recent management advice to ex-situ collections has been to transition to the use of gonadotropin-releasing hormone agonists, such as deslorelin acetate implants, which do not appear to have a similar risk of reproductive pathology but are associated with highly variable reversal times in exotic felids. Using data from 917 contraceptive records in female tigers captured by the Association of Zoos and Aquariums Reproductive Management Center and the European Association of Zoos and Aquaria Reproductive Management Group's joint Contraception Database and from supplementary surveys, this study reviews the changing use of contraceptives in captive female tigers. The aim was to describe the historical and current use of contraceptives and provide a comprehensive assessment on the use of deslorelin implants, including data on product protocols, efficacy, pathology, and reversibility. This study determined that current dose, frequency, reversibility, and anatomical placement sites of deslorelin implants are highly variable, indicating that specific, readily available, unified, evidence-based recommendations on the use of deslorelin would be useful for future contraceptive use in managed tiger populations.

Planning for work: Exploring the relationship between contraceptive use and women's sector-specific employment in India.

While the health-related benefits of contraceptive use for women are well documented, potential social benefits, including enabling women’s employment, have not been well researched. We examine the relationship between contraceptive use and women’s employment in India, a country where both factors have remained relatively static over the past ten years. We use data from India’s 2015–16 National Family Health Survey to test the association between current contraceptive use (none, sterilization, IUD, condom, pill, rhythm method or withdrawal) and current employment status (none, professional, clerical or sales, agricultural, services or production) with multivariable, multinomial regression; variable selection was guided by a directed acyclic graph. More than three-quarters of women in this sample were currently using contraception; sterilization was most common. Women who were sterilized or chose traditional contraception, relative to those not using contraception, were more likely to be employed in the agricultural and production sectors, versus not being employed (sterilization adjusted relative risk ratio [aRRR] = 1.5, p<0.001 for both agricultural and production sectors; rhythm aRRR = 1.5, p = 0.01 for agriculture; withdrawal aRRR = 1.5, p = 0.02 for production). In contrast, women with IUDs, compared to those who not using contraception, were more likely to be employed in the professional sector versus not being employed (aRRR = 1.9, p = 0.01). The associations between current contraceptive use and employment were heterogeneous across methods and sectors, though in no case was contraceptive use significantly associated with lower relative probabilities of employment. Policies designed to support women’s access to contraception should consider the sector-specific employment of the populations they target.

Women\u2019s empowerment for abortion and family planning decision making among marginalized women in Nepal: a mixed method study

BackgroundWomen’s empowerment is multidimensional. Women’s education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women’s empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women’s empowerment with abortion and family planning decision making among marginalized women in Nepal.MethodsA cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15–49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made.ResultsWomen’s empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36–0.98). We could not find any statistically significant differences among levels of women’s empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women’s decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced.ConclusionsWomen’s empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.

Association of Effective Spousal Family Planning Communication with Couples' Modern Contraceptive Use in Harar, Eastern Ethiopia.

BackgroundSpousal family planning communication plays an important role in making better reproductive health decisions and in increasing the use of modern contraceptive methods. The objective of the current study is to examine the association of spousal family planning communication in its broader context with current modern contraceptive use among couples.MethodsA community based cross-sectional survey was conducted in twelve kebeles of Harar Urban Health and Demographic Surveillance System. A total of 2700 currently married couples of whose wives were in the reproductive age participated in the study. The selection of the study participants was made using simple random sampling and data were collected using an interviewer administered structured questionnaire and analyzed using Stata version 12.ResultsThe level of current modern contraceptive use was 57.1% (95% CI: 0.53, 3.39). Effective spousal family planning communication was significantly associated with current modern contraceptive use even after controlling for socio-economic and demographic variables. Socio-economic and demographic variables such as religion of couples, number of couples’ living children, household monthly income, couples’ family planning approval and women’s counseling about family planning by health workers were significantly associated with current modern contraceptive use.ConclusionPolicies and programs aimed at increasing contraceptive prevalence should properly address the importance of spousal communication about family planning and integrate men into family planning programs to facilitate and enhance couples communication skills.

Reproductive Factors, Use of Exogenous Hormones, and Pancreatic Cancer Incidence: The Norwegian Women and Cancer Study.

