Emergency Contraception Research Articles

Assessment of Indian Medical Graduate (IMG)’s knowledge about emergency contraception (EC) in a medical college of Himachal Pradesh

Background: Undergraduate curriculum of the medicine is created to ensure achievement of goal of “health for all” in India. In addition, it aspires graduates to meet or exceed global benchmark in knowledge, attitude, skills and communication (1). Objectives: 1) To assess undergraduates’ knowledge regarding the types and correct usage of available Emergency Contraceptives. 2) To utilize the data base for capacity building by focusing on the Core Competency of Emergency Contraceptives. Methods: This cross-sectional study was done among 442 undergraduates of all the Profs in our college in September 2017 after approval from Institutional Ethical Committee (17/66) and informed verbal consent from the participants. This pretested, pre-designed and self-administered 11-questionnaire proforma in English was used as a tool of investigation. Results: Maximum participation was from 3rd and 4th year. 7.2 % had a very poor knowledge, attempted 3 or less questions correctly. Only 14.5% attempted 8 or more questions correctly. Conclusion: Young population of our country forms the broad base of the pyramid, they should be provided with correct knowledge about EC for improving their reproductive health. Since these graduates are going to serve the community, their knowledge and skill in this core competency is going to help the community.

Ulipristal Acetate Modifies miRNA Expression in Both Superficial and Basal Layers of the Human Endometrium.

(1) Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) widely used for emergency contraception and mid- to long-term leiomyoma treatment. The aim of this study was to identify modifications of miRNA expression in superficial and basal layers of the human endometrium at the end of the UPA treatment for at least 3 months. (2) Methods: Microarray miRNA analysis of formalin-fixed, paraffin-embedded hysterectomy tissue samples was conducted, followed by an Ingenuity Pathway Analysis. Samples were divided into three groups: women having had 3 months of UPA treatment (n = 7); and two control groups of UPA-naïve women in the proliferative (n = 8) or secretory (n = 6) phase. (3) Results: The UPA modified the expression of 59 miRNAs involved in the processes of cell cycle, carcinogenesis, and inflammation. Their expression profiles were different in the basal and superficial layers. Most of the processes influenced by the UPA in the basal layer were connected to the cell cycle and immune regulation. (4) Conclusion: Specific changes were observed in both layers of the endometrium in the UPA group. However, the miRNA expression in the basal layer was not consistent with that in the superficial layer. Other large studies analysing the long-term impact of SPRM on endometrial miRNA expression are necessary.

Barriers to abortion care and incidence of attempted self-managed abortion among individuals searching Google for abortion care: A national prospective study

ObjectiveStudies on self-managed abortion conducted at abortion clinics may exclude those facing the greatest barriers to care. We aimed to assess association of attempted self-managed abortion with reported barriers to abortion care. Study DesignWe used data from the Google Ads Abortion Access Study, a prospective cohort study that recruited people searching for abortion care on Google between August 2017 and April 2018. We used a stratified sampling design recruiting by state to ensure representation from all 50 states. Participants completed an online baseline survey and follow-up 4 weeks later. We modeled the adjusted odds of attempting self-managed abortion using multivariable logistic regression, with random effects for state of residence. We assessed attempted self-managed abortion at follow-up by asking: “Did you take or try to do any of the following to try to end this pregnancy?” with a closed-ended list of methods. ResultsAmong 856 participants with follow-up data, 28% (95% confidence interval [95% CI]: 25%–31%) reported attempting self-managed abortion. Most common methods used were: herbs, supplements, or vitamins (52%); emergency contraception or many contraceptive pills (19%); mifepristone and/or misoprostol (18%); and abdominal or other physical trauma (18%). Participants still seeking abortion at 4 weeks were more likely to attempt self-management (33%) than those planning to carry to term (20%, p < 0.001). Reporting having to keep the abortion a secret, fearing for one's safety/well-being, needing to gather money for travel or the abortion, or living further from an abortion facility as barriers were associated with higher odds of attempts. ConclusionsAttempted self-managed abortion is higher among people facing barriers to abortion care. ImplicationsReducing financial and distance barriers, such as by removing legal restrictions on abortion, could help reduce attempted self-managed abortion. Additionally, removing restrictions on telehealth for abortion could reduce attempted self-managed abortion. Efforts are needed to permanently remove United States Food and Drug Administration (FDA) regulations and state policies prohibiting telehealth for medication abortion, thereby allowing individuals to end their pregnancies without a clinic visit.

