High Rates Of Unmet Need Research Articles

Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial

IntroductionIn South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of...

Challenges and opportunities for improving access to adolescent and youth sexual and reproductive health services and information in the coastal counties of Kenya: a qualitative study

BackgroundGlobally, adolescents and youth experience high unmet need for sexual and reproductive health (SRH) information and services. In Kenya, evidence shows that more than half of teenage pregnancies are unintended and that half of all new HIV infections occur in people ages 15-24-year-olds, with the majority of those being female. The coastal counties in Kenya record a relatively high adolescent pregnancy rate and higher rates of unmet need for contraception for all women of reproductive age compared to the national average. This study focused on gaining a deeper understanding of the existing challenges to and opportunities for accessing SRH information and services among adolescents and youth (AY) at the Kenyan coast.MethodsUsing qualitative methods, this study conducted thirty-six focus group discussions with adolescents, youth, and community health volunteers across all the six coastal counties in Kenya. The sample included adolescents aged 10–14 years in school (male and female), adolescents aged 15–19 years not in education (male and female), youths aged 20–24 years (mix of both male and female), and community health volunteers who were conveniently sampled. Thematic analysis was used to examine the data and report the study results.ResultsThe barriers to accessing AYSRH identified in the study are individual factors (feelings of shame, lack of information, and fear of being judged) parental factors, healthcare worker and health institution factors, teacher/educators factors, and broader contextual factors such as culture, religion, poverty, and illiteracy. Factors that facilitate access to AYSRH information and services included, supportive parenting and culture, AYSRH sessions in schools, peer support, supportive health institutions, gender inclusivity, and digital technology.ConclusionsAYSRH information and services at the Kenyan coast is strongly influenced by a range of individual, social, cultural, and economic factors. Improving access to AYSHR necessitates meaningful AY engagement, provision of youth-friendly services, use of digital technology as alternative pathways for sharing SRH information, strengthening parent-AY relationships, embracing peer-to-peer support, and the adoption of gender-inclusive approaches in AYSRH programming.

Unintended Pregnancy and Associated Factors among Pregnant Women Attending Antenatal Care Unit in Public Health Facilities of Dire Dawa City, Eastern Ethiopia, 2021.

Unintended pregnancy refers to a pregnancy that is either mistimed or unwanted. Unintended pregnancy has been a troubling public health and reproductive health issue, which imposes appreciable adverse consequences on the mother, child, and the public in general. Globally 121 million unplanned pregnancies occurred from 2015 to 2019. A significant proportion (61%) of these pregnancies ended in abortions each year. In Ethiopia, the challenges of unintended pregnancy and its related complications still exist because of the high rate of unmet need for contraceptives. In addition, no research has been conducted on unintended pregnancy among pregnant women in Dire Dawa city administration. To determine the prevalence of unintended pregnancy and associated factors among pregnant women attending antenatal care public health facilities in Dire Dawa in 2021. A facility-based cross-sectional study was conducted. After being chosen randomly, 382 pregnant women were interviewed at 9 urban public health facilities. A pretested questionnaire was used to collect data, entered into Epi Info 7, and exported into SPSS version 25 for analysis. The variables, which were significant at P ≤ 0.25 in bivariate analysis, were included in multivariable analysis. Statistical significance was declared at a P value <0.05 and a 95% CI. In this study, the prevalence of unintended pregnancy was 23.8% at 95% CI (19.8-28.3). The following factors were associated with unintended pregnancy: single women (AOR = 10.93, 95% CI 3.65-32.74), low family income (2000 ETB) (AOR = 4.01, 95% CI 1.73-9.28), parity 3 (AOR = 10.3, 95% CI 4.07-25.84), no history of family planning use (AOR = 5.91, 95% CI 2.46-14.21), and husband decision-making role on reproductive health (AOR = 2.956, 95% CI 1.048-8.340). Conclusion and Recommendations. The prevalence of unintended pregnancy was relatively high in this study. Efforts should be made to scale up women's decision-making power on family planning services and give support to empower women economically. There is the need to promote family planning services to minimize unintended pregnancy and to decrease parity and family size.

