Initiation Of Contraception Research Articles

Postabortion Initiation of Long-Acting Reversible Contraception by Adolescent and Nulliparous Women in New Zealand

PurposeTo describe changes in receipt of immediate postabortion long-acting reversible contraception (LARC) by adolescent and nulliparous women in New Zealand. MethodsNationally collected data on immediate postabortion receipt of an intrauterine method (intrauterine device [IUD]/intrauterine system [IUS]) or contraceptive implant were analyzed to describe proportions and demographic characteristics of women receiving LARC between 2007 and 2013. Changes in uptake over time were presented for adolescent, nulliparous, and parous women. ResultsPostabortion LARC uptake increased between 2007 and 2013, rising from 7.9% to 42.7% for adolescents and from 8.8% to 36.9% for nulliparous women. The increase was highest among nulliparous adolescents with a seven-fold increase in LARC uptake between 2007 and 2013. Adolescents had a five-fold increase and nulliparous women (of all ages) a four-fold increase. In 2013, IUD/IUS use was lowest among adolescents (22.4%) and increased with increasing age (43% by ages 40+ years), whereas implant use was highest among adolescents (20.3%) and decreased with increasing age (to 4.6% by age 40+ years). Nulliparous women had the lowest use of both IUD/IUS and implants in 2013, with 24.6% receiving an intrauterine method (compared with 43.2% for para 3+), and 12.3% an implant (compared with 17.5% for para 3+). ConclusionsDespite an overall trend toward increased uptake of postabortion LARC by adolescent and nulliparous women, uptake in these groups still lags behind that of parous and older women. Reasons for differential uptake need to be explored and addressed if necessary to ensure all women have equitable access to the most effective methods of contraception.

Scientific evaluation on substance abuse research through web of science over the 2008–2012 period

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e149 agonist treatment for opioid dependence utilized postpartum reproductive health care services and identify the prevalence rate and contraceptive methods of this population. Methods: Data on contraceptive use were collected around the time of the postpartum OB visit for participants in the MOTHER (MaternalOpioidTreatment:HumanExperimentalResearch) study for this secondary analysis. Results: Among the 175 MOTHER participants, data about contraceptivemethodwereonlyavailable for43% (n=76)of the sample andmany reported not attending their postpartumOBvisit. Among those with data, 45% of participants (n=34) reported not using any contraception. Among those reporting contraceptive use, methods included Depo-Provera shots (13%; n=10), oral contraceptives (12%; n=9), IUDs (12%; n=9), tubal ligations (9%; n=7), condom use (8%; n=6), and natural family planning (1%; n=1). Conclusions:These results suggestopioid-maintainedpregnant women frequently utilize postpartum reproductive health services inadequately and indicate current strategies to address their reproductive health needs may not be themost efficacious. Predictors of contraceptive use postpartum need to be identified and treatment strategies revised to support prompt initiation of effective contraception. Due to regulations around opioid maintenance treatment, opioid-maintained women attend their treatment clinic on a regular basis, even early in the postpartum period. This situation may present a unique opportunity to engage opioid-dependent pregnant women about their reproductive health needs, optimize postpartum contraceptive use, and integrate their health care services. Financial support: NIDA T32 DA007242. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.405 Scientific evaluation on substance abuse research through web of science over the 2008–2012 period David Melero-Fuentes1, Remedios Aguilar-Moya2, Juan-Carlos Valderrama-Zurian3, Francisco Bueno-Canigral4, Rafael Aleixandre-Benavent5, Jose-Carlos Perez-de-los-Cobos6 1 INDOTEI, Universidad Catolica de Valencia, Godella, Spain 2 Departamento de Ciencias de la Educacion, Universidad Catolica de Valencia, Godella, Spain 3 Universitat de Valencia, Valencia, Spain 4 Plan Municipal de Drogodependencias, Ayuntamiento de Valencia, Valencia, Spain 5 INGENIO, Spanish Research Council-CSIC, Valencia, Spain 6 Servicio de Psiquiatria, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain Aims: Identify and analyze scientific production and studied drugs on specific and not specific substance abuse journals. Methods: Design of search strategy, treat the bibliographic information, classification of articles regard to drugs studied, bibliometric analysis, identify research groups altogether and by each drug studied was the method used. Results: 44,822 articles have been evaluated, the 26.88% have been published in journals (1.08%) of Web of Science (WoS) Category SubstanceAbuse (CSA),while the rest ofworkswerepublished in 3,382 journals belonging to 95 WoS categories of Health Sciences and Social Sciences. The 67.02% of the articles only study 1 drug; while that alcohol, tobacco and cannabis, and on the other handcocaine andamphetamines are thedrugsmost studied jointly. The 27% of the authors (n=35,223) have published more than 1 paper. Collaborations between 2 or more authors made up 95.18% of documents, with a collaboration index of 5.24. Conclusions: A growth in productivity of scientific research on substance abuse has been identified. The most productive journals that do not belong to WoS CSA accumulate a 0.42% more of papers that these. The multidisciplinary character of this research field is reflected in the wide range of journals as well as the collaboration index and index of transient authors, as has been noted in other studies of Biomedicine andSocial Sciences. AlthoughUSA,UK, Canada and Australia great producers dominate the consolidated research groups, main producers of not English speaking countries of European Union have the highest international collaboration indexes. Financial support: Plan Municipal de Drogodependencias, Ayuntamiento de Valencia, Spain. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.406 Screening and brief intervention for low risk drug use in primary care: A pilot randomized trial Seville Meli1, Tibor Palfai2, Debbie M. Cheng3, D. Alford4, Judith Bernstein1, Jeffrey Samet4, Richard Saitz1 1 Community Health Sciences, Boston University, Boston, MA, United States 2 Psychological and Brain Sciences, Boston University, Boston, MA, United States 3 Biostatistics, Boston University, Boston, MA, United States 4 Medicine, Boston University, Boston, MA, United