"Awareness and Utilization of Emergency Contraception Among Female High School Students in Southeast Ethiopia"

"Awareness and Utilization of Emergency Contraception Among Female High School Students in Southeast Ethiopia"

Awareness of Postpartum and Post Aborted Women Regarding Emergency Contraception

Abstract Background: Globally, there are 250 million pregnancies every year, one third of these is unintended pregnancy, one fifth of these undergo induced abortion and some of these undergo unsafe abortion. Unintended pregnancy has obvious association with health social and economic consequences. Aim: Assess knowledge, attitude and selfreported practice regarding emergency contraception among postpartum and post aborted women. Design: A descriptive research design was carried out in this study. Settings: The sample conducted at Family Planning Unit in Sohag University Hospital, Sohag General Hospital and Maternal- child health center (Dar Salama Abdallah). Sample: A purposive sample was carried out in this study. Subjects: was estimated to be 600 women. Tools: First: structured interview questionnaire, second: knowledge assessment sheet, third: attitude assessment sheet and fourth: self-reported practice assessment sheet. Results: This study revealed that near two third of women had poor knowledge about emergency contraception (EC), more than half of them had negative attitude toward it, the minority of them were used it before and the majority of them had unintended pregnancy previously. Conclusion: Poor knowledge and negative attitude regard EC is remain a major barrier regard wide spread EC use and had obvious role in occurrence unintended pregnancy. Recommendations: It is important to advise women toward using regular suitable contraception and keep EC for emergency purposes only as unprotected sexual intercourse to minimize unintended pregnancies and abortions.

BARRIERS TO EMERGENCY CONTRACEPTION ACCESS NOT ALLEVIATED WITH BRIEF PHARMACY EDUCATIONAL INTERVENTION

Levonorgestrel (LNG) emergency contraception (EC) was completely accessible in 24% of pharmacies shortly after the Food and Drug Administration (FDA) approved EC as an over the counter (OTC) product. No data exists on efforts to improve access to OTC EC with pharmacy staff education. We sought to evaluate whether OTC EC access has improved, and to evaluate if a brief educational intervention improved the ability of pharmacy staff to answer routine EC questions.

Knowledge, Attitude and Practice Toward the Use of Emergency Contraception Methods Among Women in the Kingdom of Saudi Arabia

Unintended pregnancy is a common publichealth issue worldwide, especially in the MENAregion. Unintended pregnancy has two subtypes(unplanned and unwanted). Emergency contraception (EC) plays a vital role in preventing unintended pregnancy up to 98% by delaying ovulation or preventing implantation. It is available over the counter in most of the Arab world. In our study the investigating group wanted to explore knowledge attitude and practice among women of Saudi Arabia towards EC. To achieve this objective a validated survey was used as study tool. It was found that there is improved knowledge, attitude and practice among women towards EC utilisation. Key words: Emergency contraception methods, women, Saudi Arabia

Effect of ulipristal acetate on gene expression profile in endometrial cells in culture and in vivo upon post-ovulatory administration in fertile women

Purpose To analyse the effect of ulipristal acetate (UPA) as emergency contraception (EC) on the gene expression of human endometrial cell line (HEC-1A) and endometrium from fertile women treated with UPA after ovulation. Materials and methods HEC-1A cells were treated with UPA, and endometrial tissue from four healthy women was collected in cycles before, during and 2 months after post-ovulation pill intake. Ovulation and luteal phase were monitored, and endometrial biopsies were obtained at day LH + 7 in each cycle. In all cases, we analysed the expression profile of 192 genes associated to endometrial receptivity. Results We observed a significant change in total transcriptomic activity of UPA-treated HEC-1A cells compared to controls. In vivo, we also observed a trend to down-regulation of genes in the UPA-treated cycle that was partially restored in the post-treatment cycle. Altogether, our results supported a partially reversible effect of UPA in gene expression associated with uterine receptivity. Conclusions When UPA was administered after ovulation, it seems to induce a down-regulation of the main genes involved in conditioning the endometrium for implantation. This effect is partially restored two months after pill intake. The action of UPA on the endometrium for users of EC should be further investigated.

KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT CONTRACEPTIVE AMONG REPRODUCTIVE AGE GROUP FEMALES

Background: Aim of current study was to assess the knowledge, attitude &amp; practices of contraceptives among married women of reproductive age group.&#x0D; Methods: A cross sectional study was conducted on females between 15-45 years was included while unmarried females were excluded. The participation was on voluntary basis. Questions regarding factors responsible for non use of contraception were also asked. All data were analyzed by Epi-info software.&#x0D; Results: Out of 1000 women, 634(63.40%) had knowledge about family planning. 62.00% knew about condom, followed by OCPs &amp; other methods. Only 8.00% Women were aware of emergency contraceptive.&#x0D; Conclusions: Our study highlights that knowledge and awareness doesn’t always lead to the use of contraceptives. One needs to understand the level of awareness and practices in the community before implementing the family planning program&#x0D; Keyword: Attitude, Practice, Contraception, Reproductive age group

Three-dimensional microengineered vascularised endometrium-on-a-chip.

STUDY QUESTIONCan we reconstitute physiologically relevant 3-dimensional (3D) microengineered endometrium in-vitro model?SUMMARY ANSWEROur representative microengineered vascularised endometrium on-a-chip closely recapitulates the endometrial microenvironment that consists of three distinct layers including epithelial cells, stromal fibroblasts and endothelial cells in a 3D extracellular matrix in a spatiotemporal manner.WHAT IS KNOWN ALREADYOrgan-on-a-chip, a multi-channel 3D microfluidic cell culture system, is widely used to investigate physiologically relevant responses of organ systems.STUDY DESIGN, SIZE, DURATIONThe device consists of five microchannels that are arrayed in parallel and partitioned by array of micropost. Two central channels are for 3D culture and morphogenesis of stromal fibroblast and endothelial cells. In addition, the outermost channel is for the culture of additional endometrial stromal fibroblasts that secrete biochemical cues to induce directional pro-angiogenic responses of endothelial cells. To seed endometrial epithelial cells, on Day 8, Ishikawa cells were introduced to one of the two medium channels to adhere on the gel surface. After that, the microengineered endometrium was cultured for an additional 5–6 days (total ∼ 14 days) for the purpose of each experiment.PARTICIPANTS/MATERIALS, SETTING, METHODSMicrofluidic 3D cultures were maintained in endothelial growth Medium 2 with or without oestradiol and progesterone. Some cultures additionally received exogenous pro-angiogenic factors. For the three distinct layers of microengineered endometrium-on-a-chip, the epithelium, stroma and blood vessel characteristics and drug response of each distinct layer in the microfluidic model were assessed morphologically and biochemically. The quantitative measurement of endometrial drug delivery was evaluated by the permeability coefficients.MAIN RESULTS AND THE ROLE OF CHANCEWe established microengineered vascularised endometrium-on-chip, which consists of three distinct layers: epithelium, stroma and blood vessels. Our endometrium model faithfully recapitulates in-vivo endometrial vasculo-angiogenesis and hormonal responses displaying key features of the proliferative and secretory phases of the menstrual cycle. Furthermore, the effect of the emergency contraception drug levonorgestrel was evaluated in our model demonstrating increased endometrial permeability and blood vessel regression in a dose-dependent manner. We finally provided a proof of concept of the multi-layered endometrium model for embryo implantation, which aids a better understanding of the molecular and cellular mechanisms underlying this process.LARGE SCALE DATAN/A.LIMITATIONS, REASONS FOR CAUTIONThis report is largely an in-vitro study and it would be beneficial to validate our findings using human primary endometrial cells.WIDER IMPLICATIONS OF THE FINDINGSOur 3D microengineered vascularised endometrium-on-a-chip provides a new in-vitro approach to drug screening and drug discovery by mimicking the complicated behaviours of human endometrium. Thus, we suggest our model as a tool for addressing critical challenges and unsolved problems in female diseases, such as endometriosis, uterine cancer and female infertility, in a personalised manner.STUDY FUNDING/COMPETING INTEREST(S)This work is supported by funding from the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) to Y.J.K. (No. 2018R1C1B6003), to J.A. (No. 2020R1I1A1A01074136) and to H.S.K. (No. 2020R1C1C100787212). The authors report no conflicts of interest.

