Effective Contraceptive Use Research Articles

“My Birth Control Makes Me Emotionally Psycho”: Online Female Narratives about Contraceptives

Digital communication tools have become increasingly pivotal to facilitating the engagement and management of difficult health-related conversations. Peer conversations about individual women's experiences relating to the side effects of contraceptive use are not often held outside of medical contexts. To provoke conversations about birth control, on 9 January 2018, the Sexual and Reproductive Justice Coalition (SRJC) tweeted the results of a study about the severe side effects of using Depo-Provera (a contraceptive injection), triggering diverse discussions. This article reports on a study that analysed online narratives of tweets based on female experiences of effects suffered from contraceptive use and adopted a qualitative netnography design. Three theoretical perspectives, namely, the spiral of silence theory, the critical modernism theory, and the patient-centred model of health care, were relevant to the study. The results provided oft-unheard narratives of South African female voices on personal experiences and agency about contraceptive use. Within health communication, policymakers, as well as campaign designers, need to have a holistic understanding of the factors which may influence women's decisions to (dis)continue a contraceptive method. Such information is critical to designing interventions and programmes which will enable the achievement of important birth control goals and inform the design of effective policies or health campaign messaging. Online patient empowerment on various social media platforms needs to be monitored to avoid misinformation.

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.

Effectiveness of Sex Education in Adolescents

Adolescence is the time during which the personal and sexual identity develops. The specific characteristics of adolescents and the lack of maturity facilitates the acquisition of sexual risk behaviors such as relaxation in the use of barrier contraceptives or the use of toxic substances, alcohol or drugs during sexual relations, increasing of sexually transmitted infections (STIs) and unwanted pregnancies. Health education in sexuality is one of the best ways to prevent risk behaviors and to promote healthy and responsible sexuality. While there have been different works in sex education in adolescents, there is still a lack of a comprehensive systematic literature review that including randomized and non-randomized clinical trials and quasi-experimental pre-post studies addressing education programs that provide information on healthy and responsible sexuality. Further, it is noted that a protocol drafted in consideration of the existing approaches is needed to present a basis for a systematic literature review in this area. This article, therefore, proposes a review protocol that will evaluate the impact of comprehensive sex education programs in the level of knowledge about STIs, behavioral level concerning the frequency of use of effective contraceptive methods and level of knowledge about sexual identity, diversity and/or responsible sexuality, after the intervention.

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A culturally tailored intervention to reduce risk of alcohol-exposed pregnancies in American Indian communities: Rationale, design, and methods

IntroductionPrenatal exposure to alcohol can cause lifelong physical and cognitive challenges in the form of fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs). The prevention of prenatal alcohol exposure is thus a public health priority – and one that should account for the particular needs of subpopulations, including in American Indian/Alaska Native (AI/AN) communities. Prior to conception, alcohol-exposed pregnancy prevention is accomplished by encouraging the reduction or elimination of risky alcohol use and/or promoting effective contraceptive use among risky drinkers who could become pregnant. The current study builds on promising findings about the impact of the Centers for Disease Control and Prevention CHOICES intervention with AI/AN communities by implementing a randomized control trial of Native CHOICES, a cultural adaptation of CHOICES, with AI/AN women in a rural reservation community. MethodsAI/AN women aged 18–44 who are at-risk for an alcohol-exposed pregnancy are being recruited. Participants are randomized in 1:1 proportion to the intervention and a services-as-usual, waitlist control condition. The Native CHOICES intervention consists of 2 motivational interviewing (MI) sessions, an elective contraception counseling session, and electronic messaging to boost the effects of MI. Data are collected at baseline and at 6 weeks, 3 months, and 6 months post-baseline. Those assigned to the control group are eligible to enroll in Native CHOICES following the completion of the 6 months post-baseline data collection. In addition to testing intervention effectiveness, the study is designed to yield a comprehensive economic evaluation, which will provide important information regarding the financial feasibility and sustainability of Native CHOICES for healthcare systems serving AI/ANs.

