Effective Contraception Research Articles

Educational Intervention Effects on Bilateral Tubal Ligation Knowledge among Women Attending Antenatal and Family Planning Clinics in Bomet County

Bilateral Tubal Ligation (BTL) is a highly effective contraceptive method with more than 99% effectiveness at preventing pregnancy. Its uptake remains low in Sub-Saharan Africa, at 1.6%. The Kenya Health and Demographics Survey 2014, indicated that almost half of the married women did not desire further childbearing. The low acceptance of BTL as a method of contraception in this region has been attributed to a lack of knowledge and cultural and religious misconceptions. This study aimed to determine the level of knowledge about BTL at baseline and the impact of an educational intervention among women attending ANC/Family planning clinics at Tenwek and Longisa Hospitals in Bomet County. A quasi-experimental study design was used. Demographic characteristics, knowledge of BTL, perceived risks, and benefits were assessed at baseline and post-intervention. A difference measure was used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 considered significant. The data was analyzed using STATA version 18. The mean age of the participants at baseline and post-intervention was 29.0±5.8 years and 29.2±5.6 years, respectively. Overall, 62% of participants said they would choose BTL, with 52% in the post-intervention arm. When asked if their religion allowed BTL, 80.6% said yes and were supported by their husband (92%), However, 62% said they couldn't have it if their spouse was against it. In general, lower knowledge scores were obtained in the post-intervention arm, implying that the educational intervention provided did not influence participants' knowledge of BTL. There was no statistically significant difference in the participants' knowledge levels at baseline and post-intervention [3.3 (-3.2 to 9.9); p-value=0.3]. Educating families, particularly women of childbearing age, about alternative family planning methods would increase uptake, allowing families to achieve desired family sizes while limiting the impact of unwanted pregnancies and maintaining a healthy population.

Contraceptive efficacy: Determining the threshold for effective suppression based on sperm concentration, motility, and morphology.

Human spermatogenesis is a complex process that transforms spermatogonial stem cells through mitosis and meiosis to spermatozoa. Testosterone is the key regulator of the terminal stages of meiosis, adherence of spermatids to Sertoli cells, and spermiation. Follicle-stimulating hormone (FSH) may be required for early spermatogenesis and is important for maintaining normal spermatogenesis in men. Hormonal contraception suppresses FSH, luteinizing hormone, and intratesticular testosterone concentration, resulting in marked suppression of sperm output. Clinical trials using testosterone alone or testosterone plus progestin demonstrate that sustained suppression of sperm concentration to ≤1 million/mL is sufficient to prevent pregnancy in the female partner. New agents that target spermatogenesis could use this as a target for contraceptive efficacy while others that block sperm function or transport may require a lower threshold. When sperm concentrations are suppressed to such low levels, measurement of sperm motility and morphology is technically difficult and unnecessary. With current data from fertile and infertile men, it is not possible to establish a lower limit of sperm motility or percent normal morphology that equates to the prevention of conception. New compounds that decrease sperm motility or alter sperm morphology may need to demonstrate a complete absence of sperm motility or altered morphology in all spermatozoa in the ejaculate. Sperm function tests may be useful depending on the mechanism of action of each new compound. Monitoring of sperm surrogate markers to ensure effective contraception relies on laboratories experienced in semen analyses. The development of at-home tests to assess sperm parameters has progressed rapidly. Some tests have been assessed in clinical trials and approved by regulatory agencies for at-home use for fertility assessment. However, caution must be exercised in using these tests as many have not been rigorously validated against semen parameters measured in laboratories by trained technologists using standardized tests defined in the World Health Organization Semen Manual.

Prunes May Blunt Adverse Effects of Oral Contraceptives on Bone Health in Young Adult Women: A Randomized Clinical Trial

