Long-acting Reversible Contraception Knowledge Research Articles

Long-Acting Reversible Contraception Knowledge Among Female Adolescents Presenting to a Pediatric Emergency Department.

The objective of this study was to assess awareness and use of long-acting reversible contraception (LARC) among female adolescents presenting to a pediatric emergency department (PED). During routine presentation to an urban PED in New Jersey, female adolescents, aged 15-19 years, were asked to voluntarily complete an electronic survey about sexual practices and contraception. The PED is in an urban teaching hospital, treating 35,000 children annually. Patients could schedule a follow-up appointment at the hospital's obstetrics/gynecology clinic. Data were collected over 13 months, and follow-up was monitored to determine if they attended an outpatient appointment, and if so, what the outcome was. Data for 199 participants were analyzed. The median age of participants was 18 years, whereas 79% self-identified as Black, and 17.6% self-identified as Latina. Twenty-one percent of participants used a form of birth control during their first sexual encounter, the largest percentage being condoms (77.8%). Forty percent of participants reported some prior knowledge about contraceptive implants, and 20% had knowledge about intrauterine devices, whereas only 3 (1.5%) intrauterine devices and 2 (1%) arm implants had been previously used. Of the 78 participants that requested a follow-up, 14 (17.9%) completed their appointment. Of those, 2 (14%) were prescribed contraception (Depo-Provera shot and oral contraceptive pills). Knowledge about LARC remains low in our PED, despite it being the most effective method of contraception. Even when interventions were made to link interested respondents to outpatient women's health services, follow-up attendance was poor, and no patients obtained LARC. There is a significant discrepancy between the consensus standard of contraception care across all relevant medical specialties and current utilization by high-risk populations. Future efforts must focus on how to close this gap, and the ED could be pivotal for improving both reproductive health education and intervention among adolescent patients.

The Effect of a Decade Implemented Project in Improving the Uptake of Comprehensive Contraception: Difference-In-Difference Analysis.

Promotion and use of family planning in countries with high birth rates have the potential to avert a third of all maternal deaths and nearly a tenth of childhood deaths. To support government efforts in creating wider access to comprehensive contraceptive methods, EngenderHealth has contributed to the government of Ethiopia's long-term goal of improving maternal health outcomes through its Access to Better Reproductive Health Initiative project. Difference-in-Difference approach is the main methodology in this analysis to estimate the "contribution" or "effect" of the ABRI intervention by comparing the changes in family planning outcomes from 2005 to 2016 between the ABRI and non-ABRI areas. This analysis was based on pooled data from the 2005 and 2016 Ethiopian Demographic and Health Surveys. To track temporal changes in the family planning indicators in the ABRI and non-ABRI areas, we employed simple trend analysis. The results show that overall contraceptive prevalence rate, use of injectables, women's knowledge of Long-Acting Reversible Contraception (LARC) methods, and their exposure to family planning information/messages from health workers all significantly improved in the ABRI intervention areas beyond what occurred in the non-ABRI areas. The greatest increase in the use of modern contraception was among adolescents aged 15-19 years, with a DID estimate of 22.4% (p=0.007), ABRI areas compared to no-ABRI areas. In the ABRI areas, family planning indicators recorded positive and significant changes. EngenderHealth has contributed its part in improving access to the uptake of comprehensive contraception and supporting government programs.

153. Outpatient Pediatricians' Current Practice and Knowledge of Long-Acting Reversible Contraception

153. Outpatient Pediatricians' Current Practice and Knowledge of Long-Acting Reversible Contraception

Expanding contraceptive choice among first-time mothers age 15-24 in Kinshasa: The Momentum pilot project.

Evidence shows that an expanded range of contraceptive methods, client-centered comprehensive counseling, and voluntary informed choice are key components of successful family planning programs. This study assessed the effect of the Momentum project on contraceptive choice among first-time mothers (FTMs) age 15-24 who were six-months pregnant at baseline in Kinshasa, Democratic Republic of the Congo, and socioeconomic determinants of the use of long-acting reversible contraception (LARC). The study employed a quasi-experimental design, with three intervention health zones and three comparison health zones. Trained nursing students followed FTMs for 16 months and conducted monthly group education sessions and home visits consisting of counseling and provision of a range of contraceptive methods and referrals. Data were collected in 2018 and 2020 through interviewer-administered questionnaires. The effect of the project on contraceptive choice was estimated using intention-to-treat and dose-response analyses, with inverse probability weighting among 761 modern contraceptive users. Logistic regression analysis was used to examine predictors of LARC use. Project effect was detected on receipt of family planning counseling, obtaining the current contraceptive method from a community-based health worker, informed choice, and current use of implants vs. other modern methods. There were significant dose-response associations of the level of exposure to Momentum interventions and the number of home visits with four of five outcomes. Positive predictors of LARC use included exposure to Momentum interventions, receipt of prenatal counseling on both birth spacing and family planning (age 15-19), and knowledge of LARCs (age 20-24). The FTM's perceived ability to ask her husband/male partner to use a condom was a negative predictor of LARC use. Given limited resources, expanding community-based contraceptive counseling and distribution through trained nursing students may expand family planning access and informed choice among first-time mothers.