Needs Assessment of Clients Accessing a Community Mental Health Crisis Stabilization Unit.

This study aimed to examine the needs of clients accessing a community mental health crisis stabilization unit (CSU) in Winnipeg, Canada.Sociodemographics, service connections, and need were assessed among CSU clients. The Camberwell Assessment of Need Short Appraisal Schedule - Patient (CANSAS-P) was administered to differentiate need domains that were met and unmet. An ordinal regression examined sociodemographics and level of total unmet need; client characteristics were correlated with unmet need.In total,271 questionnaires were analyzed. On average, respondents had 6.2 areas of unmet need, with "psychosocial distress" (n = 186, 68.6%), "safety to self" (n = 140, 51.7%), "company" (n = 139, 51.3%), and "physical health" (n = 124, 45.8%) being reported most often. Higher level of unmet need was predicted by disability income and absence of income.Overall,CSU clients had high rates of unmet need reflecting important determinants of health. This information can inform community mental health crisis service delivery to positively impact mental health recovery.

Exploring the unmet needs facing individuals with Alzheimer’s disease and related dementias during the COVID‐19 pandemic

BackgroundMany adults with ADRD rely on support from friends, family members, social service agencies, and their communities to meet their basic needs. It is unclear if COVID‐19 mitigation policies have made it more difficult for individuals with ADRD to receive this support. The objective of this study was to explore the types of unmet needs experienced by adults with ADRD in the United States during the COVID‐19 pandemic as well as the characteristics of adults with ADRD that are experiencing unmet needs.MethodWe performed a cross‐sectional analysis of the Medicare Current Beneficiary Survey (MCBS) summer and fall 2020 COVID‐19 supplemental surveys. The MCBS uses complex survey design to provide a nationally representative sample of Medicare beneficiaries. There were 20,800 survey participants in total and 4.07% have received a diagnosis with ADRD. Logistic regression was used to examine the characteristics of those reporting one or more unmet need.Result16.61% Medicare beneficiaries with ADRD reported having one or more unmet needs during the COVID‐19 pandemic (vs. 16.52% Medicare beneficiaries without ADRD, p=0.956). While beneficiaries with and without ADRD had no difference in unmet needs surrounding rent/mortgage, food, supplies, and medications, adults with ADRD had higher rates of unmet need for healthcare services (8.86% vs. 5.77%, p=0.008). Adults with ADRD were more likely to report having an unmet need between March‐June than between July‐November (18.10% vs. 7.84%, p<0.001). Among those with ADRD, individuals with depression (AOR=2.25, p=0.001) and multimorbidity (AOR=1.79, p=0.030) reported significantly higher unmet need, after controlling for age, sex, race/ethnicity, insurance, and geographic location. As compared with individuals without ADRD, individuals with co‐existing ADRD and depression (p<0.001) or co‐existing ADRD and multimorbidity (p<0.001) reported higher likelihood of having unmet needs.ConclusionMany adults with ADRD experienced unmet need during the first 4 months of the COVID‐19 pandemic. We also found that the ADRD patients with depression and complex health needs who require greatest number of healthcare services were more likely to voice unmet needs. The residual impact of unmet needs during the early pandemic months and on‐high risk subpopulations is currently unknown.

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation.

Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

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.

Does family planning counseling reduce unmet need for modern contraception among postpartum women: Evidence from a stepped-wedge cluster randomized trial in Nepal.

