Non-barrier Contraceptive Research Articles

E063 Discussion of contraception and family planning in the lupus clinic

Abstract Background/Aims Females with a diagnosis of systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy outcomes. Many medications used to treat SLE are teratogenic. Contraception counselling and discussion around family planning are essential to reduce pregnancy risks. This service evaluation aimed to evaluate the appropriateness of contraceptive advice given to females of childbearing age with SLE in accordance with international guidelines and assess patient adherence to recommendations provided. Methods A retrospective evaluation of electronic medical records was undertaken. All females with a diagnosis of SLE seen in the preceding 12 months were identified. Any who were menopausal or trying to conceive were excluded. Based on BSR and EULAR guidance, five standards relating to contraceptive advice were assessed, primarily focusing on frequency of contraceptive discussions and the level of adherence to recommendations provided. For analysis of the established parameters, patients were stratified into different clinic groups; tertiary lupus clinic, vs. general clinic and whether the consultation was clinician or nurse led. Results 42 females aged 16-55 were identified. 39/42 (93%) of patients had discussions regarding contraception and conception. 39/39 (100%) of females were recommended appropriate contraception methods. Only 3/42 (7.1%) received written information on family planning. Adherence to contraceptive advice was low. Only 10/39 (25.6%) of patients recommended non-barrier contraception were complying with advice. 29/42 (69%) patients were on teratogenic medication. 8/29 (27.6) were using long acting reversible contraceptives (LARC). Of those who were not, 2/29 (6.8%) were not sexually active, 1/29 (3.4%) relied on their partner’s vasectomy, 3/29 (10.3%) had alternative contraception preference and in 15/29 (51.7%) the reasons were unclear. Conception and family planning advice was given in all clinics, however those attending the tertiary lupus clinic were significantly more likely to receive follow up advice on contraception and conception advice compared to those attending general clinics (U = 44, P < 0.001). There was no difference between the frequency of nurse or clinician led advice. Conclusion Contraceptive advice in line with current guidelines is being delivered routinely in lupus clinics. There appears to be barriers to the uptake of LARC. To better understand this, exploration of patient experiences of contraception and conception discussions is underway. Disclosure K. Mashida: None. R. Benson: None. A. Redfern: None. C. Burton: None. Z. Mclaren: None.

Contraceptive effects on the cervicovaginal microbiome: Recent evidence including randomized trials.

Until recently, most data regarding the effects of non-barrier contraceptives on the mucosal microbiome have derived from observational studies, which are potentially biased due to behavioral confounders that may mask their true biological effects. This narrative review summarises recent evidence of the effect of contraceptives on the cervicovaginal microbiome, emphasising data obtained through randomized trials. Good quality data describe that initiation of long-acting progestin-only contraceptives, including levonorgestrel (LNG)-implant and the injectables depot-medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN) do not alter the mucosal microbial environment. Likewise, no strong evidence exists that the use of oral contraceptive pills (OCPs) is associated with alterations of the vaginal microbiome or increased risk of bacterial sexually transmitted infections (STIs). Limited data on the effect of intravaginal rings (IVRs) on the mucosal environment exist and show conflicting effects on the vaginal microbiota. Copper intrauterine device (Cu-IUD) initiation has been associated with bacterial vaginosis (BV) acquisition, including in a randomized trial. LNG-IUDs may have similar affects but need to be evaluated further. Different synthetic hormones have divergent effects on the microbiome and therefore novel hormonal methods need to be rigorously evaluated. Furthermore, the addition of antiretrovirals into multipurpose technologies may alter the effects of the hormonal component. There is thus a critical need to improve our understanding of the biological effects of contraceptive hormones and delivery methods with different pharmacokinetic and chemical properties on the mucosal microbiome in rigorous trials, to inform the development of novel contraceptives and improve individual family planning guidance.

The effect of depression and anxiety on nonbarrier contraception in adolescents and young adults: A scoping review.

The effect of depression and anxiety on nonbarrier contraception in adolescents and young adults: A scoping review.

