High Rates Of Unplanned Pregnancy Research Articles

Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system.

High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.

Differences in reproductive health discussions in an urban Hispanic population with SLE: lessons from the field

ObjectiveManagement of reproductive health-related issues is crucial for patients with SLE, given this is a disease that primarily affects women of childbearing age. Little is known as to how the...

Sexual and reproductive health needs of young women living with perinatally acquired HIV.

Increasingly, young women living with perinatally acquired HIV (YWLPaHIV) have transitioned from paediatric to adult services. There remains a paucity of data on the sexual and reproductive health (SRH) needs of YWLPaHIV and their access to youth-friendly care. Amidst healthcare changes due to COVID-19 pandemic restrictions, we explored SRH needs of a cohort of YWLPaHIV. Evaluation of SRH needs of YWLPaHIV attending a UK NHS-youth HIV service with data collected from patient records and self-reported questionnaires amongst women attending between July and November 2020 following easing of the first lockdown and reintroduction of in-person appointments. 71 of 112 YWLPaHIV registered at the clinic completed questionnaires during the study period and were included in the analysis. Median age was 23y (IQR 21-27, range 18-36). 51/71(72%) reported coitarche, average age 17.6y (IQR 16-18, range 14-24). 24 women reported 47 pregnancies resulting in 16 (34%) HIV-negative live-births, 19 (40%) terminations, 9(19%) miscarriages, with 3 pregnancies ongoing. 31/48(65%) sexually active women reported current contraception: 10 (32%) condoms, 19 (62%) long-acting, and 3(10%) oral contraceptive pill. 18/51(35%) reported a previous sexually transmitted infection; human papillomavirus (HPV) (11), Chlamydia trachomatis (9) and herpes simplex (2). 27/71(38%) women had undergone cervical cytology including 20/28(71%) women aged ≥25y with abnormalities documented in 29%. HPV vaccination was reported in 83%, with protective hepatitis B titres in 71%. High rates of unplanned pregnancy, STIs and cervical abnormalities highlight the continuing SRH needs of YWLPaHIV and requirement for open access to integrated HIV/SRH services despite pandemic restrictions.

Reproductive Health Counseling among Youth with Sickle Cell Disease

Study ObjectiveReproductive health counseling is important for youth with sickle cell disease (SCD) given that they experience potential infertility risks from SCD and its treatments and high rates of unplanned pregnancies. Thus, the objective of this study was to describe documented occurrences of reproductive health counseling among youth with SCD and examine differences in counseling by sociodemographic and treatment characteristics. MethodsData were abstracted from 167 electronic medical records of patients (age = 14-21, 54% female) with SCD (1/01/2015-12/31/19) at 2 sites (Nationwide Children's Hospital and Hassenfeld Children's Hospital at NYU Langone). Descriptive statistics, point-biserial correlations, and χ2 tests were used to examine sample characteristics and relationships between sociodemographic factors, clinical characteristics, site, and reproductive health counseling (fertility, contraception, and genetic counseling). ResultsSeven of 167 (4%) youth had documented discussions about the potential impacts of SCD on fertility. Fertility counseling was also low among those who received a bone marrow transplant or hydroxyurea (n = 1/2, 50%; and n = 1/104, 1%, respectively). Only 57% of youth received contraception counseling, and only 55% of sexually active youth used birth control; birth control use was associated with older age (P = .028), severe clinical disease (P = .003), and documentation of contraception counseling (P = .047). Most youth received genetic counseling (80%), although more genetic counseling occurred at Nationwide Children's Hospital (P < .001). There was no association between gender and any type of counseling. ConclusionFindings suggest reproductive health counseling gaps in this population, with important implications for future infertility distress and unplanned pregnancies. Future research should examine barriers to counseling, explore fertility impacts of SCD and treatments, and inform evidence-based guidelines for reproductive health care in SCD.

