Long-term Contraception Research Articles

Anticoncepción en la población gitana residente en dos barrios con bajo nivel de renta de Barcelona

ObjectiveTo describe the knowledge and use of contraceptive methods and health services in the Roma population (Kale/Spanish Gitanos) of two low-income neighbourhoods of Barcelona (2011-2015). MethodMixed. Community setting. 1) Descriptive cross-sectional study. We interviewed with a questionnaire a sample of residents of childbearing age. We compared the knowledge and use of contraception and services by ethnic self-identification and sex with adjusted logistic regression models to obtain adjusted odds ratio (ORa) and 95% confidence interval (95%CI). 2) Qualitative descriptive study with ethnographic method. We interviewed 10 Roma residents and three health professionals to explore aspects of contraception, family and roles. We performed a narrative analysis of discourse from the recorded texts. Results834 people participated, with an 11.8% self-identified Roma population. With regard to the non-Roma population, more Roma women used tubal ligation (ORa: 3.0; 95%CI: 1.3-7)] and implant (ORa:4.9; 95%CI: 3.1-72), and had better knowledge of IUD (ORa: 2,4; 95%CI: 1,4-4,1), tubal obstruction (ORa: 3,3; 95%CI: 1,1-9,9) and injectables (ORa: 2,4; 95%CI: 1.3-4.4). Roma men used withdrawal more frequently (ORa: 3.6; 95%CI: 1.3-10), a practice confirmed in the qualitative study. Both communities used emergency contraception and health services. In the Roma population, contraception and reproduction are in the hands of women. As abortion is culturally penalized in the Roma population, women use it, but they face it alone. ConclusionsGender emerged as a cross-cutting determinant in all issues explored. In the Roma population reproductive control and contraception remain the responsibility of women. Once the family is complete, Roma women use long-term contraception. Both populations use health services.

Talking about male body-based contraceptives: The counseling visit and the feminization of contraception

In developed countries, women bear the primary, and sometimes exclusive, responsibility for preventing pregnancy in heterosexual sexual relations. This unequal burden is not an intrinsic fact; it is the consequence of broad social narratives and interpersonal negotiations. The contraceptive counseling visit is increasingly recognized as a site of the discursive production of normative ideas about reproduction, suggesting that clinicians themselves may contribute to the assignment of responsibility for contraceptive labor to women (i.e. the feminization of contraception). Scholars have not yet considered how providers talk to patients about methods that are male body-based (i.e. condoms, withdrawal, and vasectomy) and, as such, may disrupt the feminization of responsibility for contraception. Using transcripts of 101 contraceptive counseling visits recorded between 2009 and 2012 in the San Francisco Bay Area, I investigate how clinicians discuss male body-based methods with female patients. Drawing on a constructivist approach, I find that clinicians generally devalued male body-based methods in their counseling. They did so by, first, failing to discuss them as options for long-term contraception. Second, when they did discuss them, clinicians tended to emphasize aspects of the methods that were presumed “negative” (e.g. the lower efficacy of withdrawal and condoms) but not features that patients might view positively (e.g. the high efficacy of vasectomy or the lack of side effects with condoms and withdrawal). In aggregate, these discursive practices marginalize male body-based methods as contraceptive choices. As a practical effect, this may encourage women to choose a method that does not best meet their preferences. At a structural level, by devaluing methods that could undercut the unequal division of fertility work, these discursive patterns contribute to the feminization of responsibility for contraception and the retrenchment of the unequal gendered division of fertility work.

Cost-effectiveness of emergency contraception options over 1 year

The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women seeking emergency contraception, the model estimated direct medical costs of $1,228,000 and 137 unintended pregnancies with ulipristal acetate, compared to $1,279,000 and 150 unintended pregnancies with oral levonorgestrel, $1,376,000 and 61 unintended pregnancies with copper intrauterine devices, and $1,558,000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. Model estimates were most sensitive to changes in the cost of the copper intrauterine device (with higher copper intrauterine device costs, oral levonorgestrel plus same-day levonorgestrel intrauterine device became the most cost-effective option) and the cost of a live birth (with lower-cost births, ulipristal acetate became the most cost-effective option). When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective. Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.