Reasons of Refusal to Long Acting Reversible Contraception (LARC) on Reproductive Age Women: a Scoping Review

Abstract: Contraception is essential in reproductive health service. Through proper contraception, various risks related to pregnancy and birth can be avoided. Long acting reversible contraception (LARC) is deemed as the most efficient contraceptive metod. However, it faces significant refusal among women worldwide. This study aimed to determine the reason of LARC refusal among reproductive age women. A scoping review was done using a guideline from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) on studies performed on Asian developing countries. The results showed that a total of seven articles were analyzed. The most common reason for LARC refusal was the disagreement of husband or other family members. Prior knowledge of LARC might increase the acceptance of LARC. In conclusion, since the most common reason for LARC refusal was the disagreement of husband or other family members, education of LARC method on pregnant women, their spouses, and their families is essential to reduce that rate of LARC refusal.Keywords: contraception; long acting reversible contraception; refusal

What Does He Think? Male Knowledge and Attitudes Regarding Long-Acting Reversible Contraception.

Contraceptive counseling, especially regarding long-acting reversible contraception (LARC), has generally been directed at women. However, male partners and peers may influence contraceptive decision making. As there were no published studies examining male perceptions of LARC in the United States, this study investigated male knowledge and attitudes regarding LARC. An anonymous electronic cross-sectional survey collecting qualitative and quantitative data was administered from May to September 2018. Participants were recruited via university e-mail listservs and in-person at a campus student organization fair at the University of Illinois at Chicago in Chicago (UIC), Illinois. University students identifying as male and 18-24 years of age. None. Knowledge of LARC, perceptions of LARC, interest in learning about LARC. Participants (n=97) were predominantly heterosexual (83.5%) men. Of those who were sexually active (63.9%), 98.4% reported female partners trying to avoid pregnancy. The most commonly used methods of contraception were oral contraceptive pills (48.4%) and/or condoms (80.6%). The majority (76.3%) of participants had not heard of LARC. Absence of prior LARC use by a partner was associated with knowledge deficits about LARC (odds ratio=0.26, 95% confidence interval=0.70-1.00); however, this association was not seen with other contraceptive methods. Participants familiar with LARC were generally neutral to very supportive of LARC (87.0%). Additionally, 80.4% of participants were interested in learning more about LARC. Males 18-24 years of age had limited knowledge of LARC, with an interest in learning more about LARC. This information could shape interventions to bridge knowledge gaps, ultimately helping women to make supported contraceptive choices.

Knowledge and Attitudes About Sterilization and Long-Acting Reversible Contraception.

To describe understanding of the irreversible nature of permanent contraception and knowledge and attitudes about long-acting reversible contraception (LARC) among individuals seeking and not seeking permanent contraception. We performed a cross-sectional survey among patients with Medicaid insurance attending an obstetrics and gynecology clinic in [location]. The survey consisted of 20 true/false and Likert questions assessing knowledge and perceptions about permanent contraception and LARC. Sixty-seven participants were needed to detect a small-to-medium Cohen's effect size f2 = 0.20, with 95% power and alpha = 0.05. Ninety potential participants were contacted and 67 were recruited. Forty-three participants desired permanent contraception and 24 did not. Approximately half of all participants were not aware that permanent contraception is irreversible. Participants who desired permanent contraception had lower LARC knowledge scores (62% correct versus 70%, p = 0.042) and more negative perceptions about LARC (54% versus 38%, p = 0.048). Fewer participants desiring permanent contraception identified LARC efficacy as equal to permanent contraception (32% versus 83%, p < 0.01), and fewer would consider using LARC (intrauterine device: 23% versus 58%, p < 0.01; implant: 16% versus 46%, p < 0.01). These differences persisted in multivariable models adjusting for age, gravidity, and parity. Individuals who desire permanent contraception may not be aware of its permanence, or of equally effective alternatives. They were also found to have more negative perceptions of LARC in our sample. Additional research is needed to understand factors underlying these differences. Counseling practices should be tailored to ensure accurate knowledge about permanent contraception and LARC for all people seeking to avoid pregnancy.

