High Rates Of Unintended Pregnancy Research Articles

Development and two-phased pilot RCT of a foster/kinship caregiver intervention to improve sexual health communication with youth

PurposeFoster youth have high rates of unintended teen pregnancies and other negative sexual health outcomes. Foster and kinship caregivers (FKC) are an untapped resource to reduce risks. We conducted a two-phase pilot study to evaluate feasibility, acceptability and assess preliminary efficacy of a training designed to improve caregiver communication, monitoring and conflict behaviors and improve sexual health outcomes for youth in foster care. Our study included a Randomized Controlled Trial (RCT) component. MethodPhase 1: We recruited 49 FKC and assessed feasibility quantitatively, and acceptability both qualitatively and quantitatively of our intervention (Heart to Heart). Phase 2: We conducted an RCT with 71 participants and evaluated caregiver communication, monitoring, and conflict behaviors as well as the psychological determinants thereof in intervention and control groups at 1, 3, and 6 months. ResultsPhase 1: Facilitators delivered all intervention content; >90% participants received the entire training. The intervention was highly acceptable (mean score 4.9/5 on two questions). Phase 2: 71 participants were eligible and completed baseline (68 completed at least one follow up survey). We found significant improvements in the intervention group in knowledge, communication expectations, and caregiver-youth conflict behaviors in one or more waves; the control group demonstrated no significant improvements. When groups were compared, we found significant differences in knowledge, communication frequency, and conflict behaviors at 6 months. ConclusionsHeart to Heart is feasible, acceptable, and preliminary outcomes data is promising. More research is needed to better establish evidence of efficacy for long-term behavior change in caregivers and youth.

Understanding Contraceptive Needs of Women Who Inject Drugs in Orange County: A Qualitative Study.

Women with opioid use disorder experience higher rates of unintended pregnancy compared with the general US population. Our aim was to examine the factors that may affect access to desired contraception for women who use injection drugs. Using purposive sampling, we conducted semi-structured interviews pertaining to contraceptive use with 14 women ages 18 to 44 who were current users of injection drugs living in Orange County, CA between March and December 2019. Interviews were transcribed, coded, and analyzed using grounded theory. Participants discussed logistical barriers, including homelessness and lack of transportation, as well as perceived barriers, such as a belief in the inability to become pregnant while using drugs, that affect access to contraceptive care. Women also discussed the factors that motivate them to use contraception despite these barriers, including the desire for sobriety before becoming pregnant and fear of harming a fetus while using substances. Some participants expressed feeling uncomfortable disclosing substance use to their healthcare providers out of concern for stigmatization. Several points of access for contraceptive care were elucidated, including visits for primary and postpartum care, as well as in carceral spaces. Finally, participants expressed a desire to obtain contraceptive services at a local syringe exchange program due to trusting relationships with providers and increased ease of access. Our findings highlight several causative factors for the unmet contraceptive need among women who use injection drugs, and suggest that syringe exchange programs represent a unique access point for the provision of contraceptive care for this population.

Surrogate post-coital testing for contraceptive efficacy against human sperm activity in the ovine vaginal model†.

High unintended pregnancy rates are partially due to lack of effective nonhormonal contraceptives; development of safe, effective topical vaginal methods will address this need. Preclinical product safety and efficacy assessment requires in vivo testing in appropriate models. The sheep is a good model for the evaluation of vaginally delivered products due to its close similarities to humans. The study objective was to develop an ovine model for efficacy testing of female nonhormonal contraceptives that target human sperm. Fresh human semen was pooled from male volunteers. Nonpregnant female Merino sheep were treated with control or vaginal contraceptive product (IgG antibody with action against sperm or nonoxynol-9 [N9]). Pooled semen was added to the sheep vagina and mixed with product and vaginal secretions. Microscopic assessment of samples was performed immediately and progressive motility (PM) of sperm was compared between treatments. Cytokines CXCL8 and IL1B were assessed in vaginal fluid after instillation of human semen. No adverse reactions or elevations in proinflammatory cytokines occurred in response to human semen. N9 produced signs of acute cellular toxicity while there were no cellular changes after IgG treatment. N9 and IgG had dose-related effects with the highest dose achieving complete sperm immobilization (no sperm with PM). Surrogate post-coital testing of vaginally administered contraceptives that target human semen was developed in an ovine model established for vaginal product preclinical testing. This expanded model can aid the development of much needed nonhormonal topical vaginal contraceptives, providing opportunities for rapid iterative drug development prior to costly, time-intensive human testing.

