Including Emergency Contraception Research Articles

U.S. global health aid policy and family planning in sub-Saharan Africa.

The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations receiving all U.S. health assistance from promoting abortion. Existing evidence suggests that abortion rates rise under the MCP, but the direct effect of U.S. funding restrictions on supply and use of family planning has received less attention. By studying PLGHA's impact on health service delivery providers and women in eight sub-Saharan African countries, we are able to fill this gap. We find that health facilities provide fewer family planning services, including emergency contraception, and that women are less likely to use contraception and more likely to have given birth recently under the policy. These findings suggest that PLGHA has important unintended consequences that are detrimental to reproductive health and the autonomous decision-making of health service providers and women.

Social and Medical Characteristics of Neonates Who Were Abandoned in a Tertiary Maternity Hospital in Turkey.

This study aimed to investigate the characteristics of neonates who were aban- doned in a tertiary maternity hospital and to determine the accompanying morbidities. This hospital-based, retrospective descriptive study was conducted by evaluating the medical records between 2012 and 2019 in a tertiary hospital in İzmir. During the study period, there were 76 women who left their babies in the hospital following delivery. Median age of the mothers was 23 (range 12-44) years. Among them, 31.5% (n = 24) were below 18 years of age. Seventy-three of the pregnancies (96%) were unwanted, 67 of the mothers were unmarried (88.16%), of which 17 revealed a history of rape (22.36%), and 2 of them were victims of incest (2.63%). Thirty-six (47.36%) neonates were female and 36 of them (47.36%) were delivered by cesarean section. The mean gestational age was 37.3 ± 2.2 weeks and the mean birth weight was 2927 ± 572 g. Twenty-one (27.63%) babies were born prematurely and 15 (19.73%) had low birth weight. Four babies (5.26%) had hypoglycemia, 3 (3.94%) had hyponatremia, 5 (6.57%) had hypocalcemia, and 3 (3.94%) had hypomagnesemia. Unwanted pregnancies were found to be one of the key reasons for newborn aban- donment and linked to a higher risk of complications for both mother and child. To prevent unintended pregnancy and its negative effects, it is important to ensure that all adolescents have access to high-quality education in a safe and supportive learning environment, school- based health services, and increase access to contraceptive services, including emergency contraception and safe and legal abortion services.

Levonorgestrel Emergency Contraception Availability in Louisiana Independent and Chain Pharmacies Post-Dobbs v Jackson Women’s Health Organization [ID: 1376654

INTRODUCTION: Following recent legal changes, there is increased confusion regarding availability of medications for reproductive health, including emergency contraception (EC). We aimed to quantify over-the-counter (OTC) access to levonorgestrel EC in three metropolitan Louisiana parishes (counties) among chain and independent pharmacies. METHODS: This cross-sectional study took place during August and September 2022. Secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes. Pharmacies were classified as independent or chain based on affiliation with supermarket or drug store chains. Odds ratios (ORs) with 95% CIs were used to compare availability of OTC EC. RESULTS: Among 212 retail pharmacies, 55% (n=117) were large chain pharmacies and 45% were independent stores. Only 67% (n=141) had EC in stock. Chain pharmacies were more likely to offer EC than independent pharmacies (92% versus 35%, OR 22.6, 95% CI [10.1, 50.2]). Independent pharmacies were more likely to keep OTC EC behind the counter (91% versus 11%, OR 80.0, 95% CI [21.2, 302.5]), require identification (45% versus 4%, OR 21.7, 95% CI [6.5, 72.7]), and carry no EC less than $50 (24% versus 2%, OR 17.0, 95% CI [3.4, 84.8]). Among pharmacies without EC available, no chain pharmacies described recent changes in EC stock, while 5 out of 28 (18%) respondent independent pharmacies attributed loss of EC stock to recent legislation. CONCLUSION: Independent pharmacies were less likely to carry OTC EC and more likely to enforce multiple barriers to purchase. Recent legislation has disproportionately further reduced EC availability at these pharmacies.