BackgroundOral contraceptives (OCs) may promote bone loss, thereby leading to suboptimal bone health later in life. Research is needed to determine whether dietary interventions can blunt OC-related bone loss; prune consumption, shown to be effective in improving bone density in previous studies, could provide a safe and inexpensive solution. ObjectivesThe purpose of this study was to determine whether 12 mo of consuming 50 g of prunes daily would prevent bone loss or increase bone accrual in young (18–25 y) OC users. MethodsNinety women were randomly assigned to a control group not using OCs (non-OC), an OC group not consuming prunes (OC), and an OC group consuming 50 g prunes daily (OC+P) for 12 mo. Bone mineral density (BMD) was measured at baseline and after 12 mo via dual-energy X-ray absorptiometry (at all sites) and peripheral quantitative computed tomography (at tibia). Blood samples were collected at baseline and after 6 and 12 mo to assess biomarkers. ResultsThere were no significant differences between groups for dietary intake, physical activity, serum tartrate-resistant acid phosphatase-5b, or bone alkaline phosphatase concentrations. Baseline serum C-reactive protein and vitamin D concentrations were higher (P < 0.001) for OC and OC+P groups than those in the non-OC group. Serum parathyroid hormone was higher for non-OC group than OC group at both baseline (P = 0.049) and final (P = 0.032). BMD measured by dual-energy X-ray absorptiometry at all sites did not change among groups. Ultradistal radius BMD increased over time (P < 0.05) within non-OC and OC+P groups. Trabecular density of the distal tibia as measured by peripheral quantitative computed tomography decreased from baseline to 12 mo within the OC group only (P = 0.016). ConclusionsOC use tended to promote minor negative effects on bone and consuming prunes tended to provide a potential protective effect on trabecular density of the distal tibia and ultradistal radius.This trial was registered at www.clinicaltrials.gov as NCT04785131.

Prawne aspekty dostępu do antykoncepcji w Polsce

The ability to choose safe, effective and affordable contraceptive methods and to have access to comprehensive information on all family planning methods is one aspect of reproductive rights, which are considered an integral part of human rights. According to reports by the European Parliamentary Forum for Sexual &amp; Reproductive Rights, Poland has for years recorded the worst access to contraception among European countries. The purpose of this paper is to determine whether the regulations in force in the Polish legal system provide real access to contraception that complies with international standards. The following methods of contraception were analysed: emergency, chemical, mechanical, hormonal, long-term and permanent. Furthermore, issues affecting access to contraception, such as the conscience clause, sex education, and the lack of autonomy of underage women in deciding on contraceptive methods, excluding mechanical and chemical, were covered. As the majority of contraceptives are intended for use by women, any restriction on access to them can be qualified as a form of gender discrimination.

Development of Norelgestromin Dissolving Bilayer Microarray Patches for Sustained Release of Hormonal Contraceptive.

Microarray patches (MAPs) offer a noninvasive and patient-friendly drug delivery method, suitable for self-administration, which is especially promising for low- and middle-income country settings. This study focuses on the development of dissolving bilayer MAPs loaded with norelgestromin (NGMN) as a first step towards developing a future potential drug delivery system for sustained hormonal contraception. The fabricated MAPs were designed with the appropriate needle lengths to penetrate the stratum corneum, while remaining minimally stimulating to dermal nociceptors. Ex vivo assessments showed that the MAPs delivered an average of 176 ± 60.9 μg of NGMN per MAP into excised neonatal porcine skin, representing 15.3 ± 5.3% of the loaded drug. In vivo pharmacokinetic analysis in Sprague Dawley rats demonstrated a Tmax of 4 h and a Cmax of 67.4 ± 20.1 ng/mL for the MAP-treated group, compared to a Tmax of 1 h and a Cmax of 700 ± 138 ng/mL for the intramuscular (IM) injection group, with a relative bioavailability of approximately 10% for the MAPs. The MAP-treated rats maintained plasma levels sufficient for therapeutic effects for up to 7 days after a single application. These results indicate the potential of NGMN-loaded dissolving bilayer MAPs, with further development focused on extending the release duration and improving bioavailability for prolonged contraceptive effects.

Effect of progestin-based contraceptives on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls.

Adolescent girls bear a disproportionate burden of both the HIV epidemic and unintended pregnancies; yet important questions remain unanswered regarding the effects of hormonal contraceptives on the vaginal immune microenvironment, which can impact HIV susceptibility in this group. Multiple studies report genital immune alterations associated with the progestin-based contraceptive Depot medroxyprogesterone acetate (DMPA) in adult women, but there is little available data in adolescents. The objective of this longitudinal cohort study was to evaluate the effects of short-term use of three progestin-based contraceptives, levonorgestrel intrauterine device (LNG-IUD), subdermal etonogestrel (ETNG), and injectable DMPA, on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls. Fifty-nine sexually active, HIV-uninfected girls aged 15-19, were recruited from the Washington DC metro area and self-selected into Control (condoms only), combined oral contraceptive pills, LNG-IUD, ETNG and DMPA groups. Vaginal swabs were collected at baseline prior to contraceptive use and at 3-month follow-up visit. Vaginal secretions were tested for pro-inflammatory (IL-1α, IL-1β, TNF-α, IL-6, IL-8, MIP-3α, IP-10, RANTES, MIP-1α, MIP-1β) and anti-inflammatory/anti-HIV (Serpin-A1, Elafin, Beta-Defensin-2, SLPI) immune biomarkers using ELISA and for anti-HIV activity using TZM-bl assay. Vaginal microbiome was evaluated using 16S rRNA gene sequencing. Data were analyzed using SAS Version 9. Among the 34 participants who completed both visits, no significant changes in median biomarker concentrations, HIV inhibition and microbiome composition were observed between baseline and follow-up visits for any of the contraceptive groups. IL-8 (p<0.01), MIP-3α (0.02), Elafin (p = 0.03) and RANTES (p<0.01) differed significantly by race whereas IL-6 was significantly different by age (p = 0.03). We conclude that 3-month use of LNG-IUD, ETNG and DMPA have minimal effects on adolescent vaginal immune microenvironment, and therefore unlikely to impact HIV risk. Future studies with larger sample size and longer follow-up are recommended to continue to evaluate effects of contraceptives on the lower genital tract immunity and susceptibility to sexually transmitted infections.

