Long-acting Contraception Research Articles

Awareness, attitude, and acceptance of post placental intra uterine contraceptive device (PPIUCD) among women in Jordan.

To assess the awareness, attitude, and acceptance of the Post Placental Intra Uterine Contraceptive Device (PPIUCD) as an immediate long-acting contraceptive method among Jordanian women. A cross-sectional observational study was conducted at King Abdulla University Hospital among women attending antenatal clinics after 20 weeks of gestation between January 2020 and May 2021. One thousand and 30 women had completed a structured questionnaire in Arabic. Only 41.4% of the sample was aware of the PPIUCD. The attitude toward PPIUCD after a brief introduction was 56.3%. Women who had used interval IUCD were 5.82 times more likely to express a positive attitude toward PPIUCD, while postgraduate women were 1.35 times more prone to show the same attitude. Only 34% accepted PPIUCD if offered, whereas the main barrier to acceptance was the false fear of extra complications in 34.5% of the sample. The rate of unintended current pregnancy was 35.8%, where 53.4% were using natural methods. The rate of awareness of PPIUCD is low among women in Jordan. Antenatal introduction encourages attitude toward PPIUCD.

A pioneer of hormonal contraception: Joseph W. Goldzieher.

On 19 July, 2024, at the age of almost 105 years, Joseph W. Goldzieher, the last survivor of the group of pioneers who created oral contraception, peacefully passed away. Here we briefly reconstruct the salient points in his long, productive life, and highlight his achievements in the development of hormonal contraception. His work is indissolubly enshrined in the complex history of hormonal contraception, from the first, fundamental observations, to the first clinical trials, both in the form of combined oestrogen-progestin oral pills and long-acting injectable contraceptives. After Pincus and his Group created an oral contraceptive containing an oestrogen and a progestin, Goldzieher was the second international scientist to conduct clinical trials of the new modality. He teamed-up with investigators in Mexico creating a fruitful, long-lasting collaboration. They produced evidence that ovulation inhibition could be achieved with all the progestins used at the time. Of importance, he was among the first to explore the possibility of using oestrogens to block ovulation, and developed the concept of sequential contraception. For all this lifetime of work, we believe he deserves to be named a 'giant in reproductive endocrinology'.

Potential determinants of early discontinuation of Etonogestrel implant: a cohort prospective study.

To assess the frequency of early discontinuation of Implanon as a method of contraception. The cohort prospective study was conducted at the Obstetrics and Gynaecology Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq from January 2017 to January 2021, after approval from the ethics review committee of the College of Medicine, Al-Mustansiriyha University, Bghadad, Iraq, and comprised women of childbearing age seeking long-acting contraception. The participants received Implanon, an etonorgestril implant, under local anaesthesia, and were followed up for 12 months for possible side effects. Data was analysed using SPSS 26. There were 115 women with mean age 29.8±6 years (range: 15-44 years) and mean body mass index 27±4.9 kg/m2. Early discontinuation of the plant was done by 32(27.8%) subjects, and the overall incidence of early Implanon removal per 1,000 women per month was 14.47 (95% confidence interval: 10.24-20.47). Lower body mass index, dizziness and insertion-site side effects were the potential determinants of early discontinuation (p<0.05). More than a quarter of the sample opted for early Implanon discontinuation. Low body mass index, dizziness and insertion-site side effects were potential determinants of early removal.

Predictors of long-acting contraceptive utilization hot spots in Ethiopia: using geographical weighted regression analysis.

