Contraceptive Nonuse Research Articles

Determinants of non-participation in labour force among women of reproductive age in Nigeria

Background: Studies have examined the individual-level and household predictors of women’s labour force participation in Nigeria, this study went further to examine the community-level determinants of non-participation in labour force among women of reproductive age in Nigeria. Data Source and Methods: This study analysed the 2016-2017 Nigeria Multiple indicator Cluster Survey (MICS) data of women (aged 15-49; n= 32,742). Descriptive and multivariable analyses (using multilevel binary logistic regression) were performed. Results: Results showed that 73% of the women didn’t participate in the labour force. Community poverty (medium: OR = 0.95 and high: OR = 1.38), number of children living with a woman (medium: OR = 1.05 and high: OR = 1.19), proportion of contraceptive non-users (high: OR = 2.49 and medium: OR = 1.59) and region (north: OR = 5.42) were significant (P<0.05) determinants. Conclusion: Hence, women (of reproductive age) in the north, in communities with high: poverty, family size and contraceptive non-use should be economically empowered.

Molecular markers of skeletal muscle hypertrophy following 10 wk of resistance training in oral contraceptive users and nonusers.

The objective was to determine whether skeletal muscle molecular markers and SC number were influenced differently in users and nonusers of oral contraceptives (OCs) following 10 wk of resistance training. Thirty-eight young healthy untrained users (n = 20) and nonusers of OC (n = 18) completed a 10-wk supervised progressive resistance training program. Before and after the intervention, a muscle tissue sample was obtained from the vastus lateralis muscle for analysis of muscle fiber cross-sectional area (fCSA) and satellite cell (SC) and myonuclei number using immunohistochemistry, gene expression using PCR, protein expression, and myosin heavy chain composition. Following the training period, quadriceps fCSA (P < 0.05), SCs/type I fiber (P = 0.05), and MURF-1 mRNA (P < 0.01) were significantly increased with no difference between the groups. However, SCs/total fiber and SCs/type II fiber increased in OC users only, and SCs/type II fCSA tended (P = 0.055) to be greater in the OC users. Furthermore, in OC users there were a fiber type shift from myosin heavy chain (MHC) IIx to MHC IIa (P < 0.01), and expression of muscle regulatory factor 4 (MRF4) mRNA (P < 0.001) was significantly greater than in non-OC users. Use of second-generation OCs in young untrained women increased skeletal muscle MRF4 expression and SC number following 10 wk of resistance training compared with nonusers.NEW & NOTEWORTHY The effect of oral contraceptive use on the skeletal muscle regulatory pathways in response to resistance training has not been investigated previously. Here we present novel data, demonstrating that use of second-generation oral contraceptives in young untrained women increased skeletal muscle regulatory factor 4 expression and satellite cell number following 10 wk of resistance training compared with nonusers.

A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study

PurposeFemale adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). MethodsWe conducted a prospective cohort study with sexually active female ED patients aged 14–19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). ResultsWe screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). ConclusionsDr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.

Computed tomography contrast enhancement pattern of the uterus in premenopausal women in relation to menstrual cycle and hormonal contraception.

BackgroundThere are different types of computed tomography (CT) contrast enhancement patterns of the uterus. It is not known whether these are hormonally dependent.PurposeTo assess the relationship between these patterns and the menstrual cycle in non-users of hormonal contraception, and the possible impact of hormonal contraception.Material and MethodsProspective observational study of abdominal CT scans of 53 premenopausal women of whom 28 were non-users and 25 users of hormonal contraception. The non-users were divided according to menstrual cycle phase: follicular (n = 12); ovulatory (n = 1); and luteal (n = 12). The pattern and intensity of contrast enhancement of the uterine myometrium were assessed.ResultsThe dominant pattern of contrast enhancement of the myometrium was the diffuse homogeneous type in both non-users and users. The intensity of the enhancement measured in Hounsfield units (HU) was higher in the follicular phase (median 102, range 73–130) compared to the luteal phase in non-users (median 92, range 57–130); however this was not statistically significant (P = 0.2). The HU values observed in users (median 95, range 45–160) were at the same levels compared to those of the luteal phase in non-users.ConclusionThe dominant pattern of contrast enhancement in the portal venous phase of the myometrium in fertile ages is the diffuse homogeneous type and is independent of menstrual cycle phase or the use of hormonal contraception. However, these factors seem to play a role in the intensity of contrast enhancement, with a tendency of higher HU values in the follicular phase of non-users.