101. The Relationship between Depression and Non-Barrier Contraceptive Use in Adolescent Females

101. The Relationship between Depression and Non-Barrier Contraceptive Use in Adolescent Females

Contraceptive exposure associates with urinary tract infection risk in a cohort of reproductive-age women: a case control study

Purpose Although non-barrier contraception is commonly prescribed, the risk of urinary tract infections (UTI) with contraceptive exposure is unclear. Materials and methods Using data from Vanderbilt University Medical Centre’s deidentified electronic health record (EHR), women ages 18–52 were randomly sampled and matched based on age and length of EHR. This case-control analysis tested for association between contraception exposure and outcome using UTI-positive (UTI+) as cases and upper respiratory infection+ (URI+) as controls. Results 24,563 UTI + cases (mean EHR: 64.2 months; mean age: 31.2 years) and 48,649 UTI-/URI + controls (mean EHR: 63.2 months; mean age: 31.9 years) were analysed. In the primary analysis, UTI risk was statistically significantly increased for the oral contraceptive pill (OCP; OR = 1.10 [95%CI = 1.02–1.11], p ≤ 0.05), intrauterine device (IUD; OR = 1.13 [95%CI = 1.04–1.23], p ≤ 0.05), etonogestrel implant (Nexplanon®; OR = 1.56 [95% CI = 1.24–1.96], p ≤ 0.05), and medroxyprogesterone acetate injectable (Depo-Provera®; OR = 2.16 [95%CI = 1.99–2.33], p ≤ 0.05) use compared to women not prescribed contraception. A secondary analysis that included any non-IUD contraception, which could serve as a proxy for sexual activity, demonstrated a small attenuation for the association between UTI and IUD (OR = 1.09 [95%CI = 0.98–1.21], p = 0.13). Conclusion This study notes potential for a small increase in UTIs with contraceptive use. Prospective studies are required before this information is applied in clinical settings. Condensation Although non-barrier contraception is commonly prescribed, the risk of urinary tract infections (UTI) with contraceptive exposure is poorly understood. This large-cohort, case-control study notes potential for a small increase in UTIs with contraceptive use.

Barriers and facilitators for access and utilization of reproductive and sexual health services among Female Sex Workers in urban and rural Maharashtra, India.

The public health interventions among Female Sex Workers (FSWs) have mainly addressed HIV/ STI prevention. The focus of the HIV prevention program on FSWs' Reproductive and Sexual Health (RSH) has been limited, thus, rendering them at a higher risk of unintended pregnancies, delayed pregnancy detection, and utilizing unsafe abortion methods. A multistakeholder analysis was performed to study access and use of RSH services among FSWs in urban and rural India. Between January 2016 and June 2019, a qualitative grounded theory approach was used to explore the FSWs' perspectives and experiences about services pertaining to HIV prevention, Antenatal Care (ANC), child delivery, abortion, and pregnancy prevention. Using purposive and convenience sampling, 29 In-Depth Interviews (IDIs), 2 Focus Group Discussions (FGDs) and 22 Key Informant Interviews (KIIs) were conducted with consenting FSWs and indirect stakeholders, respectively. Verbatim translated data was entered in NVivo12 Software and analyzed inductively. The following themes emerged: (1) Condomless sex, unintended pregnancy, vertical transmission, (2) Signs/ indication used for pregnancy detection causing delay (3) Pregnancy prevention methods used, (4) Pregnancy prevention or AIDS prevention, (5) Legal formalities as a barrier to access RSH, (6) Differential facility preference. Pregnancy prevention is a greater motivation for condom use than HIV prevention among FSWs. Therefore, there is an emerging need to reallocate public health resources and redesign policies to meet the RSH needs of FSWs, especially for the prevention of unintended pregnancies. FSW-focused Information Education Communication (IEC) strategies for RSH service utilization are essential to reduce the burden of unintended pregnancies. The National HIV Targeted Intervention (TI) program needs to include pregnancy testing services and information to non-barrier contraceptive methods. An ambient policy environment calls for examining the need for male involvement in pregnancy, family planning and abortion decisions.

Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study

ObjectivesTo describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. Study designWe conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. ResultsAt baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. ConclusionSexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. ImplicationsThis study addressees gaps in knowledge about U.S. Latina adolescents’ contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion.

Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.

Unmet Need for Contraception Among Female Sex Workers Initiating Oral Pre-Exposure Prophylaxis for HIV Prevention During Kenya's National Scale-Up: Results From a Programmatic Surveillance Study.