Physician Beliefs About Contraceptive Methods as Abortifacients

(Abstracted from Am J Obstet Gynecol 2022; doi: 10.1016/j.ajog.2022.09.039) Several studies have demonstrated that contraception (including emergency contraception [EC]) does not disrupt an existing pregnancy. Contraceptives prevent pregnancy before fertilization; yet, many individuals who oppose abortion state or believe that contraceptives are abortifacients (ie, substances that cause the termination of an implanted fertilized egg).

School-going adolescent girls' preferences and views of family planning services in Phalombe district, Malawi: A descriptive, cross-sectional study.

BackgroundLow uptake of family planning services by adolescent girls remains a public health concern. An estimated 120 out of every 1,000 girls aged 15 to 19 years are having unplanned pregnancies in the sub-Saharan region. Between January and June 2020, the Phalombe District of Malawi reported 3,030 adolescent pregnancies. At this stage, most Malawian schools were closed due to the COVID-19 pandemic. The high rate of adolescent pregnancies prompted the Ministry of Health to provide emergency contraceptives to reduce the number of unplanned pregnancies among adolescents. The provision of emergency contraceptives would be effective if girls were willing and able to access these family planning services. We thus explored the views of school-going adolescent girls regarding their preferences for modern family planning methods including emergency contraceptives in Phalombe, Malawi.MethodsThis was a cross-sectional, descriptive study, where quantitative data were collected using a structured questionnaire. Participants included randomly sampled school-going adolescent girls from eight purposively selected secondary schools and eight randomly selected primary schools. All the schools were sampled from three purposively selected Traditional Authorities namely Nkhulambe, Jenala and Nkhumba which had reported high numbers of adolescent pregnancies. We analyzed the GeoPoints for schools and health facilities using ArcGIS, while adolescent girls’ views were analyzed using STATA.ResultsParticipants included 388 adolescent girls, ranging in age from 10 to 19 years (median age = 15.5 years, SD = 1.9 years). Participants were hesitant to use contraceptives because they were afraid of being stigmatized and embarrassed, had to travel long distances to reach the service center, knew little about modern family planning and were afraid of medical complications.ConclusionThe uptake of family planning services by adolescent girls can be improved by bringing healthcare services closer to schools and homes. Family planning services should employ health workers who are non-judgmental and who are able to remove the stigma associated with family planning. Health workers should at any given opportunity, address the misconceptions and beliefs that adolescents have towards contraceptives. Community sensitization and health talks should be done to improve adolescent girls’ understanding of family planning services.

The availability of emergency contraception from family health centers in Turkey

Reproductive health care, including contraception, is a fundamental aspect of any public health care system and it is important to reduce barriers to access to all forms of contraception, including emergency contraception. In recent years, the rhetoric of pronatalism in Turkey has come to dominate and raises questions about the availability of reproductive health care services, in particular contraception, from state run facilities. This study aimed to determine the availability of dedicated emergency contraception (EC) from government run Family Health Centers (FHCs) in Turkey. In 2019, a team of trained researchers called a random sample of 583 FHCs located in the largest cities in twelve regions across Turkey asking for dedicated EC. Dedicated EC is largely unavailable from government supported FHCs. Only 6.1% stated that they provided EC while 53.8% stated that it was not available and that they could provide no alternative. A further 28.3% declared that they could provide an alternative to dedicated EC that almost always consisted of oral contraceptives. We found statistically significant variations in response rate and availability among cities as well as the rate of referral to pharmacies. There is little access to EC from government sponsored health clinics designated to provide family planning services, which hinders access to an essential reproductive health care service that should be available to women everywhere.