EFFECT OF HORMONAL CONTRACEPTION ON ILLNESS SEVERITY IN WOMEN WITH POSITIVE SARS-CoV2 TESTS

To evaluate if hormonal contraception affects illness severity in SARS-CoV2 positive women. Retrospective cohort study. Chart review of reproductive age (12-49 yo) women who tested positive for SARS-CoV2 at a tertiary medical center from March 28-April 27, 2020. Exclusion criterion was pregnancy. Women using hormonal contraception were compared to patients not using hormonal contraception. Patients were not contacted to confirm contraception. The primary outcome was hospital admission rate. Secondary outcomes included a composite score for illness severity and clinical signs of infection (Table 1). Multivariable logistic regression was used to control for differences at baseline. Results are reported as adjusted odds ratio (aOR) with a 95% confidence interval (CI). Calculated p values < 0.05 were statistically significant. A total of 2044 women were screened for SARS-CoV2. Of the 132 positive women, 46 used hormonal contraception: levonorgestrel IUD (n=9; 19.6%), injectable progestin (n=2; 4.35%), oral progestin (n=3; 6.52%), oral contraceptive (n= 24; 52.1%), transdermal patch (n=4; 8.70%), vaginal ring (n=4; 8.70%) and 86 did not use hormonal contraception. The rate of hospitalization for SARS-CoV2 was low for users and non-users of hormonal contraception (2.3% vs. 3.8%, respectively) and was not statistically different between groups. There was no difference between the rate of symptoms and clinical signs of infection between groups. Sex hormones may play a significant role in regulating immune response and can impact disease state. We provide preliminary evidence that use of hormonal contraception does not have a significant effect on the illness severity in SARS-CoV2 as measured by hospitalization.Table 1Primary and secondary outcomesHormonal contraception (n= 44)aNot on hormonal contraception (n=79)aAdjusted OR (95% CI)Primary OutcomeHospital admission1 (2.3)3 (3.8)0.99 (0.68-1.44)Clinical SignsComposite score of illness severityb1 (2.3)2 (2.5)0.98 (0.67-1.43)Heart rate > 100 beats/min4 (9.1)3 (3.8)0.99 (0.68-1.45)Respiratory rate > 22 breaths/min1 (2.3)1 (1.3)0.97 (0.67-1.42)Urine output < 0.5 mL/kg/hr1 (2.3)1 (1.3)0.97 (0.66-1.42)Lactate > 3 mmol/L00cTemperature > 100.4 °F6 (13.6)8 (10.1)0.98 (0.67-1.42)WBC > 12,000 or < 4,000 / mmˆ300cIntubation00cData are shown as n/N (%) unless otherwise specified a n=2 & n=7 patients excluded in the hormonal vs. not hormonal groups, respectively, due to no data on hospital admission b Components of the composite: hypoxia (O2 < 94%), > than 50% lung involvement on imaging, respiratory failure, respiratory shock, multiorgan dysfunction, death c Unable to perform logistic regression due to cells with 0 counts Open table in a new tab

Influence of Second Generation Oral Contraceptive Use on Adaptations to Resistance Training in Young Untrained Women.

Dalgaard, LB, Jørgensen, EB, Oxfeldt, M, Dalgaard, EB, Johansen, FT, Karlsson, M, Ringgaard, S, and Hansen, M. Influence of second generation oral contraceptive use on adaptations to resistance training in young untrained women. J Strength Cond Res 36(7): 1801-1809, 2022-The study purpose was to determine effects of using second generation oral contraceptives (OC) on muscle adaptations to resistance training in young untrained women. Twenty users and 18 nonusers of OC completed a 10-week supervised progressive resistance training program. Before and after the intervention, muscle cross-sectional area (mCSA) of the quadriceps was measured using magnetic resonance imaging and muscle fiber CSA (fCSA) was determined by immunohistochemistry. In addition, body composition (DXA, fat mass/fat-free mass), maximal isometric muscle strength (dynamometry), 5 repetition maximum (5RM) leg press strength, counter movement jump (CMJ) height, and average power using a modified Wingate test were determined. Serum hormone analysis ensured OC compliance and 4-day food records documented dietary intake. After the training period, quadriceps mCSA (OC: 11.0 ± 6.0% vs. non-OC: 9.2 ± 5.0%, p = 0.001), type II fCSA (OC: 19.9 ± 7.9% vs. non-OC: 16.6 ± 7.2%, p = 0.05), muscle strength (knee extension, knee flexion and 5RM, p < 0.001), and functional power (CMJ, AP, p < 0.001) were significantly increased with no significant difference between the groups. However, a tendency toward a greater increase in fat-free mass (FFM) in the OC group was observed (OC: 3.7 ± 3.8% vs. non-OC: 2.7 ± 3.5%, p = 0.08). Collectively, use of second generation OCs in young untrained women did not significantly improve adaptations to 10 weeks of resistance training compared with nonusers. The trend toward greater gains in FFM in the OC group warrant future studies.