Indirect Method of Estimation of Total Fertility Rate And Study About Births Averted Due to Family Planning Practices in India: A Ridge Regression Approach

Though, fertility is a biological phenomenon but it depends heavily on socioeconomic, demographic and cultural factors; therefore, this article describes a regression technique to estimate the TFR under dierent proposed model assumptionsand the effects of socioeconomic and demographic factors on TFR as well. The developed methodology also leads to estimate the number of births averted due to the use of family planning methods and percent of increase in births in the absence of birth control devices for 29 states of India using three different methods of births aversion through the National Family Health Survey (NFHS-III) data. The finding shows that there is a variation in number of births averted and percent of increase in births in the absence of family planning methods at the state level in India. The effective use of contraception and maximum number of births avoided due to use of family planning is in Maharashtra and Uttar pradesh. Highest percent of increase in births in the absence of contraception is in Himachal Pradesh and Andhra Pradesh

Contraception among women on probation and parole on the United States-Mexico border.

Effective contraception prevents unintended pregnancy which disproportionately affects women in the criminal justice system. This study examined selected variables associated with contraceptive use by women on probation and parole living on the United States-Mexico border. This quantitative correlational study examined individual and interpersonal variables-age, parity, ethnicity, prior contraception, self-efficacy, pregnancy attitudes, and reproductive autonomy-that may influence contraception among 52 women under community supervision. Variable were examined with bivariate, multivariate analyses, and hierarchical logistic regression. Data were collected from a demographic and contraceptive use survey, and validated scales measuring reproductive autonomy and pregnancy attitudes. Contraceptive methods were used by 89% of the women; 65% used effective methods, but this decreased to 35% among those released within the past year. Reproductive autonomy was associated with effective contraceptive use. Prior contraception and contraceptive self-efficacy were significant, but wide confidence intervals suggested instability. The remaining variables were insignificant. No known studies have examined contraception use among women on probation and parole on the border. More women used some form of contraception than might be predicted. Collaborative efforts between correctional facilities and the community are needed to expand access to contraception.

Factors Affecting Utilization of Modern Family Planning Method among Women with Psychiatric Illness Attending Psychiatric Outpatient Services at Amanuel Mental Specialized Hospital Addis Ababa, Ethiopia, 2018. An Institution Based Cross-Sectional Study

ABSTRACT Background: Barriers to effective use of contraception on the part of mentally ill patients magnified by their inability to establish reliable, long-term approaches to pregnancy prevention. The prevalence of unplanned pregnancies are high among psychiatric patients, due to the frequent lack of insight, lack of planning and behavioral control and potential medication interaction between hormonal contraceptives and some psychotropic drugs reducing contraceptive effectiveness. Therefore, Women who are mentally ill or who abuse drugs should be considered for the full range of contraceptive options. Objective: To assess utilization and associated factors of modern family planning method among women with psychiatric illness attending psychiatric outpatient services at Amanuel mental specialized hospital Addis Ababa, Ethiopia 2018. Method: Institution based cross-sectional study design was conducted to assess utilization and associated factors of modern family planning method among women with psychiatric illness attending psychiatric outpatient services and 413 study subjects were selected using systematic random sampling technique. Bivariate and multivariate analysis was carried out to determine the association between an independent variable with the outcome variable among study participants during the period of the study at Amanuel mental specialized hospital in Addis Ababa, Ethiopia. Result: out of the total sampled women with psychiatric illness (40.2%) of the respondents were using modern family planning methods at the time of the study. According to the multiple logistic regressions at 95% C.I, educational level, resident, employment and counseling about family planning by staff found to be independently associated with utilization of modern family planning method. Conclusion: In this study, 40.3% of them currently use a modern family planning method. Male condoms and injectable were the most known type of method. Moreover, injectable was the most common currently used method. Healthcare provider should be strengthening family planning counseling to enhance knowledge and utilization of modern family planning at mental health clinic and community level. Key words: utilization, modern family planning, associated factors, mental illness, Addis Ababa

Analyzing The Use Of Kb Pill Contraception Equipment With Hypertension In Fertilizer Age Women