HUBUNGAN DUKUNGAN SUAMI DENGAN KEIKUTSERTAAN KB JANGKA PANJANGdi BPM Retno Edi S,AMd.Keb SIDOARJO

One the factors that influence the succes of family planning is husband support. Based on BKKBN data until the end of December 2015, the quantity of PUS (Couple Age Fertile) amounted to 13,46%. This figur is lower than the achievement in 2014 which amounted to 16,51%. While for acceptor of KB injection equal to 49,93%, pill 26,36%, IUD 6,81%, implant equal to 9,63%, other method 2,1% (BKKBN, 2016). This study aims to determine the relationship of husband support with long-term family participation in BPM Sri Hastuti S.ST Surabaya The type of this research is the observasional design of the population in this study is the family planning acceptors which amounted to 45 people, the sample in this study is the family planning acceptors in July 2017 which amounted to 40 people. The data of this research was done in July 2017 by using questionnaire and presented in diagram. Family planning acceptors who have husband support in the selection of long-term contraceptives is 5 people (12%) who didn’t participate some 35 people (88%). The quantity of family planning acceptors taking long-term contraceptive methods was 19 (47%) while those who did not participated in 21 people (53%). Based on statistical test using chi square, it is found that p value 0,012 < α (0,05) and calculate value x² 6,316 > count value 3,841, in other words, Ho is rejected and Hi is accepted so it can be concluded that there is relationship of husband support with long-term family participation. This is in accordance with the theory that a wife in decision making to use contraception requires approval from the husband because the husband is seen as the head of the family.

Biopsychosocial Determinants of Long-term Contraceptive Use in Women of Reproductive Age in Surakarta, Central Java

Background: Family planning allows people to attain their desired number of children and determine the spacing of pregnancy. Long-term contraceptive methods are more effective, safe, with fewer contraindications than others contraceptive method. This study aimed to investigate the biopsychosocial determinants of long-term contraceptive use in women of reproductive age in Surakarta, Central Java, using a theory of planned behavior. Subjects and Method: This was an analytic observational study with a case-control design. The study was conducted in Surakarta, from January to February 2018. A sample of 210 women of reproductive age was selected for this study by fixed disease sampling. The dependent variable was long-term contraceptive use. The independent variables were age, parity, education, employment status, knowledge, attitude, subjective norm, perceived behavior control, husband support, family income, and health counseling. The data was collected by questionnaire and analyzed by path analysis. Results: Long-term contraceptive use increased with positive attitude (b=3.49; 95% CI= 1.88 to 5.11; p<0.001), supportive subjective norm (b= 2.91; 95% CI= 1.10 to 4.73; p=0.002), strong perceived behavior control (b=3.09; 95% CI= 1.29 to 4.88; p=0.001), and strong husband support (b=2.68; 95% CI= 1.04 to 4.33; p=0.001). Long-term contraceptive use was indirectly affected by knowledge, health conselling, and education level. Conclusion: Long-term contraceptive use increases with a positive attitude, supportive subjective norm, strong perceived behavior control, and strong husband support. Keywords: long-term contraceptive, the theory of planned behavior, path analysis Correspondence: Ratna Arifiana, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: arifianaratna1301@gmail.com. Journal of Health Promotion and Behavior (2018), 3(1): 37-47 https://doi.org/10.26911/thejhpb.2018.03.01.03

CONTRACEPTION DE LONGUE DUREE : EXPERIENCE D’UN HOPITAL DE REFERENCE A DAKAR ENTRE 2014 ET 2016

Objectives: Our objective was to conduct a situational analysis of the supply and use of long-term contraceptive methods in a reference hospital in Dakar. Methodology: This was a retrospective study of clients who received long-term contraception at the Gynecology-Obstetrics Department of the Institute of Social Hygiene between January 2014 and June 2016. Results: The epidemiological profile of clients was that of an average woman of 26 years, married (91.8%), pauciparous (53.6%), literate (65.5%) with at least one living child (95, 7%). The most common long-term contraceptive method was the Progestin Implant (81.2%) followed by the Copper Intrauterine Device (IUD) (18.8%). Few clients had previous contraceptive experience (15.5%); they predominantly used progestin- only injectable contraception (75%). Minor side effects were reported by 32.6% of clients during follow-up. These included small bleeding (41.8%), weight gain (20.2%), pelvic pain (16.5%), amenorrhea (15.8%) and headache (5.7%). These side effects have been adequately addressed by providers through counseling and drug usein accordance with the protocols contained in the national reference documents. With a decline of 6 to 30 months, 89% of clients are still active, 3.6% are lost to follow-up and 6.6% have changed their method. Conclusion: Longterm contraception is increasingly used at the Obstetric Gynecology Department by clients seeking family planning. The progression of use of the Implant is very satisfactory ; but efforts must be made to better reposition the IUD. Keywords : Contraception. Implants. Intrauterine device.