BackgroundFemale sex workers (FSWs) experience a higher risk for both HIV acquisition and unwanted pregnancies compared to women in the general population. Pre-exposure prophylaxis (PrEP) for HIV prevention offers protection against HIV infection but has no contraceptive effect. We examined the determinants of unmet need for contraception among FSWs who initiated PrEP to inform programs and policies to optimize contraceptive services and avert unwanted pregnancy among this high-risk group.Materials and MethodsA cross-sectional analysis was conducted on routine, de-identified client data from a large-scale PrEP service delivery project, from February 2017 to December 2019. Data were collected from FSWs during clinic visits using Ministry of Health approved tools. Records for all 17,456 FSWs initiated on PrEP from 79 health facilities in 10 counties across three geographic clusters with high and medium HIV incidence were examined for eligibility for the analysis. Unmet need for non-barrier contraception was defined as not being pregnant, not currently using the non-barrier contraceptive method, and not trying to conceive or intending to have a child in the near future. Univariate and multivariable regression analyses were conducted with selected variables to examine associations.ResultsIn the 79 sites, eligible records from 17,063 FSWs who initiated PrEP were included. Two-thirds were under 30 years, and the majority were not married and had received PrEP at drop-in centers. Overall, the unmet need for non-barrier contraception was 52.6%, higher for those under 20 years of age (60.9%) and those served in public and private health facilities (67.4 and 83.2%, respectively) rather than drop-in centers (50.6%). Women from the Nairobi and Coast cluster regions reported a higher unmet need for contraception compared to those from the Lake region. All these associations were significant (p < 0.05) at the multivariate level.ConclusionsThe high unmet need for non-barrier contraception among FSWs initiating PrEP highlights the need for integrated delivery of contraception services within PrEP programs. Identifying groups with a high unmet need could lead to higher success in an integrated program. Two recommended approaches include training healthcare providers to deliver clear contraception messaging during PrEP initiation and making a range of contraceptives accessible within PrEP services for high-risk groups. Furthermore, accelerated research on multipurpose prevention technologies is necessary to reduce the burden on individuals using multiple prevention products concurrently.

Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018.

Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN. Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20-50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP ≥130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported. Of the 8726 women, 12.4% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraceptive status. In logistic regression models, contraceptive use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001-2006) to 81.4% (2013-2018, P < 0.001). Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.

Time trends in contraceptive prescribing in UK primary care 2000–2018: a repeated cross-sectional study

BackgroundOver the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK...

Positive deviance for promoting dual-method contraceptive use among women in Uganda: a cluster randomised controlled trial

ObjectiveTo examine the effects of a positive deviance intervention on dual-method contraceptive use among married or in-union women.DesignOpen-label cluster randomised controlled trial.Setting20 health facilities in Mbarara District, Uganda.Participants960 married or...

The mediating role of partner communication on contraceptive use among adolescent girls and young women participating in a small-group intervention in Malawi: A longitudinal analysis

ABSTRACT Though effective reproductive health interventions have been developed for adolescent girls and young women (AGYW) in sub-Saharan Africa, few have explored whether specific components of the interventions are responsible for observed changes in behaviour. Data for this longitudinal mediation analysis come from a quasi-experimental, sexual and reproductive health study conducted among AGYW (age 15–24) in Malawi. We assessed the extent to which the relationship between attending communication-specific small-group sessions and contraceptive use at one-year was mediated by contraceptive communication with partners at six months, using a bootstrapping procedure to estimate indirect effects. Of 358 participants, 44% attended communication-specific small-group sessions, 37% communicated with partners about contraception at six months, and 21% used non-barrier contraception at one-year. Participants who attended communication-specific small-group sessions had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI: 1.07–2.38) and increased non-barrier contraceptive use at one-year (aOR = 3.53, 95% CI: 1.86–6.69). The relationship between attending communication-specific small-group sessions and non-barrier contraceptive use at one-year was partially mediated by contraceptive communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01–0.07). Our results suggest that contraceptive communication with partners is modifiable through interventions and important for AGYW non-barrier contraceptive uptake.

