Long-acting Methods Research Articles

Impact of Perinatal Depression on Contraceptive Planning [4N

INTRODUCTION: Contraceptive choice may be influenced by disturbances in perinatal mood disorders, but studies have shown mixed results. We wished to assess the postpartum contraceptive choices of women at risk for perinatal depression, specifically in regard to hormonal contraception, long-acting reversible methods, and surgical sterilization. METHODS: This retrospective cohort study evaluated a population of women (n= 419) who participated in a calibration pilot for depression screening while pregnant and after delivery using a novel computerized adaptive diagnostic screener (CAT-MH). Maternal age, race and gestational age at delivery were used to match cases (n=64) to controls (1:2). Chart review was used to screen for choice of contraception and potential confounders including pre-pregnancy mental health disorders and/or current mental health treatments. Bivariate analyses and multiple logistic regressions were used to study the impact of depressive symptoms on contraceptive planning. RESULTS: No significant differences in contraceptive choice were observed between depressed and control groups. However, worsening postpartum mood was associated with the choice of non-hormonal methods when compared to stable mood after delivery (24.1% vs. 48.3%, p=0.016). This association persisted in a multivariate logistic regression which included age, race, insurance status, obstetric history, mode of delivery, and NICU admission. Women who were treated with psychiatric medications while pregnant were more likely to choose surgical sterilization (11.3% vs. 33.9%, p=.02). CONCLUSION: A relationship between depressed maternal mood and contraceptive planning may be mediated by preexisting mental illness and use of psychiatric medications, influencing both hormonal contraception and surgical sterilization choices.

Developing acceptable contraceptive methods: Mixed-method findings on preferred method characteristics from Burkina Faso and Uganda

Background: Unmet need remains high in developing regions. New contraceptive technologies may improve uptake and use. This study examines desirable product characteristics. Methods: We added a module to the female questionnaire of the PMA2020 surveys in Burkina Faso and Uganda and conducted 50 focus group discussions (FGDs) with women, 10 FGDs with men, and 37 in-depth interviews (IDIs) with providers across the two countries. FGDs with women and IDIs with providers included a semi-structured ranking exercise on pre-selected product characteristics. Results: Effectiveness, duration, few side effects, cost, and access were the characteristics most commonly reported as important in choosing a method by survey respondents across both countries. Half or more of women surveyed in each country would like a method that lasts at least one year, while 65% in Burkina Faso and 40% in Uganda said they would use a method causing amenorrhea. Qualitative findings show that women want methods with minimal and predictable side effects. Reactions to increased bleeding were negative, especially in Burkina Faso, but perspectives on reduced bleeding were more mixed. Women and providers preferred methods that are discreet and not user-dependent, and associate duration with convenience of use. Some women in Uganda expressed concerns about the invasive nature of long-acting methods, and cost was an important consideration in both countries. In the ranking exercise, discreet use and few side effects often ranked high, while causing amenorrhea and not requiring a pelvic exam often ranked low. Conclusion: Product development should consider user preferences for success in these settings.

Spatial and socio-economic correlates of effective contraception among women seeking post-abortion care in healthcare facilities in Kenya.

IntroductionInformation, counseling, availability of contraceptives, and their adoption by post-abortion care (PAC) patients are central to the quality of PAC in healthcare facilities. Effective contraceptive adoption by these patients reduces the risks of unintended pregnancy and repeat abortion.MethodsThis study uses data from the Incidence and Magnitude of Unsafe Abortion Study of 2012 to assess the level and determinants of highly effective contraception among patients treated with complications from an unsafe abortion in healthcare facilities in Kenya. Highly effective contraception was defined as any method adopted by a PAC patient that reduces pregnancy rate by over 99%.ResultsGenerally, contraceptive counseling was high among all PAC patients (90%). However, only 54% of them received a modern family planning method—45% a short-acting method and 9% a long-acting and permanent method. Adoption of highly effective contraception was determined by patient’s previous exposure to unintended pregnancies, induced abortion and modern family planning (FP). Facility level factors associated with the uptake of highly effective contraceptives included: facility ownership, availability of evacuation procedure room, whether the facility had a specialized obstetric-gynecologist, a facility that also had maternity services and the number of FP methods available for PAC patients.Discussion and conclusionFor better adoption of highly effective FP, counseling of PAC patients requires an understanding of the patient’s past experience with contraception and their future fertility intentions and desires in order to meet their reproductive needs more specifically. Family planning integration with PAC can increase contraceptive uptake and improve the reproductive health of post-abortion care patients.

