Permanent Contraception Research Articles

Barriers to Women’s Access to Voluntary Sterilization in Canada

Introduction: In Canada, any adult who is aware of the permanent consequences of a tubal ligation is allowed to receive it, yet many doctors refuse to perform the procedure on women, especially those from marginalized communities. The purpose of this report is to investigate and identify some of the barriers that impede Canadian women’s ability to access voluntary sterilization. There is a particular focus on how Canada's history of eugenics and coerced sterilization shapes the current conditions under which women seek and are too often refused access to permanent contraception. Methods: Six qualitative, semi-structured interviews were conducted with scholars and activists in the field of Reproductive Justice (RJ) and reproductive healthcare. The interviews facilitated discussions about reproductive autonomy, patient rights, and patriarchal attitudes in medicine. An RJ framework and thematic analysis were used to uncover systemic barriers from the interview responses. Results: As discovered through the interviews, the most prevalent barriers to access to voluntary sterilization in contemporary Canada include race, class, language, ethnicity, disability, age and parity. An RJ framework identifies historical parallels to these present-day barriers by looking at the historical and colonial forces that disempower intersectional marginalized communities and influence their reproductive decisions today. Discussions: Canada’s eugenics attitudes from the past seep into the current barriers to access faced by women of colour, low-income women, female newcomers, women with disabilities, and young or nulliparous women. The assumption that these women are not capable of deciding the right course of action for their own bodies and thus should not be trusted by healthcare providers in making these decisions is a consistent problem in both time frames. Conclusion: The restrictions and modes of disempowerment placed on variously positioned women in the past come back in a new form that leads to those same groups being doubted and denied reproductive justice in the present. Many of the interviewees believed that increasing diversity in the medical field is necessary to help alleviate the discrepancies in how contraceptive healthcare is given.

Prevalence of Serous Tubal Intraepithelial Carcinoma (STIC) at the Time of Postpartum Contraceptive Procedures during Caesarean Delivery

Background: To assess the prevalence of serous tubal intraepithelial carcinoma (STIC) in women underwent opportunistic salpingectomy at the time of caesarean delivery (CD). Methods: We conducted a retrospective cohort study (2014–2017) of women who received either bilateral total or partial salpingectomy as postpartum permanent contraception procedure during CD. We collected the characteristics of the patients, the type of CD (elective versus unscheduled), the type of surgical procedure and the related complications. We analysed surgical outcomes and calculated the point prevalence of STIC. Results: We enrolled 280 patients. Of these, 107 (38.2%) and 173 (61.8%) underwent respectively total and partial bilateral salpingectomy. Majority of CDs were elective (81.8%); we did not find differences for intra- and post-operative surgical procedure-related complications. Bilateral fimbriated-part of the tube was available for analysis in 245 patients and STIC was identified in only one patient (prevalence of 0.4%). Conclusions: The frequency of STIC in patients undergoing partial or total bilateral salpingectomy during CD is extremely low, less than 1%. Total bilateral salpingectomy can be proposed as post-partum permanent contraception procedure without increasing surgical related complications. Further randomised studies are needed to confirm the benefits and safety of this procedure.

Forced Sterilization

Forced Sterilization

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study.

Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices. We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant-comparative approach to code transcripts and identify themes. We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception. Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling.

Inequalities in short-acting reversible, long-acting reversible and permanent contraception use among currently married women in India