English

BACKGROUND Adolescence is the period between the onset of puberty and the cessation of physical growth roughly from 11 to 19 years of age. Adolescence vacillates between being children and being an adult. They are adjusting to the physiologic changes their bodies are undergoing and are working to establish sexual identification and use these changes for their benefit as well as that of the society. The objectives of the study were to assess the socio-demographic characteristics of boys, various adolescent health problems, explore the nutritional status of children through B.M.I and psycho-social behaviour and suicidal tendencies among adolescent boys. METHODS The parent study was done in Govt. Boys school which is a multistage sampling. Firstly from DOE, a list of Govt. Boys school, Gwalior was taken, and from that list the schools were randomly selected. A predesigned, pretested, structured and validated questionnaire in Hindi was given to the student returned questionnaire. RESULTS Out of 400 students, 176 (44 %) had fouling of gums; 44 (11 %) had bleeding gums; 152 (38 %) had hair fall, 76 (19 %) had white patches on their nails; 40 (10 %) had urinary irritation; 48 (12 %) had pain in the ear; 8 (2 %) had diabetes; 8 (2 %) had high B.P ; 12 (3 %) had asthma; 4 (1 %) had low B.P ; 176 (44 %) had acne; 100 (25 %) had short height. CONCLUSIONS They have simple but wide pervading crucial reproductive health needs-menstrual hygiene, contraception (including emergency contraception) safety from sexually transmitted infection (STI) and HIV. A communication gap exists between parents and other adults (lack of family connectedness) which needs to be corrected. KEY WORDS Adolescent, Reproductive Health, Communication Gap.

Use of Protection for Unwanted Pregnancy and Sexually Transmitted Infections in Six Birth Cohorts in Norway 2020: A Descriptive Study

This study describes the use of contraception and protection for sexually transmitted infections (STIs) in six different birth cohorts of the general population in Norway. The results are based on a 2020 national web panel survey among 18–89 year-olds in Norway (n = 4160). For respondents born within 1931–1950 versus those born within 1990–2002, there was a significant increase in the use of protection against unwanted pregnancy and STIs during sexual intercourse, and a significant drop in the proportion of those who did not use any protection at all. More women today (than in previous decades) are using hormonal contraception. The main reason for not using condoms during intercourse was both parties felt safe that they were healthy, especially those born within 1990–2002. To prevent unwanted pregnancy and STIs, it is beneficial to continue to increase the availability of free or subsidized hormonal contraception, including emergency contraception, and free condoms in public arenas that people frequent and where they meet their partners.

Regulatory standards and processes for over-the-counter availability of hormonal contraception and drugs for medical abortion in five countries in the Eastern Mediterranean Region

The World Health Organization 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights includes recommendations on self-administration of injectable contraception, over-the-counter (OTC) oral contraception and self-management of medical abortion. A review of the regulatory status of these two self-care interventions can highlight processes required to ensure that the quality of the medicines and safety of individuals are safeguarded in the introduction and scale-up in countries. This review outlines the legal regulatory status of prescription-only medicine (POM) and OTC contraceptives, including emergency contraception, and drugs for medical abortion in Egypt, Jordan, Lebanon, Morocco and Tunisia using information obtained from internet searches, regulatory information databases and personal contacts. In addition, the review examines whether the national medicines regulatory authorities have documented procedures available to allow for a change in status from a POM to OTC to allow for increased accessibility, availability and uptake of self-care interventions recommended by WHO. Egypt, Jordan and Lebanon have a documented national OTC list available. The only contraceptive product mentioned in the OTC lists across all five countries is ellaOne (ulipristal acetate for emergency contraception), which is publicly registered in Lebanon. None of the five countries has an official documented procedure to apply for the change of POM to OTC. Informal procedures exist, such as the ability to apply to the national medicines regulatory authority for OTC status if the product has OTC status in the original country of manufacture. However, many of these procedures are not officially documented, highlighting the need for establishing sound, affordable and effective regulation of medical products as an important part of health system strengthening. From a public health perspective, it would be advantageous for licensed products to be available OTC. This is particularly the case for settings where the health system is under-resourced or over-stretched due to health emergencies. Readiness of national regulatory guidelines and OTC procedures could lead to increased access, availability and usage of essential self-care interventions for sexual and reproductive health and rights.