7. Using the Theory of Planned Behavior to Identify Predictors of Contraceptive Use Intentions and Behaviors in Adolescents

<h3>Background</h3> Adolescent unintended pregnancy has dropped in the United States, while sexually transmitted infection (STI) prevalence in this population has increased. We utilize the Theory of Planned Behavior (TPB) to identify predictors of STI and pregnancy prevention intentions and behaviors in adolescents. <h3>Methods</h3> Baseline data were obtained from 2GETHER—The Dual Protection Project, a randomized clinical trial aiming to decrease STIs/pregnancy in African American adolescents. Participants were eligible if they engaged in vaginal sex in the past 3 months and finished the baseline survey (n=697). This secondary analysis examines the relationships between TPB constructs (attitudes, subjective norms, perceived behavioral control (PBC)) and contraceptive intentions and behaviors in three ways. First, we examined the relationship between TPB constructs related to pregnancy with intentions to use and use of contraception. Next, we examined TPB constructs related to STI prevention with intentions to use and use of condoms. Finally, we created composite TPB construct variables for dual protection (simultaneous prevention of pregnancy and STI) and examined the relationship between intention and contraceptive and condom use (dual method, condom alone, non-barrier contraception alone, no method). Chi square analysis and multinomial logistical regression were used to examine relationships. Institutional Review Board approval was obtained from both Emory University and the Centers for Disease Control and Prevention. <h3>Results</h3> The average age of participants was 17.35 years (range=14-19, SD=1.265). 50.2% of adolescents reported a STI diagnosis would be worse than pregnancy; 36.0% rated them equally bad. For pregnancy constructs, anti-pregnancy attitudes (p<.001) and subjective norms (p=.031) were associated with increased intentions to use contraception. Higher PBC (p<.001), intentions to use contraception (p<.001), and anti-pregnancy attitudes (p=.010) were associated with contraceptive use. For STI constructs, subjective norms were associated with intentions to use condoms (p=.014). Lower PBC was predictive of decreased condom use (p<.001). In multinomial regression analysis, participants with negative attitudes were 3.9 times more likely to intend to use dual methods compared to no protection (OR=3.900, CI=(1.477, 10.299)). Participants with higher PBC were more likely to have used dual methods (OR=1.997, CI=(1.146, 3.482)) and condoms only (OR=3.668, CI=(2.251, 5.975)) compared to no method. <h3>Conclusions</h3> Participants viewed STIs more negatively than pregnancy. However, attitudes, PBC and subjective norms for pregnancy prevention were more predictive of intentions and use of contraception than they were to predict intentions and use of condoms.

The Association Between Nonbarrier Contraceptive Use and Condom Use Among Sexually Active Latina Adolescents

PurposeThis study aimed to determine the association between use of highly effective methods of nonbarrier contraception and condom use in a sample of Latina adolescents and whether the change to a more effective method of nonbarrier contraception is associated with a change in condom use. MethodsAs part of a larger study, 442 sexually active Latina adolescents aged 14–18 years were surveyed immediately before an appointment with a medical care provider at a school-based health center and 3 months later. Ordinal logistic and linear regression were used in the analysis of cross-sectional and longitudinal data to assess the relationship between patterns of nonbarrier contraception and condom use. ResultsThe use of all types of nonbarrier methods of contraception was significantly associated with decreased condom use. Change over time from a less effective to a more effective nonbarrier method of contraception was also associated with a decrease in condom use. Greater number of sexual encounters was associated with lower the frequency of condom use. ConclusionsThe use of highly effective methods of nonbarrier contraception was associated with reduced frequency of condom use. This highlights the need to promote condom use concurrently with nonbarrier methods of contraception to improve protection against both pregnancy and STIs.

Brief Report: Incidence and Correlates of Pregnancy in HIV-Positive Kenyan Sex Workers.