Contraception initiation in the emergency department: providers' knowledge, attitudes, and practices

Contraception initiation in the emergency department: providers' knowledge, attitudes, and practices

Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services

PurposeThe purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. MethodsHealth center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. ResultsHealth centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. ConclusionsThe assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities.

Gastrointestinal symptoms among endometriosis patients--A case-cohort study.

BackgroundWomen with endometriosis often experience gastrointestinal symptoms. Gonadotropin-releasing hormone (GnRH) analogs are used to treat endometriosis; however, some patients develop gastrointestinal dysmotility following this treatment. The aims of the present study were to investigate gastrointestinal symptoms among patients with endometriosis and to examine whether symptoms were associated with menstruation, localization of endometriosis lesions, or treatment with either opioids or GnRH analogs, and if hormonal treatment affected the symptoms.MethodsAll patients with diagnosed endometriosis at the Department of Gynecology were invited to participate in the study. Gastrointestinal symptoms were registered using the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS); socioeconomic and medical histories were compiled using a clinical data survey. Data were compared to a control group from the general population.ResultsA total of 109 patients and 65 controls were investigated. Compared to controls, patients with endometriosis experienced significantly aggravated abdominal pain (P = 0.001), constipation (P = 0.009), bloating and flatulence (P = 0.000), defecation urgency (P = 0.010), and sensation of incomplete evacuation (P = 0.050), with impaired psychological well-being (P = 0.005) and greater intestinal symptom influence on their daily lives (P = 0.001). The symptoms were not associated with menstruation or localization of endometriosis lesions, except increased nausea and vomiting (P = 0.010) in patients with bowel-associated lesions. Half of the patients were able to differentiate between abdominal pain from endometriosis and from the gastrointestinal tract. Patients using opioids experienced more severe symptoms than patients not using opioids, and patients with current or previous use of GnRH analogs had more severe abdominal pain than the other patients (P = 0.024). Initiation of either combined oral contraceptives or progesterone for endometriosis had no effect on gastrointestinal symptoms when the patients were followed prospectively.ConclusionsThe majority of endometriosis patients experience more severe gastrointestinal symptoms than controls. A poor association between symptoms and lesion localization was found, indicating existing comorbidity between endometriosis and irritable bowel syndrome (IBS). Treatment with opioids or GnRH analogs is associated with aggravated gastrointestinal symptoms.