Hormonal Contraceptive Use and Association with Thromboembolism in Women with Sickle Cell Disease

Introduction Women with sickle cell disease (SCD) require broad access to highly effective contraceptive methods due to high rates of unplanned pregnancy and adverse maternal and fetal outcomes. Combined (estrogen-containing) hormonal contraception carries a known risk of thromboembolism (TE) in the general population, and women with SCD have higher baseline risk of TE, thus use of these agents in women with SCD may further increase that risk. The paucity of safety data on hormonal contraceptive use in women with SCD limits the ability of providers and patients to make informed decisions. Objectives This study aims to use population-level administrative claims data of publicly insured women with SCD in the United States (US) to assess patterns of hormonal contraception use and evaluate risk of TE during the first year of use. We hypothesized that TE rates are higher in women prescribed combined hormonal contraceptives (CHC) as compared to women prescribed progestin-only contraceptives (POC). Methods We obtained data using the Centers for Medicare and Medicaid Services Analytic eXtract (CMS MAX) from 2006-2018. Study population included females of reproductive age (12-44 years) with >3 ICD-9 or ICD-10 codes consistent with SCD. Women had to have ≥12 months of continuous enrollment with at least 6 months of data as 'washout period' prior to enrollment period. A new prescription for hormonal contraception was identified using national drug codes in pharmaceutical claims or ICD-9 or 10 procedure codes. CHC included the combined oral contraceptive pill (OCP), transdermal patch, and vaginal ring. POC included the progestin-only pill, depot medroxyprogesterone acetate (DMPA) injection, intrauterine device (IUD) and subdermal implant. TE was defined as the presence of ≥2 ICD-9 or ICD-10 codes for venous TE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) or arterial TE (stroke or myocardial infarction (MI)). Arterial TE was also required to have an associated inpatient admission. Women were included in the analysis for 12 months after contraception initiation, or censored in the event of either contraceptive switch, pregnancy or abortion, or TE occurrence. Data were summarized descriptively and TE incidence rates were calculated as events per 1,000 person-years. Results We identified a total of 41,012 reproductive-aged women with SCD enrolled in CMS MAX, of whom 22.6% (n=9,261) had received ≥1 new prescription for hormonal contraception. Among women with new contraceptive use, 58.5% (n=5,420) initiated CHC and 41.5% (n=3,841) initiated POC. Median age at the start of contraception was 22.3 years (range: 12.0-43.9) and median age at the start of CHC and POC were 22.1 and 22.7 years respectively. Among CHC users, 84.6% (n=4,584) of women were prescribed the combined OCP, 7.7% (n=419) the transdermal patch, and 7.7% (n=417) the vaginal ring. For POC users, DMPA was prescribed to 72.3% (n=2,777), progestin-only pills to 21.2% (n=816), IUD to 4.2% (n=163) and subdermal implant to 2.2% (n=85) of women. A total of 141 (1.5%) new contraceptive users with SCD were identified to have a TE during the follow-up period. The median time from contraception initiation to TE diagnosis was 183 days (IQR: 82-244). The most common TE event was PE (46.1%) followed by DVT (41.8%), stroke (6.4%), and MI (2.1%); 3.5% of women had multiple TE events. TE rate was 16.4 events per 1,000 person-years in CHC users, and the TE event rate was 17.0 events per 1,000 person-years in POC users (p=0.84). Rates of TE did not differ between the two most commonly used methods in each group, the combined OCP (15.5 events per 1,000 person-years ) and DMPA (17.7 events per 1,000 person-years) (p=0.48). Conclusion Our work provides population-level data regarding contraceptive practices for women with SCD in the US. We found that CHC was more frequently prescribed than POC, and identified low rates of long-acting reversible contraception use. The most frequently prescribed agents were the combined OCP and the DMPA injection. TE rates after initiation of the combined OCP and DMPA did not differ. Although limited by the retrospective study design and use of administrative claims data, this study suggests a similar safety profile for CHC and POC in women with SCD with respect to risk of TE.