Provision of immediate postpartum contraception to women living with HIV in the Eastern Cape, South Africa; a cross-sectional analysis

BackgroundUniversal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa.MethodsIn this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort.ResultsParticipants were predominantly single (69.1%), unemployed (75.1%), had a grade 7–12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10–3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children.ConclusionsWe found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region.Plain English SummaryEnsuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.

Material Hardship and Contraceptive Use During the Transition to Adulthood.

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

Nursing personality and features in children with autism spectrum disorder aged 0–2: an exploratory case-control study

ABSTRACT Aim Although studies have investigated relationships between autism spectrum disorder (ASD) and breastfeeding duration, information concerning these children’s nursing styles is limited. This study investigated nursing personality and features and ASD. Method One hundred forty-one children aged 24–72 months diagnosed with ASD and 128 healthy children were included. Information concerning the family’s sociodemographic characteristics and the child’s developmental stages was obtained through forms prepared by the authors and from hospital records. The Childhood Autism Rating Scale (CARS) was used to determine symptom severity in ASD. Development levels of children with ASD were determined using the Denver Developmental Screening Test 2nd Edition (DDST II). Results Mothers of children with ASD reported higher rates of unintended pregnancies (p = 0.029) [2.380*(1.093–5.182)]. Children with ASD exhibited less nursing strike (NS) behavior (p = 0.042) [0.388(0.156–0.967)] and less eye contact during breastfeeding (ECDB) (p = 0.009) [2.300(1.236–4.282)]. NS reduced the risk of ASD 2.6-fold, while absence of ECDB increased the risk 2.3-fold, and unintended pregnancy increased the risk 2.4-fold. Higher CARS scores were determined in children with ASD with vaginal delivery histories (p = 0.041) and histories of incubation (p = 0.025). Lack of ECDB was associated with decreased social and gross motor scores at DDST-II (p = 0.005). Conclusion Babies with ASD began breastfeeding at least as early as typically developing peers and for similar lengths of time. However, babies with ASD exhibited less NS behavior and less eye contact during breastfeeding. Babies with ASD perceive no emotional cues even in the first months, and may therefore not exhibit NS behavior.

The prevalence of pregnancy among adolescent girls and young women across the Southern African development community economic hub: A systematic review and meta-analysis.

Background: Despite the high rate of HIV infections, there is still high rate of early unprotected sex, unintended pregnancy, and unsafe abortions especially among unmarried adolescent girls and young women (AGYW) 10-24 years of age in sub Saharan Africa. AGYW face challenges in accessing health care, contraception needs, and power to negotiate safer sex. This study aimed to estimate the rate of pregnancy among AGYW aged 10-24, 10-19 and 15-19 years in the Southern African Development Community (SADC) economic region. Methods: A systematic review and meta-analysis was used to describe the prevalence of pregnancy among AGYW in 15 SADC member countries between January 2007 and December2017. The articles were extracted from PubMed/MEDLINE, African Index Medicus, and other reports. They were screened and reviewed according to PRISMA methodology to fulfil study eligibility criteria. Results: The overall regional weighted pregnancy prevalence among AGYW 10-24 years of age was 25% (95% CI: 21% to 29%). Furthermore, sub-population 10-19 years was 22% (95% CI:19% to 26%) while 15-19 years was 24% (18% to 30%). There was a significant heterogeneity detected between the studies (I=99.78%, P < 0.001), even within individual countries. Conclusion: The findings revealed a high pregnancy rate among AGYW in the SADC region. This prompts the need to explore innovative research and programs expanding and improving sexual and reproductive health communication to reduce risk and exposure of adolescents to early planned, unplanned and unwanted pregnancies, SRHR challenges, access to care, HIV/STIs, as well as other risk strategies.