KADAR HEMOGLOBIN PADA AKSEPTOR KB IUD

The IUD is one of the most effective long-term use methods of contraception but has a side effect ofincreased menstrual blood volume. The purpose of this study was to determine whether there is arelationship between the length of use of IUD against hemoglobin levels. The design of this research isanalytic correlation with cross sectional approach. Population of 49 AKDR acceptors in PandanwangiVillage Working Area Puskesmas Pandanwangi Malang. The number of samples were 33 respondents.Sampling using stratified random sampling. Data collection uses observation sheets and hemoglobinlevels checks using the GCHb Easy Touch digital stick via home visits. Analysis of this research datausing Spearman Rank Correlation. Based on statistical test with α = 0,05 got value of r counted -0,531with value ρ value 0,023 (ρ = &lt;0,05) which means that Ho rejected means there is relationship betweenlong use of Intrauterine Contraception (IUD) to Hemoglobin Level. Therefore, women with an anemictendency are not advised to use the IUD contraceptive method.Keywords: Duration of IUD Use, Hemoglobin Level

Planning parenthood: the Affordable Care Act young adult provision and pathways to fertility

This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences type methods using the 2008–2010 and 2012–2013 American Community Survey, 2006–2009 and 2012–2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006–2010 and 2011–2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.

An Injectable Thermogel Containing Levonorgestrel for Long-Acting Contraception and Fertility Control of Animals.

The demand of contraception and fertility control of animals is huge in livestock field and pet market. In this study, we suggest a formulation made up of an injectable and biodegradable thermogel for sustained delivery of levonorgestrel (LNG), a hormonal contraceptive, to realize the long-acting animal contraception. A thermogelling poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) triblock copolymer was synthesized in a one-pot reaction. The micelles formed by the amphiphilic polymer carriers in water could serve as a reservoir for the solubilization of hydrophobic LNG molecules. The concentrated polymer aqueous solution exhibited a reversible sol-gel transition upon heating, and the incorporation of various amounts of LNG was found not to affect the thermogelation of the polymer/water system. In vitro release profiles showed that the entrapped LNG was sustainedly released from the thermogel matrix and the initial drug-loading amounts had a significant influence on the release kinetics of LNG. In vivo pharmacokinetic studies demonstrated that the use of PLGA-PEG-PLGA thermogel markedly extended the release of LNG after subcutaneous injection into SD rats. Consequently, this study revealed that the injectable PLGA-PEG-PLGA thermogel was a promising candidate for sustained delivery of LNG, and provided an attractive option for long-term contraception and fertility control of animals by a way of facile fabrication, easy administration and low expense.

Faktor yang Memengaruhi Pemilihan Metode Kontrasepsi

Contraception was the most effective way to control the population growth. The most widely favored in Indonesia was a short-term contraceptive methods. High attainment acceptor on short-term contraceptive methods because short-term contraceptive methods was a methods contraception affordable, while the fees for the long-term contraceptive methods was more expensive. The incidence of injectable contraceptives and pills drop-out was higher than the long-term contraceptive methods that contributed to the failure of population growth control program. This study to analyze the factors that affect the selection contraceptive methods. This study was an observational study with cross sectional design. Sampling with systematic random and obtained were 79 acceptors. The independent variables were the cost of contraceptive use, non-material costs (experience side effects), cultural obstacle, social adjustments obstacle, physic and mental health obstacle, and accessibility obstacle. Data collected using the questionnaire and analyse by multiple logistic regression. The results showed that the significant factor were the cost of contraceptive usage (pvalue = 0.002), the cost of non-material (experience side eff ects) (pvalue = 0.007), and factors that didn’t have signifi cant influence were cultural obstacle (pvalue = 0.105), social adjustments obstacle (pvalue = 0.999), physic and mental health obstacle (pvalue = 0.920), and accessibility obstacle (pvalue = 0.438). The conclusion were the cost of contraceptive use and non-material costs (experience side eff ects) aff ected the selection of contraception. It was need the cooperation between religious leaders, community leaders, and health care workers in a common understanding on the cost of contraceptive usage.