Attitude and usage of Contraceptives among Married Couples in Northern Nigeria: A Review

In Nigeria, particularly in Northern Nigeria, low contraception use is one of the most important predictors of high fertility. Traditional methods such as periodic abstinence and coitus interrupts are recommended over modern contraceptives, which include hormonal and non-hormonal options, because they are more effective and have lower failure rates. High rates of unplanned pregnancies, abortions, maternal illness, and mortality are all associated with low contraceptive use. Contrary to popular belief, modern contraception is an important part of maternal, infant, and child health care. The idea of contraception, modern and traditional methods of contraception, couples' attitudes about contraceptive usage, and variables that limit contraceptive use are all discussed in the report. The internet, academic publications, conference papers, and textbooks were used to gather secondary data. Women's attitudes regarding contraception were influenced by myths and misconceptions, opposition from their spouses, religion, traditional beliefs, and habits, according to the study.

A cross-sectional study on knowledge, attitude and practice towards contraception among medical students in a tertiary care center of coastal Karnataka, India

High rates of unplanned pregnancies are due to continued gaps in awareness and access to contraception. An exemplary health care infrastructure would play a major role in resolving this issue. To investigate knowledge, attitude and practice towards contraception among medical students in a tertiary care center of Karnataka. A cross-sectional study was conducted including 100 undergraduate medical students during September 2018 to February 2019 using predesigned questionnaire on contraception and analyzed using percentages. Nearly 93% of students chose condom as best way to prevent sexually transmitted infections and 47% chose emergency contraceptive pills as risk factor for ectopic pregnancy. Failure rates of natural methods was 20-25% according to 33% of the students. Majority of participants believed that both sexes have equal responsibility for contraception and chose intrauterine contraceptive devices as best contraception for nulliparous women. Oral contraceptive pills had least failure rates as per 70% of the subjects compared to diaphragm, condom or natural methods. Irregular bleeding was considered as most common side effect of oral contraceptives by half of participants while 91% thought condoms were best for couples who were not regularly sexually active. Around 84% of undergraduates preferred to consult a doctor for contraceptive advice and were comfortable discussing contraception with partner. Overall, students had reasonably good knowledge on contraception. Similar studies in future would pave the way for upgrading current health curriculum to strengthen knowledge base of future clinicians.

Lessons Learned from Replicating a Randomized Control Trial Evaluation of an App-Based Sexual Health Program.

This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18–20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women online across the U.S. and automatically randomized participants to either the Pulse reproductive health app or a general health control app, stratifying by age and race/Latinx ethnicity. Participants received reminder text messages to view the app as well as text messages with app-related content throughout the intervention. Linear probability models were conducted on the analytic sample of 871 participants who completed the six-week survey and 798 who completed the six-month survey and adjusted for permuted block randomization and multiple hypothesis testing. Compared to the control group, intervention group participants had higher contraceptive knowledge (p = 0.000), which replicates findings from an earlier evaluation. However, these impacts were not sustained at six-month follow-up (p = 0.162). We found no other significant program impacts. This contrasts with an earlier evaluation that found intervention participants were less likely to have had sex without a hormonal or long-acting reversible contraceptive (LARC) method and had greater self-confidence to use contraception consistently than the control group. Different demographic characteristics, lower app usage, and more negative attitudes about and usage of hormonal/LARC contraception in the current sample may help to explain fewer impacts than the earlier evaluation.

Intrauterine device use is safe among nulligravidas and adolescent girls.

The use of intrauterine devices (IUDs), including the copper-bearing device and the levonorgestrel intrauterine system (LNG-IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health-care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non-hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD-induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short-acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long-term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.