Young migrant and refugee people’s views on unintended pregnancy and abortion in Sydney

ABSTRACT Although abortion rates appear to be declining in high-income nations, there is still a need for accessible, safe abortion services. However, limited attention has been paid to understanding the social contexts which shape access to abortion information and services for communities who are less engaged with sexual and reproductive health care more generally. This paper explores the views and experiences of 27 migrant and refugee young people (16–24 years old) living in Sydney, Australia, regarding unintended pregnancy and abortion. Pregnancy outside marriage was described by all participants as a shameful prospect as it revealed pre-marital sexual activity. Even when abortion was described as culturally and/or religiously unacceptable, it was believed many families would find an abortion preferable to continuing an unintended pregnancy outside marriage. However, a pervasive culture of silence regarding sexual and reproductive health may limit access to quality information and support in this area. To better meet the needs of these young people, greater attention must be paid to strengthening youth and community awareness of the availability of contraception including emergency contraception, pregnancy options, and access to abortion information and services.

198. Young Women’s Preferences for Lower Efficacy Contraceptive Methods: Balancing Reproductive Autonomy and Pregnancy Prevention Goals

Increasingly, provider groups, policymakers and funders have emphasized removing structural barriers to “top-tier” contraceptive methods that are highly effective at preventing pregnancy. While it is critical that young women have access to these methods, this focus overlooks the diverse reasons why some young women choose methods – including emergency contraception (EC), condoms, and withdrawal – that are less effective at preventing pregnancy even when top-tier methods are available. Concerns about sexual risk-taking and childbearing tend to overtake consideration of young women’s own contraceptive preferences, decision-making capacity, and reproductive autonomy.

Accessibility of emergency contraception for adolescents in Quebec community pharmacies.

Access to effective contraceptives, including emergency contraception (EC), is critical to reducing unintended adolescent pregnancy. This study evaluates the accessibility of Ln-EC (levonorgestrel EC) for adolescents in Quebec community pharmacies. We conducted an anonymous self-administered electronic survey of Quebec community pharmacists between June 1, 2016 and October 31, 2016. Pharmacists were asked about the availability of Ln-EC in their pharmacy, whether they prescribed Ln-EC, and their experience with adolescents who requested Ln-EC. Five hundred and ninety-one pharmacists responded, with representation from across the province. Ninety-five per cent had Ln-EC in stock. Most pharmacists (90%) reported being comfortable prescribing Ln-EC, though they were less comfortable prescribing to adolescents than to adults (*P<0.001). Pharmacists also reported that cost and confidentiality are barriers to accessing Ln-EC for some adolescents. This study indicates that availability and pharmacist comfort are not likely to be barriers to Ln-EC use for adolescents. On the other hand, cost and/or confidentiality do represent a barrier for some adolescents. This study lays the groundwork for a national study examining the accessibility of EC for adolescents.

Emergency Contraceptives: Knowledge and Practice towards Its Use among Ethiopian Female College Graduating Students.

Introduction Ethiopia has a high incidence of unwanted pregnancies and incomplete and unsafe abortions, particularly among adolescents. This can be avoided by using different contraceptive methods including emergency contraceptives (EC). This study aimed to assess the knowledge and practice of EC among female college graduating students in Harar, Eastern Ethiopia. Methods Institution based cross-sectional study was conducted on 214 female students selected from two randomly selected colleges. Data was collected using a self-administered questionnaire and analyzed using SPSS for Windows version 20.1. Level of significance was taken at P <0.05. Results The mean (±SD) age of the participants was 21.06 (±2.14) years. Of the 200 (93.5%) study participants who had ever heard of ECs, 140 (70.0%) had good knowledge. Among the 214 graduating female students, 66 (33.0%) had ever used EC. Being above the age of 20 years old, father's and mother's literacy were found to be determinants of knowledge of EC. Moreover, knowledge was the only determinant factor of practice of EC. Conclusion Most of the respondents had relatively good knowledge of EC. The study revealed that female students of older age and higher educational status of parents had higher knowledge and practice of EC.