Faktor Sosiodemografi yang Memengaruhi Pemilihan Metode Kontrasepsi

Long term contraception entered into government programs. Government suggested to use long term contraception effectively to postponing pregnancy, spacing of birth and terminating fertility. In fact, couples of reproductive ages in Indonesia were likely to still choose short-term contraceptive than long-term contraceptive. This research analyzed sosiodemografi factors that aff ecting the selection of contraception method in Gading Public Health Center Tambaksari Surabaya. This research used analytical study with case control design. Research population totaled 84 respondents. Sampling technique used simple random sampling and got 42 cases and 42 controls. The variables were sosiodemografi factors. Data were analyzed using that multivariate logistic regression with a level of signifi cance value α = 0,05. The results showed four signifi cant variables were age (p=0,018), education (p=0,024), occupation (p=0,008), parity (p=0,034), also status of women (p=0,002. Sosiodemografi factors such as age, occupation, parity and status women aff ect the injection contraceptive acceptors did not choose long acting contraception method in Tambaksari Surabaya Gading Public Health Center. The granting of complete information about all types of contraception is important so that the fertile age couples can choose contraception that suits their need.

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka

BackgroundWhen faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women’s long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka.MethodsAn unmatched case-control study was conducted in nine hospitals among 171 women admitted for care following an unsafe abortion (Cases) and 600 women admitted to same hospitals for delivery of an unintended term pregnancy (Controls). Interviewer-administered-questionnaires assessed their socio-economic, reproductive and fertility (decisions on family size, family completion) characteristics, contraceptive method last used (traditional, modern), reasons for discontinuation/never-use, and contraceptive practices assessed at different time points.Using several regression models, the risk of abortion was assessed for ‘non-use’ of contraception against ‘ineffective use’ at conception; for non-use further categorised as ‘never-use’, ‘early-discontinuation’ (discontinued before last birth interval) and ‘late-discontinuation’ (discontinued during last birth interval); and for any interaction between the contraceptive practice and contraceptive method last used among the ever-users of contraception.ResultsAt conception, ‘non-use’ of contraception imparted a two-fold risk for abortion against ineffective use (adjusted-OR = 2.0; 95% CI: 1.2–3.2). The abortion risk on ‘non-use’ varied further according to ‘early’ (adjusted-OR = 1.7; 95% CI: 1.1–3.1) and ‘late’ (adjusted-OR = 2.3; 95% CI: 1.5–3.6) discontinuation of contraception, but not with ‘never-use’ (crude-OR = 1.1; 95% CI: 0.6–2.3).Among the ever-users, the risk of abortion varied within each contraceptive practice by their last used contraceptive method and reasons for discontinuation. A significant interaction between modern contraceptives and early discontinuation (adjusted-OR = 1.4; 95% CI = 1.1–3.1) demonstrated a seven-fold abortion risk for early discontinuation of modern methods against its ineffective use. In particular, hormonal methods seemed to be responsible for this risk (51.1% cases versus 42.5% controls).ConclusionsLong-term contraceptive practices showed varying risk for abortion, and was further modified by early discontinuation of modern contraceptives. This knowledge should be applied during postnatal visits by public-health staff.

Antisperm antibodies as a factor of male infertility. Relevance, modern methods of diagnosis and treatment

According to WHO statistics 40 % of childless marriage is due to factors of male infertility. One of them is the presence of antisperm antibodies in the male organism, which may be in blood serum, on the surface of spermatozoids and seminal plasma. Aim. Оn the grounds of specialized literature analysis, to show the relevance of this problem in Reproductive Medicine, to descript Basic methods of Modern treatment and diagnosis of this pathology in the body of infertile males. The most common methods of antisperm antibodies identifying are: MAR-test sample Shuvarskiy–Sims–Hyuner, Kurtsrok–Miller test, the method of latex agglutination, solid-phase immunoenzymatic blood test. Indications for antisperm antibodies determining are: modified indices, deviations in post-coital test, a negative test of sperm and cervical mucus interaction in vitro, unexplained infertility in the married couples, failure or low indices during IVF ( in vitro fertilization) and of course, the exclusion of other causes of infertility. When antisperm antibodies are detected, the strategy of treatment may be destined to reduction of their titer for further pregnancy. Such types of therapy can be used: contraceptive (long-term use contraception barrier to reduce antisperm antibodies titer in women), plasmapheresis, artificial insemination with pretreated from antisperm antibodies husband's sperm, methods of assisted reproductive technologies. Conclusoins. The formation of antisperm antibodies leads to infertility of immunological genesis (in 20 % of couples with unexplained infertility). To confirm their presence in the male body it is necessary to perform the MAR-test, Shuvarsky test, other tests and, of course, the exclusion of other causes of infertility. Men of reproductive age with an immunological factor of infertility provides for a comprehensive treatment, including elimination of all possible causative and contributing factors of infertility (infection of the male reproductive system, varicocele etc.), decreased production and removal of spermatozoa-associated antisperm antibodies and assisted reproductive technologies – intrauterine insemination and in vitro fertilization.

Perbedaan Motivasi Wanita PUS Usia 35-49 Tahun untuk Menggunakan Implant Sebelum dan Setelah Diberi Penyuluhan di Dusun Mojolegi Desa Bendo Kec. Pare.

Women who have age 35 these group will get increased morbidity and mortality experience if they pregnant. Implant is one method of effective an safety long-term contraception. Bendo Health Center have the lowest acceptor implants in Kediri that is 0%. The purpose of this research to know the difference motivation of childbearing age couples women in age 35-49 years to use implant before and after giving information. The design used a pre-experiment design with one group pre-test post-test design, the population was all childbearing age couples women in age 35-49 years at Mojolegi Hamlet Bendo Village Pare District who have children, not use contraception or still use non-Long Term contraception Method which total 72 people. The samplehave a lot 61 people according to inclusion and exclusion criteria. The sample removal technique used simple random sampling. The result of this research, from 61 respondents get average of respondent motivation before give information is 65 and after give information is 69, show that respondent’s motivation get increase after got information. And after going through the data analysis it was found z calculate ; z table, so in this case have difference motivation of childbearing age couples women in age 35-49 years to use implants before and after giving information.; Keywords: Counseling, Motivation, Implants

Schizophrenia and induced abortions: A national register-based follow-up study among Finnish women born between 1965–1980 with schizophrenia or schizoaffective disorder

BackgroundThe objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination. MethodsUsing the Care Register for Health Care, we identified Finnish women born between the years 1965–1980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.12.2013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register. ResultsThe number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 2.28; 95% CI 2.20–2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-be's medical condition. Induced abortions after 12weeks gestation were more common among cases. However, cases had no more complications related to termination. ConclusionsThe incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception.

Trends in use of and complications from intrauterine contraceptive devices and tubal ligation or occlusion

BackgroundLong-acting reversible contraceptives such as intrauterine devices (IUDs) are highly effective in preventing pregnancy, cost effective, and increasing in popularity. It is unclear whether changes in IUD use are associated with changes in rates of irreversible tubal sterilization. In this analysis, we evaluate changes in rates of tubal sterilization, insertion of copper or levonorgestrel (LNG) IUDs, and related complications over time.MethodsData were obtained from a retrospective claims database (OptumTM ClinformaticsTM Data Mart) of women aged 15 to 45 years who underwent insertion of copper or LNG IUD or tubal sterilization between 1/1/2006 and 12/31/2011. Outcomes of interest included annual rates of insertion or sterilization and annual rates of potential complications and side effects.ResultsThe number of women included in the analysis each year ranged from 1,870,675 to 2,016,916. Between 2006 and 2011, copper IUD insertion claim rates increased from 0.18 to 0.25% and LNG IUD insertion claim rates increased from 0.63 to 1.15%, while sterilization claims decreased from 0.78 to 0.66% (P < 0.0001 for all comparisons). Increases in IUD insertion were apparent in all age groups; decreases in tubal sterilization occurred in women aged 20 to 34 years. The most common side effects and complications were amenorrhea (7.36–11.59%), heavy menstrual bleeding (4.85–15.69%), and pelvic pain (11.12–14.27%). Significant increases in claims of certain complications associated with IUD insertion or sterilization were also observed.ConclusionBetween 2006 and 2011, a decrease in sterilization rates accompanied an increase in IUD insertion rates, suggesting that increasing numbers of women opted for reversible methods of long-term contraception over permanent sterilization.