Colonoscopic removal of an intrauterine device with rectal perforation: A case report.

The intrauterine device is one of the effective, safe, convenient, economical, and reversible contraceptive methods. Although its contraceptive effect is definite, some female patients may experience complications such as expulsion, bleeding, and pregnancy with the device in place. Rectal perforation is one of the rare and serious complications, which can lead to complications such as abdominal infection and intestinal adhesions, severely affecting the quality of life of patients. A 34-year-old female was sent to the Department of Gastroenterology with noticeable left lower quadrant abdominal pain. She had presented with abdominal discomfort and anal tenesmus 1 year earlier. Two months ago, her abdominal pain had gradually worsened and she was presented to our hospital. Investigations, including colonoscopy and computed tomography scan, had revealed an intrauterine device migrated and perforated into the rectum. The patient underwent successful colonoscopic removal of the intrauterine device. She recovered well after the treatment. This case proves that endoscopic therapy can be considered the preferred method for removing intrauterine devices displaced into the digestive tract lumen.

Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison.

Women of reproductive age experience cyclical variation in the female sex steroid hormones 17β-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk. ClinicalTrials.gov NCT05587920; https://classic.clinicaltrials.gov/ct2/show/NCT05587920. DERR1-10.2196/50542.

Influence of Oral Contraceptives on Lipid Profile and Trajectories in Healthy Adolescents—Data From the EVA-Tyrol Study

PurposeOral contraception is one of the most popular contraceptive methods both in adults and adolescents. However, the effects of oral contraception on lipids in adolescents are not well studied. MethodsLipid profiles were measured and contraceptive use was assessed in 14- to 19-year-old female participants of the prospective population-based Early Vascular Ageing-Tyrol Study between 2015 and 2018, twice on average 22 months apart. ResultsFor this analysis, data from 828 young women with a median age of 17.0 years were available. Of them, 317 (38%) used oral contraceptives (OCs). OC users had a slightly higher systolic and diastolic blood pressure and larger changes over time and were more likely to use cigarettes than nonusers. Total cholesterol (179.6 vs. 162.4 mg/dL), low-density lipoprotein-cholesterol (106.4 vs. 94.6 mg/dL), and triglycerides (104.0 vs. 67.0 mg/dL) were significantly higher in OC users after multivariable adjustment in linear regression models. No difference in high-density lipoprotein-cholesterol between the two groups was found. In 558 females, follow-up data were available. Those who initiated OC use had on average 15.4 mg/dL higher low-density lipoprotein-cholesterol and 36.2 mg/dL higher triglyceride level changes between baseline and follow-up than never users. Duration of OC use did not show a significant association with lipid levels and changes. DiscussionWe showed an independent association between OC use and blood lipids as well as lipid trajectories over time in a large cohort of healthy adolescents. These changes are especially relevant to consider in adolescents with other risk factors for dyslipidemia or other cardiovascular risk factors.

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center.