The perpetuating cycle of unplanned pregnancy: underlying causes and implications in Eswatini

Unplanned pregnancies constitute a major health problem globally carrying negative social, economic and health consequences for individuals and families. In this study, we explored the underlying causes and implications of this phenomenon in Eswatini, a country with high rates of unplanned pregnancy. Three focus group discussions were conducted in January 2018 with female health workers called mentor mothers, chosen because they offer a twofold perspective, being both Swati women and health workers in socially and economically disadvantaged settings. Using inductive thematic analysis, we identified five sub-themes and an overarching theme called ‘the perpetuating cycle of unplanned pregnancy’ in the data. A social-ecological model was used to frame the results, describing how factors at the individual, relationship, societal and community levels interact to influence unplanned pregnancy. In this setting, factors such as perceived low self-esteem as well as poor conditions in the community drove young women to engage in transactional relationships characterised by abuse, gender inequality and unprotected sex, resulting in unplanned pregnancy. These pregnancies led to neglected and abandoned children growing up to become vulnerable, young adults at risk of becoming pregnant unintendedly, thus creating an iterative cycle of unplanned childbearing.

A cohort study of the service-users of online contraception

BackgroundIn January 2017, the first free service providing oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark – ethnically and...

Short-Term Impacts of Pulse: An App-Based Teen Pregnancy Prevention Program for Black and Latinx Women.

Black and Latinx women aged 18-20years have high rates of unplanned pregnancy. Furthermore, this age group is less likely than school-aged youth to be served by pregnancy prevention programs typically administered in schools. The study's purpose was to assess the effectiveness of a new app-based teen pregnancy prevention program created for this population using an online- and texting-only recruitment and evaluation approach. The study design was a randomized controlled trial with individual-level assignment of 1,304 women aged 18-20years recruited online. Seventy-six percent of participants were black or Latinx. Women were randomized to the Pulse reproductive health app or a general health app and received regular text messages with program content and reminders to view the app. An intention-to-treat approach was used for analyses, and significance tests were adjusted to account for permuted block random assignment and multiple hypothesis testing. Linear probability models controlling for the baseline measure of each outcome, whether the participant reported ever having vaginal sex, age, and race/ethnicity, assessed program impacts for 1,124 participants 6 weeks after randomization. Participants who received the intervention were 7.6 percentage points less likely (p= .001) to report having had sex without a hormonal or long-acting contraceptive method. Intervention participants also scored 7.1 percentage points higher on contraceptive knowledge (p= .000) and were 5.7 percentage points more likely to be confident that they can use birth control during every sexual intercourse (p= .027). Impacts at 6 weeks are promising, particularly for a self-led intervention with no direct contact with study staff.

The service-users of online contraception: a cohort study

BackgroundIn January, 2017, the first free service offering 3 or 6 months’ supplies of oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark—an ethnically and socioeconomically diverse area with high rates of unplanned pregnancy. There are concerns that online services may only benefit more advantaged groups; therefore, we aimed to describe service users according to age, ethnicity, and index of multiple deprivation (IMD) quintile of area of residence, and determine whether these factors were associated with repeat use of the service. MethodsWe analysed routinely collected data from all 1186 requests for OCPs from January, 2017, to April, 2018, describing service users and their patterns of use. The primary outcome was two or more orders of OCPs from the online service during these 15 months, excluding those whose index prescription had not expired. Logistic regression analysis examined factors associated with this outcome at the bivariate and multivariable level, adjusting for age, IMD quintile, and ethnic group. Ethics approval was granted by The Proportionate Review Sub-Committee of the National Research Ethics Service (NRES) Committees – North of Scotland. FindingsThe online service was accessed by 726 individuals, 526 (72%) of whom were aged between 20 and 29 years and 427 (59%) of whom were of white ethnic group. 575 (79%) were residents of the first and second most deprived IMD quintiles. Compared with service users reported as being of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted odds ratio 0·52, 95% CI 0·31–0·89; p=0·016), as were those of Asian (0·39, 0·20–0·77; p=0·007) and mixed ethnic groups (0·37, 0·20–0·70; p=0·002). InterpretationThese are the first findings on free, online contraception and suggest that early users reflect the population of the local area in terms of ethnic diversity and socioeconomic deprivation. Black and minority ethnic groups had lower odds of repeat use than did those of the white ethnic group, reflecting broader disparities in contraceptive continuation across services. Online service development should prioritise the identification and removal of barriers that might inhibit repeat online use for black and minority ethnic groups. FundingGuy's and St Thomas’ Charity.

Expanding choice through online contraception: a theory of change to inform service development and evaluation

BackgroundThis study presents the theory of change underpinning an intervention to provide online contraceptive care in an inner London area with high rates of unplanned pregnancy. It aims to suggest...

Understanding Contraceptive Behaviour to Prevent Unintended Alcohol-Exposed Pregnancies

 &#x0D; Materials and Methods&#x0D; Participants were recruited through the university research participation website where a link to an online survey was made available to first year undergraduate psychology students. The online questionnaire included questions on contraceptive and alcohol consumption behaviours in the past month, and questions that assessed participants’ knowledge and attitudes. A total of 106 participants were included in the current study.&#x0D;  &#x0D; Results&#x0D; The majority of participants reported using contraception when having sex in the past month. The most common form of contraceptive used was male condoms (~60%), followed by the oral contraceptive pill (~46%). There was a significant difference in one of the knowledge scales between the two contraceptive groups: participants who reported Never/Sometimes using contraception had higher knowledge of reproduction compared to those who reported using contraception more often. The proportion of participants who used contraception more frequently reported having more positive attitudes towards contraception compared to those who reported Never or Sometimes using contraception.&#x0D;  &#x0D; Conclusion&#x0D; Given the lifelong impacts that can be experienced for individuals with Fetal Alcohol Spectrum Disorder (FASD), prevention of unintended alcohol-exposed pregnancies is an area that requires serious attention. If the high prevalence rates of FASD are to be reduced, prevention needs to take place for people of reproductive age, particularly in Australia where we have high rates of unplanned pregnancies and a binge drinking culture.

Fertility Counseling for Adolescents.

Fertility awareness, or general knowledge about one's fertility, is low in adolescents and in adult women as well. Misconceptions about reproduction contribute to high rates of unplanned pregnancy in the United States, as well as delayed childbearing and infertility. Alhough primary care providers caring for adolescents have historically focused on contraception and reduction of sexually transmitted infections during their sexual and reproductive health conversations with adolescents and young adult women, fertility awareness counseling would help these women optimize their future fertility and make informed reproductive choices throughout their life. This is particularly true for adolescents with chronic medical conditions, certain gynecologic conditions, or a history of therapies that could potentially affect fertility, for whom preemptive conversations about fertility are needed, but often overlooked. [Pediatr Ann. 2019;48(2):e86-e91.].

Miranda Waggoner, The Zero Trimester: pre-pregnancy care and the politics of reproductive risk

Tapping into the flourishing fields of the history and sociology of American pregnancy, Miranda Waggoner enters the fray with her engaging study of the emergence of pre-pregnancy care in the early twenty-first century. Waggoner seeks to determine why pre-pregnancy care emerged when it did and what its development can tell us about contemporary meanings of motherhood, women’s health and medicine. Utilising a wide range of interviews, medical publications and popular media stories and articles, Waggoner claims that this in-depth analysis of pre-pregnancy care exposes the continuing tensions between women’s health and reproductive health, as well as the continued distance between maternal health rhetoric and reproductive realities. Over the past 15 years, the CDC and many other health advocates have constructed a new framework for pregnancy, one that stresses the importance of the health and lifestyle of women who are not pregnant (regardless of whether they intend to get pregnant in the near future or not). Waggoner analyses the work and rhetoric of these groups and finds that while they often describe pre-pregnancy care as a new attempt to increase positive outcomes and combat the continual high rates of unplanned pregnancies in the face of modern acknowledgements of the limits of traditional prenatal care, the public campaigns, clinical encounters and medical publications coming out of this field reiterate old tropes of the centrality of maternity in American femininity and the differential racial understandings of reproduction and motherhood.