>Modern Contraception: Uptake and Correlates among Women of Reproductive Age-Group in a Rural Community of Osun State, Nigeria.

Universal contraceptive access is one of the key strategies for achieving sustainable developments in any country. Yet, uptake has remained low in most developing nations like Nigeria. The reasons for low use must be contextually understood to aid effective contraceptive programming. This study assessed contraceptive use and its determinants among reproductive aged women in Ejigbo, Osun State, Nigeria. A quantitative study involving 405 participants which were recruited using multi-stage sampling method was carried out. Data were collected using pretested semi-structured, interviewer-administered questionnaire. Chi-Square test and binary logistic regression analysis were used for inferential statistics. The mean age of the respondents was 28±6. The majority (92.8%) of the respondents were aware of family planning, 68.9% of them possessed good knowledge but only 53% of them demonstrated favorable contraceptive attitude. Less than half (33.0%) of those who had heard about contraception were current users of modern methods. Injectables (45.0%) and male condoms (30.0%) were the most prevalent contraceptive methods among the respondents. The main determinants of contraceptive uptake were respondents' educational status (AOR=0.525, 95%CI=0.284-0.972), contraceptive knowledge (OR=0.512, 95%CI=1.242-1.968) and attitude (OR=0.512, 95%CI=1.2421.968). Fear of perceived side effects (45.2%), low pregnancy risk perception (35.7%) and spousal refusal (12.5%) were the main reasons for non-contraceptive use among non-users. Contraceptive demand in the study population was low in spite of high awareness level. There is a need to increase contraceptive literacy in the study population and make the services more acceptable to rural dwellers so as to meet the SDG-3 target in Nigeria.

Perceptions of women with systemic lupus erythematosus undergoing high-risk prenatal care: A qualitative study

BackgroundSystemic lupus erythematosus (SLE) is a multisystem autoimmune disease that often leads to situations of harm to the mother-fetus binomial. Given the potential for complications and morbidities in these pregnant women, it is essential that a multidisciplinary team be involved in pregnancy planning, as well as monitoring the course of the pregnancy and the postpartum period. Owing to the imminent risks of disease worsening along with consequent disabilities, these women may experience psychological and psychosocial impacts conflicting with the psychological demands of pregnancy. ObjectiveTo understand the meanings attributed to pregnancy by women with SLE. DesignA qualitative design with face-to-face interview following a semi-structured script of open-ended questions. SettingA specialized outpatient clinic where during prenatal care, women with stable disease undergo scheduled appointments. ParticipantsThe sample was intentionally composed of women visiting a specialized outpatient clinic from July 2017 to July 2018. The participants (N = 26) were interviewed in depth, with no refusal. Thematic analysis according to the 7 steps of qualitative analysis was conducted using NVivo 11. FindingsFour categories were identified: (1) unplanned pregnancy and nonuse of contraception, (2) feeling healthy despite a doctor's warning of the disease worsening because of pregnancy, (3) joy coupled with fear of the future and pregnancy, and (4) self-perception and straight perception. ConclusionsThe experiences of pregnant women with SLE are permeated by ambiguous feelings. These women feel healthy because they can bear a child despite the chronic disease diagnosis and, at the same time, experience fear and insecurity owing to the imminent possibility of disease-related disabilities and limitations. They especially wish to experience motherhood, and they strive for safety and support. Implications for practiceHealth teams must be structured to welcome and advise these women in planning relationships and pregnancy, as well as choosing the best contraceptive methods and making optimal reproductive decisions. The development of strategies to deal with changes in the perinatal period may be helpful, as these women are willing to take care of themselves.