Hypertension in couples of childbearing age can be caused by the use of hormonal birth control which continues to be used by women of childbearing age, it can cause fatal complications, such as heart attacks, strokes and kidney failure. Hypertension can also cause blindness, irregular heart rhythms and heart failure. The aim of analyzing the effect of contraceptive use is the birth control pill with the incidence of hypertension in women of childbearing age in the village of Paleleh, Paleleh District, Buol District.
 The design used in the study was a cross sectional survey. Population is all women of childbearing age who have become KB pill acceptors. The sample size was 40 respondents using Accidental sampling technique. The independent variable of the study was the use of pill contraception. The dependent variable is the incidence of hypertension. Data was collected using a questionnaire, then data were analyzed using the Spearman Rho test, with a significance level of α ≤ 0.05.
 The results of the study showed that at most respondents had a duration of using the Pill for 24 months as many as 10 respondents (52.6%), the incidence of stage 2 hypertension was 15 respondents (37.5%), the results showed that the statistical test obtained p = 0,000 with a = 0.05, which means that H0 is rejected and H1 is accepted so that it can be interpreted that there is a significant relationship on the variable length of birth control pills with the incidence of hypertension, with a correlation coefficient of 0.851 which means having a strong relationship.
 Birth control pills can affect blood pressure which can cause hypertension in women of childbearing age.

Relationship of Contraceptive Use Depo Provera with The Side Effects On Acceptance in Nulle Health Center

Contraception is an effort to prevent the onsany of pregnancy that is temporary and can be permanent. One of the contraceptive methods that is in demand by the public is the hormonal contraceptive method, namely the injectable contraceptive Depo Provera. Hormonal contraceptive methods are considered one method with high effectiveness, but on the other hand hormonal contraceptives especially those containing progesterone have some side effects such as menstrual cycle disorders, spotting, increased blood pressure and weight gain. This study aims to find out the relationship between the use of injectable contraceptive Depo Provera with the occurrence of side effects on the acceptance in Nulle publick health center South Central Timor Regency in 2020. This type of research is quantitative research using a cross sectional study approach. The sample in this study was 95 acceptances spread across 8 villages that became the working area of Nulle Health Center. The data analysis used is univariate analysis and bivariate analysis using Chi-square test. The characteristics of the majority of respondents aged 21-30 years and 31-40 years were 42.9%, not working 55.6%, high school education 54.0% and parity 1-2 people as much as 49.2%. The results of the data analysis showed there is a relationship between the use of injectable contraceptive Depo Provera with side effects in the form of menstrual cycle disorders (ρ-value = 0.004), spotting (ρ-value = 0.006) and increase in weight (ρ-value = 0.010) while unrelated side effects are an increase in blood pressure (ρ-value = 0.423). Advice for health officials especially in the field of maternal and child health and family planning to increase the frequency of counseling/information to acceptors, especially injectable contraceptive acceptors Depo Provera regarding the side effects of contraceptive use and other factors that can influence the onsling of such side effects by utilizing health promotion media, so that the acceptor can have a good information/understanding of the contraceptive used.
 

Contraceptive awareness, and practices among rural women in Lucknow

Objective: This cross sectional observational study was done to asses awareness regarding family planning methods and the practice of contraceptives among rural women in Lucknow. Materials and Methods: Five hundred women between the ages of 15-45 years, living with their husbands and coming from rural area, attending gynecology OPD of integral institute of medical sciences and research, Dasauli, Lucknow were included in this study. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, source of knowledge and practice of contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity, religion and educational status. Results were expressed as percentages. Results: Out of 500 interviewed majority of women (49.2%) were between 22-25 years of age. 61% were illiterate belonging to low socioeconomic status, 63.3% belonged to Hindu religion. In the present study, it was observed that, 94.4% had some knowledge about family planning methods, and almost all (94.4%) of them were aware about Cu T and oral pills. The media and social circle were provided information of contraceptives in 46.6% women. Regarding the usage of contraceptive methods, 41.2% of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 26.8%, pills in 5.6%. Cu T users were 3.2% and 1.2% were using DMPA for contraception. 4.4% of women had already undergone tubal ligation. It was noted that awareness about pills and Copper was good, but their practices were very low. There were multiple reasons for non use like fear of side effects, no support from the husbands, low fertility, inhibition to ask about the contraceptives. Conclusion: There is need for strong motivation of couples through media and health personnel to achieve effective use of contraceptives, specially for Cu T and oral pills. Keywords: Contraception, Awareness, Prac

Material Hardship and Contraceptive Use During the Transition to Adulthood.