Contraceptive Use Among Adolescents With and Without Disabilities

PurposeThe aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. MethodsData were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse—including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception—by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. ResultsGirls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference −2.6%, 95% CI −.26%, −4.9%; adjusted prevalence ratio .97, 95% CI .95–1.00, p = .03). ConclusionsWe observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

The history of emergency contraception

Emergency contraception (EC) has evolved since the 1960's to enable a better tolerance. Lower hormone doses, simplified schemes, withdrawal of estrogens have led to a user friendly, over-the-counter available EC. The copper intra-uterine device, requiring health care professionals' intervention, is less accessible. However, it allows simultaneous initiation of a reliable long-term contraception. Unfortunately, EC is still underused and information reinforcement is needed to overcome reluctance to its use.

Future Pharmacists' Opinions on the Facilitation of Self-Care with Over-the-Counter Products and Whether This Should Remain a Core Role.

Background: The aim was to investigate pharmacy students’ views on the role of the pharmacist in facilitating self-care with over-the-counter (OTC) medicines, particularly in light of new roles, and establish personal practice. Methods: Final year pharmacy students at Queen’s University Belfast were invited to participate. Data were collected via a pre-piloted questionnaire, distributed at a compulsory class (only non-identifiable data were requested). Descriptive statistics were performed, and non-parametric tests were employed for inferential statistical analysis (responses by gender). Results: The response rate was 87.6% (78/89); 34.6% (27/78) males and 65.4% (51/78) females. Over a third [34.6% (27/78)] reported using OTC medicines about once a month. All appreciated the importance of an evidence-based approach to optimize patient care. Most [(96.2% (75/78)] deemed OTC consultations should remain a fundamental responsibility of pharmacists and 69.2% (54/78) thought OTC consultations have the potential to be as complex as independent pharmacist prescribing. Females felt more confident recommending OTC emergency contraception than males (p = 0.002 for levonorgestrel and p = 0.011 for ulipristal acetate). Many [61.5% (48/78)] considered more medicines should not be deregulated from prescription-only status. Conclusions: Data from this single institution suggests that enabling self-medication is an important part of practice but there were confidence issues around deregulations.

Pemilihan Kontrasepsi Oleh Aseptor Kb Selama Masa Pandemi Covid-19 dalam Menjaga Kesehatan Reproduksi di Wilayah Kerja Puskesmas Moncongloe Maros

: Indonesia is a developing country with a large population. The population growth rate in Indonesia has increased by 1.49% or an increase of 4.5 million every year with a fairly large population, showing that Indonesia is not without population problems. So during the Covid-19 pandemic, it is necessary to emphasize the importance of using contraception and emergency contraception in maintaining reproductive health and emphasize the importance of using contraception and emergency contraception. So that family planning does not deviate from the planned path. This also supports maternal mental health, baby health and family welfare. The aim of this activity is to help PUS in choosing the type of contraception during the Covid-19 pandemic in maintaining reproductive health with counseling methods and assistance in choosing contraception. This community service activity has been successfully implemented. WUS in the Moncongloe Maros Health Center area have also received information about contraception, especially during the Covid-19 pandemic. Judging from the EFA response, this activity was welcomed and considered to have provided positive benefits during the pandemic.

A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol.

To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.