BackgroundPostpartum women have high rates of unmet need for modern contraception in the two years following birth in Nepal. We assessed whether providing contraceptive counseling during pregnancy and/or prior to discharge from the hospital for birth or after discharge from the hospital for birth was associated with reduced postpartum unmet need in Nepal.MethodsWe used data from a larger a stepped-wedge, cluster randomized trial, including contraceptive counselling in six tertiary hospitals. Group 1 hospitals (three hospitals) initiated the intervention after three months of baseline data collection, while Group 2 hospitals (three hospitals) initiated the same intervention after nine months. We have enrolled 21,280 women in the baseline interviews and conducted two follow-up interviews with them, one and two years after they had delivered in one of our study hospitals. We estimated the effect of counseling and its timing (pre-discharge, post- discharge, both, or neither) on unmet need for modern contraception in the postpartum period, using random-effects logistic regressions.ResultsUnmet need for modern contraception was high (54% at one year and 50% at two years). Women counseled in either the pre-discharge period (Odds ratio [OR] 0·86; 95% CI: 0·80, 0·93) or in the post-discharge period (OR 0·86; 95% CI: 0·79, 0·93) were less likely to have an unmet need in the postpartum period compared to women with no counseling. However, women who received counseling in both the pre- and post-discharge period were 27% less likely than women who had not received counseling to have unmet need (OR 0.73; 95% CI: 0·67, 0·80).ConclusionsCounseling women either before or after discharge reduces unmet need for postpartum contraception but counseling in both periods is most effective.

P18 High satisfaction scores but high rates of unmet need- what is missing in breast cancer survivorship care?

Background and purpose Breast cancer survivorship care will become increasingly important as advances in treatment continue to increase survival. This study was a benchmarking project for a large metropolitan breast cancer service. Methods Participants consisted of 130 women who were >1 year since diagnosis of breast cancer, attending any Breast Service outpatient clinic. They were assessed for demographic and clinical characteristics and completed a series of self-report questionnaires examining service satisfaction, clinical benchmarks, prevalence of survivorship issues, ongoing service utilisation, and incorporating the externally validated Cancer Survivorship Unmet Needs (CaSUN) questionnaire. The questionnaire concluded with a ‘blue sky’ qualitative question asking for suggestions for future service improvement. Results 91.3% of participants were satisfied or highly satisfied with their overall breast cancer care. However, 67% of participants reporting at least one unmet need, with an average of 4.9 unmet survivorship needs per participant. The most prevalent unmet needs were fear of cancer recurrence, difficulty coping with stress, coordination of medical care, hospital parking, and information provision. Despite this, utilisation of available services such as cancer psychology, social work, and cancer care coordinators was low. ‘Blue sky’ suggestions for improvement largely related to practical assistance such as free parking and reduced clinic wait times. Conclusions Despite high satisfaction ratings, ongoing unmet survivorship needs and issues were common in this patient group, and usage of relevant multidisciplinary care was low. Improvements in survivorship care must focus on deliberately eliciting patient survivorship needs and connecting them with available services.

Visual impairment and spectacles ownership among upper secondary school students in northwestern China

To assess the prevalence of visual impairment and spectacles ownership among academic and vocational upper secondary school students in rural China. This cross-sectional study included 5583 students from four academic upper secondary schools (AUSSs) and two vocational upper secondary schools (VUSSs) in Mei and Qianyang counties, Baoji Prefecture, Shaanxi Province. In March and April 2016, students underwent assessment of visual acuity (VA) and completed a questionnaire regarding spectacles use and family characteristics. Students with visual impairment (presenting VA ≤6/12 in the better eye) and students needing spectacles (uncorrected VA ≤6/12 in the better eye, which could be improved to >6/12 with refraction) were identified. Among 5583 students (54% boys, mean age 16.4±1.0 years) in grades 10 and grade 11 attending AUSSs (n=4549) and VUSSs (n=1034), visual impairment was detected in 4026 students. Among the AUSS students, 3425 (75%) needed spectacles; 2551 (75%) had them. Among the VUSS students, 601 (58%) needed spectacles; this proportion was significantly smaller (P=0.004), as was the proportion who had spectacles (n=212, 35%, P<0.001), compared with the AUSS students. Multivariate analysis showed that ownership of spectacles among children who needed them was associated with worse uncorrected VA (P<0.001), male sex (P<0.001), and residence in an urban area (P<0.034). Spectacles ownership was also strongly associated with AUSS education (P<0.001). There is a high rate of unmet need in visual care among upper secondary school students. Lack of spectacles ownership among children who needed them was significantly associated with VUSS education.