The use of long-acting contraceptives is a common health challenge in Ethiopia. Therefore, the current study aimed to assess the determinants of using long-acting contraceptive hot spots in Ethiopia using data from the Ethiopian Mini Demographic and Health Survey for 2019. This study used data from the Ethiopia Mini Demographic and Health Survey 2019 and included a total weighted sample of 8,885 women in the analysis. The geographical variation of long-acting contraceptive usage was initially observed using hot spot analysis. Arc GIS version 10.7 was used for geographically weighted regression. Ordinarily, least squares regression was performed to identify predictors that explain the geographical variation in the use of long-acting contraceptives. Geographic weighted regression was used to predict the hot spot area of long-acting contraceptive methods. The overall prevalence of long-acting contraceptive utilization use was 6.9% (95% confidence interval: 6.4-7.45). Most of the statistically significant hot spots for long-acting contraceptives were found in lactated areas of the Oromia part of Amhara and Dire Dawa. Primary education, followers of the Muslim religion, marital status, and women with >4 children were the determinants of spatial variation use of hot spot areas for long-acting contraceptive methods. A detailed map of long-acting contraceptive use hot spots and their determinants will enable decisions to target their sociodemographic-related predictors of women.

A Review of Concordance and Quality in Clinical Guidelines for Hormonal Contraceptives to Mitigate Drug-Drug Interactions in Women With Epilepsy.

Concomitant use of hormonal contraceptive agents (HCAs) and enzyme-inducting antiepileptic drugs (EIAEDs) may lead to contraceptive failure and unintended pregnancy. This review identified and evaluated concordance and quality of clinical treatment guidelines related to the use of HCAs in women with epilepsy (WWE) receiving EIAEDs. Relevant clinical guidelines were identified across four databases and were independently evaluated for quality utilizing the AGREE-II protocol instrument. Quality in this context is defined as the rigor and transparency of the methodologies used to develop the guideline. Guidelines were further assessed in terms of concordance and discordance with the latest body of knowledge concerning the use of hormonal contraception in the presence of EIAEDs. A total of n = 5 guidelines were retrieved and evaluated. Overall guideline scores ranged from 17% to 92%, while individual domain scores ranged from 0% to 100%. Contraceptive guidelines consistently recommended the use of intrauterine systems and long-acting injectables in the presence of EIAEDs, recommended against the use of oral, transdermal, and vaginal ring contraceptives, and differed regarding recommendations related to implants. Guidelines agreed regarding recommendations that women treated with EIAEDs should receive intrauterine systems and long-acting injectables; however, the suggested frequency of administration of injectable contraceptives differed. The use of intrauterine systems in this population is supported by evidence, but there is uncertainty surrounding the use of long-acting injectables and contraceptive implants. To mitigate the risk of unintended pregnancy and its consequences, recommendations related to implants and long-acting injectable contraceptives should be evidence-based.

Two years in a post- Dobbs world: clinical, social and professional consequences.

Dobbs v Jackson Women's Health Organization revoked the decades-old precedent that pregnancy termination is a constitutional right. This review article explores the research landscape describing the consequences of overturning Roe v Wade for patients and providers. To date, fourteen states have enforced total bans on abortion, with seven more restricting abortion access to levels not seen since before Roe. Dobbs has had immediate and swift consequences from clinical, social and professional perspectives, with increases in maternal mortality and demand for long-acting and permanent contraception, matched by declines in both access to methotrexate and applications to Obstetrics & Gynecology training programs. Eighteen million patients now live in states where abortion access is highly if not completely inaccessible. Abortion restrictions have profound implications beyond those desiring pregnancy termination; future research should continue to explore the ways Dobbs has affected clinical care, public health and social practices.

Decomposition analysis of racial and ethnic differences in receipt of immediate postpartum, long-acting, reversible, and permanent contraception