Improving Knowledge of Long-Acting Reversible Contraception in an Adolescent and Young Adult Female Population

ObjectiveTo improve adolescent and young adult clients’ knowledge of long-acting reversible contraception (LARC) methods by standardizing the education they received at an outpatient clinic. DesignThe Plan-Do-Study-Act was used as a framework to implement and evaluate a practice change aimed at improving the contraceptive education provided to adolescent and young women. Setting/Local ProblemThis single-center quality improvement project took place at a community-based clinic in the Northeastern United States where clinicians’ practice for contraceptive counseling lacked use of a standardized educational tool. ParticipantsThirty female participants between the ages of 14 and 25. Intervention/MeasurementsA pre- and postintervention survey was used to assess participants’ knowledge of LARC methods after viewing an online video. A focus group of clinicians was held to assess their thoughts on the use of the video education. ResultsSurvey results indicated improved knowledge of participants on all six knowledge points assessed in the survey. Focus group feedback indicated the video education was considered sustainable and desired by clinicians for an additional year and Plan-Do-Study-Act cycle. ConclusionOnline, video-based education may be an effective and sustainable way to provide adolescent and young adult clinic clients with evidence-based information on LARC methods to help them make informed decisions about contraception.

Improving Access to Immediate Postpartum LARC: A Quality Improvement Project [15J

INTRODUCTION: Access to immediate postpartum long acting reversible contraception (LARC) can aid in pregnancy spacing and avoidance of complications associated with unintended and short interval pregnancies. Comprehensive prenatal counseling includes the full spectrum of contraceptive options, ideally available regardless of ability to pay. METHODS: A multidisciplinary team including representatives from pharmacy, billing, coding, nursing, and the OB/GYN department was created to implement an immediate PP LARC program at a community/academic hospital without access to grant funding. Baseline provider knowledge of immediate postpartum LARC was determined via a department wide survey. Education was then provided via didactic lectures and simulated post-placental IUD placement. Billing and coding terms were clarified for inpatient use of copper containing IUD, levonorgestrel-releasing IUD, and etonogestrel implant. Patient counseling and inpatient documentation templates were created for provider use. RESULTS: Based on survey results, provider knowledge of LARC improved after didactic education and simulation training. Within the first 3 months of implementation (4/16/19 to 7/31/19), 42 inpatient LARCs were provided. Of these, 69% were IUDs and 31% were implants. Data collection is ongoing and seeks to determine the impact of this implementation on adolescent and short interval pregnancy rates. CONCLUSION: It is feasible to implement an immediate postpartum LARC program in less than one year when utilizing a multidisciplinary approach. While grant funding is not necessary for the provision of this service to patients with medical assistance, ongoing quality improvement will necessitate advocacy at a state level in order to provide inpatient coverage for women with private insurance.

Foreign objects in college bodies: young women’s feelings about long-acting reversible contraception (LARC)

ABSTRACT Long-acting reversible contraceptives (LARC) are now recommended for use among nulliparous young women to prevent unintended pregnancy. While research has explored LARC knowledge, attitudes, and use among young women in the United States, college women’s feelings about LARC have received limited attention. This article reports findings from a focus group study conducted with a convenience sample of 45 women, ages 18–25 years, enrolled in a large public university in the southeastern USA in April 2017. Focus groups combined LARC users and non-users and elicited a range of positive and negative affective responses to LARC. Some participants had an aversion to LARC because they perceived them to be unnatural, while others felt a sense of security because of their long-term effectiveness. Feelings about the location and mode of insertion for the intrauterine device (IUD) versus the implant played a significant role in the decision to use a specific LARC method: some found being able to feel the implant in their arm reassuring, while others found it disturbing and preferred the IUD. College-going LARC users also appear to be effective advocates for LARC use among their peers.

How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement.

Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement. To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed. We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests. A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs. Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.