Ecological risk factors for unmet needs in oral health care in Chegutu rural district in Zimbabwe a cross-sectional study

ABSTRACT An unmet need in oral health care is a need for oral health care which individuals have failed to access. About 90% of the Zimbabwean population will suffer from oral diseases in their lifetime and a substantial proportion seeks only curative dental care. This study sought to assess the unmet oral health need among the adult population in Chegutu District and its underlying determinants. We carried out a cross-sectional study at Chegutu District Hospital. Two hundred and seventy-six participants were randomly enrolled using systematic sampling. Interviewer administered questionnaires were used to collect data, and data analysis was done by computer using the EPI Info package. The prevalence of unmet need for oral health in Chegutu urban’s adult population was 89.1%. Having an unmet need in oral health care was influenced by demographic, behavioural and health service-related factors. For instance, having attended school up to primary level (POR: 2.75; 95% CI: 1.2–6.23) and high costs to oral health care (POR = 7.5; 95% CI = 3.3–17) were significantly associated with having an unmet need. The prevalence of unmet need in oral health care in Chegutu district’s urban population is high. The demographic factor that significantly contributed to the high rate of unmet need was low educational level. Behavioural factors like use of tobacco also contributed to an unmet need. High cost of service as a barrier to oral health care access had a greater likelihood of having an unmet need.

Sub-national levels and trends in contraceptive prevalence, unmet need, and demand for family planning in Nigeria with survey uncertainty

BackgroundAmbitious global goals have been established to provide universal access to affordable modern contraceptive methods. To measure progress toward such goals in populous countries like Nigeria, it’s essential to characterize the current levels and trends of family planning (FP) indicators such as unmet need and modern contraceptive prevalence rates (mCPR). Moreover, the substantial heterogeneity across Nigeria and scale of programmatic implementation requires a sub-national resolution of these FP indicators. The aim of this study is to estimate the levels and trends of FP indicators at a subnational scale in Nigeria utilizing all available data and accounting for survey design and uncertainty.MethodsWe utilized all available cross-sectional survey data from Nigeria including the Demographic and Health Surveys, Multiple Indicator Cluster Surveys, National Nutrition and Health Surveys, and Performance, Monitoring, and Accountability 2020. We developed a hierarchical Bayesian model that incorporates all of the individual level data from each survey instrument, accounts for survey uncertainty, leverages spatio-temporal smoothing, and produces probabilistic estimates with uncertainty intervals.ResultsWe estimate that overall rates and trends of mCPR and unmet need have remained low in Nigeria: the average annual rate of change for mCPR by state is 0.5% (0.4%,0.6%) from 2012-2017. Unmet need by age-parity demographic groups varied significantly across Nigeria; parous women express much higher rates of unmet need than nulliparous women.ConclusionsUnderstanding the estimates and trends of FP indicators at a subnational resolution in Nigeria is integral to inform programmatic decision-making. We identify age-parity-state subgroups with large rates of unmet need. We also find conflicting trends by survey instrument across a number of states. Our model-based estimates highlight these inconsistencies, attempt to reconcile the direct survey estimates, and provide uncertainty intervals to enable interpretation of model and survey estimates for decision-making.

Use of Mental Health Services by Children With Mental Disorders in Two Major Cities in Brazil.