Pregnancy Intentions, Contraceptive Knowledge And Educational Aspirations Among Community College Students.

Community college students, representing more than one-third of U.S. undergraduates, are a diverse population of young people motivated to seek higher education who are at elevated risk of unintended pregnancy. However, it is unknown how well prepared they are to prevent pregnancy and what they think about it in terms of their educational aspirations. In-depth interviews were conducted with 57 students aged 18-25, inclusive of all genders, in three community colleges in California in 2015. Content analysis was used to code data and identify themes. All participants reported strong desires to prevent pregnancy in the next year and perceived their pregnancy risk as low, but many reported unprotected sex with opposite-sex partners. Participants had specific timelines for completing their degrees and believed pregnancy would make that far more challenging, but would not ultimately prevent them from achieving their goals. Female students expressed concern about the risks of exacerbated poverty, housing instability and unachieved career goals. Participants had little knowledge of their pregnancy risks and of the health benefits, side effects or effectiveness of contraceptives. They held negative beliefs about hormonal contraception (including emergency contraception, IUDs and the implant), fearing long-lasting effects and infertility. Gay or bisexual students shared concerns about contraceptives, although several were using methods for noncontraceptive reasons. Many community college students not desiring pregnancy have limited awareness of pregnancy risk and prevention.

The knowledge and perceptions of the first year medical students of an International University on family planning and emergency contraception in Nicosia (TRNC)

BackgroundInforming the individuals on family planning including emergency contraception is a significant step for preventing unintended pregnancies. Although there is a number of studies on family planning and emergency contraception globally and in Turkey, no such data are available in the Turkish Republic of Northern Cyprus. The objective of this study was to evaluate the knowledge and perceptions on family planning and emergency contraception of the first year students of an international medical school in Nicosia, Northern Cyprus and to increase awareness for developing new policies on the issue.MethodsThe data of this cross-sectional study were collected in February 2016 by a questionnaire of 36 questions. Of the 229 students, 189 (82.5%) completed the questionnaire. The data were evaluated by SPSS 18.0 statistical program. The differences of variables were evaluated by Chi square test, p < 0.05 being accepted as significant.ResultsThe distribution of participants from 23 countries according to nationality revealed three leading countries: Nigeria, Turkey and Syria. Of the students, 53.6% knew the definition of family planning. The sources of information were mainly school, the internet and media, with a total of 60.9% of the participants who stated having prior information on the subject.Awareness of contraceptive methods was indicated by more than 90% and emergency contraception by 66.1% of the participants. However, the students were unable to differentiate between modern and traditional family planning methods; 85.6% did not have knowledge of the most effective period for emergency contraception and 63.1%, of the definition of emergency contraceptive pills.ConclusionsIn conclusion, the knowledge and awareness level of the first year medical students on family planning and emergency contraception was insufficient. Family planning and emergency contraception education should be provided for the students at the first year of all faculties as well as medical schools and relevant programs should be included in the curricula of medical education.

A Contraceptive Review and Update

There are many effective, well-tolerated, safe and readily reversible contraceptives. Clinicians should remain informed regarding contraceptive methods, including emergency contraception. The following is a concise summary of the important aspects of various contraceptives, including current recommendations for options that may be tailored to the unique needs of individual women.