ObjectivesThis study aimed to determine the factors contributing to racial and ethnic disparities in the use of immediate postpartum, long-acting reversible contraception (IPP LARC) and permanent contraception among Medicaid recipients. Study designWe conducted a cross-sectional study using 3 years of national Medicaid claims data to examine the rates of IPP LARC use alone and a composite measure of postpartum permanent contraception and IPP LARC within 7 days of delivery by race and ethnicity. We used a Blinder–Oaxaca model to quantify the extent to which medical complexity, age, rurality, mode of delivery, and year explained differences in outcomes among different minoritized groups in comparison to non-Hispanic White women. ResultsOur study sample contained 1,729,663 deliveries occurring from 2016 through 2018 among 1,605,199 people living in 16 states. IPP LARC use rates were highest among Black (2.2%), followed by American Indian and Alaska Native at 2.1% and Hawaiian/Pacific Islander beneficiaries at 1.9%, Hispanic (all races) at 1.2%, and Asian at 1.0%. IPP LARC was lowest among White beneficiaries (0.8%). Medical complexity, age, rurality, year, and mode of delivery explained only 12.3% of the difference in IPP LARC rates between Black and White beneficiaries. Postpartum permanent contraception was highest among White (7.6%), Hispanic (7.2%), and American Indian and Alaska Native (6.8%), followed by Black (6.3%), Hawaiian/Pacific Islander (5.1%) and lowest among Asian women (4.1%). When we examined the use of IPP LARC or postpartum permanent contraception together, these same factors explained 94.4% of the differences between Black and White beneficiaries. ConclusionsWhile differences in the use of IPP LARC by race and ethnicity were identified, our findings suggest that overall use of inpatient highly effective contraception are similar across racial and ethnic groups. ImplicationsWhen IPP LARC and postpartum permanent contraception are examined jointly, their use is similar across racial and ethnic groups.

Health care and contraceptive decision-making autonomy and use of female sterilisation among married women in Malawi.

Female sterilisation is the most common contraceptive method used globally. The use of female sterilisation is disproportionately low in sub-Sahara Africa (SSA) at just 1%. Nonetheless, the prevalence of sterilisation among married women in Malawi is quite high at about 11%. While a few recent studies in SSA have examined the relationship between women's decision-making autonomy and use of long-acting contraceptives, very few have investigated whether different dimensions of decision-making autonomy predict the use of female sterilisation differently. The objective of this study was therefore to examine the relationship between health care and contraceptive decision-making autonomy and the use of female sterilisation in Malawi. The study relied on secondary data from the 2015-16 Malawi Demographic and Health Survey. The sample comprised 9,164 married women in Malawi that were using a modern contraceptive. Multinomial logistic regression analysis was used to examine the association between health care and contraceptive decision-making autonomy and the use of female sterilisation, controlling for key socio-demographic characteristics. The study revealed that the percentage of married women that made health care and contraceptive decisions independently was quite low. The main finding of this study was that contraceptive decision-making autonomy increased the relative likelihood of using female sterilisation while health care autonomy was associated with a lower likelihood of being sterilized. The socio- demographic characteristics that significantly predicted the use of female sterilisation included age, place of residence, household wealth and the number of children a woman had. This study demonstrates that health care and contraceptive decision making have different effects on the use of female sterilisation among married women in Malawi. Specifically, women with autonomy in health care decision making had a relatively lower likelihood of using female sterilisation while those with contraceptive decision-making autonomy had a higher likelihood of using female sterilisation. This suggests that intervention aimed at increasing the uptake of female sterilisation in Malawi need to focus on empowering women in the contraceptive decision-making domain.

ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study.

In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.

Determinants of postpartum long-acting reversible contraceptives in the extended postpartum period in Shashago district, Central Ethiopia: a cross-sectional study conducted in the community