Low Level of Knowledge of Contraceptive Methods among Pregnant Teens in Brazil.

To describe knowledge and use of contraceptive methods among pregnant teens in Brazil. A cross-sectional survey. A tertiary care center in Bahia, Brazil. Pregnant teens 10-19years old. Participants were asked about contraceptive knowledge and previous contraceptive use. Contraceptive knowledge, previous contraceptive use, and contraceptive intentions for after pregnancy. Other survey topics included demographic characteristics, school attendance, and sexual history. A total of 90 participants wereincluded in the study, with an average age of 15.4 ± 1.7 years, and a mean age at first sexual intercourse of 13.8 ± 1.2 years. Most participants were unmarried (58/90), of mixed race (57/90), had a household income below minimum wage (59/83), lived with their parents (54/90), and unemployment (81/90). More than 80% were not using contraception or were using it irregularly whenthey became pregnant. Most participants reported knowledge of condoms (82/90), of the combined oral contraceptive pill (75/90) and of injectable contraceptives (68/90). However, less than half reported knowledge oflong-acting reversible contraceptive methods. In terms of contraceptive intentions after pregnancy, the most commonly cited methods were the contraceptive injection (36/90), the intrauterine device (17/90) and the combined pill (9/90). In this study we found a low level of knowledge of contraceptive methods, and especially of long-acting reversible contraceptive methods, among pregnant teens in Northeast Brazil. Low socioeconomic status and high rates of unplanned pregnancy might be reasons for insufficient sexual and reproductive health counseling in this population.

Knowledge, Attitude, Practice and Barriers Regarding Safe Sex and Contraceptive Use in Rural Women in Fiji

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fiji has a low contraceptive uptake rate and high rates of unplanned pregnancy and sexually transmitted infections (STIs).  In this paper we report the result of a study on Knowledge, Attitude, Practice and Barriers (KAPB) to safe sex and contraceptive use, conducted on 1494 rural women aged between 18 to 75 years in Fiji.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; To explore the knowledge, attitudes, practice and barriers regarding safe sex and contraceptive use in rural women of Ba, Lautoka and Nadi, in Fiji.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Structured questionnaires were administered to women presenting to rural outreach Sexual and Reproductive Health (SRH) education sessions and clinics conducted by trained health educators and clinicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Knowledge on how pregnancy occurred and how to avoid pregnancies was high&lt;strong&gt; &lt;/strong&gt;(86% and 83% respectively); but when it came to practice 43% of women had never used a contraceptive. Despite 81% of women having completed either secondary or tertiary education, 88% were not aware of emergency contraception. Fifty three percent of respondents were unaware that condom use provided protection against both pregnancy and STIs. Sixty three percent knew how an STI is contracted but 48% were unaware of any of the symptoms of STIs. Women offered ‘lack of knowledge’ (53%), ‘being married’ (17%), ‘difficulty accessing’ (10%) or ‘partner disagrees’ (7%) as the common barriers to condom use. Forty percent of women were unable to articulate a barrier to contraceptive use and said they did not know whereas 21% said ‘fear’, 15% said ‘partner objecting’ and 5% said ‘religion’ were barriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While a high percentage of women had some knowledge of how to avoid pregnancies and how STIs were contracted, this did not translate to practice of safe sex or use of contraceptives.&lt;strong&gt; &lt;/strong&gt;Review of current education and health programs is necessary to ensure that misinformation and false perceptions do not act as barriers. The influence of the partner needs further research.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Hydroxycarbamide (HU), Sickle Cell Disease and Pregnancy, a Multicentric Retrospective Study