Trends in sexual violence patterns and case management: a sex disaggregated analysis in Goma, Democratic Republic of Congo

BackgroundBoth conflict and non-conflict sexual violence have been well described in the Democratic Republic of Congo (DRC). However, there is little empiric data comparing sexual violence patterns for males and females in the DRC, and little is known about how post-sexual assault care experiences may differ between the two sexes.MethodsThis was a retrospective, registry-based study at HEAL Africa Hospital. Researchers extracted and analyzed available data for all patients seeking post-sexual assault care between July 2013 and December 2017. Comparative analysis was conducted using SAS to document patterns of sexual violence among male and female survivors and to describe the clinical management of males and females seeking post-assault care.ResultsBetween July 2013 and December 2017, the hospital provided post-sexual assault care to 1766 patients (1623 female and 93 male). Female survivors were more likely to be minors under the age 18 (p < 0.0001) with a mean age 16.5 years versus 22.3 years for males. For both sexes, approximately half of all perpetrators were civilians who were known to the survivor (friends, family members, colleagues or neighbors). After sexual assault, males (79.6%) were more likely than females (55.7%) to present to the hospital within 72 h (p-value < 0.0001). Among female patients, 12% had a positive pregnancy test at the time of presentation and another 43% received emergency contraception. Male survivors were more likely to test positive for HIV (p-value = 0.0032) and to receive HIV post-exposure prophylaxis as well as prophylactic antibiotics (p-value < 0.0001).ConclusionsIn this single-centre registry, non-conflict-related sexual violence affected both women and girls as well as men and boys in North Kivu with civilian-perpetrated assaults being most common, and girls under the age of 18 being disproportionately affected. Overall, delays to seeking post-assault care appear to have decreased over time, although females presented later than males. These differences, as well as sex discrepancies in receiving HIV prophylaxis and prophylactic antibiotics, are not well understood. Additional research is needed to understand these phenomena such that equitable and optimal care can be ensured for both female and male sexual violence survivors.

Kentucky pharmacists’ perceptions regarding provision of hormonal contraception

BackgroundAlthough Kentucky pharmacists recently gained authority to provide protocol-driven care for 13 conditions, provision of prescription hormonal contraception (HC) services is not currently authorized. A board-approved protocol allowing for provision of nonprescription over-the-counter (OTC) emergency contraception (EC) was recently approved by the Kentucky Board of Pharmacy but has yet to be implemented. ObjectivesThe objectives of this study were (1) to assess Kentucky pharmacists’ interest in providing prescription HC and OTC EC services via protocol and (2) to identify perceived benefits/barriers regarding provision of prescription HC. MethodsAn online questionnaire was disseminated electronically to a convenience sample of Kentucky pharmacists. The questionnaire collected (1) demographic information, (2) opinions regarding provision of prescription HC and OTC EC, and (3) perceived benefits and barriers regarding provision of prescription HC. For analysis, responses were limited to pharmacists in community-based practice. McNemar’s test was used to identify statistically significant differences in support by dosage form. In addition, a multivariable logistic regression model was used to examine associations between demographic factors and support for pharmacist provision of prescription HC. ResultsWe received 151 responses from community-based pharmacists. Support for provision of prescription HC was highest for oral (61%) and transdermal (54%) forms. We found no statistically significant differences in support among demographic factors other than number of years in practice, with more recent graduates being at higher odds of support. In addition, time, reimbursement, training, and belief in the need for pelvic exams were the most commonly cited barriers to implementation. With regard to OTC EC provision, pharmacists were largely supportive (62%) and confident in their abilities. ConclusionsCommunity-based pharmacists in Kentucky are supportive of provision of oral, vaginal, and transdermal prescription HC as well as OTC EC via protocol. Barriers, including time, reimbursement, training, and belief in the need for pelvic exams, should be addressed to increase support for prescription HC provision.

Emergency contraceptive utilization and associated factors among college students in Dire Dawa City, Eastern Ethiopia: A cross-sectional study.