Desire for and barriers to obtaining effective contraception\xa0among women experiencing homelessness

BackgroundHomelessness is a significant and growing problem in the United States. Women experiencing homelessness face unique challenges as they have high rates of unintended pregnancy. They often face significant barriers to obtaining effective contraception. This study aimed to explore the contraceptive preferences, desire for, and barriers to obtaining effective contraception among women experiencing homelessness.Study designIn this cross-sectional study, 54 women experiencing homelessness in Chicago who were at risk for unintended pregnancy were surveyed.ResultsWhile 94% of the women experiencing homelessness surveyed desired avoiding pregnancy, most were using the least effective contraceptive methods. Among participants, 80% had health insurance, 75% had a high school diploma, and 90% knew where to obtain birth control. Despite these factors, participants faced barriers to obtaining contraception. One significant barrier was lack of comprehensive contraceptive counseling as 62% report a physician had never counseled them on LARC methods. Approximately half of participants desired or would consider using a LARC in the future.ConclusionsWomen experiencing homelessness in our study demonstrate significant unmet needs for effective contraception. Women experiencing homelessness would benefit from comprehensive contraceptive counseling and improved access to effective forms of contraception.

Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study

BackgroundAdolescent girls and young women (AGYW) in low- and middle- income countries (LMICs) have high rates of unintended pregnancies and are at higher risk for HIV infection compared to older women of reproductive age. Using a socio-ecological model approach, this research investigated perceptions of contraception services among AGYW who had been recipients of a combination HIV-prevention intervention, to better understand factors affecting their access to and use of contraception services.MethodQualitative methods used in this study included focus group discussions (FGDs) and in-depth interviews (IDIs) with 185 AGYW aged 15–24 years living in five of the ten intervention districts. All interviews and FGDs were audio-recorded and data were analyzed thematically using Nvivo 12 software with manual identification of themes and labelling of raw data.ResultsThe findings reveal that many AGYW, especially those in the younger age group 15–19 years, experience difficulties in accessing contraception services, mainly at the interpersonal and health service levels. Lack of support for the use of contraceptives from parents/caregivers as well as from sexual partners were key barriers at the interpersonal level; while providers’ negative attitude was the main barrier at the health service level. The majority of school-going AGYW felt that bringing contraception services and other sexual and reproductive health (SRH) services on to the school premises would legitimize their use in the eyes of parents and help to overcome barriers related to parental support and acceptance, as well as overcome some of the health service and structural level barriers. However, views among school-going AGYW about school-based provision of contraception services were mixed, clouded with concerns relating to confidentiality.ConclusionInterventions to improve parental/caregiver and sexual partner support for the use of contraception services by AGYW, as well as efforts to expand the provision of contraception services on the school premises are urgently needed. Future interventions should incorporate multi-level approaches to address structural and contextual barriers to access and use of contraception services to gain maximum effect.