The influence of trust in health care systems on postabortion contraceptive choice

ObjectivesThis study investigates whether trust in the health care system or other patient-level characteristics are associated with interest in immediate initiation of long-acting reversible contraception (LARC) after abortion. Study designA structured, self-administered survey was provided to English-speaking women 18years or older presenting to a reproductive health center in the Southeastern United States for first-trimester surgical abortion. The survey collected information about patient characteristics, choice of postabortion contraception, health literacy and trust in the health care system. Trust was measured using a 17-item, previously validated survey and was treated as the primary independent variable. Our primary outcome variable is interest in immediate LARC placement postabortion. Statistical analysis was performed using Chi-square tests, Student’s t tests and logistic regression with SAS® 9.2. ResultsOf 162 respondents who completed the survey, 24% planned to use LARC postabortion, which increased to 37% if LARC placement was available on the day of their abortion. The mean trust score was 59±8 (possible score of 17–85) and did not differ significantly between women who indicated an interest in immediate LARC placement postabortion and those who did not (p=.9). Women with a history of a prior birth were 3.4 times more likely to indicate interest in immediate postabortion LARC than others (adjusted odds ratio 3.42, 95% confidence interval 1.63, 7.18). ConclusionDesire to accept LARC immediately postabortion is associated with history of a prior birth but not with trust in the health care system or other demographic variables. Participant interest in postabortion LARC varied based on immediate device availability. ImplicationsThis research underscores the importance of policies and clinical practices that promote access to LARC methods on the day of an abortion. Further research is needed to elucidate factors that correlate with choice of LARC postabortion.

Contraception post severe maternal morbidity: a retrospective audit

IntroductionRapid repeat pregnancy is associated with maternal and neonatal morbidity. Effective postpartum contraception should be offered to all women, including those who experience severe acute maternal morbidity (SAMM), but little is known about contraceptive initiation in this group. Severe preexisting comorbidities with high pregnancy-related mortality risks are an important subset. This study examines contraceptive advice and prescription for SAMM cases with or without severe preexisting comorbidity. Materials and methodA retrospective audit of 98 SAMM cases was conducted to identify contraceptive advice and prescription preconception (for women with severe preexisting comorbidities), antenatally and/or postnatally. This is a secondary analysis of SAMM cases audited for preventability of SAMM in four District Health Board areas (covering a third of annual births in New Zealand) during a 17-month period. Case notes and preventability audit were manually searched. ResultsOf 98 SAMM cases reviewed, 84 (85.7%) left hospital without a contraception prescription. Of 14 with contraception documented on discharge from hospital, 4 (4.1%) had peripartum hysterectomy, 3 (3.1%) had tubal ligation at cesarean section, 1 partner had a vasectomy booked, 1 (1%) had a Jadelle© contraceptive implant inserted and 5 (5.1%) had condom prescriptions. Of 7 women with severe preexisting comorbidity, 4 had preconception advice against conceiving. All 7 left hospital postpartum without contraceptive prescription. DiscussionThese results indicate substandard contraceptive care for women experiencing SAMM. All those with severe preexisting comorbidities left hospital postpartum without receiving contraception. Improvement in immediate postpartum contraceptive care for these women is advocated to avoid future morbidity and mortality.

P140 Missed opportunities for ensuring adequate contraception: lessons from a rural sexual health service

<h3>Background/introduction</h3> Our county-wide service is undergoing increasing integration which makes public health sense. Ideally, risk of both sexually transmitted infections and pregnancy should be addressed with patients. <h3>Aim(s)/objectives</h3> We looked at missed opportunities for ensuring adequate contraception during routine GU appointments. <h3>Methods</h3> A retrospective notes review of 50 consecutive new female attendances over 2/12 was conducted, with a follow up at 4/12 to check contraception initiation or pregnancy. <h3>Results</h3> Consultations were conducted by 16 different staff, 44%(7) of whom are trained to initiate oral contraceptive pills (OCPs), 4 fit implants and 2 fit IUCD/IUS. 23 and 27 patients were seen by nurses and doctors respectively. Contraception methods, including none, were universally documented. 22(44%) patients were using long acting reversible methods of contraception (LARC) and 28%(14) an OCP. Pill compliance was documented in 5(36%) and advice given in 1 case. Only 4(14%) of the 28 non –LARC patients had LARC discussion. 7 patients used condoms and 7 no contraception. 5(36%) of these were advised to book a contraception clinic (CC)/GP appointment for contraception, 2 of whom failed to attend a subsequent CC. 1 patient was quick- started on an OCP. 2 patients were known to have conceived during the subsequent 4/12; 1 had LARC and 1 OCP at initial visit. 6(12%) and 1 patient/s were deemed at risk of pregnancy and appropriately provided with emergency contraception respectively. <h3>Discussion/conclusion</h3> There were missed opportunities to maximise contraception efficacy. Time restrictions and lack of staff training pose barriers which we need to address.

Prenatal contraceptive counseling and method provision after childbirth

Postpartum contraception is undergoing major changes, not only in timing, but also in content. Failure to provide immediate postpartum contraception contributes to the problems of unintended pregnancies and rapid repeat pregnancy because often the highest-risk women do not return for postpartum care. If they do attend that visit, they have often lost the insurance coverage that would enable them to use the most effective forms of birth control. Most of the issues surrounding early initiation of progestin-only methods and breastfeeding have been favorably resolved. In some cases, insurance coverage for delivery has been expanded to cover the costs of providing intrauterine devices and implants before the woman is discharged home. All of these new opportunities shift the burden of counseling about postpartum contraception onto the shoulders of the prenatal care provider. This article provides information about the advantages and disadvantages of providing immediate postpartum contraception with each of the eligible methods so clinicians can provide the needed counseling both during pregnancy and during hospitalization for delivery. It also provides guidance for initiation of bridging contraception, if needed, to initiate a method for a woman later in the postpartum period.

Post-abortion initiation of long-acting reversible contraception in New Zealand

BackgroundPost-abortion initiation of long-acting reversible contraception (LARC) reduces subsequent abortion rates within 24 months, but the prevalence of post-abortion LARC use in New Zealand is unknown.AimTo describe post-abortion initiation of...

Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Postpartum contraception improves the health of mothers and children by lengthening birth intervals. For lactating women, contraception choices are limited by concerns about hormonal effects on milk quality and quantity and passage of hormones to the infant. Ideally, the contraceptive chosen should not interfere with lactation or infant growth. Timing of contraception initiation is also important. Immediately postpartum, most women have contact with a health professional, but many do not return for follow-up contraceptive counseling. However, immediate initiation of hormonal methods may disrupt the onset of milk production. To determine the effects of hormonal contraceptives on lactation and infant growth We searched for eligible trials until 2 March 2015. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, POPLINE, Web of Science, LILACS, ClinicalTrials.gov, and ICTRP. We also examined review articles and contacted investigators. We sought randomized controlled trials in any language that compared hormonal contraception versus another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception includes combined or progestin-only oral contraceptives, injectable contraceptives, implants, and intrauterine devices.Trials had to have one of our primary outcomes: breast milk quantity or biochemical composition; lactation initiation, maintenance, or duration; infant growth; or timing of contraception initiation and effect on lactation. Secondary outcomes included contraceptive efficacy while breastfeeding and birth interval. For continuous variables, we calculated the mean difference (MD) with 95% confidence interval (CI). For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio (OR) with 95% CI. Due to differing interventions and outcome measures, we did not aggregate the data in a meta-analysis. In 2014, we added seven trials for a new total of 11. Five reports were published before 1985 and six from 2005 to 2014. They included 1482 women. Four trials examined combined oral contraceptives (COCs), and three studied a levonorgestrel-releasing intrauterine system (LNG-IUS). We found two trials of progestin-only pills (POPs) and two of the etonogestrel-releasing implant. Older studies often lacked quantified results. Most trials did not report significant differences between the study arms in breastfeeding duration, breast milk composition, or infant growth. Exceptions were seen mainly in older studies with limited information.For breastfeeding duration, two of eight trials indicated a negative effect on lactation. A COC study reported a negative effect on lactation duration compared to placebo but did not quantify results. Another trial showed a lower percentage of the LNG-IUS group breastfeeding at 75 days versus the nonhormonal IUD group (reported P < 0.05) but no significant difference at one year.For breast milk volume, two older studies indicated lower volume for the COC group versus the placebo group. One trial did not quantify results. The other showed lower means (mL) for the COC group, e.g. at 16 weeks (MD -24.00, 95% CI -34.53 to -13.47) and at 24 weeks (MD -24.90, 95% CI -36.01 to -13.79). Another four trials did not report any significant difference between the study groups in milk volume or composition with two POPs, a COC, or the etonogestrel implant.Seven trials studied infant growth; one showed greater weight gain (grams) for the etonogestrel implant versus no method for six weeks (MD 426.00, 95% CI 58.94 to 793.06) but less compared with depot medroxyprogesterone acetate (DMPA) from 6 to 12 weeks (MD -271.00, 95% CI -355.10 to -186.90). The others studied POPs, COCs versus POPs, or an LNG-IUS. Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.

Using the Hospital as a Venue for Reproductive Health Interventions: A Survey of Hospitalized Adolescents

Less than one-half of sexually active adolescents have received counseling regarding contraception and sexually transmitted disease (STD) from their health care provider. We hypothesized that hospitalized adolescents would be interested in receiving reproductive health education and/or STD testing. In addition, we assessed the opinion of female adolescents on initiation of contraception during hospitalization. A convenience sample of 13- to 18-year-old male and female adolescent patients hospitalized at a tertiary pediatric hospital were approached for inclusion. Consenting patients completed a self-administered anonymous questionnaire. Questionnaires from 49 female adolescents and from 51 male adolescents were collected. Based on their answers, 37% of female adolescents and 44% of male adolescents want to learn more about contraception and/or abstinence in the hospital independent of sexual activity. Thirty percent of respondents reported a desire for STD testing in the hospital. Fifty-seven percent of female subjects answered that adolescents should be offered contraception while in the hospital. Among hospitalized adolescents in this study, there was an interest in reproductive health education and contraception even among those with a primary care provider and without sexual experience. Thus, hospital-based pediatricians can play a pivotal role in expanding critical sexual health services by discussing and offering sexual health care to hospitalized adolescents. We recommend that hospitals make a brochure available to all admitted adolescents, with opportunity for follow-up discussions with their hospitalist.

An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception

ObjectiveWe examine the association between depressive symptoms and contraceptive method choice among adolescents initiating prescription contraception. Study designThis cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15–19 years) presenting for prescription contraceptive initiation at a comprehensive, free-of-cost, adolescent health center in New York City. All participants met with a health care provider who provided standard contraception counseling before initiating contraception. Each participant then selected a short- or long-acting contraceptive: a 3-month supply of the pill, patch, ring or a medroxyprogesterone acetate depot injection (short-acting), or placement/referral for an intrauterine device (IUD; long-acting). We assess the independent association between contraceptive method selection and symptoms of depression [assessed by the Center for Epidemiological Studies — Depression (CES-D) scale]. ResultsTen percent (n=21/220) of adolescent females selected an IUD. Bivariate analysis revealed that those with elevated levels of depressive symptoms were more likely to select an IUD as compared to those with minimal symptoms (mean CES-D score 20 vs. 13; t=3.052, p=.003). In multivariate logistic regressions, adolescent females had increased odds of selecting an IUD if they reported moderate to severe depressive symptoms (adjusted odds ratio=4.93; confidence interval, 1.53–15.83; p=.007) after controlling for ethnicity/race, education, number of lifetime partners and gravidity. ConclusionsInner-city, minority adolescents with elevated symptoms of depression who present for prescription contraceptive initiation may be more likely to select an IUD rather than shorter-acting methods. By recognizing adolescent females with depressive symptoms, providers can strategize their approach to effective contraception counseling.

Examining quality of contraceptive services for adolescents in Oregon's family planning program

ObjectiveTo assess the quality of care provided to adolescents (10–19 years old) compared to women (aged 20–25 years) who accessed services in Oregon's Contraceptive Care (CCare) program. Study DesignWe analyzed data routinely collected using the Clinic Visit Record form from women aged 25 years and younger who visited CCare clinics between January 1, 2004, and October 31, 2010. Modern methods were characterized into three tiers: Tier 1 is the intrauterine device, implant and sterilization; Tier 2, hormonal methods; and Tier 3, all barrier methods. Nonmodern methods included no method, withdrawal and natural family planning. We used multivariable logistic regression models to examine the effect of age on three indicators of quality of contraceptive care: transitioning from a nonmodern to a modern method, transitioning from Tier 3 methods to Tier 1 or Tier 2 methods, and initiation of long-acting reversible contraception (LARC). We then produced predicted probabilities to facilitate data interpretation. ResultsAdolescents accounted for 344,856 (41%) of the 848,221 clinic visits occurring in CCare among women under age 25. Compared with women (ages 20–25 years), young and older adolescents had decreased odds of LARC initiation [odds ratio (OR) 0.24 (95% confidence interval [CI] 0.16–0.35) and OR 0.44 (95% CI 0.38–0.52), respectively]. However, compared with women, both young and older adolescents had increased odds of leaving with any contraceptive method [OR 1.8 95% (CI 1.26–2.59) and OR 1.42 (95% CI 1.21–1.66)]. Among clients presenting with no method of contraception at the beginning of the visit, 78.7% of young adolescents (95% CI 73.84–83.03) compared with 81.44% (95% CI 77.02–85.52) of older adolescents, and 76.63% (95% CI 69.90–80.75) of young women left with a modern method, controlling for other covariates. ConclusionAlthough adolescents served by CCare are more likely to initiate contraception, they are less likely to receive LARC than women aged 20–25 years. ImplicationEfforts are needed to ensure that adolescents have access to highly effective reversible contraception.

A checklist approach to caring for women seeking pregnancy testing: Effects on contraceptive knowledge and use

ObjectiveTo assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing. MethodsPre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models. ResultsBetween January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, aOR=4.64, 95% CI 1.77-12.17), have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, p<0.001). Three months after visiting the study clinic, participants from the intervention period were more knowledgeable about intrauterine and subdermal contraception and were more likely to be using intrauterine, subdermal or injectable contraception (aOR=2.18, 95% CI 1.09-4.35). ConclusionsWomen seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in the 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling. ImplicationsA checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.

Time to second abortion or continued pregnancy following a first abortion: a retrospective cohort study.

What proportions of women have a second abortion or continued pregnancy within 12-46 months of a first abortion? Estimated return rates for a second abortion were 5, 10.9 and 19.8% at 12, 24 and 46-months, respectively, and rates of continued pregnancy were 5.6, 12.9 and 24.3% at the same intervals. Studies attempting to identify women at risk for 'repeat abortion' for intervention purposes have described a range of demographic and behavioural characteristics associated with presentation for more than one abortion, but few have taken timing of abortions into account. Retrospective cohort study involving women presenting for a first abortion at a public hospital abortion clinic in New Zealand (2007-2010). Electronically stored records were analysed for women discharged from a public hospital abortion clinic in New Zealand. Outcome measures were the proportion of women having a second abortion or continued pregnancy within 24 months of a first abortion, and characteristics associated with shorter time to subsequent pregnancy. Cox proportional hazards modelling was used to detect factors associated with time to a second abortion or continued pregnancy, and Kaplan-Meier survival analyses were used to estimate time to one of these two pregnancy outcomes. A total of 6767 women had a first abortion between 2007 and 2010. Some data were missing for 11 women so were excluded from the cohort and analyses. Return rates for a second abortion estimated from survival analyses were 5, 10.9 and 19.8% at 12, 24 and 46 months, respectively. Estimated rates of continued pregnancies were 5.6, 12.9 and 24.3% at 12, 24 and 46 months, respectively. Younger age, non-European ethnicity and greater parity were significantly associated with shorter time to a second abortion and to a subsequent continued pregnancy (P < 0.01 for all factor P-values). Hazard ratios (HR) for a second abortion were highest among those aged 16-19 years (HR 1.6, 95% confidence interval (CI) 1.3-1.9, Reference 20-24), of Pacific Island (HR 1.35, 95% CI 1.1-1.7) or Maori ethnicity (HR 1.26, 95% CI 1.1-1.5, Reference New Zealand European), and with 1 (HR 1.41, 95% CI 1.1-1.7) or 2 (HR 1.41, 95% CI 1.1-1.9, Reference nulliparous) children at the time of the first abortion. Both pregnancy outcomes were observed among 120 women (1.8%), with 60% of these women having a second abortion before the continued pregnancy. This study was limited to analysis of routinely collected clinical and demographic data for women presenting for abortion over a 4-year period. Conclusions could not be drawn about a wider range of personal and situational factors influencing pregnancy and pregnancy outcomes. Data were drawn from only one clinic but characteristics of the study sample were broadly representative of those reported nationally. Loss to follow-up for women seeking a second abortion elsewhere in the country cannot be ruled out and would serve to underestimate return rates reported here. To date, the most effective public health measure known to reduce abortion return rates within 24 months is the initiation of long-acting reversible contraception (LARC) at the time of an abortion. The high proportion of women seeking a second abortion <4 years after a first abortion (20%) could be significantly reduced by use of LARC, as could unintended pregnancies that are continued soon after a first abortion, particularly among teenaged and young women. Barrier-free access to a range of LARC methods should be prioritized to prevent unintended and mistimed pregnancies. Funded by a Lottery Health Research Grant and a University of Otago Research Grant. The authors have no competing interests. Not applicable.

Contraceptive Use and Pregnancy Incidence among VOICE Participants in Uganda

Background: Recent HIV prevention trials have required use of effective contraceptive methods to fulfill eligibility for enrolment. We compared pregnancy rates in participants enrolled in the VOICE (MTN-003) trial who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment (new users) relative to those already on DMPA or COCs. Methods: Data were analyzed from HIV-1 seronegative participants enrolled in Uganda. Prior to enrolment information on contraceptive type and initiation date was obtained; contraception was provided to new users. Participants received urine pregnancy tests at monthly follow-up visits. Cox proportional hazards models stratified by baseline contraceptive method were used to compare pregnancy incidence among new users (initiated 60 days prior to enrolment). Participants were censored after the first observed pregnancy on study. Results: Of 322 women enrolled 296 were COC or DMPA users; 82 (28%) were new users (50 [61%] initiated DMPA and 32[39%] initiated COCs) and 214 (72%) were established users. Overall pregnancy incidence was 13.35 per 100 person-years [p-yrs] (49/367 p-yrs) with an incidence in DMPA users of 5.39 per 100 p-yrs (13/241 p-yrs) compared to 28.62 per 100 p-yrs (36/126 p-yrs) in COC users. In new DMPA users pregnancy incidence was 10.20 per 100 p-yrs versus 3.48 per 100 p-yrs in established DMPA users (adjusted hazard ratio [aHR]=2.84; 95% confidence interval [CI] 0.92 - 8.74). Similarly in new COC users pregnancy incidence was 42.67 per 100 p-yrs versus 23.67 per 100 p-yrs in established COC users (aHR 2.08; 95% CI 1.02 - 4.23). Conclusions: New contraceptive users in VOICE had an increased pregnancy risk. Pregnancy incidence was high among both new and established COC users. New DMPA and all COC users participating in HIV prevention trials may benefit from intensive contraceptive counseling and provision of less user-dependent methods.

Oral Contraception and Romantic Relationships—from the Lab to the Real World

We review recent evidence that suggests that hormonal contraceptives may influence the dynamics of sexual relationships and the human pair-bond. Hormonal contraception likely has positive effects on cementing the pair-bond by decoupling sex from conception. However, changes in women’s evolved mate preferences associated with initiation or discontinuation of hormonal contraception may alter attraction to her partner, with potentially negative consequences for relationship satisfaction. We describe the evidence for such changes produced by laboratory studies, including prospective experimental designs, and how the consequences of such changes are being explored beyond the laboratory. In view of the growing prevalence of modern hormonal contraceptive methods across the globe, further study of such effects is urgently required.

Impact of a theory-based video on initiation of long-acting reversible contraception after abortion

Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention.

Ambivalence About Pregnancy and Its Association With Symptoms of Depression in Adolescent Females Initiating Contraception

PurposeTo examine the association between symptoms of depression and ambivalence about pregnancy in an inner-city adolescent female population. MethodsThis study analyzed data from 220 urban minority adolescent females (ages, 15–19 years) presenting for contraceptive initiation in a comprehensive, free-of-cost, adolescent health center in New York City. Cross-sectional baseline data were examined to define the relationship between participants' ambivalence toward pregnancy (defined by responses to items previously used in the National Longitudinal Study of Adolescent Health) and symptoms of depression (assessed by the Center for Epidemiological Studies–Depression scale). After controlling for covariates, multivariate logistic regression was used to identify the unique contribution of symptoms of depression on the pregnancy ambivalent group. ResultsOver one third of adolescent females self-reported ambivalence about pregnancy (n = 73, 33%). In our sample, 20% (n = 45) reported mild and 14% (n = 30) reported moderate-to-severe symptoms of depression. After controlling for potentially confounding factors, adolescent females who reported mild symptoms of depression had increased odds of reporting pregnancy ambivalence (adjusted odds ratio, 3.53; confidence interval, 1.64–7.62; p = .001) compared with those with minimal symptoms of depression. ConclusionsA substantial number of adolescents, despite planning to initiate contraception, were ambivalent about pregnancy; those reporting ambivalence were more likely to report mild symptoms of depression. When counseling adolescents about contraception initiation, clinicians should be aware that mild symptoms of depression may contribute to ambivalence about pregnancy.