Long-acting reversible contraception knowledge, attitudes and use among HIV-infected and -uninfected women and their providers

Objective(s)To describe differences in contraceptive knowledge, attitudes and use among HIV-infected and HIV-uninfected women served by an academic medical center in New York City and to describe gaps in knowledge and practice of gynecologic and HIV clinicians providing care at the same clinic sites where patients completed surveys. Study designWe conducted a survey comparing contraceptive knowledge, attitudes, reproductive histories and long-acting reversible contraception (LARC) use in HIV-infected and -uninfected women. We also conducted a survey to elicit clinician demographic characteristics and education, contraceptive practice patterns and their knowledge of current contraceptive guidelines. We surveyed clinicians and patients at five ambulatory sites. ResultsWe screened 90% of patients approached. All 257 women who were eligible completed a survey. These included 107 (42%) HIV-infected women and 150 (58%) HIV-uninfected women. HIV-infected women were older, were more likely to be black/African-American, were less likely to be Latina, were more likely to receive public assistance and had lower educational attainment. HIV-infected women reported lower lifetime LARC use (12% vs. 28%) and higher recent condom use (58% vs. 25%) than HIV-uninfected women. Both groups reported similar attitudes toward intrauterine devices (IUDs) and implants. HIV clinicians were less likely to have had training in or discuss LARC methods with their patients. ConclusionsHIV-infected women were less likely to be current (last 30 days) or ever LARC users, despite having similar attitudes toward IUDs and implants, compared to HIV-uninfected women. HIV providers had lower levels of knowledge of HIV-specific contraceptive guidelines compared with gynecology practitioners. ImplicationsHIV-infected women and their providers share a knowledge gap regarding LARC. Increased interdisciplinary collaboration may help mitigate the resulting disparities in access to highly effective contraception in HIV-infected women. Knowledge of HIV-specific contraceptive guidelines and ability to place contraceptive implants were low among all surveyed providers, suggesting need for additional training.

Assessing Delaware Parents’ Knowledge, Attitudes and Preferences About Long Acting Reversible Contraceptives for Teens Using Participatory Action Research

OBJECTIVETo decrease barriers to long-acting reversible contraception (LARC) for teens, this study aimed to reveal knowledge, attitudes, and beliefs that parents have about LARC. METHODS: A participatory action research approach was used. We recruited a diverse group of community researchers who participated in all phases of our study. Four focus groups were recruited using snowball sampling. Two researchers used a values coding process to code data independently. The team met to identify emerging themes. RESULTS: The 46 parents were predominately female and ethnically diverse. Preventing teen pregnancy was salient although a double standard between parents of boys and girls became apparent. A key theme that emerged was the importance of prevention of sexually transmitted infections (STIs). There were some reservations about LARC provision in school-based health centers. Another theme was the need for access to confidential birth control for other teens but not for their own teens. Lastly, the advantages of LARC mentioned were effectiveness and ease of use. The disadvantages were increased STIs, risky behavior, hormonal changes, and side effects. CONCLUSION: Most of the parents in our study had limited knowledge of LARC. They were aware of its benefits but were uneasy about actual and perceived side effects.

Video Media in Clinic Waiting Areas Increases Interest in Most Effective Contraceptive Methods.

To examine the utility of a patient-level information video as part of the contraception consultation visit. Specifically, to assess the impact of the video on women's contraception choice, and, further, to assess patient and provider acceptability of incorporating the video into the patient visit. A pre-post study design was used to assess the impact on patients' contraceptive choices and knowledge. Participants (n = 49) answered questions regarding contraceptive preferences and knowledge of long-acting reversible contraception (LARC), then watched a 12-minute patient-level counselling video that presented evidence-based information about contraception in descending order of effectiveness. Clinicians (n = 39) also viewed the video and completed a survey. A retrospective chart review of 100 contraception visits was completed. Patient preference for IUDs increased significantly, whereas condoms decreased pre-to-post video (hormonal: 8.2% to 20.4%; copper: 0% to 16%; condoms: 32.7% to 18%, P < 0.05). Although 74.4% of clinicians believed that the hormonal IUD was the "ideal" form of contraception when no contraindications were present, 95% stated that the oral contraceptive pill was most often prescribed, and a chart review revealed that the oral contraceptive pill was discussed at 88% of contraceptive counselling visits. Both patients and clinicians found the video useful and acceptable. A patient-level contraceptive information video improved interest in LARC. Both patients and clinicians viewed the video as an acceptable addition to the contraceptive counselling visit.

Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries

ObjectiveTo identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico). Study designWe analyzed baseline data of 7049 women of childbearing age (15–49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013). ResultsWomen in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59–0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58–0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39–0.64). Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility (OR 1.64, CI: 1.13–2.36). ConclusionsOur study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities. Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use. ImplicationsWe show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need.

Association between contraceptive implant knowledge and intent with implant uptake among postpartum Malawian women: a prospective cohort study.