BackgroundWomen who fail to initiate contraceptive use within the first year after childbirth face an increased likelihood of experiencing unintended pregnancies in close succession. In regions with limited resources, the use of postpartum contraceptives, particularly long-acting reversible contraceptives, remains notably low. Consequently, this study sought to assess the prevalence and determinants of postpartum long acting reversible contraceptives in the extended postpartum period in the Shashago district, Central Ethiopia.MethodsThis study employed a community-based cross-sectional design, conducted between March 1, 2021, and April 15, 2021, involving a total of 617 women of reproductive age. The selection of study participants was performed using a multistage stratified sampling technique. Data collection was carried out through the use of a structured interviewer-administered questionnaire. Subsequently, the collected data were entered into Epi-data version 3.1 and exported to SPSS version 25 for further analysis. Bivariate and multivariable logistic regression analyses were conducted, and statistical significance was determined using a P value of 0.05, along with adjusted odds ratios (AORs) and their corresponding 95% confidence interval (CI).ResultsA total of 224(36.3%) women used long-acting contraceptives after giving birth. Among these women, 31.1% used Implanon, while 5.2% used an intrauterine device (IUD). Factors significantly associated with the use of long-acting contraceptives after childbirth included age 25–29 years (AOR: 1.8, 95% CI: 1.1-3.0), age ≥ 35 years (AOR = 8.7, 95% CI: 3.6–21.5), primary education (AOR = 3.3, 95% CI: 1.6–6.7), secondary education and above (AOR = 3.5, 95% CI: 1.5–8.3), and history of abortion (AOR = 2.7, 95% CI: 1.3–5.4). Additionally, having good knowledge of long-acting contraceptives after childbirth (AOR: 2.4, 95% CI: 1.5–3.9) was significantly associated with their use.ConclusionThis study revealed that a small number of women opt for long-acting contraceptives after childbirth, with Implanon being more popular than IUDs. Factors such as age, education level, abortion history, pregnancy counseling, and knowledge about long-acting contraceptives were linked to their usage. Integrating contraceptive counseling into routine antenatal and postnatal care is essential for ensuring access to postpartum contraception. Tailored interventions based on age and education level could also help promote long-acting contraceptive use. More research and targeted interventions are needed to overcome these barriers and improve access to these methods for postpartum women.

Evaluating Contraception Counseling and Desire for Immediate Postpartum Long-Acting Contraception in Publicly Insured Adolescents [ID 2683512

INTRODUCTION: Adolescent pregnancy is associated with a high prevalence of short interval birth and unplanned pregnancy, along with other risks. Immediate postpartum long-acting reversible contraception (IPP LARC) has the potential to improve these outcomes. This study aimed to examine the presence of counseling, desire, and obtainment of IPP LARC during hospitalization. METHODS: This retrospective cohort analysis used electronic health records to capture demographics, pregnancy details, and contraceptive discussions and plans for pregnant patients admitted for delivery in one East Tennessee hospital. Exclusion criteria included those with private insurance or received permanent sterilization during hospitalization. Adolescence was defined as age less than 20 years at the time of delivery. Data were extracted from March 2018 to June 2023. Chi-squared tests were conducted in SPSS. RESULTS: 10,492 patients that met inclusion criteria delivered between March 2018 and June 2023. Of these, 10.8% (n=1,128) were adolescents. Desire for IPP LARC upon admission was higher among adolescents (31.6% versus 25.1%; P&lt;.001). IPP LARC placement was significantly higher among adolescents (overall, 24.0% [n=2,523]; adolescents, 27.5%, versus age 20 and older, 23.6%; P=.005). Adolescents who self-reported receiving contraceptive counseling during prenatal care were more likely to receive IPP LARC (66.5% versus 42.4%; P&lt;.001). CONCLUSION: In this study, prenatal contraception counseling increased patient obtainment of desired postpartum contraceptive plan, including IPP LARC. Adolescents both desired and obtained IPP LARC more frequently than their older counterparts. Improved contraceptive counseling and access to all contraceptive options, including IPP LARC, may improve teen pregnancy and birth rates.

Assessing Pregnant Patients' Postpartum Contraceptive Plans After the SCOTUS Dobbs Decision in a Highly Restrictive State [ID 2683439

INTRODUCTION: The June 2022 SCOTUS Dobbs decision removed federal protection to abortion access. In August 2022, a Tennessee trigger law made ending a pregnancy for any reason a felony. We hypothesized that this change would result in more pregnant patients desiring highly effective (long-acting or permanent) contraceptive methods after delivery. METHODS: This retrospective cohort analysis used electronic health records to capture demographic and pregnancy data for pregnant patients admitted for delivery in one East Tennessee hospital. Documented contraceptive plans chosen during pregnancy were categorized as highly effective (long acting or permanent) or moderate/least effective. Data were extracted from July 2019 to April 2020 (baseline) and compared to July 2022 to April 2023 (post-Dobbs). Chi-squared tests and binary logistic regression were conducted in SPSS. RESULTS: One-half (50.6%) of 7,489 records analyzed were post-Dobbs; 90.4% had a documented contraception plan upon hospital admission. Record of choosing a highly effective contraception plan during pregnancy decreased significantly baseline to post-Dobbs (47.2% to 39.6%; P&lt;.001). Logistic regression was used to further analyze the relationship between the Dobbs decision and highly effective contraception plan desired postpartum. Patients who delivered after the Dobbs decision had lower odds (adjusted odds ratio 0.726; 95% CI [0.652, 0.809]; P&lt;.001) of having highly effective contraception plans after controlling for age, number of living children, race/ethnicity, and insurance. CONCLUSION: A lower percentage of patients from the post-Dobbs cohort desired highly effective contraception after delivery. Further investigation should explore these surprising results. Regardless, patients should participate in patient-centered contraceptive counseling during prenatal care to make informed decisions after delivery.