The study examined lifetime use of mental health services among children diagnosed as having mental disorders in two major cities in Brazil and identified characteristics associated with unmet need. The data were collected as part of the High Risk Cohort Study, a community study conducted in Sao Paulo and Porto Alegre, Brazil. During the period from 2010 to 2011, a total of 2,511 children ages 6 to 12 were assessed, and 652 were given a diagnosis of at least one mental disorder. The current study analyzed data for a subsample of 651 children with complete information on use of mental health services. Eighty-one percent of the children with mental disorders had not received mental health treatment in the past. The majority who received treatment were treated with psychotherapy or a combination of psychotherapy and medication. Mixed-race children were significantly more likely to have unmet need for treatment, compared with white children. The high rate of unmet need among children with mental disorders should be addressed with strategies to improve access to health care.

Assessing Reproductive Decision-making Among HIV-Positive Women in Kumasi, Ghana.

Background or Objectives:HIV-positive women have higher rates of unmet need for contraception and unintended pregnancy and face unique obstacles in accessing family planning services, such as healthcare-related stigma and disclosing HIV status to partners. This study characterizes factors that influence the reproductive decision-making of women living with HIV and identifies areas for improvement in reproductive counseling in Kumasi.Methods:In this cross-sectional study, HIV-positive women, ages 18 to 45 years, presenting for care at Komfo Anokye Teaching Hospital between June and August 2017 were interviewed using structured surveys. Information gathered included demographics, method of contraceptive use, initiation of anti-retroviral therapy (ART), knowledge and use of contraception, and future reproductive plans. The primary outcome was current family planning use and future reproductive desire. Univariate analysis was used to characterize the demographics of the study group. Bivariate analysis including Chi-squared test was employed to assess the association between use of family planning between women with an HIV-positive and HIV-negative partner, with significance set at p < 0.05.Results:A total of 88 women were interviewed. The unmet need for contraception was 10%. Among all sexually active women, 26% did not use contraception. Fewer women with HIV-negative or untested partners were using contraception (65% and 67%, respectively), compared to women with HIV-positive partners (93%). Partner preference was the most common reason cited for not using a method of contraceptive (46%). Similar trends were found in future reproductive desires based on age cohorts, partner status, and use of family planning.Conclusion and Global Health Implications:Significant barriers to family planning use among HIV-positive women remain, especially those with a serodiscordant partner. Most partners were aware of their partner’s HIV status. This highlights an important opportunity to include partners in HIV and contraceptive counseling.

Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia

This paper compares income-based inequities in access to psychotherapy and other mental health services in Canada and Australia, two federal parliamentary systems with sharply contrasting responses to high rates of unmet need. Income-based inequity is measured by need-standardized concentration indices, using comparable data from the Canadian Community Health Survey 2011–2012 and the Australian National Survey of Mental Health and Well-Being 2007. The results indicate that utilization of psychologist services is more concentrated at higher income levels (i.e. pro-rich) than the other provider groups in both countries, and may be more pro-rich in Canada than in Australia. While the distribution of unmet need for psychotherapy was expected (as a negative indicator of access) to be more concentrated at lower income levels (i.e. pro-poor) under Canada’s two-tier system, unmet need was not more equitable in Australia despite expanded public insurance coverage. As psychotherapy was made universally affordable for the first time in Australia in 2006, a possible backlog effect may have driven up both service utilization and unmet need, particularly among lower-income Australians. The impact of different Medicare co-payment policies also warrants further exploration.

Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali.

Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family planning services, even in settings with low contraceptive prevalence.

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence.

Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.

Relationships between depression, pain and sleep quality with doctor visits among community-based adults in north-west China