IntroductionThe incidence of pancreatic cancer is increasing worldwide and characterized by a particularly low survival rate. Studies have reported weak and inconsistent evidence for associations among reproductive factors, use of exogenous hormones, and pancreatic cancer incidence in women.PurposeTo investigate relationships between reproductive factors, exogenous hormones, and the rate of pancreatic cancer incidence in a large population-based prospective cohort of women in Norway.MethodsWe used data from the Norwegian Women and Cancer study on 588 incident cases of pancreatic cancer diagnosed among 165,419 women, with mean follow-up of 18.7 years. Cox proportional-hazard models were used to estimate HRs and 95% CIs for associations of interest.ResultsCumulative breastfeeding duration >24 months was associated with 63% decreased incidence of pancreatic cancer compared to no breastfeeding. We observed an inverse linear dose–response trend between cumulative breastfeeding duration and pancreatic cancer incidence, which was confirmed in parous women and ever-smokers. Higher age at first birth and menopause were inversely associated with pancreatic cancer incidence, though with less precise effect estimates. Current use of oral contraceptives was associated with a doubling of pancreatic cancer incidence, but the analysis was hampered by a small number of cases. There was no evidence of any associations between age at menarche, parity or use of menopausal hormone therapy, and incidence of pancreatic cancer.ConclusionOur results suggest a potential protective effect of breastfeeding duration against pancreatic cancer incidence. Inconsistent results for the other reproductive factors suggested no important role of estrogens in pancreatic cancer etiology.

Induced abortion in Ghana: prevalence and associated factors.

The termination of unwanted pregnancies is a growing health-related issue around the world. This study used the 2017 Ghana Maternal Health Survey to examine the factors associated with the prevalence of induced abortion in Ghana. The study sample included 18,116 women of reproductive age who had a pregnancy in the 5 years preceding the survey. A multivariate logistic regression technique was applied. The prevalence of induced abortion was higher among women aged 25-34 years, those who had secondary-level education, those living in urban areas and in the Ashanti region, those of Akan ethnicity and those belonging to non-Catholic Christian denominations. Moreover, the prevalence was higher among single women, those who had no children, those who started sexual intercourse before the age of 18, those who were currently using a contraceptive, those exposed to media and those who knew about the legality of abortion. The multivariate analysis found that education, place and region of residence, marital status, ethnicity, current contraceptive use, religion, age at sexual debut, media exposure and knowledge about abortion legality were all significant predictors of induced abortion among women in Ghana. The study findings support a call for action to strengthen family planning services and educational programmes on induced abortion in Ghana to reach the target groups identified.

Types of Lifetime Reproductive Coercion and Current Contraceptive Use

Background: Intimate partner violence and differential power dynamics are associated with contraceptive behaviors. This study examines the role of reproductive coercion (RC) by an intimate partner in women's decisions about contraceptive use. Materials and Methods: A self-report survey was administered to a probability sample of a diverse group of women of reproductive age in Delaware's Title X health care facilities. Currently used contraceptive methods were categorized into three effectiveness levels based on typical use failure rates: no method or low effectiveness (>10% failure), moderate effectiveness (>1% and <10% failure), and high effectiveness (<1% failure). The short-form RC scale was used to categorize RC experiences: no RC, verbal only, or behavioral. We conducted multinomial logistic regression to examine the association between types of RC and effectiveness level of current contraceptive method, taking our sampling design into account and adjusting for covariates. Results: Among 240 women (weighted n = 6529) included in the sample, 13.9% reported experiencing only verbal RC, and 16.1% reported behavioral RC. Women who reported behavioral RC were more likely to currently be using highly versus moderately (adjusted relative risk ratio [aRRR]: 26.71, 95% confidence interval [CI]: 4.59-156.0) and low effective methods (aRRR: 3.08, 95% CI: 0.97-9.82), but less likely to be using moderately (aRRR: 0.12, 95% CI: 0.02-0.77) than low effective methods. Conclusions: Using highly and low effective methods may indicate two opposing ways of managing behavioral RC experiences: controlling fertility by choosing less detectable but highly effective methods or feeling disempowered and using no or low effective partner-dependent methods.

Couple communication and contraception use in urban Senegal.

Objectives:Couple communication about family planning has been shown to increase uptake of contraception. However, couple communication is often measured based solely on one partner’s report of communication. This research investigates the influence of couple-reported communication about family planning on current and future use of contraception using couple-level data.Methods:We used baseline data from the Measurement, Learning, and Evaluation (MLE) project collected through household surveys in 2011 from a cross-sectional representative sample of women and men in urban Senegal to conduct secondary data analysis. We used multivariable logit models to estimate the average marginal effects of couple communication about family planning on current contraception use and future intention to use contraception.Results:Couple communication about family planning reported by both partners was significantly associated with an increased likelihood of current use of contraception and with future intention to use contraception among non-contracepting couples. Couples where one partner reported discussing family planning had a 25% point greater likelihood of current contraception use than couples where neither partner reported discussing, while couples where both partners reported discussing family planning had a 56% point greater likelihood of current contraception use, representing more than twice the effect size. Among couples not using contraception, couples where one partner reported discussing family planning had a 15% point greater likelihood of future intention to use contraception than couples where neither partner reported discussing, while couples where both partners reported discussing family planning had a 38% point greater likelihood of future intention to use contraception.Conclusion:These findings underscore the importance of the inclusion of both partners in family planning programs to increase communication about contraception and highlight the need for future research using couple-level data, measures, and analysis.

Socio-Demographic and Economic Characteristics Associated with Current Use of a Modern Contraceptive Method by Women in Kita, Mali

The objective of this study is to analyse the socio-demographic and economic characteristics associated with the current use of a modern contraceptive method by women in Kita, Mali. This research is of interest because it will determine the nature of individual and economic determinants associated with current use of modern contraception. The methodology was based on a literature search and a quantitative survey and analytical study (bivariate analysis). The questionnaire was administered to a random sample of 281 women aged 15 - 49 years who had had at least one child. The bivariate logistic regression analysis revealed socio-demographic and economic characteristics associated with current use of a modern contraceptive method. The study found that 19.6% of women of reproductive age [WRA] were using a contraceptive method at the time of the survey. The characteristics associated with this practice are: age, number of living children, level of knowledge of modern contraceptives, the woman’s attitude towards contraception, the identity of the person who decides on all care in the household, and the level of education. In contrast, marital status and access to family planning information are not statistically significantly associated with current contraceptive use by [WRA]. Consideration of these relevant characteristics will improve the effectiveness of ongoing family planning programmes in this city.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal.

Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. : This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants. : A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. : All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Rural-urban residence and emergency contraception use, access, and counseling in the United States, 2006-2017

ObjectiveTo estimate differences in emergency contraception (EC) use, access, and counseling by rural-urban residence among reproductive age women in the United States. Study designWe examined respondent data (2006–2017) from the National Survey of Family Growth for women ages 15-44 (n = 28,448) to estimate EC use, access, and counseling by rural-urban county of residence. Rural-urban prevalence ratios for EC outcome measures were estimated using predicted margins from logistic regression models, which were adjusted for demographic differences and current contraceptive method use. Changes in ever-use of EC over time were estimated for rural and urban respondents, separately, using Chi-square tests and trends were estimated using inverse variance weighted linear regression models. ResultsDuring 2006 to 2017, 10% of rural and 19% of urban women who had ever had sex reported ever using EC pills. Among rural women, ever-use increased from 6% in 2006-2008 to 15% in 2015-2017 (Chi-square p < 0.01; trend p-value < 0.01); among urban women, ever-use increased from 11% to 27% (Chi-square p < 0.01; trend p-value < 0.01). Rural and urban women were similarly likely to have obtained EC without a prescription and from a drug store. Rural women were less likely to have received EC counseling than urban women; however, counseling rates were low among all women. ConclusionWe observed differences in EC ever-use and receipt of EC counseling by rural-urban residence among US women ages 15 to 44, adding to the evidence that rural-urban residence is an important factor in reproductive health. More research is needed to explore factors contributing to rural-urban differences in EC use. ImplicationsOur key finding that EC use varied by rural-urban county residence offers additional evidence that rural-urban residence should be considered in reproductive health practice and policy. We discuss areas for future research into potential barriers to EC use in rural populations.

Up takes of Postpartum Contraceptives

Background: Post-partum family planning aims to prevent an intended pregnancy within the first year postpartum. Closely spaced pregnancy within the first year of PP is associated with higher risk of preterm birth, low birth weight or small for gestational age. However, the perceived uptakes of postpartum contraceptives are very low. The intention of this study was determine uptakes and associated factors of postpartum family planning in southern Ethiopia. Methods: The study was conducted in Hawassa city administration which is the capital of SNNPR. Community based cross sectional study was employed women who gave birth in the last 12 months before survey. Data was collected using structured questionnaire proceeding informed verbal consent. Logistic regression model was used to identify associations between variables and findings were presented. Result: The prevalence of current post-partum contraceptive use was 85.1%. After adjusting for covariates; the odds of using postpartum contraceptive were 1.31 times, 12.13 times, 5.17 times, 10.77 time and 4.69 times higher among women with, knowledge about advantages and side effects of contraceptives, partner support for contraceptive use, previously contraceptive use and not returned period respectively with (P <0. 05). Conclusion: Uptakes of postpartum contraceptives in Hawassa city administration was promising. Detailed counseling about postpartum contraceptive use, could assist equipping women with knowledge of family planning methods; empowering them to be decisive in the health and positivity of male partners are very crucial to promote postpartum use of contraceptives.

Drivers of desire for more children among childbearing women in sub-Saharan Africa: implications for fertility control

BackgroundDespite the extensive research on fertility desires among women the world over, there is a relative dearth of literature on the desire for more children in sub-Saharan Africa (SSA). This study, therefore, examined the desire for more children and its predictors among childbearing women in SSA.MethodsWe pooled data from 32 sub-Saharan African countries’ Demographic and Health Surveys. A total of 232,784 married and cohabiting women with birth history, who had complete information on desire for more children made up the sample for the study. The outcome variable for the study was desire for more children. Multilevel logistic regression analysis was conducted. Results were presented using adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CI).ResultsThe overall prevalence of the desire for more children was 64.95%, ranging from 34.9% in South Africa to 89.43% in Niger. Results of the individual level predictors showed that women aged 45–49 [AOR = 0.04, CI = 0.03–0.05], those with higher education [AOR = 0.80, CI = 0.74–0.87], those whose partners had higher education [AOR = 0.88; CI = 0.83–0.94], women with four or more births [AOR = 0.10, CI = 0.09–0.11], those who were using contraceptives [AOR = 0.68, CI = 0.66–0.70] and those who had four or more living children [AOR = 0.09 CI = 0.07–0.12] were less likely to desire for more children. On the other hand, the odds of desire for more children was high among women who considered six or more children as the ideal number of children [AOR = 16.74, CI = 16.06–17.45] and women who did not take decisions alone [AOR = 1.58, CI = 1.51–1.65]. With the contextual factors, the odds of desire for more children was high among women who lived in rural areas compared to urban areas [AOR = 1.07, CI = 1.04–1.13].ConclusionsThis study found relatively high prevalence of women desiring more children. The factors associated with desire for more children are age, educational level, partners’ education, parity, current contraceptive use, ideal number of children, decision-making capacity, number of living children and place of residence. Specific public health interventions on fertility control and those aiming to design and/or strengthen existing fertility programs in SSA ought to critically consider these factors.

13674 Eligibility criteria related to hormone therapy in acne clinical trials

Despite multiple guidelines on acne management, there is a paucity of high-quality data on the treatment of acne among patients receiving hormone therapy. In the United States, this potentially impacts the treatment of acne among 9.1 million women using oral contraceptive pills in 2015-2017 and 2.3 million cisgender and transgender men receiving testosterone replacement therapy. We examined exclusion criteria of acne clinical trials to identify potential barriers to the enrollment of patients receiving hormone therapy. We searched clinicaltrials.gov using the term “acne” from 1/1/2009 to 5/16/2019 for exclusion criteria of acne interventions. Of the 115 studies included, 33% had exclusion criteria related to hormone therapy, including recent changes in therapies such as oral contraceptives, estrogens and anti-androgenic medications within specified time ranges (4 weeks to 1 year). Patients with medication-induced acne or a hormone disorder were excluded in 8.7% and 2.6% of trials, respectively. Other exclusion criteria included current use of oral contraceptives (2.6%), androgen blockers (3.5%), hormone-replacement therapy (1.7%), or any medication (5.2%). Findings were limited to the interventions posted on clinicaltrials.gov. Acne is the most common dermatologic condition in the United States, yet robust evidence guiding the optimal treatment of acne in patients receiving hormone therapy remains scarce. These data highlighted limitations in generalizability of many existing acne clinical trials, as well as the need to expand the eligibility criteria to improve real-world effectiveness of acne treatment across large and diverse populations receiving hormone therapies.