A 5-Year Audit of the Use of Sub-dermal Contraceptive Implants in a Teaching Hospital in Ekiti State, Nigeria

A 5-Year Audit of the Use of Sub-dermal Contraceptive Implants in a Teaching Hospital in Ekiti State, Nigeria

Pengaruh Media Booklet dan Audio Visual terhadap Pengetahuan Akseptor KB tentang Kontrasepsi Jangka Panjang di Wilayah Bogor Utara Tahun 2023

Long-acting contraception is one effective method of family planning. However, sufficient knowledge about long-acting contraception is still low among birth control acceptors in the North Bogor Region. Therefore, this study aims to investigate the effect of the use of booklet and audio-visual media on the knowledge of birth control acceptors regarding long-term contraception in the region. The purpose of this study was to evaluate whether the use of booklet and audio-visual media can increase the knowledge of family planning acceptors about long-term contraception in the North Bogor Region. This study used a pseudo-experimental design with a control group pretest-posttest design. The study sample consisted of 100 KB acceptors selected by purposive sampling and divided into two groups, namely the experimental group that received intervention using booklet and audio-visual media, and the control group that did not receive the intervention. The study data were collected through knowledge questionnaires before and after the intervention. Data analysis was performed using independent t-test and t-paired test. The results showed that there was a significant increase in knowledge of birth control acceptors after receiving interventions using booklet and audio-visual media. The experimental group showed a higher increase in knowledge compared to the control group, in the treatment group with audiovisual media the increase in knowledge was better when compared to the health education control group with Booklet media The average level of knowledge of the control group before being given treatment was 12.5 After being given treatment the average score of the control group rose to 13.4. While the average Audio visual group average score was 13.25. After being treated, the average score increased by 14.6. The t-test result shows a p value (0.000&lt;0.05). The use of booklet and audio-visual media is effective in increasing the knowledge of birth control acceptors about long-acting contraception.

Enhancing Utilization of Long-Acting Contraceptive Methods among Women: A Study in Hoima Regional Referral Hospital

Family planning is crucial for reducing fertility rates, maternal mortality, and infant welfare. Reversible long-acting contraceptives (LACMs) are effective for women who want to limit childbearing and space births, potentially playing a significant role in reducing maternal mortality. However, the use of LACMs has not kept pace with short acting methods like oral contraceptives and injectables. A study was conducted to determine the level of utilization of long-acting contraceptive methods among women attending the MCH clinic at Hoima Regional Referral Hospital and related factors. The majority of participants (50.9%) were aged 30-39, married (68.4%), housewives (40.4%), protestant (36.8%), and had attained tertiary education (47.4%). The most common contraceptives used were pills (33.3%), injectable (24.6%), condoms (15.8%), implants (10.5%), IUCD (3.5%), and others (12.3%). Eight participants were using long-acting methods, accounting for 14.0% of the study. Factors associated with the utilization of long-acting contraceptive methods included marital status, level of education, residence, partner involvement, knowledge of LACMs, attitude towards LACMs, and access to the desired method of contraception. The study highlights the need for improved access to long-acting contraceptive methods among women of reproductive age. Keywords: Long-Acting Contraceptive, Women, MCH Clinic, Maternal mortality

P768 Appropriateness of small molecule agents for patients with IBD of childbearing age – a RAND appropriateness panel