INTRODUCTIONEmergency contraception is a contraceptive method that can be used to prevent pregnancy after unprotected sexual intercourse. Higher education students fall under the sexually active age group and form a high-risk group for unintended pregnancy, because of limited utilization of emergency contraception. The aim of this study was to assess emergency contraceptive utilization and associated factors among college students in Dire Dawa City, Eastern Ethiopia.METHODSAn institutional-based cross-sectional study was conducted in May 2019. A total of 286 students using simple random sampling technique were included in the study. Data were collected by using self-administered questionnaires and entered into EpiData (Classic) Entry version 3.1 and analysed using SPSS version 24.0. Binary and multivariable logistic regression analysis were done to determine the association between the outcome and predictor variables.RESULTSA total of 286 female students participated in the study giving a response rate of 100%. Eighty-six (86) participants had a history of sexual practice, and 60 (69.7%) had ever used emergency contraceptive. Having knowledge about emergency contraceptive (AOR=3.24; 95% CI: 1.32–7.98), age at first sexual intercourse ≥20 years (AOR=4.04; 95% CI: 1.72–9.52), history of previous pregnancy (AOR=3.12; 95% CI: 1.34–7.24) and previous use of regular contraceptives (AOR=5.01; 95% CI: 2.23–11.27) were found to be significant predictors of emergency contraceptive utilization.CONCLUSIONSThis study showed that emergency contraceptive utilization among female college students having unprotected sexual intercourse is still low. Level of knowledge, age at first sexual intercourse, previous use of regular contraceptives and history of pregnancy were major predictors of emergency contraceptive utilization. Therefore, focus on awareness creation activity and delaying sexual activity is recommended.

Comparison of Contraceptive Sales Before and After the SARS-CoV-2 Pandemic in Brazil

Background: The SARS-CoV-2 (COVID-19) pandemic has put the health care system under severe strain. Sexual and reproductive health services, including contraception provision, were one of the most disrupted. Our objective was to assess the impact of the COVID-19 pandemic on the sales of modern contraceptive methods in Brazil.Methods: We analysed monthly data of short-acting, long-acting reversible contraceptives (LARCs; implants and intrauterine devices [IUD]), and COVID-19 related deaths. We categorised the sales in: i) emergency contraceptive (EC), ii) oral contraceptives, rings and patches, iii) injectable contraceptives, iv) LARC methods, including copper-IUD, and v) LARC methods, except Cu-IUDs.Findings: Contraceptives sales had a non-significant increase in the year 2020 compared to the year 2019, and the annual average ranged from 12·8 to 13·0 million units/month. We observed an increase in the sales of injectable contraceptives for the February-May/2020 and EC pills for the June-July/2020 and a non-significant variation for pills, patches and rings. The hormonal-IUD/ENG-implant had three patterns: a decrease in sales between February-April, which coincides with the closure of family planning services; an increment of sales since April, which coincide with the first COVID-19 related deaths and an important increment of sales since July/2020.Interpretation: The COVID-19 pandemic has disrupted the Brazilian healthcare system and due to the fact that many family planning clinics were closed, the sales of most of the modern contraceptives fall over the year 2020; however, the increment of sales of the LNG-IUD/ENG-implant at private sector indicated the inequity in access of contraception.Funding Information: This study received partial financial support from the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP; award number 2015/20504‐9) and from the Brazilian National Research Council (CNPq; grant number 573747/2008‐3). Moreover, CMC and AM received funding from SRH, part of the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organisation (WHO), to complete their Post-graduate studies. This article represents the views of the named authors only and does not represent the views of the mentioned organisations.Declaration of Interests: LB received honoraria as lecturer from Bayer Healthcare and MSD. The other authors declared no conflict of interest.

Contraceptive and abortion practices of young Ghanaian women aged 15\u201324: evidence from a nationally representative survey

BackgroundYoung Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women’s contraceptive and abortion practices and needs.MethodsIn 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women’s preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends’ and partners’ influence. We also examined youth’s self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion.ResultsAmong Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive discontinuation. Relative to older women, young women’s social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment.ConclusionsYoung people’s intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet.