Initiation Of Contraception Research Articles

Effect of baseline menstrual bleeding pattern on copper intrauterine device continuation

Heavy menstrual bleeding is a leading cause of copper intrauterine device discontinuation. Thus, girls and women with heavy baseline menstrual bleeding may be at increased risk for early copper intrauterine device discontinuation. Our objective was to assess if there was an association between baseline menstrual bleeding pattern prior to intrauterine device insertion and discontinuation rate at 12 months among study participants who chose copper intrauterine device at baseline. We performed a secondary analysis of the Contraceptive CHOICE Project, a prospective observational cohort study of 9256 girls and women offered no-cost contraception for 2-3 years. Included in our study were participants who chose copper intrauterine device for contraception and for whom method continuation data at 12 months were available. Prior to contraception initiation, participants were asked to qualify their menstrual bleeding over the past year as: light, moderate, moderately heavy, or heavy. Light bleeding corresponded to using ≤10 pads/tampons per period. Moderate, moderately heavy, and heavy bleeding corresponded to 11-20 pads/tampons, 21-30 pads/tampons, and >30 pads/tampons per period, respectively. Subjects were then categorized into either a "heavy" baseline group (those reporting moderately heavy or heavy bleeding at baseline), or a "not heavy" group (those reporting light or moderate bleeding). The 12-month continuation rate for each group was then calculated using Kaplan-Meier survival function, and hazard ratio for risk of discontinuation was evaluated using a Cox proportional hazard model to determine if moderately heavy or heavy bleeding at baseline was associated with early discontinuation. Of the 918 girls and women meeting the inclusion criteria for this analysis, 165 were in the heavy baseline bleeding group, while 753 were in the not heavy bleeding group. The 12-month continuation rates for groups were similar: 80.2% (heavy) and 85.0% (not heavy; P= .24). Patients reporting either moderately heavy or heavy baseline bleeding were not at increased risk for early discontinuation of copper intrauterine device (hazard ratio, 1.21; 95% confidence interval, 0.88-1.66). Our sample size provided >90% power to detect a clinically important difference of 15% (assuming 20% discontinuation rate in not heavy bleeding group and a 35% discontinuation rate in the heavy bleeding group). We did not find that girls and women who reported baseline moderately heavy or heavy menstrual bleeding were at increased risk for early discontinuation. Thus, we do not believe that girls and womenwith heavy menstrual bleeding should be discouraged from using this safe and highly effective form of contraception.

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

ObjectivesTo explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. Study designThe HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. ResultsBased on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05–1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07–1.26) or those who were uncertain (PR=1.19; 95% CI 1.09–1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96–0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice. ConclusionsPregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants. ImplicationsPregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.

Association of Anticipated Insertional Pain With Intrauterine Device Initiation

PurposeMany providers cite pain as a barrier to intrauterine device (IUD) initiation. Our objective was to determine if young women who initiate other contraceptive methods anticipate more pain with IUD insertion than those who initiate IUDs. MethodsIn this prospective cohort study, we enrolled women ages 14–24 initiating contraception at a family planning clinic. Participants rated expected pain with IUD insertion on a 0–10 scale. IUD and implant initiators additionally rated experienced pain and whether they would recommend their method, both after procedure and at 6 months. We compared anticipated pain between IUD and other contraceptive initiators. For IUD and implant initiators, we compared pre- and postprocedure pain. ResultsOf 172 participants, 29% initiated IUDs, 30% initiated implants, and 41% initiated other methods. The median age was 20 years (range 14–24), participants were racially diverse (39.5% white, 40.1% Hispanic, 11.0% black, 9.3% other), and 92% were nulliparous. IUD initiators were older and more likely to be white. The median pain anticipated with IUD insertion was similar among IUD (6.0, range 0–10), implant (5.0, range 0–10), and other contraceptive initiators (6.0, range 2–10) (p = .65). IUD initiators reported higher pain than expected (7.0, range 1–10) (p = .004), yet most recommended the IUD after procedure and at 6 months (78% and 74%, respectively). ConclusionsInsertional pain may not be a barrier to IUD initiation. Women initiating other contraceptives anticipated similar pain with insertion than those initiating IUDs. IUD initiators experienced higher pain than expected, but most still recommended the method.

Contraception: Influence on Vaginal Microbiota and Identification of Vaginal Lactobacilli Using MALDI-TOF MS and 16S rDNA Sequencing.