Access to contraception in local health departments, four Midwest states, 2017–2018

ObjectiveDescribe contraception availability at local health departments (LHDs) serving largely rural populations. Study designWe invited administrators at LHDs located in four Midwest states to participate in an online survey conducted from September 2017–April 2018. We collected data on clinic staffing, patient population, receipt of Title X funds, and services provided to assess the proportion of LHDs providing any prescription method of contraception; secondary outcomes included healthcare staff training level and other reproductive health services provided. ResultsOf 344 LHDs invited, 237 administrators completed the survey (68.9%). Three-quarters served rural populations. One-third (34.6%) provided short-acting hormonal contraception; however, availability varied by state (Kansas: 58.0%, 40/69; Missouri: 37.5%, 33/88; Nebraska: 16.7%, 3/18; Iowa: 9.7%, 6/62; p<.01). Only 8.4% of LHDs provided IUDs; 7.6% provided implants, and 5.9% provided both methods. LHDs in Nebraska and Kansas provided any long-acting method more frequently (Kansas: 17.4%, Nebraska: 16.7%, Iowa: 8.1%, Missouri: 4.6%; p=.04). LHDs receiving Title X funds (27.0%) were much more likely to provide any prescription contraception (85.1% vs. 14.2%, p<.01). Most LHDs relied on registered nurses (RNs) to provide medical care; 81.0% reported that RNs provided care≥20 days per month. Pregnancy testing was widely available in Missouri and Kansas (>87%) and less commonly available in Iowa and Nebraska (<18%) (p<.01). ConclusionLHDs in these states are currently ill-equipped to offer comprehensive contraceptive services. Women seeking care at LHDs have limited, if any, contraceptive options. ImplicationsLocal health departments in the Midwest, serving a largely rural population, rarely offer prescription contraception, especially long-acting reversible methods. Women residing in settings without broad access to publicly-funded healthcare providers may have limited access to comprehensive contraceptive services. Efforts to ensure rural access are needed.

Interventions using social networking sites to promote contraception in women of reproductive age.

Social networking sites (SNSs) have great potential as a platform for public health interventions to address the unmet need for contraception. To evaluate the effectiveness of interventions using SNSs to promote the uptake of and adherence to contraception in reproductive-age women. We searched CENTRAL, MEDLINE, Embase, and six other databases on January 2018. We also searched Google Scholar, key conference proceedings, checked the reference lists of included studies, and contacted study authors to identify additional studies. We considered randomised controlled trials (RCTs) and non-randomised interventional studies (NRS) in women of reproductive age. SNSs requiring a social profile within a bounded or restricted-access system of shared connections were included. We also included trials that utilised SNSs only or as an adjunct to an intervention. Studies had to have a follow-up outcome assessment of at least three months. Two authors independently screened titles, abstracts and full-text studies, and extracted data from included studies. A third author was assigned to arbitrate areas of disagreement. Authors assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. We were unable to conduct a meta-analysis due to the heterogeneity of the study designs and outcome measures. Of the 461 unique records found, only two studies met our inclusion criteria. Both studies were conducted in the USA and were at high risk of bias. One RCT included 2284 women exposed to a web-based SNS or nothing. The groups were no different post intervention in their self-reported consistency of contraceptive use or knowledge of the relative effectiveness of different methods. There was a small but significant increase in the use of more effective methods (long-acting reversible methods) at 12 months' follow-up.The second study, a cluster RCT with 1578 women, used a closed Facebook page showing sexual health content compared to a modified Facebook news page that avoided sexual health content. They found no differences in the use of condoms at last act of sexual intercourse at six months or the intention to use condoms between the intervention and control groups. Despite the prevalence of SNSs, we found little scientific evidence to support the use of SNSs to improve contraceptive use or adherence among women.