Maternal Characteristics Associated With Preconception Marijuana Use

Given the increase of marijuana use among U.S. women, higher rates of unintended pregnancies among women who use marijuana, and potential consequences of maternal use, there is a need to identify factors associated with marijuana use in the period leading up to pregnancy. This study aims to provide estimates of preconception marijuana use and describe associations between preconception marijuana use and maternal characteristics among a population-based sample of recently delivered women in the U.S. This was an analysis of 2016 Pregnancy Risk Assessment Monitoring System data from 6 states (Louisiana, Maine, New Mexico, Vermont, Wisconsin, and Wyoming). Characteristics were compared between respondents who did and did not report marijuana use using chi-square tests and logistic regression models. Statistical analysis was performed in 2019 and 2020. Approximately 8% of respondents reported that they had used marijuana in the month before pregnancy. After controlling for a number of factors, marital status, education level, parity, and living in a state with medical or recreational marijuana legalization or decriminalization remained independently associated with marijuana use. Those who reported marijuana use were 3-5 times more likely to also report symptoms of depression and tobacco and alcohol use before or during pregnancy than respondents who did not report marijuana use. Reproductive-aged women who are intending pregnancy or likely to experience an unintended pregnancy should be asked about and encouraged to refrain from marijuana use, especially given the strong association with depressive symptomology and concurrent use of other substances, including tobacco.

Pregnancy and Parenting Among Youth Transitioning from Foster Care: A Mixed Methods Study

BackgroundOver 400,000 children and youth are in foster care at any given time in the United States, with nearly one-third exiting care between ages 13 and 20. Pregnancy among women in this population is nearly double national averages, with one-third becoming pregnant by age 17 and nearly half of those experiencing repeat pregnancies by age 19. Research is needed about the sources of formal and informal information and support foster care youth receive about pregnancy and parenting, their access to and use of contraception, and the involvement of fathers/non-custodial parents in raising children.ObjectiveThe purpose of the current study was to better understand the experiences of foster care youth to inform policy and practice recommendations that address the high rate of unintended pregnancies and early parenting among youth transitioning from foster care.MethodsThis is a secondary analysis of data from a mixed-method study with a concurrent explanatory design including survey and focus group data. Complete survey responses included 81 participants (female n = 61; male n = 20) between the ages of 18–25, and 9 females took part in two focus groups.ResultsSexual experiences were common for foster care youth and they reported few educational opportunities and supportive relationships. Themes that emerged from the focus group discussions centered on socialization about reproduction, social support, and parenting.ConclusionsAccess to educational opportunities and supportive personal relationships were lower than what would be expected from national estimates of non-foster care youth. Findings from both the survey and focus group data suggest enhancing programs for foster care youth with a specific focus on education and support for reproductive health, pregnancy, and parenting.

Contraceptive use among sexually active women living with HIV in western Ethiopia.

Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM). A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia. Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09-1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50-0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20-1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28-1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility. Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.

Knowledge and misconceptions surrounding family planning among Young Maasai women in Kenya

ABSTRACT Adolescent fertility rates are high in Kenya and increase the likelihood of maternal and infant morbidity and mortality. Our objective was to explore the knowledge, perceptions, and barriers surrounding the use of family planning services among young Maasai women in Laikipia County, Central Kenya. Individual interviews with 50 participants were conducted in Laikipia County, Kenya during June and July of 2019. Qualitative data was visualised using JMP software and coded using the framework method for content analysis. Several overarching themes were identified. First, we identified a high rate of unintended pregnancy and a low rate of family planning use. Second, we found that many young Maasai women believe that only women that are married and have finished childbearing should utilise family planning services. Finally, we document highly prevalent myths among young women in the Maasai community that the use of family planning will lead to negative health consequences, such as infertility and cancer. We conclude that the Maasai community of Laikipia County, Kenya needs comprehensive family planning education that will improve knowledge and dispel myths in order to empower young Maasai women to make informed decisions surrounding family planning.

Contraceptive use among women with no fertility intention in Ethiopia.

IntroductionEthiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children.MethodsWe used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance.ResultsContraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0–55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use.ConclusionContraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.

A Mobile Phone-Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study.

BackgroundFemale sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.ObjectiveThis paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability.MethodsThe research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach.ResultsThe intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information.ConclusionsOur results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.