Decades of research have attempted to understand the paradox of stubbornly high unintended pregnancy rates despite widespread use of contraception. Much of this research has focused on socioeconomic disparities in rates of unintended pregnancy, finding that economically disadvantaged women tend to use less effective contraceptive methods and use them less consistently. Building on this research, this study examines how material hardship is associated with less consistent contraceptive use among women who do not desire to become pregnant. Using the Relationship Dynamics and Social Life (RDSL) Study, a weekly longitudinal survey, I find lower levels of contraceptive use and less consistent use of contraception among women experiencing material hardship, relative to those without hardship experiences. I also investigate the extent to which this association is explained by access barriers and lower contraceptive efficacy among women experiencing hardship. Using structural equation modeling, I find that these mediators significantly explain the relationship between hardship and risky contraceptive behaviors, suggesting that hardship creates mental and resource constraints that impede successful implementation of contraception. However, net of these mediators, material hardship remains associated with riskier contraceptive behaviors among young women, calling for further research on how hardship exposes women to greater risk of unintended pregnancies.

Abortion Surveillance - United States, 2018.

Problem/ConditionCDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States.Period Covered2018.Description of SystemEach year, CDC requests abortion data from the central health agencies for 50 states, the District of Columbia, and New York City. For 2018, 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2009–2018. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15–44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2017 were assessed as part of CDC’s Pregnancy Mortality Surveillance System (PMSS).ResultsA total of 619,591 abortions for 2018 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2009–2018, in 2018, a total of 614,820 abortions were reported, the abortion rate was 11.3 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 189 abortions per 1,000 live births. From 2017 to 2018, the total number of abortions and abortion rate increased 1% (from 609,095 total abortions and from 11.2 abortions per 1,000 women aged 15–44 years, respectively), and the abortion ratio increased 2% (from 185 abortions per 1,000 live births). From 2009 to 2018, the total number of reported abortions, abortion rate, and abortion ratio decreased 22% (from 786,621), 24% (from 14.9 abortions per 1,000 women aged 15–44 years), and 16% (from 224 abortions per 1,000 live births), respectively.In 2018, women in their 20s accounted for more than half of abortions (57.7%). In 2018 and during 2009–2018, women aged 20–24 and 25–29 years accounted for the highest percentages of abortions; in 2018, they accounted for 28.3% and 29.4% of abortions, respectively, and had the highest abortion rates (19.1 and 18.5 per 1,000 women aged 20–24 and 25–29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.6%, respectively) and had the lowest abortion rates (0.4 and 2.6 per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios in 2018 and throughout 2009–2018 were highest among adolescents (aged ≤19 years) and lowest among women aged 25–39 years. Abortion rates decreased from 2009 to 2018 for all women, regardless of age. The decrease in abortion rate was highest among adolescents compared with women in any other age group. From 2009 to 2013, the abortion rates decreased for all age groups and from 2014 to 2018, the abortion rates decreased for all age groups, except for women aged 30–34 years and those aged ≥40 years. In addition, from 2017 to 2018, abortion rates did not change or decreased among women aged ≤24 and ≥40 years; however, the abortion rate increased among women aged 25–39 years. Abortion ratios also decreased from 2009 to 2018 among all women, except adolescents aged <15 years. The decrease in abortion ratio was highest among women aged ≥40 years compared with women in any other age group. The abortion ratio decreased for all age groups from 2009 to 2013; however, from 2014 to 2018, abortion ratios only decreased for women aged ≥35 years. From 2017 to 2018, abortion ratios increased for all age groups, except women aged ≥40 years.In 2018, approximately three fourths (77.7%) of abortions were performed at ≤9 weeks’ gestation, and nearly all (92.2%) were performed at ≤13 weeks’ gestation. In 2018, and during 2009–2018, the percentage of abortions performed at >13 weeks’ gestation remained consistently low (≤9.0%). In 2018, the highest proportion of abortions were performed by surgical abortion at ≤13 weeks’ gestation (52.1%), followed by early medical abortion at ≤9 weeks’ gestation (38.6%), surgical abortion at >13 weeks’ gestation (7.8%), and medical abortion at >9 weeks’ gestation (1.4%); all other methods were uncommon (<0.1%). Among those that were eligible (≤9 weeks’ gestation), 50.0% of abortions were early medical abortions. In 2017, the most recent year for which PMSS data were reviewed for pregnancy-related deaths, two women were identified to have died as a result of complications from legal induced abortion.InterpretationAmong the 48 areas that reported data continuously during 2009–2018, decreases were observed during 2009–2017 in the total number, rate, and ratio of reported abortions, and these decreases resulted in historic lows for this period for all three measures. These decreases were followed by 1%–2% increases across all measures from 2017 to 2018.Public Health ActionThe data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is a major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