Village Funding Allocation for Improving the Use of Long-Acting and Permanent Methods of Contraception (LAPM) in West Nusa Tenggara Province

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FAKTOR YANG MEMPENGARUHI PENGGUNAAN JENIS METODE KONTRASEPSI JANGKA PANJANG (MKJP) PADA WANITA MENIKAH USIA SUBUR DI PROVINSI JAWA TIMUR

Long-Acting and Permanent Method (LAPM) is a very effective method of contraception, but women of childbearing age majority use short-term contraceptive methods. The purpose of this study was to apply multinomial logistic regression analysis in predicting factors affecting Fertile Women in the use of LAPM in East Java Province in 2012. This research use secondary data that was result of Indonesia Demographic Health Surveys (IDHS) year 2012 using the number of 171 respondents. The results of this study indicated the variables that affected the use of LAPM of WUS age (p = 0.008), education level (p = 0,004), occupation (p = 0,029), source of family planning services (p = 0,000), residence area (p = 0.016). The conclusion of this study was age, educational level, occupation, source of FP services, and residential areas affecting the use of long-term contraceptive methods in women of childbearing age. Therefore the government through the National Family Planning Coordinating Board (BKKBN),­ still pay attention to the family planning program and ensure every community to implement family planning programs and educate and promote family planning programs to resolve the problems of the population.

Inequalities in contraceptive use in Latin America and the Caribbean.

Inequalities in contraceptive use in Latin America and the Caribbean.

Fertility intentions and the adoption of long-acting and permanent contraception (LAPM) among women: evidence from Western Kenya

BackgroundThe use of long-acting and permanent method (LAPM) for family planning (FP) is of importance to the FP movement. A better understanding of how fertility-related intentions shape the usage of LAPM is important for programming. This paper explored the interaction of fertility intentions with LAPM use in rural western Kenya.MethodsWe draw on monitoring data from 28,515 women aged 15–49 years who received FP services between 2013 and 2015 as part of a community-based FP project. We assessed the association between the use of LAPM and fertility intentions, adjusting for age, parity, education, service delivery model, FP counseling and year of data collection.ResultsOf the 28,515 women who accessed FP services during the period (2013–2015), about two-thirds (57%) reported using LAPM, much higher than the national rates, and around 46% wanted another child within or after two years. In a multivariable regression model, women who desired no more children tended to use LAPM more than those wanting a child within or after some years as well as those uncertain about their future intentions.ConclusionThe significant rates of utilization of LAPM between both women who desired no more children and the fair proportion of use among women spacing births underscore the benefits of sustained community level interventions that address both the demand and supply barriers of contraceptive adoption and use.

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries.

SummaryBackgroundThe rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys.MethodsOur data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15–49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15–49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied.FindingsWe report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15–17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives.InterpretationLong-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis.FundingWellcome Trust, Pan American Health Organization.