Postpartum Contraception by Pregnancy Intent in a Cohort of Women at an Urban Academic Health Center [22J

INTRODUCTION: Nearly half of all pregnancies are unintended. We aim to understand postpartum contraceptive preferences in the context of pregnancy intention (PI). METHODS: Prospective cohort study analyzing postpartum contraceptive behaviors in 431 postpartum women who delivered at the University of Cincinnati Medical Center. Postpartum contraceptive choice (PCC) was compared between women with intended and mistimed/unintended pregnancies, classified using an adapted National Survey of Family Growth construct. Regression analysis estimated the influence of PI on PCC. RESULTS: 71.9% of all pregnancies were unintended. They are more likely in women who are non-Hispanic black (62.3%), unmarried (86.3%), between 18 and 24 years old (51.3%), and use Medicaid (80.1%), compared to intended pregnancies, p-value&lt;0.001. The most popular choices of postpartum contraception overall were IUDs (21.4%), BTL (20.7%), and Depo-Provera (20.2%). Women with unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, RR 1.83 (95% CI 1.36, 2.47), and especially more likely to desire sterilization BTL, RR 2.7 (95% CI 1.58, 4.59). Among women sure of their PCC, those with unintended pregnancy were still &gt;50% more likely to use highly effective, user-independent methods compared to user-dependent methods, RR 1.56 (95% CI 1.18, 2.06). CONCLUSION: Women with unintended pregnancy are significantly more likely to choose highly effective postpartum contraception but are also more likely to be medically underserved. Public health initiatives to improve access to family planning services and PPC are important areas of focus to address the high rate of unintended pregnancy.

Anti-fertility properties of Cissus rotundifolia (Forssk.) Vahl. Extract using female Wistar rats

A third of the worldwide disease burden among women in their reproductive age ( 15-45 years) is associated with sexual and reproductive complications. The developing world experiences an unmet contraceptive demand that affects nearly 200 million women. The high rates of unintended pregnancies in sub-Saharan Africa increase the prevalence of unsafe abortions in nations. The use of conventional steroids and non-steroid based contraceptives though effective is also linked to increasing side effects. The roots decoction of Cissus rotundifolia is used by women in Tana River County, Kenya as a fertility regulator. The study evaluated the phytochemical compounds present in the Cissus rotundifolia aqueous extract. It also evaluated the effect of the plant extract on oestrus cycle and other selected female reproductive parameters; mating success, fertility index, gestation length, and litter size using female Wistar rats. The phytochemical screening established the presence of alkaloids, tannins, saponins, phenols, and glycosides in the root aqueous extract of Cissus rotundifolia. The plant extract caused a dose-dependent significance increase in proestrus and metestrus phases and a significant reduction in estrus and diestrus phases (P&lt;0.05). There was no significant difference in mating success. It caused a dose-dependent reduction in fertility index compared to the control. Gestation length was significantly increased and litter size significantly reduced (P&lt;0.05).This probably is the reason for the traditional use of the plant as a fertility regulator. However, further work on reversibility, reproductive hormonal profile and ovarian histomorphology should be undertaken to improve the novel contraceptive pool.Â

Does Education Promote Acceptance?: Perceptions of Emergency Contraception on the U.S.-Mexico Border [13I

INTRODUCTION: Given the high unintended pregnancy rate and infrequent use of emergency contraception (EC) in the U.S., it is imperative that providers investigate patients’ beliefs regarding EC. This study’s aim was to assess the impact of EC patient education on knowledge of and willingness to use EC. METHODS: 75 women ages 18-50 years were recruited from university clinics in El Paso, a multicultural city on the U.S.-Mexico border. IRB approval was obtained and participants underwent informed consent. Knowledge of EC was measured before and after subjects watched an educational video. Adjusted odds ratios for patients’ knowledge post-intervention were calculated from logistic regression models using Firth’s bias-reducing penalized likelihood. RESULTS: The average participant’s age was 28.4 years and 82.7% self-identified as Hispanic. Before watching the video, 30.7% of participants answered that EC would only work before implantation, and this proportion increased to 37.0% after the video. Women with moderate religious beliefs were less likely than women without very strong religious beliefs or with none at all to correctly identify that EC works before implantation occurs (OR 0.21, P=.03). 21.3% of subjects initially stated that they considered an abortion to be interrupting pregnancy after implantation occurs, whereas 37.8% conveyed the same opinion after the video. Prior to the educational intervention, 17.6% of patients reported they would never use EC, and after the video, this figure was 16.2% (P=.71). CONCLUSION: Women with moderately strong religious beliefs were less likely to correctly identify EC’s mechanism of action. The educational intervention did not significantly affect participants’ willingness to use EC.