SummaryBackgroundUnless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception.MethodsWe did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete).FindingsBetween Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2–35·0) in the intervention group (mean 58·4%, 48·6–68·2), than in the control group (mean 40·5%, 29·7–51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred.InterpretationProvision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception.FundingNational Institute for Health Research (Health Technology Assessment Programme project 15/113/01).

Health Spending, Medicaid, And More

From the Editor-In-Chief Health AffairsVol. 39, No. 11: Health Spending, Medicaid & More Health Spending, Medicaid, And MoreAlan R. WeilPUBLISHED:November 2020Free Accesshttps://doi.org/10.1377/hlthaff.2020.01945AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSCosts and spendingMedicaidGlobal healthCOVID-19PandemicsCoronavirusLow incomeHigh-deductible health plansFee-for-serviceAffordable Care ActPhysician paymentMedicareMedicaid physician feesHealth disparitiesRacismEthnic disparitiesDisparities in accessHealth equityImmigrantsIn addition to the final versions of five papers originally published online, four of which relate to coronavirus disease 2019 (COVID-19), this month’s issue of Health Affairs covers a range of topics, including health spending, Medicaid policy, equity, and global health.Health SpendingFee-for-service payment is routinely blamed for excess US health spending. Michael Gusmano and coauthors analyze how physician fees are set in France, Germany, and Japan—countries that pay physicians fee-for-service. Although their approaches differ, all three countries set fees through centralized negotiation within the context of spending constraints. In the US, the authors conclude, “The absence of arrangements similar to those in the three countries we have studied leaves payers fragmented and gives providers too much control over their own prices.”Geographic variation in Medicare spending has long been viewed as evidence of health system inefficiency. With administered pricing, Medicare spending variation reflects different patterns of care that cannot be explained by population health characteristics. Analyzing fee-for-service data between 2007 and 2017, Yongkang Zhang and Jing Li report that the risk- and price-adjusted gap in spending between the highest- and lowest-decile hospital referral regions declined by 14 percent.MedicaidRebecca Myerson and coauthors explore the effects of Medicaid expansion on preconception health. Centers for Disease Control and Prevention surveillance data show important improvements in preconception health among low-income women with a recent live birth, including a 4-percentage-point increase in the share of women reporting a preconception health conversation with a provider. They also find increases in the share of women reporting daily folic acid intake in the month before pregnancy and in the use of effective contraception during the postpartum period.Providing Medicaid coverage as adults transition from incarceration to living in the community can yield significant health and social benefits. Justin Blackburn and coauthors examine how Indiana combined Medicaid expansion through a Section 1115 waiver with additional policies designed to maximize Medicaid coverage for low-income justice-involved adults. Implementation of these policies was associated with an increase in enrollment within 120 days of release from 8.8 percent to 44.9 percent. Key to the state’s success were interagency cooperation and data sharing.Oral health is an area of significant unmet need, particularly among people with low incomes. Hawazin Elani and colleagues, analyzing how the Affordable Care Act affected dental coverage for adults with incomes below 125 percent of poverty, find that it increased rates of dental coverage by almost 20 percentage points among this population in states that expanded Medicaid and that include dental care as a benefit. In states that do not offer dental coverage through Medicaid, dental coverage for this population remained below 20 percent.EquityHigh-deductible health plans (HDHPs), which are increasingly prevalent among people with private health insurance, are often paired with health savings accounts (HSAs) to improve access to care before the enrollee meets their deductible. Using survey data, Jacqueline Ellison and coauthors identify racial and ethnic, as well as socioeconomic, disparities in enrollment in HDHPs and HSAs. “The fact that HDHP enrollment is increasing over time for low-income, Hispanic, and Black adults, without similar rates of increase in HSA participation, may further contribute to…disparities,” the authors warn.Leonard Egede and colleagues examine racial and ethnic disparities in COVID-19 outcomes in Milwaukee, Wisconsin, a highly segregated “minority-majority” city. Blacks and Hispanics are 3.7 times and 3.1 times, respectively, more likely to test positive for COVID-19 than non-Hispanic Whites. Among those who test positive, members of either group are twice as likely to be hospitalized as Whites, with Hispanics twice as likely to die as Whites.Global Health PolicyAs many countries aim to implement universal health coverage, James Macinko and coauthors examine whether adults ages fifty and older are being left out. Using survey data from twenty-three high- and middle-income countries, the authors find that catastrophic health care expenditures (out-of-pocket expenses that are 25 percent or more of the household’s income) were more prevalent among rural inhabitants, those with incomes in the lowest quintile, people with a greater number of health problems, and current and former smokers.Alexander Peters and coauthors estimate the macroeconomic consequences of firearm-related fatalities in the thirty-six Organization for Economic Cooperation and Development (OECD) countries. They estimate cumulative losses of $239.0 billion in economic output from 2018 to 2030, with $152.5 billion attributable to the US alone, meaning that losses in the US exceed the combined losses of all other OECD countries. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 November 2020 Information© 2020 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