Sexuality, fertility and family planning characteristics of married women aged 15 to 19\u2009years in Ethiopia, Nigeria and Tanzania: a comparative analysis of cross-sectional data

BackgroundAdolescents 360 (A360) is an initiative being rolled out across Ethiopia, Nigeria and Tanzania with the aim of increasing uptake of voluntary modern contraception among sexually active women aged 15 to 19 years. Using evaluation baseline survey data, we described key sexuality, fertility and contraceptive use characteristics of married women aged 15 to 19 years living in three sub-national settings.MethodsCross-sectional baseline surveys of married women aged 15 to 19 years were conducted in Oromia (Ethiopia), Nasarawa (Northern Nigeria), and Mwanza (Tanzania) between August 2017 and February 2018. We also interviewed the husbands of a sub-group of married respondents to measure spousal acceptance and support for adolescent women to use modern contraception. A clustered sampling design was used in all three countries. We produced descriptive statistics on the socio-demographic and sexual and reproductive health characteristics of married women aged 15 to 19 years by study setting.ResultsIn Oromia, Nasarawa and Mwanza, 31.4% (327/1198), 27.4% (1321/4816) and 7.5% (15/201) of married women surveyed had no education, and 68.3, 81.3 and 83.1% had ever been pregnant, respectively. Unmet need for modern contraception was 20.5, 21.9 and 32.0% in married women in Oromia, Nasarawa and Mwanza, made up almost entirely of unmet need for spacing. The vast majority of married women surveyed in Oromia (89.1%) and Mwanza (90.1%) had seen or heard about contraception in the last 12 months, compared to 30.1% of those surveyed in Nasarawa. Modern contraceptive prevalence (mCPR) was highest in married women aged 15 to 19 years in Oromia (47.2%), followed by Mwanza (19.4%) and Nasarawa (8.7%). Of those using a modern method of contraception in Oromia, 93.4% were using injectables or long-acting methods, compared to 49.4% in Nasarawa and 69.6% in Mwanza.ConclusionsOverall, unmet need for modern contraception is high among married women aged 15 to 19 years across the three settings. mCPR for married women aged 15 to 19 years is low in Nasarawa and Mwanza. Ultimately, no single intervention will suit all situations, but improving the quality, analyses and utilisation of subnational data can help decision-makers design more context specific interventions.

Sexual Activity and Weekly Contraceptive Discontinuation and Selection Among Young Adult Women in Michigan

Understanding young women’s contraceptive and pregnancy prevention behaviors is important for helping women and their partners control if and when they have children. Prior research on associations between patterns of sexual activity and contraceptive behaviors is limited. We assessed the influence of recent sexual activity on discontinuation and selection of specific contraceptive methods. We used weekly data from the Relationship Dynamics and Social Life (RDSL) study, a longitudinal 2.5-year population-based project that sampled woman ages 18 and 19 (N = 1,003) in one Michigan county. We estimated logistic and multinomial regression models that accounted for clustering of weekly observations within partnerships and women. Weekly discontinuation of longer-acting methods declined with increasing sexual activity in the past month, as did discontinuation of shorter-acting hormonal methods. Sexual activity was associated with decreased selection of condoms relative to other methods. Future research into life events that lead to changes in the frequency of sexual activity may provide insight into times when women are at risk of contraceptive discontinuation. These findings underscore the importance of anticipatory guidance in contraceptive counseling so that when women change their contraceptive behavior they are equipped in advance with resources to make safe transitions between methods.

State policy and contraceptive choices: evidence from China 1979–2012

ABSTRACTThis study examines the relationship between China’s contraception policy and married women’s (20–49 years) choice between long-acting and short-acting contraceptive methods during two periods–1980–1994 and 1995–2012. The aim is to examine the link between strictness of the contraception policy and married women’s contraceptive choice. Using data from the 1988 and the 2006 National Family Planning and Reproductive Health Surveys, we estimated the effect of contraception policy in the tightened and the loosened policy periods using a permutation test. The results show that while contraception policy promoted long-acting contraceptive methods, many married women themselves preferred short-acting contraceptive methods. During the tightened policy period, we found married women on average were 2.7 times more likely to use long-acting methods. The effect was only 1.7 times during the loosened policy period. The effect was also parity dependent. The more stringent the contraception policy was, the more likely married women used a long-acting contraceptive method. This study provides the first ever proper estimation of China’s contraception policy effects during the two periods.