Perspectives on prescribing hormonal contraception among rural New Mexican pharmacists

ObjectivesNew Mexico is a large rural state with high rates of unintended pregnancy and limited access to contraception. In 2017, the New Mexico Pharmacist Prescriptive Authority Act was amended to allow pharmacists to prescribe hormonal contraception. We explored pharmacist perspectives on prescribing hormonal contraceptives, including perceived barriers and facilitators to implementation in rural New Mexico and opinions on over-the-counter (OTC) access, and prescribing and inserting subdermal contraceptive implants. MethodsThis qualitative study recruited rural pharmacists using contact information from the New Mexico Board of Pharmacy and at a state-level pharmacist conference. We conducted semistructured telephone interviews with pharmacists focusing on benefits and concerns about prescribing hormonal contraception, resources required, perspectives on OTC access, and interest in prescribing and placing contraceptive implants. Deidentified transcribed interviews were analyzed by 2 independent coders for emerging themes. ResultsFrom November 2017 to January 2018, we recruited 25 rural pharmacists and conducted 21 interviews. The majority of participants were male (71%), aged over 60 years (43%), and in practice for over 20 years (52%). Interviewees were mostly positive about prescribing hormonal contraception citing community benefits. The top 3 perceived barriers were training needs, reimbursement, and liability. The top 3 facilitators were the availability of private areas within pharmacies, pharmacists’ role as knowledgeable health care team members, and pharmacist accessibility without appointments. Most pharmacists did not support OTC access to hormonal contraception, and over half were interested in certification to prescribe and place subdermal contraceptive implants. ConclusionNew Mexico pharmacists identified community benefits of pharmacy access to hormonal contraception and were interested in training. Several barriers must be addressed to realize the potential of this practice expansion.

Barriers and facilitators to contraceptive use among Somali immigrant women in Oslo: A qualitative study

The European Action Plan for Sexual and Reproductive Health emphasizes the importance of improving access to contraceptive services for disadvantaged groups. However, a prior study showed that the prevalence of abortion is two times higher among refugees compared to non-immigrants in Norway. Similarly, a recent study reported that 50% of Somali women in Oslo had unintended childbirth on one occasion or more. These findings are supported by several studies in Europe that showed immigrant and refugee women have higher rates of unintended pregnancy and abortion than Non-immigrant women, and more than half of immigrants, who seek abortion are not using any form of contraception, raising concerns about their access to utilization of modern contraception. However, none of these studies have explored reasons underlying immigrant women's underutilization of modern contraception. The present study aimed to explore the barriers and facilitators to contraceptive usage among Somali immigrant women in Oslo area. A qualitative study using unstructured in-depth interviews with twenty one Somali women of reproductive age, >18 years, was conducted in Oslo from May-August 2018. The participants were recruited using purposive sampling method. Interviews began with a general question and were followed with some probing questions, and were continued until data saturation was reached. Data were analyzed using thematic analysis. Although the majority of the participants were educated, aware of the importance of contraceptive methods and interested in child spacing, systemic and socio-cultural barriers were found to be hindering their access to contraception. Several barriers were identified, including: language problems, lack of adequate information, religious beliefs, gender roles and social pressure. Eliminating the barriers which prevent women from receiving their desired form of contraception will have important public health implications, including lengthening inter-pregnancy intervals, and fewer unplanned pregnancies and abortions. These findings can support policy makers, civil society organizations and health providers to develop cultural sensitive programmes and educational interventions, which help Somali immigrant women overcome the identified barriers to contraception.