HU is a myelosuppressive drug marketed since 1968 for the treatment of hematological malignancies, and authorized since 2007 in Europe as an orphan medicinal product for the prevention of recurrent vaso-occlusive crises and acute chest syndrome in adults and children older than 2 years with sickle cell disease (SCD). ESCORT-HU (European Sickle Cell Disease Cohort - Hydroxyurea) is a multicenter prospective non interventional study implemented in Europe to collect more information about the safety profile and morbidity-mortality in SCD patients treated with HU. The study responds to an EMA (European Medicines Agency) request and has been approved by the Ethical Committee of Necker Enfants Malades Hospital (Paris, France).Some teratogenic effects of HU have been observed in fetuses of treated pregnant rodents (Woo, Katayama et al. 2004;Yan and Hales 2005 ;Chahoud and Paumgartten 2009). Hydroxyurea has been demonstrated to be embryotoxic at doses over 150 mg/kg/day in rats and in monkeys (Liebelt, Balk et al. 2007). Embryotoxicity was characterized by decreased fetal viability, reduced live litter sizes, and developmental delays. On the other hand, a recent study on pregnant mice showed no evidence of teratogenic effects with intraperitoneal injection of HU (25mg/kg) on gestation day (GD) 7.5 (Zhen Guan et al. 2015).Due to the potential teratogenic effects in animal models, although no malformations have been reported in humans to date (Khushnooma et al. 2010,), the use of HU is not recommended during pregnancy.The pregnancy in SCD can be associated with adverse maternal and perinatal outcomes. The rate of spontaneous abortion is more than 30% in our cohort at Necker Hospital and in literature (Regina Amelia Lopes Pessoa Aguiar et al. 2014, Sophie Lanzkron et al. 2012). Women of childbearing potential receiving HU should be advised to use contraception to avoid becoming pregnant. If there is a desire for pregnancy, HU must be stopped 3 to 6 months before conception and switched for chronic transfusion until the delivery or the end of breast feeding with a significant risk of allo-immunization (Ngo et al. 2010, Howard et al. 1995). In our experience, we have noticed that as pregnancies started frequently under HU, it is necessary to improve our knowledge about the use of HU during pre-conception or organogenesis in SCD patients and eventually develop new therapeutic strategies.From June 2008 to July 2016, 1050 patients (496 children and 554 adults) were enrolled in ESCORT-HU from 3 European countries, Greece (11.7%), Germany (13.4%), and France (74.9%). Among the 315 women with childbearing potential (aged more than 15 to 49 years), 28 pregnancies in 27 women treated with HU have been reported despite the information to stop HU before conception (Table 1). Clinical data regarding the newborn are reported for 7 pregnancies with HU exposure and no malformations were observed.In women treated with HU:• HU was stopped in 15 (15 pregnancies) women during the first trimester of pregnancy (9 before 6 WA). The outcome of these pregnancies were 5 normal births, 5 premature births, 3 ongoing pregnancies, 1 voluntary abortion, 1 unknown• HU was used during the whole pregnancy in 1 woman (issue normal birth),• Information on treatment discontinuation was not reported in the database for 8 women.In our study, a large majority of pregnancies (89%) occurred while HU was not stopped which correlates with the high rates of unplanned pregnancy in SCD women (Smith-Withley et al 2014, Eissa et al 2014). The use of HU during organogenesis or pre-conception period in our cohort seems to have no impact on the materno-fetal and new-born morbi-mortality which is consistent with literature data (Khushnooma et al. 2010).Even if women of childbearing potential receiving HU should be advised to avoid becoming pregnant, in this series nested in the ESCORT HU cohort pregnancies occurred safely despite HU. These results are important because they could help to limit the indications and duration of transfusion and therefore the risk of allo-immunization and delayed hemolytic transfusion reaction in this at-risk population. Nevertheless this preliminary work needs to be confirmed by a comprehensive collection which could help us to evaluate the risk-benefit ratio, of HU versus blood transfusion during pregnancy in SCD women. [Display omitted] DisclosuresRibeil:Bluebirdbio: Consultancy; Addmedica: Research Funding.