The incidence of pregnancy in female sex workers (FSWs) living with HIV is not well characterized. Current and former FSWs living with HIV and enrolled in a prospective cohort study in Mombasa, Kenya, were followed monthly to ascertain sexual behavior and underwent quarterly pregnancy testing. Pregnancies were considered planned, mistimed, or unwanted according to fertility desires and pregnancy intentions. Cox proportional hazards models were used to estimate hazard ratios (HRs) of the association between characteristics and incident pregnancy. Two hundred seventy-nine FSWs were eligible (October 2012-April 2017). Most women had a nonpaying, regular partner (83.2%, 232/279), were not using modern nonbarrier contraception (69.5%, 194/279), and did not desire additional children (70.6%, 197/279). Of 34 first incident pregnancies [5.8/100 person-years (p-y); 95% confidence interval (CI): 4.1 to 8.0], 91.2% (n = 31) were unintended. The incidences of planned (5.7/100 p-y, n = 3), mistimed (10.4/100 p-y, n = 9), and unwanted pregnancies (4.9/100 p-y, n = 22) were similar (P = 0.15). In univariable analysis, oral contraceptive pill use (versus no contraception), having a nonpaying, regular partner, transactional sex, vaginal washing, condomless sex, and higher sex frequency were associated with an increased pregnancy risk. Older age was associated with a lower pregnancy risk. In multivariable analysis, having a nonpaying, regular partner (adjusted HR 4.0, 95% CI: 1.2 to 14.1) and age ≥40 years (aHR 0.2, 95% CI: 0.0 to 0.9) remained significantly associated with a higher and lower pregnancy risk, respectively. In this cohort of HIV-positive FSWs, most pregnancies were unintended. Identifying FSWs' fertility desires and pregnancy intentions could facilitate efforts to increase contraceptive use and implement safer conception strategies.

The Prevalence of Chlamydia Trachomatis Infection Among Gynecological Outpatients Attendees at Central Basra Hospitals Using One-Step Chlamydia Test

Objective: The objective of this study is to estimate the prevalence rate of chlamydia infection among gynecological outpatients attendees at central Basra hospitals and assessing the predisposing factors and clinical features. Methods: This is a cross-sectional study that was conducted at central Basra hospitals during the period from 15 February 2018 to 10 May 2019. The distribution of cases according to the hospitals was 290 patients from Basra maternity and child hospital, 85 patients from Basra general hospital, 75 patients from AL Mawani hospital and 50 patients from AL Fayhaa hospital, this variation in the number depend on outpatient clinics attendees. participants were assessed according to a predesigned questionnaire and screening test for Chlamydia Trachomatis was done for all patients under study by using one-step chlamydia test (Chlamydia Rapid Test Device). Results: Among 500 patients 60% of them were from the age group 20-40 year, 62% were P2-4 and 89% from multipara and grand multipara, 60% were illiterate and 38% were having primary and secondary school, 61% from low socioeconomic class, nonusers of contraception were 23.7% and about 90% of patients were living at the central areas of Basra. Several factors have a statistically significant effect on the Chlamydia Trachomatis infection like being infertile p-value 0.000 or having high parity p-value 0.013 or non-barrier contraceptives users p-value 0.035. While other factors have no statistically significant effect like age p-value 0.506, socioeconomic state p-value 0.779, and level of education p-value 0.986. Conclusion: The prevalence rate of Chlamydia infection is low among the population in the central areas of Basra city compare to other countries. Being infertile or of high parity are among the significant risk factors. Barrier contraceptives significantly reduced the risk of infection and can be used to protect against the transmission of infection.

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.

Rapid repeat pregnancy in women with schizophrenia

AimWomen with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. MethodsThis population-based cohort study in Ontario, Canada (2002−2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. ResultsWomen with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07–1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26–2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99–2.29) or induced abortions (aRR 1.07, 95% CI 0.81–1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93–1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35–2.07). DiscussionWomen with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.

Engagement in Antiretroviral Treatment and Modern Contraceptive Methods Among Female Sex Workers Living With HIV in Lesotho

Female sex workers (FSW) are disproportionately affected by HIV in Lesotho, which highlights the importance of contraception and antiretroviral therapy (ART) given occupational risks of unwanted pregnancies. Seven hundred and forty-four FSW recruited through respondent-driven sampling in Maputsoe and Maseru in Lesotho completed a questionnaire and HIV testing in 2014. RDS-adjusted HIV prevalence was high (66.1; 95% CI: 58.7–72.8); 56% of HIV + participants were not using non-barrier contraception, and 32% were on ART. Among HIV-positive FSW not using non-barrier contraception, negative correlates of ART engagement were older age, lower HIV education, and consuming 5+ alcoholic drinks/day. Tailored HIV information delivery efforts for FSW in Lesotho’s high HIV burden environment may reduce horizontal and vertical transmission risks.