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.

Increasing role of abstinence and infecundity in non-use of contraceptive methods in India.

This paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005-06: N=37,296; 2015-16: N=247,024), which surveyed currently married women aged 15-49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex: 10%; infrequent sex: 3%) and infecundity (menopausal/hysterectomy: 12%; subfecund/infecund: 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015-16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005-06 to 2015-16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples.

Determinants of Fertility and Contraceptive Use among Palestinian Women in the Gaza Strip: Qualitative Study

The current total fertility rate among Palestinian women in the Gaza Strip (4.5 births per woman) is higher than that of all neighbouring countries, and the population growth rate of 3.3% per year is also one of the highest in the world. This study aimed to examine the main determinants of fertility and contraceptive use among Palestinian women in the Gaza Strip. The study entailed collecting primary qualitative data that were collected through focus group discussions with contraceptive users and non-users who have at least one child less than 5 years of age. Six focus groups were assembled with 9 participants per group. Framework analysis was used to analyse the focus group data. The findings of study verified that the lack of social security policies and welfare services for elderly people encouraged parents to have many children to secure old age support. The current Israeli-Palestinian conflict was a driving force for fertility. Women desire more children as insurance against expected deaths due to the on-going conflict. Also, unemployment among women was a motivating factor for women to have more children and to use contraceptive, while Religion: “the Islamic doctrine”–does not have a direct effect on fertility decisions and contraception use. The findings of this study suggest that the Palestinian National Authority need to implement strategies to increase women’s labor force participation rate and to establish a social security system to provide income and other social welfare services to needy elderly people. Finally, increased knowledge about the availability and best practices of contraceptive methods is an important policy action.

Effects of a dopamine agonist on trusting behaviors in females.

Trust is central to bonding and cooperation. In many social interactions, individuals need to trust another person exclusively on the basis of their subjective impressions of the other's trustworthiness. Such impressions can be formed from social information from faces (e.g., facial trustworthiness and attractiveness) and guide trusting behaviors via activations of dopaminergic brain regions. However, the specific dopaminergic effects on impression-based trust are to date elusive. Here, in a double-blind, placebo-controlled, within-subject design, we administrated a D2/D3 dopamine agonist (pramipexole) to 28 healthy females who subsequently played a one-shot trust game with partners of varying facial trustworthiness. Our results show that by minimizing facial attractiveness information, we could isolate the specific effects of facial trustworthiness on trust in unknown partners. Despite no modulation of trustworthiness impressions, pramipexole intake significantly impacted trusting behaviors. Notably, these effects of pramipexole on trusting behaviors interacted with participants' hormonal contraceptive use. In particular, after pramipexole intake, trust significantly decreased in hormonal contraceptive non-users. This study fills an important gap in the experimental literature on trust and its neural dynamics, unearthing the cognitive and neural modulations of trusting behaviors based on trustworthiness impressions of others.

Intentionally or Ambivalently Risking a Short Interpregnancy Interval: Reproductive-Readiness Factors in Women's Postpartum Non-Use of Contraception.

A focus of research on short interpregnancy intervals (IPI) has been on young disadvantaged women whose births are likely to be unintended. Later initiation of family formation in the United States and other high-income countries points to the need to also consider a woman's attributes indicative of readiness for purposefully accelerated family formation achieved through short IPIs. We test for whether factors indicating "reproductive readiness"-including being married, being older, and having just had a first birth or a birth later than desired-predict a woman's non-use of contraception in the postpartum months. We also test for whether this contraceptive non-use results explicitly from wanting to become pregnant again. The data come from the 2012-2015 Pregnancy Risk Assessment Monitoring System, representing women who recently gave birth in any of 35 U.S. states and New York City (N = 120,111). We find that these reproductive-readiness factors are highly predictive of women's postpartum non-use of contraception because of a stated desire to become pregnant and are moderately predictive of contraceptive non-use without an explicit pregnancy intention. We conclude that planning for, or ambivalently risking, a short IPI is a frequent family-formation strategy for women whose family formation has been delayed. This is likely to become increasingly common as family formation in the United States is initiated later in the reproductive life course.