Background:The vaginal microbiome is influenced by a wide variety of factors, including contraceptive methods.Aim:To evaluate the effect of contraceptive methods on vaginal microbiota and to compare MALDI-TOF MS and 16S rDNA sequencing for lactobacilli identification.Patients and Methods:One hundred and one (101) women consulting for birth control were included in a prospective study. Their vaginal content was sampled and analyzed once before they started using the contraceptive method of their choice, and twice after the initiation of contraception, at three months (94/101 women attended) and at six months (89/101 women attended). The relative frequencies of yeasts and trichomonas were analyzed. MALDI-TOF MS and 16S rDNA sequence analysis were applied for the identification of lactobacilli in their vaginal microbiota. The following contraceptive methods were assessed: Combined Oral Contraceptive Pill (COCP), Condom (CON) and The Rhythm Method (RHYT). McNemar’s statistical test was applied.Results:A statistically significant association between COCP and normal microbiota was observed after three months (p< 0.01) and after six months (p< 0.0001), when the vaginal microbiota was modified. At six months, inflammatory reaction was detected in 3/7 women in the CON group, while 6/7 patients using RHYT showed the same state. Yeast colonization increased with the COCP. Identification of lactobacilli by MALDI-TOF MS analysis compared to 16S rDNA sequencing yielded 92.9% concordant results. Lactobacillus gasseri and L. crispatus were the predominant species.Conclusion:The pattern of vaginal states was significantly modified. Hormone administration apparently corrected the alterations and retained a normal vaginal state. MALDI-TOF MS has the potential of being an accurate tool for the identification of vaginal lactobacilli species L. murinus was for the first time isolated from the vagina.

One in three: challenging heteronormative assumptions in family planning health centers

ObjectivesTo estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative. MethodsThis survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior. ResultsAmong 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusively heterosexual women and demonstrated a preference for the copper T380 IUD. Exclusively heterosexual and lesbian women did not differ in their contraceptive method selection, however, by behavior, women with only female partners selected IUDs or implants less frequently than those with only male partners. ConclusionOne in three women attending family planning centers for contraception identified as a sexual minority. Sexual-minority women selected IUDs or implants more frequently than exclusively heterosexual women. ImplicationsProviders should avoid care assumptions based upon sexual identity. Sexual-minority women should be offered all methods of contraception and be provided with inclusive contraceptive counseling conversations.

Premenstrual Psychosis in an Adolescent: A Case Report.

Premenstrual psychosis is a rare phenomenon initiating during or preceding menses, often lasting one to two weeks after the onset of menses. Previous literature shows links between the estrogen decline of the menstrual cycle's late luteal phase and the worsening of preexisting symptomatology in psychosis. There is thought to be a similar etiology in premenstrual psychosis. Current literature describes mostly clinical cases showing successful treatment using oral contraceptives and/or atypical antipsychotics. We present an adolescent who suffered from a new episode of psychosis beginning just before the onset of menses. Her symptoms abated after the completion of menses and with the initiation of combined oral contraceptives and olanzapine.

Factors associated with initiating long-acting reversible contraception immediately after first-trimester abortion

ObjectiveThe objective was to identify predictors of postabortion long-acting reversible contraception (LARC) initiation to increase providers' understanding of motivators of contraceptive choices. Study designWe prospectively enrolled a cohort of women having abortions at <13 weeks’ gestational age who were eligible to receive no-cost contraceptive methods immediately postprocedure (N=1662) to evaluate the demographic and reproductive factors associated with choosing and receiving a long-acting contraceptive versus a short-acting method. We used stepwise logistic regression to identify independent predictors of LARC initiation. ResultsDuring the study period, 1072 (64.5%) chose an immediate postabortion LARC method and 590 (35.5%) chose another method. Compared to the group of women who chose a non-LARC method, women who chose a LARC method were more likely to have a surgical abortion and were younger, more likely to be Hispanic, more likely to live greater than 70 miles from the clinic, more likely to have a nonurban address and less likely to have had a prior abortion. ConclusionsWe found that the differences in the demographic and reproductive factors of women choosing and receiving postabortion LARC were those which have been shown to be associated with difficulty in accessing contraception. Providers should offer a full range of contraceptive options to women immediately postabortion. ImplicationsPostabortion LARC is more likely to be utilized by women from groups who have been shown to have difficulty accessing traditional family planning clinical care: those who are young, do not live in a city and are from groups with recognized health disparities. Offering postabortion LARC increases the options for these women.

Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: A randomized trial

ObjectiveTo investigate whether an early 3-week postpartum visit in addition to the standard 6-week visit increases long-acting reversible contraception (LARC) initiation by 8 weeks postpartum compared to the routine 6-week visit alone. Study designWe enrolled pregnant and immediate postpartum women into a prospective randomized, non-blinded trial comparing a single 6-week postpartum visit (routine care) to two visits at 3 and 6 weeks postpartum (intervention), with initiation of contraception at the 3-week visit, if desired. All participants received structured contraceptive counseling. Participants completed surveys in-person at baseline and at the time of each postpartum visit. A sample size of 200 total participants was needed to detect a 2-fold difference in LARC initiation (20% vs. 40%). ResultsBetween May 2016 and March 2017, 200 participants enrolled; outcome data are available for 188. The majority of LARC initiation occurred immediately postpartum (25% of the intervention arm and 27% of the routine care arm). By 8 weeks postpartum, 34% of participants in the intervention arm initiated LARC, compared to 41% in the routine care arm (p=.35). Overall contraceptive initiation by 8 weeks was 83% and 84% in the intervention and routine care arms, respectively (p=.79). There was no difference between the arms in the proportion of women who attended at least one postpartum visit (70% vs. 74%, p=.56). ConclusionThe addition of a 3-week postpartum visit to routine care does not increase LARC initiation by 8 weeks postpartum. The majority of LARC users desired immediate rather than interval postpartum initiation. Clinical trial registrationClinicaltrials.govNCT02769676 ImplicationsThe addition of a 3-week postpartum visit to routine care does not increase LARC or overall contraceptive initiation by 8 weeks postpartum when the option of immediate postpartum placement is available. The majority of LARC users desired immediate rather than interval postpartum initiation.

Effect of the depot medroxyprogesterone acetate injectable and levonorgestrel implant on HIV genital shedding: a randomized trial

ObjectivesTo assess the effect of the depot medroxyprogesterone acetate injectable (DMPA) and of the levonorgestrel (LNG) implant on genital HIV shedding among women receiving antiretroviral therapy (ART). MethodsWe randomized HIV-infected Malawian women to either DMPA or LNG implant from May 2014 to April 2015. HIV RNA was measured in cervicovaginal lavage (CVL) fluid and TearFlo Strips (TFS), and HIV DNA was measured in cells collected by CVL. We compared the frequency and magnitude of HIV genital shedding before and for 6 months after initiation of contraception and between arms among women receiving ART. We also compared genital HIV RNA levels obtained by sample type (TFS versus CVL). ResultsWe analyzed data for 68 HIV-infected women receiving ART: 33 randomized to DMPA and 35 randomized to the LNG implant. Overall, HIV RNA was more often detectable and the quantity was higher on TFS compared with CVL. HIV DNA was detected very rarely in CVL cell samples (4 of 360 samples). The frequency of genital shedding and the genital HIV quantity did not increase after contraceptive initiation with either DMPA or LNG implant among women receiving ART. ConclusionsHIV-infected women receiving ART initiating contraception with either DMPA or LNG implant did not have any increase in genital HIV shedding during the first 6 months of contraceptive use. These findings are consistent with growing evidence that progestin contraception is not associated with increased HIV transmission risk from such women to their male partners. Consistent with other studies, genital HIV RNA detection was higher in TFS than in CVL fluid. ImplicationsIn this randomized trial, neither DMPA nor the LNG implant, two of the most commonly used hormonal contraceptives among African women with HIV, was associated with increased genital HIV shedding in HIV-infected women receiving ART. These findings are reassuring and add to the currently limited information available for the highly effective contraceptive, LNG implant.

What is the efficacy and safety of immediate postpartum initiation of longacting reversible contraceptives (LARCs) versus waiting until 6 weeks postpartum?

What is the efficacy and safety of immediate postpartum initiation of longacting reversible contraceptives (LARCs) versus waiting until 6 weeks postpartum?

Unfulfilled need for contraception among women with unmet need but with the intention to use contraception in Rakai, Uganda: a longitudinal study

BackgroundLongitudinal data from a rural Ugandan cohort was used to estimate rates of unfulfilled need for contraception, defined as having unmet need and intent to use contraception at baseline but having an unintended pregnancy or with persistent unmet need for contraception at follow up.MethodsBetween 2002 and 2009 (5 survey rounds), a total of 2610 sexually active non-pregnant women with unmet need for contraception at the start of an inter-survey period were asked whether they intended to use any method of contraception until they desired a child. Modified Poisson multivariate regression was used to estimate unadjusted and adjusted prevalence ratios (PR) and 95% CI of unfulfilled need for contraception.ResultsThe proportion of women with unmet need at the start of an interval who intended to use contraception significantly increased from 61 to 69.1% (p < 0.05). However the majority of women who said they intended to use contraception had unfulfilled need for contraception at the subsequent survey (64.8 to 56.8%). In the adjusted analysis, significant predictors of unfulfilled need for contraception included age 40–49 years (PR = 1.34; 95% CI 1.04–1.74) and those with unknown HIV status (PR = 1.16; 95% CI 1.06–1.26).ConclusionsThere is a significant discrepancy between women’s intent to use contraception (> 60%) and subsequent initiation of use (< 30%) with many having unintended pregnancies which might explain the persistent high fertility in Uganda. Future research needs to address unfulfilled need for contraception among women at risk of unintended pregnancies.

Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care

PurposeCertified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program. MethodsBetween February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0–25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6–12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13–25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation. ResultsOf 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs. ConclusionsProgram findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods.

Reproductive health in women following abdominal organ transplant.

Fertility is commonly impaired in women with end-stage kidney and liver disease, although most women will have restoration of fertility within 1year of transplant. Family planning is therefore critical to discuss with reproductive-aged transplant recipients in the early posttransplant period, in order to ensure timely initiation of contraception, and optimal timing for conception. For women seeking pregnancy, the risks to the mother, graft, and baby should be discussed, including evaluation of immunosuppression safety and potential for adjusting medications prior to conception. With an increasing number of transplant patients now breastfeeding, immunosuppression safety in lactation continues to carry great importance.

Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy

Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion.Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January–May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014.Results: During the 21 months ([median], IQR 20–22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68–2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06–0.48). When adjusted for LARC initiation status, age <25 years was a risk factor for subsequent abortion (27 abortions/283 women, 9.5%) compared to women ≥25 years (27/383, 7.0%, HR1.95, 95% CI 1.04–3.67).Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.

Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative.

To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1. Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results.

A Contraception Quality Improvement Initiative with Detained Young Women: Counseling, Initiation, and Utilization.

To assess the effect of providing standardized counseling to improve the rates of contraception initiation and utilization among detained young women. This was a quality improvement (QI) project conducted at a large urban juvenile short-term detention center. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The intervention included educating all staff and care providers, counseling detained young women on various contraceptive options, and offering contraception initiation with oral contraceptive pills or depot medroxyprogesterone acetate injection. Retrospective chart review before February 2012 established baseline contraception initiation and utilization rates. The QI intervention began in February 2012 and continued for 6months followed by chart review. Outcomes measured included number of patients counseled about contraception, started contraception, and overall contraception utilization. We reviewed 120 and 186 charts before and after intervention, respectively. Compared with baseline data, the intervention group had statistically significant (P<.05) higher proportions of patients counseled (10% [10/120]baseline vs 84% [156/186] intervention) and who started contraception (7% [8/120] baseline vs 52% [97/186] intervention). This contraception QI intervention showed significant improvement in the rates of contraception counseling, contraception initiation, and utilization among detained young women. Most of youths' guardians were supportive and approved contraception initiation. This project showed it is feasible for health care providers to include contraception services for all intake assessments at juvenile detention facilities.

The Zika Contraception Access Network: a feasibility programme to increase access to contraception in Puerto Rico during the 2016–17 Zika virus outbreak

SummaryBackgroundPrevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. The Zika Contraception Access Network (Z-CAN) aimed to build a network of health-care providers offering client-centred contraceptive counselling and the full range of reversible contraception at no cost to women in Puerto Rico who chose to prevent pregnancy during the 2016–17 Zika virus outbreak. Here, we describe the Z-CAN programme design, implementation activities, and baseline characteristics of the first 21 124 participants.MethodsZ-CAN was developed by establishing partnerships between federal agencies, territorial health agencies, private corporations, and domestic philanthropic and non-profit organisations in the continental USA and Puerto Rico. Private donations to the National Foundation for the Centers for Disease Control and Prevention (CDCF) secured a supply of reversible contraceptive methods (including long-acting reversible contraception), made available to non-sterilised women of reproductive age at no cost through provider reimbursements and infrastructure supported by the CDCF. To build capacity in contraception service provision, doctors and clinic staff from all public health regions and nearly all municipalities in Puerto Rico were recruited into the programme. All providers completed 1 day of comprehensive training in contraception knowledge, counselling, and initiation and management, including the insertion and removal of long-acting reversible contraceptives (LARCs). Z-CAN was announced through health-care providers, word of mouth, and a health education campaign. Descriptive characteristics of programme providers and participants were recorded, and we estimated the factors associated with choosing and receiving a LARC method. As part of a Z-CAN programme monitoring plan, participants were invited to complete a patient satisfaction survey about whether they had obtained free, same-day access to their chosen contraceptive method after receiving comprehensive counselling, their perception of the quality of care they had received, and their satisfaction with their chosen method and services.FindingsBetween May 4, 2016, and Aug 15, 2017, 153 providers in the Z-CAN programme provided services to 21 124 women. 20 110 (95%) women received same-day provision of a reversible contraceptive method. Whereas only 767 (4%) women had used a LARC method before Z-CAN, 14 259 (68%) chose and received a LARC method at their initial visit. Of the women who received a LARC method, 10 808 (76%) women had used no method or a least effective method of contraception (ie, condoms or withdrawal) before their Z-CAN visit. Of the 3489 women who participated in a patient satisfaction survey, 3068 (93%) of 3294 women were very satisfied with the services received, and 3216 (93%) of 3478 women reported receiving the method that they were most interested in after receiving counselling. 2382 (78%) of 3040 women rated their care as excellent or very good.InterpretationZ-CAN was designed as a short-term response for rapid implementation of reversible contraceptive services in a complex emergency setting in Puerto Rico and has served more than 21 000 women. This model could be replicated or adapted as part of future emergency preparedness and response efforts.FundingNational Foundation for the Centers for Disease Control and Prevention.

Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007\u20132015

BackgroundAlthough Indonesia has relatively high contraceptive prevalence, postpartum family planning (PP-FP) has not been a particular point of emphasis. This article reports the results of analyses undertaken in order to (1) better understand levels and trends in unmet need for family planning among postpartum women, (2) assess the extent to which unmet need is concentrated among particular population sub-groups, and (3) assess the policy priority that PP-FP should have in relation to other interventions.MethodsThe analyses were based on data from the 2007 and 2012 Indonesia Demographic and Health Surveys (IDHS) and the 2015 PMA2020 survey. Postpartum contraceptive use and unmet need were analyzed for fecund women who had given birth in the 3–5 years of preceding the respective surveys who were in the extended postpartum period at the time of the respective surveys. Factors associated with contraceptive use and unmet were assessed via multivariable logistic regressions using merged data from all three surveys. A wide range of biologic, demographic, socio-economic, geographic and programmatic factors were considered.ResultsContraceptive use during the extended postpartum period is high in Indonesia, with more than 74% of post-partum women reporting currently using a family planning method in the 2015 PMA2020 survey. This is up from 68% in 2007 and 70% in 2012. Total unmet need was 28% in 2007, falling slightly to 23% in 2012 and 24% in 2015. However, the timing of contraceptive initiation is less than optimal. By six months postpartum, only 50% of mothers had begun contraceptive use. Unmet need was highest among older women, women with 4+ children, with limited knowledge of contraceptive methods, making fewer ANC visits, from poor families and residents of islands other than Java and Bali.ConclusionUnmet need for family planning among postpartum women in Indonesia is low in comparison with other low- and middle-income countries. However, because of limited durations of exclusive breastfeeding, many Indonesian women do not initiate contraception early enough after delivering children. Given already high contraceptive prevalence, targeting postpartum women for increased programmatic attention would seem strategically prudent.

A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder.

To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder. Retrospective chart review. Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults. Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N=123). None. Prescription contraceptive use at baseline and initiation of a new method within 90days. Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69). Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions.

Operation PINC: Process Improvement for Non-Delayed Contraception.

The Department of Defense is under intense scrutiny for the reported increased unintended pregnancy rate in active duty women. To minimize barriers to contraception and improve access to care for family planning needs, a novel full-service walk-in clinic for contraception was created. The objective of this study is to describe utilization of a walk-in contraceptive clinic including patient demographics, long-acting reversible contraception (LARC) initiation rates, projected cost savings, and patient satisfaction within the first 6 months of operation. This is a prospective cohort and quality improvement study of 2,207 women presenting to a same day full-service contraception clinic from February 1, 2016, to August 31, 2016. Patient volume, demographics of participants, type of contraceptive service provided, LARC initiation, and LARC removal rates were recorded prospectively. Outcomes were compared with the Student t-test or χ2 test as appropriate. The mean age of participants seen in the first 6 months was 25 years; 70% of attendees were active duty women and 88% were enlisted service members. LARC initiation increased from 12% to 39%. Operation PINC is a cost savings initiative, saving the Navy a potential $15 million a year and 2.7 million lost person-hours by preventing unintended pregnancy. Offering same day contraceptive services is a potential cost savings, patient satisfier, which targets women at risk for unintended pregnancy, improves LARC initiation, and has the potential to improve operational readiness of female service members and ultimately decrease unintended pregnancy rates.