RELATIONSHIP BETWEEN CONTRACEPTIVE USE AND OCCUPATIONAL STATUS WITH UNWANTED PREGNACNY RISK AMONG COUPLES OF CHILDBEARING AGE

Unwanted pregnancy is a world problem. In 2008, there were 208 million pregnancies in the world, and 41% of them were unwanted pregnancy. Cross-national reproductive health studies have indicated that the unwanted pregnancy rates remain substantially high in many developing regions, including in Indonesia (Bearak et al. 2018). Unwanted pregnancies in Indonesia increased from 13.6% in 2012 to 16% in 2015. The high rates of unwanted pregnancies are often linked to the gaps in family planning services such as the effective use of contraceptive methods which is also influenced by family socioeconomic backgrounds such as their occupational status. Using the case study at health clinics of PKBI in East Java, this paper attempts to explore the association or relationship between the risk of unwanted pregnancy among couples of childbearing age (CCA) with their use of contraceptive methods and occupational status. A quantitative method of a case-control research design was applied by using a random sampling technique. The study was 50 women couples of childbearing age (15–45 years), who had unwanted and wanted pregnancies. Simple correlation analysis shows that the association are relatively significant between the occurrence of an unwanted pregnancy with the long-term contraceptive use (p-value = 0.008), and with the employed in occupational status (p-value = 0.027). However, there is no correlation between the unwanted pregnancy occurrence with the short-term contraceptives use (p-value = 0.118). The study concludes that the use of short-term contraceptive methods and the employed status can still affect the risk of unwanted pregnancies, while the effective use of long-term contraceptive method has a vital role in preventing unwanted pregnancies.

Stumbling blocks in population control.