Differences in prevalence and associated factors of underweight and overweight/obesity according to rural–urban residence strata among women of reproductive age in Bangladesh: evidence from a cross-sectional national survey

ObjectivesThis study aimed to investigate the differences in prevalence and factors influencing underweight and overweight/obesity stratified by region of residence among women of reproductive age in Bangladesh.DesignSecondary analysis of cross-sectional...

Societal Influences on the Utilization of Contraception Amongst Women in South Africa

The strong desire to experience motherhood, mediated by prevailing social and cultural norms encourage childbearing in society. Contraceptive use and pregnancy among HIV positive women in South Africa is of growing concern as it may be associated with various adverse factors having socio-economic and health impacts. The timeous initiation and optimal utilisation of antenatal care services is imperative to ensure positive pregnancy outcomes and good maternal health; not always possible due to various challenges in developing countries. Motherhood is a component of a women&amp;rsquo;s identity in cultural societies and important for female social status. Major challenges are gender-based violence and gender inequality as well as physiological factors that place women at risk like cultural and behavioural practices requiring parental consent for access to reproductive and sexual health services tend to discourage girls and women in their pursuit for decision making in reproductive health. This study examines the societal influences on contraceptive usage amongst women attending an antenatal clinic, their contraceptive use and HIV status in the city of Durban, province KwaZulu-Natal, South Africa. A cross-sectional study was conducted at a Primary Health Care (PHC) facility with a total of 283 pregnant women in trimester one visiting the antenatal clinic for the first time who completed a self-administered questionnaire. Results evidenced that almost 70% of the study population are aware of their HIV status prior to conceiving. Contraceptive usage in HIV positive participants was similar 82 (81%) to 97 (75%) in HIV negative participants. The HIV positive participants were aware of the consequences of non-contraceptive use. HIV positive women were not deterred by the desire to use contraception nor conceive (OR: 1.04, CI: 0.61 - 1.79). The study reports a high number of the women are single (&amp;gt;75%), low level of education (90%), unemployed (&amp;gt;70%). HIV status has no impact on contraceptive use and the prevalence of pregnancy among HIV positive women. The number of miscarriages (11%) and early neonatal deaths (6%) reported appeared higher in HIV positive women. Smoking (&amp;gt;50%) and alcohol consumption (&amp;gt;50%) were equally high amongst the pregnant women. Comprehensive programs for planned pregnancies in HIV positive women is necessary for a paradigm shift in the prevailing social and cultural norms worldwide. Reproductive health education extending to embrace the boys and men in the population will increase the importance and acceptance of contraception usage for both HIV positive and negative women in reproductive health care.

KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT CONTRACEPTIVE AMONG REPRODUCTIVE AGE GROUP FEMALES

Background: India is the second most populous country in the world having a rapidly growing population which is currently increasing at the rate of 16 million each year.&#x0D; Methods: A cross sectional study was conducted on females between 15-45 years served as inclusion criteria, while unmarried females were excluded. The women interviewed were informed of the study and consent was taken. The participation was on voluntary basis. Questions regarding factors responsible for non use of contraception were also asked.&#x0D; Results: Out of 100 women, 68 (68.00%) had knowledge about family planning. 63.00% knew about condom, followed by OCPs &amp; other methods. Contraceptive usage in our study was 62.00%.&#x0D; Conclusions: Effort should be made to educate the public about the safety and convenience of modern, long term, reversible methods of contraception among both in health care professional and public.&#x0D; Keyword: Knowledge, Attitude, Practice, Contraception

Oral contraceptives linked to symptoms of depression in 16‐year‐old girls

Sixteen‐year‐old girls who used oral contraceptives reported more concurrent depressive symptoms than nonusers of contraceptives in the same age group, a population‐based study in the Netherlands has found. The 16‐year‐olds were the only group in the study of young women ages 16 to 25 in which oral contraceptive use was associated with concurrent depressive symptoms, the researchers reported.

Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017

ObjectiveTo describe characteristics of U.S. contraceptive non-users to inform tailored contraceptive access initiatives. Study designWe used National Survey of Family Growth data from 2011 to 2017 to identify characteristics of contraceptive non-users compared to other women ages 15–44 at risk for unintended pregnancy. We also examined reasons for not using contraception by when non-users expected their next birth. We calculated unadjusted and adjusted prevalence ratios using two definitions of contraceptive non-use: (1) contraceptive non-use during the interview month, and (2) a more refined definition based on contraception use during the most recent month of sexual intercourse and expectation of timing of next birth. We considered p-values <0.05 statistically significant. ResultsApproximately 20% (n=2844) of 12,071 women at risk of unintended pregnancy were classified as standard contraceptive non-users. After adjusting for all other variables, non-users were more likely to be low-income, uninsured, never married, expect a birth within 2 years, and have zero or one parity. The top reasons for contraceptive non-use were not minding if they got pregnant (22.6%), worried about contraceptive side effects (21.0%), and not thinking they could get pregnant (17.6%). After applying the more refined non-user definition, we identified 5.7% (n=721) of women as non-users; expecting a birth within 2–5 years and having a parity of one were associated with non-use after adjustment of all other factors. ConclusionOur more refined definition of non-users could be used in future studies examining the causes of unintended pregnancy and to inform programmatic interventions to reduce unintended pregnancy. ImplicationsDescribing contraceptive non-users and reasons for contraceptive non-use could help us better understand reasons for unintended pregnancy and inform tailored contraceptive access initiatives.

Modern Contraceptive Use Following an Unplanned Birth in Bangladesh: An Analysis of National Survey Data

Ineffective use or nonuse of contraceptives following an unplanned birth can contribute to the risk of a subsequent unintended pregnancy; however, the literature on the relationship between unintended pregnancy and postpartum contraceptive use is sparse, especially in low- and middle-income countries. Data on 4,493 women from the 2014 Bangladesh Demographic and Health Survey were analyzed; the subjects of the analysis had had a live birth in the three years prior to the survey and were currently at risk of pregnancy. Multilevel logistic regression analysis was used to examine associations between the intendedness of a woman's last pregnancy resulting in a live birth and her current modern contraceptive use adjusting for individual, household and community-level variables. Twenty-six percent of women reported that their last pregnancy resulting in a live birth had been unintended (15% mistimed and 11% unwanted); 61% reported current use of a modern contraceptive method. Compared with women who reported the pregnancy as having been wanted, those who reported the pregnancy as mistimed had greater odds of current modern contraceptive use (odds ratio, 1.6); no association was found between having had an unwanted pregnancy and subsequent modern contraceptive use. Other important correlates of modern contraceptive use included women's autonomy and desire for children, time since last birth and community-level poverty. Bangladeshi women who experience an unwanted pregnancy may have an elevated risk of subsequent unintended pregnancy. Broader coverage of family planning services, and integration of family planning with maternal health care, may increase modern contraceptive use following an unplanned birth.

Oral Contraceptive Types in Relation to ABO Blood Groups Among Saudi Women of Different Reproductive Age Groups and Impact on Venous Thromboembolism.

Saudi women have recently started using oral contraceptives (OCs), which has led to risk of venous thromboembolism (VTE). The risk varies with the type of OC generations used, and with OC use the risk for VTE increases by 2- to 6-fold. This study evaluated the effect of OC types in relation to ABO blood group on the risk of VTE among Saudi women. Thrombin generation (TG) was measured in the plasma of the women in the presence and absence of platelet rich plasma, platelet poor plasma and thrombomodulin or activated protein C. OC usage increased TG parameters ETP and Peak height by 9.81% and 16.04%, respectively. An increased risk of VTE was seen among women on third generation OCs as compared to those on second generation products. Within OC generations, we found that for women using fourth generation OCs, their ETP increased by 36.18% as compared to those using second generation and by 6.07% in those using third generation compared to those using second generation. There was significant difference with respect to ABO blood groups and OC generation types, but larger sample size is required. Women who are 40 years and older and using third generation OC had a higher risk of having thrombosis (11.84%), as compared to those using second generation OC (8.79%) and to those using fourth generation OC (5.03%). An association between different OC groups and non-O blood group in thrombosis generation was noted. TG parameters were significantly increased in relation to BMI when comparing to OC users versus non-users. In addition, inhibition of TG parameters in the presence of recombinant human thrombomodulin (TM) and activated protein C (APC) were significantly increased.