Abstract Background Many women of childbearing age with IBD require advanced therapies. While biologics are largely low risk during pregnancy, the novel small molecules Tofacitinib, Filgotinib, Upadacitinib and Ozanimod (TFUO) have shown concerning reproductive results in animal studies. Therefore, their use in women of childbearing age needs careful consideration. Methods We convened a RAND appropriateness panel of 6 gastroenterologists, 2 IBD nurses, 1 IBD pharmacist and 3 expert patients. Following a literature review, 13 statements were drafted and voted upon in 2 rounds. Results 13 statements were voted on in two rounds. All statements were deemed appropriate after one round of revisions. Here we present a selection of key statements: 1. Women with IBD of childbearing age who wish to commence therapy with TFUO, need to use effective contraception. Counselling regarding the risk of TFUO in unplanned pregnancies should be provided. 2. For women using contraception while on JAK therapy, we suggest the preferred use of progesterone-only or non-hormonal long-acting contraception over combined oestrogen-progesterone formulations to reduce the risk of venous thromboembolism. 3. TFUO are contraindicated during pregnancy due to serious teratogenicity concerns. 4. Regardless of physical wash out periods, we recommend that women currently receiving TFUO cease therapy with enough time to establish clinical remission ideally for at least 3 months prior to conception. This window allows to safely establish whether the alternative (or no) therapy can maintain remission. 5. Therapies other than TFUO should be considered as first line therapy in women with IBD of childbearing age, with the exception of select individual social or medical circumstances, or women who have completed family planning and agree to use effective contraception. 6. TFUO may be appropriate choices for women of childbearing age after failure of, intolerance of or contraindications to one biological agent licensed for IBD. 7. In women who wish to have children in the future, a minimum treatment period for TFUO should be considered. Where the wish to start a family is less than 1 year in the future it is recommended to consider agents other than TFUO. 8. TFUO are contraindicated during breastfeeding. 9. If a woman conceives while taking TFUO, the medication should be ceased, she should receive counselling about potential known and unknown maternofoetal complications, and alternative IBD therapy may be commenced if required. Conclusion We developed 13 practice statements derived from a RAND appropriateness panel of clinicians and patients to guide decision making for women of childbearing age regarding TFUO small molecules therapies for IBD.

Uptake, discontinuation, and continuation rate of long-acting contraceptive methods when offered at no cost in Campinas, Brazil

ObjectivesThis study aimed to compare the uptake, reasons for discontinuation, continuation, and satisfaction of long-acting contraceptive methods (LARC) when offered at no cost in Campinas, Brazil. Study designThis was a prospective cohort study conducted at University of Campinas, Campinas, São Paulo, Brazil, including women aged 18 to 48 years, who adopted one of three methods. Participants underwent telephone follow-up every 3 months for up to 24 months after insertion. Satisfaction was assessed at the end of 2 years of use through the Likert scale. ResultsWe invited 1222 women, and among the 971 women who volunteered to participate in follow-up, 414 (42.6%) chose the levonorgestrel 52-mg intrauterine device (IUD), 358 (36.9%) chose the etonogestrel (ENG) implant, and 199 (20.5%) chose the TCu380A IUD. Discontinuation due to bothersome bleeding was higher among users of the ENG implant (10/358; 2.4%) and the TCu380A IUD (32/199; 8.9%), and expulsion was higher for the TCu380A IUD (30/199; 15.1%). Women continued at 24 months were 340/414 (82.1%), 270/358 (75.4%), and 119/199 (59.8%) among users of the levonorgestrel 52-mg IUD, ENG implant, and TCu380A IUD, respectively. The users of the levonorgestrel 52-mg IUD (301/339, 88.8%), the ENG-implant (222/270, 82.2%), and the TCu380A IUD (105/119, 88.2%) were satisfied or very satisfied by 24 months of follow-up. ConclusionsThe three LARC methods had great uptake, high continuation, and discontinuation due to bothersome bleeding was higher among users of the ENG implant and the TCu380A IUD, and expulsion was higher for the TCu380A IUD compared to the 52-mg levonorgestrel IUD. Most of the participants reported being very satisfied. ImplicationsWhen the LARC methods were offered at no cost in a Brazilian public clinic the uptake, satisfaction and continuation were high by 24 months after device placement, and high level of satisfaction was reported by most of the participants.