ObjectivesPrevious studies have suggested that the high rates of unmet need for mental health services in China among depressed people are related to a cultural tendency to deny mental and emotional symptoms and instead express them somatically. Such somatization may lead a sufferer to a consultation with a healthcare professional but rarely leads to appropriate mental health treatment. This study aimed to elucidate the relationships of depression, sleep quality and perceived physical pain with doctor visits among community-based adults in China, and thus to help guide the development of clinical practices aimed at reducing unmet mental health service need. Study designCross-sectional study. MethodsIn total, 7602 north-west Chinese adults aged >40 years were included in the survey. The Center for Epidemiologic Studies Depression Scale–Chinese Edition was used to assess depressive symptoms. Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index. The Brief Pain Inventory–Chinese Version was used to measure pain severity and pain interference. ResultsIn this study, 16.2% of people reported physical pain, and 20.0% of those who reported poor sleep quality had seen a doctor in the past month. Only 14.4% of those with depression had seen a doctor. The results of the logistic regression analyses indicated that subjects with pain were significantly more likely to have seen a doctor than subjects without pain (odds ratio [OR] 1.61; 95% confidence interval [CI] 1.32–1.97). Poor sleep quality was significantly associated with doctor visits (OR 1.76, 95% CI 1.40–2.21). Depression was not associated with doctor visits after adjusting for pain, sleep quality and potentially confounding factors. ConclusionWhen attempting to screen for depression and risk of depression in middle-aged and older adults in China, mental health professionals should focus on perceived physical pain and poor sleep quality.

Knowledge, Attitude, and Practice of Contraception among Pregnant Women in Ende District, East Nusa Tenggara, Indonesia

ABSTRACT Introduction Indonesia has the fourth largest population in the world with 255.7 million people and a rate of birth of 21 per 1,000 population. There is also a high rate of unmet need and total fertility rate (TFR), which can potentially lead to unwanted pregnancies, consequently increasing the maternal mortality rate (MMR). Thus, family planning program through postpartum contraceptive use is one of the efforts to reduce the MMR and TFR. This study is conducted to assess the knowledge, attitude, and practice (KAP) of contraception among pregnant women in Ende district. Materials and methods A cross-sectional study was carried out at three primary health centers in the main district of Ende from July to August 2015. A total of 305 pregnant women who completed questionnaires assessing their KAP of contraception were enrolled in this study. The data were analyzed using Statistical Package for the Social Sciences version 23.0 for Windows with Pearson or Spearman correlation tests. Results In this study, 86.53% of pregnant women were aware of family planning methods, among which the best known was injection (63.97%). Most respondents obtained information from health professionals (63.30%). More than half of the respondents agreed that contraception was beneficial and would recommend it to their families. The most prevalent reason for not wanting to use contraception in the future was the desire to have a child (44.59%). The total knowledge score was correlated with attitude and practice scores (p &lt; 0.001). Conclusion More than half of respondents knew, agreed, and would like to recommend contraception. Primary health care providers play a major role in improving women's knowledge of family planning. To support the success of family planning, the government should emphasize on family planning education. In particular, there appears to be need for counseling about family planning for pregnant women. How to cite this article Santoso BI, Surya R. Knowledge, Attitude, and Practice of Contraception among Pregnant Women in Ende District, East Nusa Tenggara, Indonesia. J South Asian Feder Obst Gynae 2017;9(2):104-112.

LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.

Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.e., not transgender) women, cisgender lesbians, cisgender bisexual women, and transgender people. This was a cross-sectional Internet survey. We used targeted sampling to recruit 704 sexual and gender minority people and heterosexual cisgendered adult women across Ontario, Canada. To ensure adequate representation of vulnerable groups, we oversampled racialized and low socioeconomic status (SES) women. Trans participants were 2.4 times (95% confidence intervals [CI] = 1.6-3.8, p < 0.01) and bisexual people 1.8 times (95% CI = 1.1-2.9, p = 0.02) as likely to report an unmet need for mental healthcare as cisgender heterosexual women. Trans participants were also 1.6 times (95% CI = 1.0-27, p = 0.04) more likely to report untreated depression. These differences were not seen after adjustment for social context factors such as discrimination and social support. We conclude that there are higher rates of unmet need and untreated depression in trans and bisexual participants that are partly explained by differences in social factors, including experiences of discrimination, lower levels of social support, and systemic exclusion from healthcare. Our findings suggest that the mental health system in Ontario is not currently meeting the needs of many sexual and gender minority people.