BackgroundIn India, the usage of modern contraception methods among women is relatively lower in comparison to other developed economies. Even within India, there is a state-wise variation in family planning use that leads to unintended pregnancies. Significantly less evidence is available regarding the determinants of modern contraception use and the level of inequalities associated with this. Therefore, the present study has examined the level of inequalities in modern contraception use among currently married women in India.MethodsThis study used the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Our analysis has divided the uses of contraception into three modern methods of family planning such as Short-Acting Reversible Contraception (SARC), Long-Acting Reversible Contraception (LARC) and permanent contraception methods. SARC includes pills, injectable, and condoms, while LARC includes intrauterine devices, implants, and permanent contraception methods (i.e., male and female sterilization). We have employed a concentration index to examine the level of socioeconomic inequalities in utilizing modern contraception methods.ResultsOur results show that utilization of permanent methods of contraception is more among the currently married women in the higher age group (40–49) as compared to the lower age group (25–29). Women aged 25–29 years are 3.41 times (OR: 3.41; 95% CI: 3.30–3.54) more likely to use SARC methods in India. Similarly, women with 15 + years of education and rich are more likely to use the LARC methods. At the regional level, we have found that southern region states are three times more likely to use permanent methods of contraception. Our decomposition results show that women age group (40–49), women having 2–3 children and richer wealth quintiles are more contributed for the inequality in modern contraceptive use among women.ConclusionsThe use of SARC and LARC methods by women who are marginalized and of lower socioeconomic status is remarkably low. Universal free access to family planning methods among marginalized women and awareness campaigns in the rural areas could be a potential policy prescription to reduce the inequalities of contraceptive use among currently married women in India.

The Urologist's Guide to Religion and Male Factor Fertility Treatment

To create a reference guide for six of the major U.S. religions for use by reproductive health specialists to provide patient-centered care for a culturally diverse patient population. We utilized primary source reviews of various religious texts and verified electronic databases to examine perspectives on use of, in vitro fertilization (IVF), intrauterine insemination (IUI), sterilization procedures such as vasectomy and tubal ligation, and surrogacy for six major U.S. religions: Catholicism, The Church of Jesus Christ of Latter-Day Saints (LDS), Hinduism, Judaism, Buddhism, and Islam. Each statement of religious belief was either taken directly from primary source documents or cross-referenced across several secondary sources to ensure accuracy. Perspectives were compiled into a reference document and table for clinical use. Most religions have focused statements concerning assisted reproduction and vasectomy. While there are caveats for most religions, IVF and IUI are largely opposed only by the Catholic church, surrogacy is not permissible in the LDS Church, Catholic Church, and Islam, and vasectomy is not permissible for the Catholic Church, LDS Church, Judaism, and Islam. Similarly, tubal ligation is also not permitted for these religions with the exception of Judaism of which while vasectomy is considered a violation of the Torah, sterilization of a woman is not explicitly discussed in the old testament. Instead, a rabbinic decree states permanent female sterilization as against the views of the faith. The religions with the most lenient rules concerning reproduction and permanent contraception explored include Buddhism and Hinduism each of which have no reservations pertaining to IVF, IUI, surrogacy, or permanent sterilization. Religion often plays a significant role in patients' attitudes towards use of ART, permanent sterilization, and surrogacy. Familiarity with the religious beliefs and perspectives is important for the reproductive health specialist in order to provide appropriate counseling for their patients. A summative reference guide can help provide patient-centered care for reproductive health and family planning.

Work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training

To explore work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training. We invited educational stakeholders to participate in telephone interviews that elicited strategies for overcoming barriers to family planning training in religious settings. Eighteen out of 30 invited programs leaders participated. Work-arounds included reliance on non-contraceptive indications for contraception and permanent contraception provision, obtaining ethics committee approvals for service provision, and developing partnerships with offsite centers for training. Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions.

Drug Eluting Embolization Particles for Permanent Contraception.

Medical technology that blocks the fallopian tubes nonsurgically could increase access to permanent contraception and address current unmet needs in family planning. To achieve total occlusion of the fallopian tube via scar tissue formation, acute trauma to the tubal epithelium must first occur followed by a sustained and ultimately fibrotic inflammatory response. Here, we developed drug-eluting fiber-based microparticles that provide tunable dose and release of potent sclerosing agents. This fabrication strategy demonstrates high encapsulation of physicochemically diverse agents and the potential for scalable manufacturing by utilizing free-surface electrospinning to generate material for fiber micronization. Manipulation of nanofiber formulation such as drug loading, drug hydrophobicity, polymer hydrophobicity, and crystallinity allowed for modulation of the sustained release properties of our fiber microparticles. We assessed various fibrous microparticle formulations in vivo using a newly developed and validated guinea pig model for contraception. We found that fiber microparticles with bolus release doxycycline effectively elicited acute trauma and those formulated with highly loaded phenyl benzoate caused sustained inflammation in the target organs. The demonstrated potency of these electrospun microparticles, as well as their embolic size and shape, suggests potential for proximal agglomeration and inflammatory activity in the fallopian tubes following transcervical delivery.