Characteristics of Maternal Mortality Cases in a Tertiary Hospital

Objective: To identify the characteristics of maternal mortality cases in a tertiary hospital in Jakarta, including socio-demographic characteristics, previous medical and obstetric history, and patient’s clinical condition on arrival at the hospital. &#x0D; &#x0D; Method: This was a survey to identify the descriptive data of maternal mortality cases through medical records during study period. Manual review of 51 medical records was conducted for 2 years from January 2013 to December 2014 in Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital (RSCM).&#x0D; &#x0D; Result: Of 51 cases of maternal deaths, 46 subjects (90.19%) had nine years of minimum education background. There were two subjects less than 21 years old and another was 42 years old. None of these subjects were using intrauterine device (IUD) or implant as the contraceptive methods where 66.6% subjects with underlying disease never used contraception. Ninety-two percent of subjects did antenatal care (ANC) regularly and 80.4% (41 subjects) of them was done in midwives. There were 14 subjects (29.78%) who had ANC in the first trimester of pregnancy. Severe preeclampsia is the most prevalent complication in pregnancy (26 subjects, 65%), which all (100%) patients arrived at RSCM with HELLP Syndrome. Therefore, preeclampsia was the leading cause of death in RSCM. &#x0D; &#x0D; Conclusion: The characteristics of maternal death in RSCM are prevalent in the group of 25-34 years old with the high school as the educational background. Most of them are multiparity and do not use the long-term contraceptive methods. Preeclampsia is the major cause of maternal death in RSCM.&#x0D; &#x0D; Keywords: maternal mortality, risk factors, tertiary hospital

What do patients want to know about contraception and which method would they prefer?

The aim of this study was to determine the extent to which women's choice of contraceptive method depends on the advice received from their gynecologist and whether more intensive counseling might lead to more frequent use of long-acting reversible contraception (LARC). A total of 1089 physicians and 18,521 women responded to 32 or 37 questions, respectively, using an online questionnaire. The women were asked about their current use of contraceptive methods, the extent of their satisfaction with them, their satisfaction with the counseling they had received, and whether they wanted to have more information about contraception. The physicians were similarly asked which contraceptive methods were being used, how satisfied with them they were, how they would assess their patients' satisfaction with them, and whether the women wanted to have more information. The results showed that 61% of the women were using oral contraceptives, and a total of only 9% were using behavior-independent long-term contraceptive methods. However, 60% of the women stated that long-term contraception would be an option for them if they had more information about it. Gynecologists underestimated this figure, at only 18%. Whereas 66% of the gynecologists believed that their patients never forgot to take the pill, nearly, half of the women stated that they had forgotten it at least once during the previous 3months. The small number of women who use long-term contraception is in clear contrast to the fact that many women want to have a very safe but also behavior-independent method.

POLA PEMAKAIAN KONTRASEPSI DAN PEMANFAATAN KARTU BADAN PENYELENGARA JAMINAN SOSIAL (BPJS) KESEHATAN DALAM PELAYANAN KELUARGA BERENCANA DI INDONESIA

Background: By 2019, the government requires all Indonesian citizens to become Jaminan Kesehatan Nasional (JKN) participants through Badan Penyelenggara Jaminan Sosial kesehatan (BPJS - health) and is entitled to health insurance benefits including family planning services. Objective: In order to describe the family planning services, contraceptive usage pattern, and BPJS health card utilization for family planning services in JKN era. Methods : This study used secondary data analysis from the results of the Intercensal Population Survey (SUPAS) in 2015. The sample is 189,652 ever married women, aged 10-54 years in all provinces in Indonesia, and have received family planning services both before and during JKN. The analysis used chi-square test. Result: One year after the introduction of the JKN program, the proportion of contraceptive use including the Long-term Contraceptive Method (LTCM) fell significantly compared to before JKN, whereas injections and pills remained high. Family planning services at Puskesmas increased sharply, while hospital and government service both went down and services by doctors and private practice midwives remained high. Utilization of BPJS health card for family planning services is still low. The use of BPJS Health card for family planning services has a significant relationship to the use of LTCM. Conclusion: Non contraceptive use of LTCM is still high. Utilization of BPJS health card for family planning services is still low, whereas the use of BPJS health card has almost four chance to encourage the use of KB MKJP.

Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

BackgroundThe objective was to analyse the contribution of the provision at no cost to users of the 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS) towards disability-adjusted life years (DALY) averted over...