The Uptake of Modern Contraceptive Methods Among Clients of Post-Abortion Care Services in Urban Guinea

In West Africa, there are limited data on the uptake of modern contraceptive methods among post-abortion care (PAC) clients. This study aimed at describing the knowledge, attitudes and practices of PAC clients towards modern contraceptive methods and identifying the factors associated with the uptake of long-acting contraceptive methods in Guinea. We conducted a cross-sectional study from March to August 2014 with a sample of 426 PAC clients in two communal medical centres in Conakry. Data were collected using a structured questionnaire and analysed using Stata software, version 14. A logistic regression was conducted to identify the factors associated with the uptake of long-acting contraceptive methods. Overall 45,5 % were students, and among them, 66.9% had a secondary or higher level of education. Among the respondents 21,8% had a history of abortion. Induced abortion (83.6%) was the most common type of abortion leading women to seek PAC services. Most of clients (73.6%) had previously heard about family planning (FP), either at school (42.7%), in a health facility/pharmacy (26.5%) or in the neighbourhood (5.9%). Among them, only 34% had used a contraceptive method in the last six months prior to the PAC visit. However, 79.1% of the sample had an unmet need for FP. During the PAC visit, 86.6% of women expressed a desire to postpone any pregnancy in the next 12 months. Overall, 388 women (91.1%) adopted a modern contraceptive method. Most of women (n=375; 96.6%) obtained the chosen contraceptive method before discharge. The intra-uterine device (IUD) was the preferred contraceptive method for women (n=130; 34.7%) followed by implants (n=107; 28.5%). Having a history of abortion (OR= 2.5; CI= 1.3-4.7) and a non-desire for pregnancy in the following 12 months (OR= 4.8; CI= 2.0-11.5) were the factors statistically significantly associated with the uptake of long-acting contraceptive methods. In our context, induced or unsafe abortion mainly concerned students. There is a need to improve the uptake of contraceptive methods, especially among students and intensify awareness on the consequences of unsafe abortion among youths.

Partnering with Private Providers to Promote Long-Acting Contraceptives in Urban Bangladesh: A Mixed-Methods Feasibility Study.

Bangladesh's pluralistic health system has diversified opportunities for clients to obtain family planning, but public-private partnerships could improve access to services, particularly in urban areas. Sixteen providers, clients and program managers were interviewed to assess perspectives on a family planning orientation and demand-side financing referral program tested in Mirpur, Bangladesh. The 15-month program, conducted in 2015-2016, was designed to encourage private providers to identify non-family planning clients with unmet contraceptive needs, promote choice of a broader contraceptive mix and refer clients to one of three public or nonprofit clinics for provision of their preferred method. Use of the system was assessed by tracking referral slips. Most stakeholders reported that it was acceptable and feasible to discuss fertility intentions with clients presenting for non-family planning matters. Providers were able to alleviate clients' misconceptions and fears concerning long-acting contraceptive methods, but were unable to address patriarchal and religious barriers. The majority of referrals were done by private providers who had a pre-existing relationship with one of the family planning clinics and referred clients to that clinic; overall, documented referrals accounted for 13% of provision of reversible and permanent methods at that clinic during the study period. Providing private practitioners with appropriate training on contraceptives and referral could improve Bangladeshi women's access to long-acting and other contraceptive methods in urban areas, and may be useful for other types of health workers. Further study of suitable referral systems is warranted.

Do young men's reports of hormonal and long-acting contraceptive method use match their female partner's reports?