Pharmacists’ Provision of Contraception: Established and Emerging Roles

Pharmacists’ roles in provision of family planning products is expanding in the United States (U.S.). This article details established as well as emerging roles for U.S. pharmacists in the provision of contraception. These include helping patients develop reproductive life plans; dispensing prescription contraceptive products and counseling patients; assisting and educating patients with non-prescription contraceptive products, including emergency contraception; participating in collaborative practice agreements; administering contraception products; and making referrals and developing partnerships. The provision of contraception in the U.S. is dynamic, and pharmacists should continue to be aware of changes that will impact them professionally. As approximately 45% of pregnancies in the U.S. are unintended, through these roles pharmacists can impact an important public health priority.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties&#x0D; &#x0D; Type: Idea Paper

An educational intervention on contraception among community college students

Objectives: Community college students are at high risk of unintended pregnancy and frequently struggle to reach educational goals. They make up 46% of undergraduates, and only 25% receive their degree/certificate within 6 years. We conducted an educational intervention on contraception to help support students to prevent unintended pregnancy before completion of education. Methods: Guided by formative qualitative research, we designed an educational intervention based on tools we created with Bedsider for young, low-income populations. We recruited 800 students aged 18–25 from three sites for a 10-min educational intervention. We administered pre- and postintervention questionnaires and analyzed changes in knowledge through generalized estimating equations (GEE) with robust standard errors. Results: Almost 41% were first-generation college students, with positive aspirations: 98% were confident they would reach educational goals. Some 25% of sexually active women reported prior unplanned pregnancy, and 96% said preventing pregnancy was important to them. Only 4% thought it likely that they would get pregnant in the next year. However, 29% reported unprotected intercourse at last sex. Postintervention results revealed high cognition from the visual educational materials and significantly increased knowledge about all methods, including emergency contraception (EC). For example, the proportion who knew that EC pills work best when taken immediately after sex increased from 73% to 97% (p<.001), and the proportion who were willing to consider using the IUD as EC from increased from 43% to 71% (p<.001). Conclusions: Interventions for young people outside of clinical settings are necessary to address the extremely low levels of contraceptive knowledge and elevated unintended pregnancy in the United States.

Comportamento do aborto induzido entre jovens em situação de pobreza de ambos os sexos – Favela México 70, São Paulo, Brasil, 2013

ObjectiveIdentify the role of induced abortion on reproductive behavior of young slum Mexico 70 compared to results obtained in previous investigation in the slum Inajar de Souza, 2007. MethodThis survey was designed to interview all young people 15‐24 years old, living in the slum Mexico 70, in the municipality of São Vicente in Sao Paulo. The vast majority of young people (94%) agreed to answer the questionnaire. Altogether they were interviewed 455 women and 339 men. Among them, they had started sex life 327 and 253, respectively. The analysis, at first, refers to the total number of interviewees and then only to those with an active sexual life. In determining the differential behavior by sex, appealed to the chi‐square test for qualitative variables and the Student t test for quantitative. Has set itself a p<=0.05. ResultsHaving as reference another survey in the same methodological manner in Inajar slum Souza in 2007, among other important, the most important findings, were the low prevalence of women with induced abortion and a high rate of recurrence of emergency contraception. ConclusionIt is essential to develop studies to deepen knowledge of the effects arising from the self‐medication of contraceptives, including emergency contraception, even if these contribute to the reduction of induced abortions.

Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents.

Conscientious objection to reproductive healthcare (refusal to perform abortion, assisted reproductive technologies, prenatal diagnosis, contraception, including emergency contraception and sterilization, etc.) has become a widespread global phenomenon and constitutes a barrier to these services for many women. Adolescents are a particularly vulnerable group because some providers object to specific aspects of their reproductive healthcare because of their status as minors. Recent peer-reviewed publications concerning conscientious objection address provider attitudes to abortion and emergency contraception, ethical arguments against conscientious objection, calls for clarification of the current laws regarding conscientious objection, legal case commentaries, and descriptions of the country-specific impact of policies in Russia and Italy. Conscientious objection is understudied, complicated, and appears to constitute a barrier to care, especially for certain subgroups, although the degree to which conscientious objection has compromised sexual and reproductive healthcare for adolescents is unknown. Physicians are well positioned to support individual conscience while honoring their obligations to patients and to medical evidence.