Effects of a Community-Based Program on Voluntary Modern Contraceptive Uptake Among Young First-Time Parents in Cross River State, Nigeria.

Reproductive health programs for youth have largely overlooked first-time parents (FTPs)-defined as young women younger than 25 years old who are pregnant or already have 1 child, and their partners. To address this gap, we implemented and evaluated a program to improve child spacing, modern contraceptive use, and related gender outcomes among FTPs in Cross River State (CRS), Nigeria. This paper examines the effectiveness of FTP interventions in improving voluntary uptake of contraception. We conducted small group sessions and home visits with FTPs from May to August 2018 in 2 local government areas of CRS. A pretest-posttest study examined the effectiveness of these interventions regarding healthy timing and spacing of pregnancy/family planning knowledge, attitudes, intentions, communication, decision making, and contraceptive use. We performed a bivariate analysis and logistic binomial regression to confirm change over time in the primary study outcome, current use of a modern method of contraception. We also performed analysis of demographic characteristics and secondary outcomes (e.g., birth spacing intentions and couple communication). We interviewed 338 participating first-time mothers (FTMs) and 224 participating partners at baseline and endline. Important indicators of contraceptive awareness, attitudes, and couples' communication increased significantly from baseline to endline. Voluntary current modern contraceptive use increased from 26% to 79% among nonpregnant FTMs (P<.000), and from 44% to 81% among partners (P<.000). After controlling for significant factors related to family planning use, FTMs were 3.3 times more likely (P<.001) and partners 3.7 times more likely (P<.000) to be using a modern contraceptive method at endline. Program participation was associated with significant improvements in voluntary uptake of modern contraceptive methods and multiple secondary outcomes. Even within a short timeframe, this intensive, multi-intervention effort achieved significant advancements across healthy timing and spacing of pregnancy and family planning outcomes for this vulnerable youth population.

Intake of Lycopene and other Carotenoids and Incidence of Uterine Leiomyomata: A Prospective Ultrasound Study

BackgroundUterine leiomyomata (UL) are the leading indication for hysterectomy in the United States. Dietary supplementation with lycopene was associated with reduced size and incidence of oviduct leiomyoma in the Japanese quail. Two US prospective cohort studies of women reported little association between intake of lycopene, or other carotenoids, and UL incidence. However, these studies relied on self-reported physician-diagnosed UL, which is prone to misclassification. ObjectiveThis study examines the association between dietary intake of carotenoids and UL incidence. DesignData were derived from the Study of the Environment, Lifestyle, and Fibroids, a prospective cohort study. Women completed self-administered baseline questionnaires on demographic characteristics, reproductive history, and lifestyle, including a 110-item validated food frequency questionnaire, from which dietary intakes of carotenoids—including alpha carotene, beta carotene, cryptoxanthin, lutein-zeaxanthin, and lycopene—and vitamin A were estimated. Participants/settingOne thousand two hundred thirty Black women aged 23 to 35 years who did not have a previous diagnosis of UL, cancer, or autoimmune disease were eligible for enrollment (2010-2012). Participants were residents of the Detroit, MI, metropolitan area. Main outcome measuresTransvaginal ultrasound was used to assess UL at baseline and 20, 40, and 60 months of follow-up. Statistical analyses performedCox regression was used to estimate hazard ratios and 95% CIs, adjusted for energy intake, age at menarche, education, body mass index, parity, age at first birth, years since last birth, current use of oral contraceptives or progestin-only injectables, alcohol intake, and cigarette smoking. ResultsAmong 1,230 women without prevalent UL at baseline, 301 incident UL cases during follow-up were identified. Intakes of lycopene, other carotenoids, and vitamin A were not appreciably associated with UL incidence. Hazard ratios comparing quartiles 2 (2,376 to 3,397 μg/day), 3 (3,398 to 4,817 μg/day), and 4 (≥4,818 μg/day) with quartile 1 (<2,376 μg/day) of lycopene intake were 1.03 (95% CI 0.72 to 1.47), 1.22 (95% CI 0.86 to 1.72), and 0.95 (95% CI 0.67 to 1.36), respectively. ConclusionsStudy findings do not support the hypothesis that greater carotenoid intake is associated with reduced UL incidence.