ObjectiveTo assess whether young men's reports of hormonal and long-acting contraceptive methods match their female partner's reports. Study designWe analyzed a sample of 1096 heterosexual couples (aged 18–26) from the National Longitudinal Study of Adolescent to Adult Health Romantic Pair subsample. We compared male and female partner reports of hormonal/long-acting method use using class of method (hormonal/long-acting) rather than type (e.g., intrauterine device). Regression analyses linked men's reports of individual and relationship characteristics with alignment of reporting. ResultsSixteen percent of young men reported hormonal/long-acting method use at last sex differently than their female partner, that is, had a mismatched report. Men who had fewer lifetime sexual partners, had greater relationship satisfaction, believed their partner was monogamous and had a matched report of condom use at last sex were more likely to match their partner's report of hormonal/long-acting contraceptive use. Men living with children (from either partner) were less likely to have a matched report. Hispanic men were more likely to have a matched report than black men. ConclusionsMen are an increasingly important part of pregnancy prevention efforts. Pregnancy prevention and healthy relationship programs that incorporate communication skills may also indirectly improve young men's knowledge of their partner's contraceptive use and engagement in contraceptive decision making. ImplicationsAnalyses showed that nearly two thirds of the 16% of young men that did not accurately report their partner's hormonal/long-acting method use at last sex underreport method use. Men at increased risk of misreporting may benefit the most from targeted pregnancy prevention programs.

Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants

Nearly half of women will switch or discontinue using their selected contraceptive method in the first year. Research on early switching or discontinuation provides important clinical and public health insights, although few studies have assessed associated factors, particularly among longitudinal cohorts. The current study explores attributes associated with early contraceptive method switching or discontinuation (<6 months of initiation) among participants enrolled in the intervention cohorts of the Highly Effective Reversible Contraceptive Initiative Salt Lake Contraceptive Initiative (Utah, United States). Highly Effective Reversible Contraceptive Initiative Salt Lake participants have access to no-cost contraception for 3 years. This includes both the initial selection and the ability to switch or to discontinue methods without cost. Methods available included the following: nonhormonal behavioral methods (male/female condoms, withdrawal, diaphragms, cervical caps, and fertility awareness); short-acting methods (pill, patch, ring, and injectable); and long-acting methods (intrauterine devices and contraceptive implants). Participants completed surveys at baseline and at 1, 3, and 6 months. We collected data on participant demographics, contraceptive continuation, switching, and discontinuation, as well as factors associated with these changes, including established measures of pregnancy intention and ambivalence and reasons for switching or discontinuing. We conducted descriptive statistics, univariable, and multivariable Poisson regression analyses to assess predictors of both discontinuation and switching. We also conducted χ2 analyses to compare reported reasons for stopping between switchers and discontinuers. At 6 months, 2,583 women (70.0%) reported continuation of their baseline method, 367 (10%) reported at least 1 period of discontinuation, 459 (12.4%) reported switching to a different method, and 279 (7.6%) did not provide 6-month follow-up. Factors associated with discontinuation included selection of a short-acting method (incidence rate ratio [IRR], 2.49; 95% confidence interval [CI], 1.97, 3.12), report of Hispanic ethnicity (IRR, 1.45; 95% CI, 1.12, 1.89) and nonwhite race (IRR, 1.48; 95% CI, 1.08, 2.02), and having any future pregnancy plans, even years out. Participants with some college education were less likely to report discontinuation (IRR, 0.73; 95% CI, 0.57, 0.94). Selecting a short-acting method at baseline was also associated with increased likelihood of method switching (IRR, 2.29, 95% CI, 1.87, 2.80), as was having 2 or more children (IRR, 1.37; 95% CI, 1.08, 1.74). Women were less likely to switch if they were on their parents' insurance (IRR, 0.74; 95% CI, 0.56, 0.99). Among participants who switched methods, 36.9% switched to a long-acting reversible method, 31.7% switched to a short-acting hormonal method, and 31.1% switched to a nonhormonal behavioral method, such as condom use. Of participants providing a reason for stopping, 454 women (73.2%) reported side effects as 1 reason for switching or discontinuing their initial method. Early contraceptive method switching and discontinuation are frequent outcomes of contraceptive use. These changes are common even with removal of contraceptive access barriers.