This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

Contraceptive Utilization and Perceived Spousal Involvement among Female Employees of Child-bearing Age in a Private University in Ogun State, Nigeria

Objective: This study assessed the utilization and perceived spousal involvement in contraceptive use among female employees of child-bearing age in a private university in Nigeria. Methods: This was a descriptive cross-sectional study of 270 women who were selected using a purposive sampling method. A structured interviewer-administered questionnaire was used to elicit data. Contraceptive utilization was assessed as ever or never utilized. Perception of male involvement was graded as good or poor using items on the questionnaire. Data analysis was done using IBM SPSS version 22 and presented as tables. P&lt; 0.05 was taken as statistically significant. Results: Participants' mean age was 35.3± 5.9 years. Most 236 (87.4%) of them had tertiary education. Four-fifths- 219 (81.1%) had ever been counselled on family planning or utilized contraceptives 216 (80.0%). The majority 232 (85.9%) of the women had good perceived spousal involvement scores, while 38 (14.1%) of the women had poor perceived spousal involvement scores. There were statistically significant associations between receiving family planning counselling, spouse involvement in contraceptive choices, fear of side effects, and spousal refusal with the utilization of contraceptives and perception of spousal involvement (p&lt;0.001 in all instances) Conclusion: Receiving family planning counselling and spousal support positively influenced the utilization of contraceptives and the perception of male involvement, while the fear of contraceptive side effects had negative effects on both outcomes. There is a need to improve male engagement and female counselling in contraceptive use. Health education should also focus on debunking exaggerations of contraceptive side effects.

PROSPECTS FOR THE USE OF CONTRACEPTIVE VAGINAL PATCH ZB-06

With the high frequency of unplanned pregnancies in many countries, there is an urgent need for more affordable and effective contraceptives. In recent years, scientists around the world have been actively developing new methods of barrier contraception. This method is very simple and convenient due to the fact that it has no systemic effect, side effects are minimized, and a woman can use it when she needs it. In order to fill the gap in this niche, scientists have developed the ZB-06 vaginal contraceptive film containing the HC4-N human contraceptive antibody (HPA). Purpose. Study literature sources on the use of contraceptive vaginal film ZB-06. Materials and methods. Materials from PubMed and PubMedCentral resources of the US National Library of Medicine, Google Scholar, Elsevier Clinical Key and Elsevier Science Direct were used to analyze the literature. For the analysis of scientific literature, a qualitative method based on content analysis was used, namely, the definition of units of analysis - headings, annotations and keywords of articles; calculation of the frequency and percentage distribution of analysis units by analysis categories using the Excel program; interpretation and generalization of analysis results. Results. This review presents summarized research results that demonstrate that the ZB-06 contraceptive film has a number of advantages and disadvantages. This method of contraception provides effective levels of mucosal antisperm antibodies for at least 3 hours after use. Conclusion. Contraceptive vaginal film ZB-06 is an innovative, non-hormonal, topically applied vaginal film (containing HC4-N PPA), which in phase 1 of the study showed a high level of effectiveness and met the safety requirements for contraceptives.

Low Usage of Modern Contraceptives Among Women of Reproductive Age in Tanzania: Analysis Beyond Availability and Awareness Factors

Most studies on contraceptives have linked low use with awareness and problems of availability. However, these studies have not considered low or discontinuation of use of contraceptives to be a positive phenomenon where women exercise their reproductive rights or autonomy. Hence, this article has adopted a Marxist-Feminist theory of contraceptives to examine the association between socio-demographic factors and low usage of contraceptives among women of reproductive age. It also evaluates the influence of the availability and awareness on the use or non-use of contraceptives among such a group of women. The article is based on a cross- sectional case study conducted in Kigoma Rural District, Tanzania. The data were collected through questionnaires modified from TDHS, interviews with nurses, and an in-charge of a health facility. Secondary data were collected from TDHS (2016, 2022), Tanzania Service Delivery Point report, Stock Inventory Charts and Our World data sets. Quantitative analysis was performed through STATA 14, and secondary data was processed through content analysis. The study found that though the majority of the reproductive age are aware of contraceptives, most (80%) have not used them. We do not treat this as a problem, but an exercise of reproductive rights and autonomy by women. In addition, there is no significant evidence to prove any influence of socio-demographic factors on low use of contraceptives. Low use and discontinuation of contraceptives are associated with the need for more children by women, and the side effects of contraceptives. Therefore, we conclude that women should be left to decide when and how to use contraceptives: they should not be forced through direct or indirect health services.