Long-Acting Contraceptive Switching and Its Associated Factors among Married Women in Southwest Ethiopia.

Contraceptive switching from a more effective to a less effective method is a concern, especially in developing countries with high unmet needs for family planning. Indeed, the lack of understanding regarding the reasons behind contraceptive switching behavior in the study area poses a significant challenge in effectively addressing this issue. This study aimed to assess the magnitude and factors associated with long-acting contraceptive switching in Mizan-Aman town, southwest Ethiopia. A community-based cross-sectional study was conducted, involving 345 women randomly selected from the population of married women in their reproductive age group. Data collection was conducted through interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were employed to ascertain factors linked with contraceptive method switching status. Statistical significance was determined at a P-value of less than .05. Out of the 345 participants interviewed, the prevalence of switching from long-acting to short-acting contraceptives was 28.4%, 95% CI (13.6%, 33.2%). Upon adjusting for confounding variables, factors significantly associated with contraceptive switching included women aged 31-35 [adjusted odds ratio (AOR) = 0.58; 95% CI (0.36, 0.74)] and aged 41-49 [AOR = 0.54; 95% CI (0.48, 0.82)], those with formal education [AOR = 0.79; 95% CI (0.52, 0.87)], those desiring future pregnancy [AOR = 2.12; 95% CI (1.98, 3.38)], experiencing complications from previous method use [AOR = 3.67; 95% CI (2.57, 7.40)], and encountering stockouts of their preferred contraceptive choice [AOR = 2.01; 95% CI (1.39, 3.24)]. The study area exhibited a notable prevalence of switching from long-acting contraceptives. Complications arising from prior method use and the unavailability of preferred contraceptive options emerged as significant factors influencing this switching behavior. Thus, it underscores the importance of providing counseling and ongoing support to women, ensuring access to safer and more effective modern contraceptive methods.

A Prática de Planeamento Familiar em Mulheres de Baixa Renda: Caso do Município da Cidade de Cuamba entre 2019 a 2020

This article addresses the issue of family planning, with a view to evaluating its practice among low-income women in the municipality of Cuamba City, Mozambique. It recognized the rights that people have through family planning, to determine the constitution of their families and the right to choose the number of children. The study was based on direct interviews with users of the Sapura health unit. The study reveals that 66 percent of women are in a de facto union, where the man has always been dominant in couples, as the person who can decide whether the woman can have family planning or not, and 74 percent of women have family planning without their partner's consent. The most commonly used method is DEPO - a long-acting injectable hormonal contraceptive method made up of a synthetic hormone similar to progesterone.

Use of long-acting contraceptive methods and main concerns among women in Brazil

Resumo Objetivos: determinar os fatores associados ao uso de métodos reversíveis de longa ação (LARC) e às preocupações das usuárias. Métodos: estudo transversal conduzido em ambiente digital de abril a junho de 2021, por meio de instrumento estruturado disseminado por redes sociais. Foram incluídas mulheres em idade reprodutiva (18 a 49 anos de idade), não grávidas, não histerectomizadas, não esterilizadas e cujos parceiros não eram vasectomizados. Os dados foram analisados por meio de regressão logística e multinominal. Resultados: a população do estudo foi constituída por 1596 mulheres de 18 a 49 anos de idade residentes em todas as regiões do país, das quais 22% usavam LARC. Os aspectos associados ao uso de LARC foram a idade mais jovem, ter plano de saúde, estar em um relacionamento e não querer engravidar. Metade das usuárias de LARC relatou ter algum tipo de preocupação com o método, sendo a mais frequente o risco de engravidar (36,2%). Os aspectos associados a ter preocupação com o uso de LARC foram o tipo de método, não estar em um relacionamento e não querer engravidar. Conclusões: observou-se que as usuárias de LARC não são homogêneas entre si e que a experiência com o uso de LARC está permeada por preocupações, inclusive em relação a sua eficácia.