BackgroundLong-acting reversible contraception (LARC) can assist women with birth spacing and reduce unintended pregnancies. Sub-Saharan Africa has low uptake of the two available methods of LARC, the subdermal implant and intrauterine contraception (IUC). Our primary objectives were to: 1) calculate the incidence of LARC use among postpartum Malawian women, and 2) assess if LARC knowledge and intent to use LARC were associated with LARC uptake.MethodsThis study was a prospective cohort study of 634 postpartum women who were recruited from the postpartum ward of Bwaila Hospital in Lilongwe, Malawi. Study participants completed a baseline survey in the postpartum ward. Follow-up telephone surveys about contraceptive use were conducted at 3, 6, and 12 months postpartum. Cox proportional hazards regression analysis was performed to evaluate if implant knowledge and intent to use implant were associated with implant uptake.ResultsOne hundred thirty-seven implant and 10 IUC placements were reported over 12 months of follow-up; given the low rate of IUC uptake, further analysis was only done for implant uptake. The incidence rate for implant uptake was 35.6 per 100 person-years (95 % CI 30.0, 42.2). Correct implant knowledge (adjusted HR = 1.69; 95 % CI 1.06, 2.68) and intent to use implant (adjusted HR 1.95; 95 % CI 1.28, 2.98) were both associated with implant uptake.ConclusionsMore women reported implant use than IUC use in our study. Correct implant knowledge and intent to use implant were both associated with implant uptake, with a stronger association for intent. Interventions to increase LARC uptake should focus on improving LARC knowledge and removing barriers to LARC.Trial registrationClinical Trial Registration #: NCT01893021

“I don't know enough to feel comfortable using them:” Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus

ObjectiveTo assess multiple dimensions of long-acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. Study DesignWe conducted an Internet-based study of 1982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women's understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate and linear regression statistics. ResultsFew college women had used (5%) or heard of (22%) LARC, and most self-reported “little” or “no” knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0–20), and scores differed across sociodemographic groups (p values<.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation and contraceptive history. Perceived barriers to IUDs included the following: not wanting a foreign object in body (44%), not knowing enough about the method (42%), preferring a “controllable” method (42%), cost (27%), and not being in a long-term relationship (23%). Implant results were similar. “Not knowing enough” was women's primary reason for IUD (18%) and implant (22%) nonuse. ConclusionLack of knowledge (both perceived and actual) was the most common barrier among many perceived individual-, systems- and community-level factors precluding these college women's LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability and uptake of LARC on campuses. ImplicationsLack of knowledge of IUDs and implants served as a primary barrier to highly effective contraceptive use among these college women. Comprehensive, patient-centered and multi-level educational public health strategies are needed to promote positive campus climates around LARC and improve family planning outcomes among this substantial reproductive-aged population.

Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study.

BackgroundAustralia has high rates of teenage pregnancy compared with many Western countries. Long-acting reversible contraception (LARC) offers an effective method to help decrease unintended pregnancies; however, current uptake remains low. The aim of this study was to investigate barriers to LARC use by young women in Australia.MethodsHealthcare professionals were recruited through publicly available sources and snowball sampling to complete an interview about young women’s access to and use of LARC. The sample consisted of general practitioners, nurses, medical directors of reproductive and sexual health organisations, a sexual health educator, and health advocates. In addition, four focus groups about LARC were conducted with young women (aged 17–25 years) recruited via health organisations and a university. The data were analysed thematically.ResultsFifteen healthcare professionals were interviewed and four focus groups were conducted with 27 young women. Shared barriers identified included norms, misconceptions, bodily consequences, and LARC access issues. An additional barrier identified by young women was a perceived lack of control over hormones entering the body from LARC devices. Healthcare professionals also raised as a barrier limited confidence and support in LARC insertions. Strategies identified to increase contraceptive knowledge and access included increasing nurses’ role in contraceptive provision and education, improving sex education in schools, and educating parents.ConclusionsChallenges remain for young women to be able to make informed choices about contraception and easily access services. More research is needed around innovative approaches to increase LARC knowledge and access, including examining the role of nurses in enhancing young women’s reproductive health.

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% vs. 37%, p = 0.004). Nearly all women (97%) did not want a child in the next 2 years, but HIV-infected women were more likely to desire no more children (adjusted prevalence ratio [PR]: 1.59; 95% confidence interval [CI]: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR: 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR: 0.83; 95% CI: 0.75, 0.92) are safe during breast-feeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breast-feeding may facilitate postpartum use.