Reduced threat avoidance but increased stress induced approach bias in women taking oral contraceptives

Recent research has increasingly acknowledged the impact of oral contraceptives on affective behavior and stress responses; however, the underlying mechanisms are still not well understood. Studies have previously shown that steroid hormones modulate automatic approach and avoidance behavior. Here, we thus investigated the effects of oral contraceptives on approach and avoidance behavior and whether these effects are modulated by stress. The study comprised 130 female participants, half of whom were using oral contraceptives, while the other half were not using any hormonal contraception (NC). The participants completed the Approach Avoidance Task (AAT), which measures automatic approach and avoidance behavior to socio-affective signals. The AAT was run once before and once after a stress manipulation using the Socially Evaluated Cold Pressor Test. OC users showed absent avoidance behavior to social threat signals and a stress-induced increase in approach behavior to positive social signals. The latter was found in particular in women taking androgenic acting OC, demonstrating that different OC preparations need to be taken into account in research on OC effects. However, OC and NC group did not differ in their cortisol stress response. Overall, the results suggest that OC usage impacts on approach and avoidance behavior to social signals, which might also contribute to the development of affective side effects.

The Effect of Progestin Injection Contraception on Changes in Amount of Fat and Muscle in Female Patients at Slamet Riyadi Hospital, Surakarta

This study aims to determine the effect of Progestin Injection Contraception on changes in the amount of fat and muscle in female patients at Slamet Riyadi Hospital, Surakarta. The research method used a quantitative research design with a Quasi-Experimental approach and a one-group pretest-posttest design. The population in this study was women who used progestin injection contraception as a method of contraception in the last three months, totaling 20 acceptors. Meanwhile, the sample of this study was 14 people. This research was conducted at Slamet Riyadi Hospital, Surakarta, over three months. Data analysis consisted of two stages: univariate analysis and bivariate analysis. The results showed that there was an effect of Progestin Injection Contraception administration on changes in fat and muscle levels before and after, with P values of 0.006 and 0.027, respectively. Therefore, these findings underscore the importance of monitoring body composition for Progestin Injection Contraception users and the need for further studies to understand the long-term impact of this type of contraception. muscle

The Effects of Oral Contraceptives on Body Composition After Resistance Training Interventions: A Systematic Review

The Effects of Oral Contraceptives on Body Composition After Resistance Training Interventions: A Systematic Review

Denial of reproductive potential: a predictor of unperceived pregnancy in an Austrian neonaticide sample.

This study aims to describe the phenomenon of unperceived pregnancy followed by neonaticide with a focus on the lack of awareness of reproductive potential in an Austrian sample. An explorative comparative study of neonaticide cases with single and repeat perpetrators was conducted using nationwide register-based data from 1995 to 2017. A total number of 55 cases out of 66 were included in the analysis. A standardized coding sheet was used and calculations were performed. 48 women gave birth to 101 children, of which 55 were killed, 23 children lived out of home care and 23 lived with the perpetrator We found a higher fertility rate in both neonaticide perpetrators in the single (1,9) and the repeat group (4,25) in comparison to the general population (1,4). The use of contraception was only 31% among neonaticide perpetrators, deviating substantially from the general Austrian population age group (16-29yrs) which used contraception in 91%. The neonaticide perpetrators used an effective contraception method (pearl-index < 4) in only 2%, whereas 20% of the general population did so. The number of unperceived pregnancies was high in both groups (50/55) 91%. Future case reports and forensic evaluations should take reproductive behavior into account, as it may offer valuable insights into the events leading up to neonaticide. Our findings suggest that denial of reproductive potential often precedes unperceived pregnancies. In the Austrian cohort, women who experienced unperceived pregnancies resulting in unassisted births and subsequent neonaticide showed a low prevalence of contraceptive use. This is particularly noteworthy given that the primary motive for neonaticide is unwanted pregnancy.

Identifying the Optimal Birth Control for Patients

Despite decreases in pregnancy and abortion rates over the past few decades, unintended pregnancy remains a personal and public health challenge.1 In the 1960s, the first birth control pills (progestin only and combined) revolutionized contraceptive effectiveness despite their high estrogen doses. In the 1980s, safety became front of mind, as older intra-uterine devices (IUDs) and implants were removed from the market, leading to the development of newer, safer options we enjoy today. In the 1990s, pill-related venous thromboembolism (VTE) scares led to surges in unintended pregnancy rates in the United Kingdom and Europe, only to be repeated in the 2000s. In the 2010s, long-acting reversible contraception (LARC) was hailed as the path forward for reducing pregnancy rates and, indeed, this has contributed to modest reductions in unintended pregnancy and abortion rates. This decade has seen two major shifts in contraceptive care: the transition to blended models of service delivery (especially virtual and subscription-based options) and a transition toward “needs-based” counselling.

Does reversible postpartum contraception reduce the risk of pregnancy condition recurrence? A longitudinal claims-based study from Maine

PurposeTo estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI). MethodsWe used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders. ResultsApproximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74). Conclusion(s)Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System.

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.