Fistula Prevention Awareness Activities of Community Volunteerism Niger: A way to improve Access to Information and Care

Aims: To assess the effects of community volunteer (CV) activities on use of maternal and reproductive health services in Niger. The USAID-funded Fistula Care Plus Project (FC+) strengthens fistula prevention, detection, treatment and reintegration. In Niger, FC+ engaged CVs to increase facility delivery, promote pre- and post-natal care and to improve access to family planning (FP) in Tahoua and Maradi health districts.&#x0D; Methods: FC+identified CVs and trained them to explain obstetric fistula, identify pregnancy danger signs, promote safe motherhood, and discuss male involvement. CVs provide community monitoring through household visits and awareness activities. CVs collect data on pregnant women, follow up on antenatal (ANC)/post-natal (PNC) visits, and provide counseling on all FP methods. We used routine facility data to summarize maternal health service usage in Tahoua and Maradi.&#x0D; Results: 774 CVs were trained between March 2015 and April 2016; they held 9,999 community outreach events, reaching 98,654 individuals. The number of women completing their first ANC visit increased from 13,041 in 2015 to 14,978 in 2016 (15%). 12% and 25% increases were documented, respectively, for fourth ANC visit and PNC visit completion in 2016 relative to 2015.A 48% increase in new acceptors of long-acting FP methods also occurred. Data require standardization against population changes and triangulation with qualitative data from community stakeholders.&#x0D; Conclusions: Engaging community volunteers may improve access to information and services, resulting in increased use of FP and maternal health care. A follow-up system to ensure continued engagement among stakeholders could promote sustainability.

Increasing use of long-acting contraception in primary care

Long-acting, reversible contraception is a safe and effective way to control fertility, enabling women to have the sex life they want without the risk of pregnancy. Nurses working in primary care are important in providing contraception and promoting long-acting methods. Actively reviewing staff’s knowledge about the accessibility and availability of all contraceptive methods and identifying any gaps informs decisions concerning investment in their training and development. Sexual health and the provision of contraception, as well as the promotion of long-acting contraception, can be achieved by embracing social media and technology, not only with the practice population but with staff accessing e-learning and training pathways.

Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda.

Reproductive Health Uganda (RHU), a local NGO, introduced subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana Press) in 4 districts of Uganda between April 2016 and March 2017. RHU trained public and private facility providers on all family planning methods including DMPA-SC; trained community health workers (known as village health teams, VHTs) to give family planning counseling, provide short-acting methods including DMPA-SC, and make referrals for long-acting and permanent methods; conducted mobile outreach and raised awareness of family planning; and provided family planning commodities. We used a retrospective cross-sectional evaluation design drawing on data from (1) in-depth interviews with 32 facility- and community-based providers; (2) key informant interviews with 7 policy makers and program staff; and (3) family planning program statistics from 4 RHU clinics, 26 mobile outreach sites, and 40 VHTs in 4 study districts. Data collection took place between April and June 2017. Over 12 months, 14,273 units of DMPA-SC were provided in RHU clinics, by mobile outreach teams, and by VHTs. DMPA-SC units were mostly administered in community settings either by VHTs (70%) or at mobile outreach events (26%). A substantial proportion (43%) of DMPA-SC units were administered to young people (<25 years), a significantly higher proportion compared with other methods provided to this age group through the project (P<.001), except condoms. In addition, a greater proportion of DMPA-SC units provided at the community level by VHTs were used by young people (45%) compared with units provided at outreach (36%) or in clinics (35%). Overall, injectables (DMPA-SC and intramuscular DMPA combined) came to represent 43% of all contraceptive methods provided, up from a baseline of 20%. This shift occurred despite significant increases in the volume of all other methods provided (P<.001). Qualitative data revealed various factors that facilitated introduction, including comprehensive training, commodity availability, strong referral links, and early community engagement. RHU's experience supports the viability of community-based delivery of DMPA-SC and identifies opportunities to strengthen this approach. There is further evidence that DMPA-SC may be popular with young people, especially in community settings.