Objectives: This study was conducted to determine frequency of contraceptive use, reasoning for not using any method and complications of various methods among low socioeconomic section of society. Study Design: Cross Sectional Observational study. Setting: Department of Obstetrics and Gynecology, Farooq Hospital, Westwood Branch, Lahore. Period: From 1st July 2019 to 31st December 2019. Material &amp; Method: All married women between 18-40 years of age,having at least one child, presenting to gynae outdoor, were included in the study. Sample size was 408. Mean and standard deviation calculated for age and parity. Frequency and percentage of remaining variables calculated by using SPSS version 16. Results: Out of total 408 participants, 48.3% were in age range of 21-30 years and 86.5% were having parity of ≥ 2. 47.5% participants were illetrate and 52.5% were having different level of education. 53% participants were not using any contraception and only 47% were practicing contraception. Most commonly used method among users were interval IUCD (32.3%) and barrier method (30.2%). Least common method used was Implanon (1.04%). Most common reasons among nonusers were lack of knowledge (30.5%) and fear of side effects (21.7%). Least common reasons were myths and false beliefs (8.8%). Common complications among users were menstrual irregularity (29.6%),vaginal discharge (12%) and failure of method leading to conception (7.8%). Conclusion: There is need for strong implementation of government family planning policies and motivation of couples through media and health personnel to achieve effective use of contraceptives.

Changes in expectation of relationship permanence, pregnancy acceptability and desire, and contraceptive use over time among young Latino/a women and men: An exploratory analysis

ObjectiveWe longitudinally assess associations between changes in expectation of relationship permanence—a measure that incorporates both relationship duration and commitment—pregnancy desire and acceptability, and highly effective contraception use among young U.S. Latino/as. Study designWe used multivariable logistic regression to analyze associations between changes in relationship factors, pregnancy acceptability and desire, and contraceptive method use over 6 months among 299 U.S. Latino/a women and men (ages 18–34) in relationships in a longitudinal study (retention rate: 32.4%). ResultsRespondents who found a pregnancy less acceptable at endline than at baseline were more likely to use highly effective contraception at endline (OR 2.97, 95% CI 1.09, 8.08). Respondents estimating an increase in relationship permanence more than one standard deviation of the mean were 4.90 (95% CI 1.17, 20.55) times more likely to use highly effective contraception at endline, compared to those without a change in estimation of relationship permanence. ConclusionIn this longitudinal study of young adult Latino/as in relationships, we found associations between changes in respondents’ perceptions of the acceptability of a pregnancy and expectation of the permanence of their relationship and highly effective contraceptive use. Our findings reiterate the complicated, intertwined links between relationship dynamics, pregnancy orientation, contraception, and time. ImplicationsThe significance of decreased pregnancy acceptability (but not desire) for using highly effective contraception suggests the importance of acknowledging pregnancy acceptability in contraceptive counseling, particularly because providers are more likely to direct Latino/a young adults towards methods that may not fulfill their contraceptive desires. Including discussion of young people’s expectations of relationship permanence may also be meaningful in counseling.

Alignment of PrEP use and effective contraceptive use among East African women in HIV serodiscordant partnerships.

Women who have a prevention mindset may opt for concurrent use of oral pre-exposure prophylaxis (PrEP) and all forms of contraception; we therefore assessed how contraception may influence PrEP use or vice versa. We analyzed data from Kenyan and Ugandan HIV-uninfected non-pregnant women in sero-discordant partnerships who were participating in the Partners Demonstration Project. Using multivariable generalized estimating equation models, we estimated the associations between effective contraceptive use and 1) PrEP dispensation 2) high effective PrEP use. Among the 311 women (93.1% of all those followed in the Partners Demonstration Project) median age was 29 years (interquartile range [IQR] 24.0-35.0) and 115 (37.0%) reported using effective contraception at baseline. All the women initiated PrEP during the study and moderately high PrEP adherence was recorded at 73.1% of visits over an average 7.5 months following PrEP dispensation. Women (14.8%) consistently used an effective contraceptive throughout study follow-up. PrEP dispensation was more frequent among those concurrently using effective contraception, (adjusted relative risk [aRR] = 1.19; 95% confidence interval [CI] = 1.08-1.32) and contraceptive use was more common among those on PrEP (aRR = 1.63; 95% CI = 1.18-2.25). Among East African women at high risk of HIV infection, PrEP dispensation was more frequent among women using effective contraception, indicating that family planning outlets may be efficient locations to deliver PrEP.

The mediation effect of contraceptive use and women\u2019s autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia

BackgroundIntimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy.MethodsThis study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects.ResultsTwenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively.ConclusionWomen’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.