Fulfillment of Desired Postpartum Permanent Contraception: a Health Disparities Issue.

Women of color experience marked disparities in fulfillment of desired postpartum permanent contraception. While many attribute the disparity to the required Medicaid sterilization consent form and 30-day waiting period established in response to forced and coerced sterilizations, the policy does not entirely explain the disparity; racial and ethnic disparities persist even within strata of insurance type. We therefore propose framing postpartum permanent contraception as a health disparities issue that requires multi-level interventions to address. Based on the literature, we identify discrete levels of barriers to postpartum permanent contraception fulfillment at the patient, physician, hospital, and policy levels that interact and compound within and between individual levels, affecting each individual patient differently. At the patient level, sociodemographic characteristics such as age, race and ethnicity, and parity impact desire for and fulfillment of permanent contraception. At the physician level, implicit bias and paternalistic counseling contribute to barriers in permanent contraception fulfillment. At the hospital level, Medicaid reimbursement, operating room availability, and religious affiliation influence fulfillment of permanent contraception. Lastly, at the policy level, the Medicaid consent form and waiting period pose a known barrier to fulfillment of desired postpartum permanent contraception. Unpacking each of these discrete barriers and untangling their collective impact is necessary to eliminate racial and ethnic disparities in permanent contraception fulfillment.

Contraception utilization in women with pregestational diabetes

Objective To compare contraception use between women with and without pregestational diabetes. Methods Cross-sectional data on women aged 18–44 years from 2011 to 2017 National Survey of Family Growth (NSFG) was analysed. Maternal diabetes was defined as the presence of pre-gestational type 1 or type 2 diabetes. Bivariate and multiple logistic regression analyses were run to evaluate the association between the use of contraception and by contraception type: permanent, long-acting reversible contraception (LARC), other hormonal method, other non-hormonal method, and none, and maternal diabetes status, controlling for relevant covariates. Results Among the total study sample of 28,454, 1344 (4.7%) had pregestational diabetes. Unadjusted analysis showed women with a history of pregestational diabetes were more likely to use permanent contraception following pregnancy (58.0% vs. 38.7%, p < 0.001) or no contraception (27.2% vs. 24.5%, p < 0.001), but less likely to use LARC (3.4% vs. 11.7%, p < 0.001), other hormonal contraception (4.1% vs. 8.9%, p < 0.001), or other non-hormonal contraception (7.2% vs. 16.4%, p < 0.001). In adjusted analyses, permanent (aOR 1.62, 95% CI 0.72–2.26) remained significant, however the differences were no longer statistically significant: LARC (aOR 0.34, 95% CI 0.12–1.00); other hormonal (aOR 0.61, 95% CI 0.27–1.35); other non-hormonal (aOR 0.59, 95% CI 0.25–1.43); and None (aOR 1.11, 95% CI 0.65–1.89). Conclusion In this analysis, we found that women with pregestational diabetes were more likely to use permanent contraception methods compared to women without pregestational diabetes; however over a quarter of women with pregestational diabetes did not use contraception between pregnancies.

Factors affecting the use of long term and permanent contraceptive methods: a Facebook-focused cross-sectional study

IntroductionIn the Muslim world, the use and acceptance of long-term and permanent contraceptives were limited. Our aim was to investigate those limiting factors so we can help making these methods widely available and acceptable to the society.Methods and data analysisThere were 1365 women from Facebook groups in the period 08/10/2020–8/11/2020. Participants were married women, living in Jordan. This was a cross-sectional study. Statistical Package for Social Sciences (SPSS), version 16, software was used for statistical analysis (Chicago, Illinois, USA).ResultsAmong participants, 22.3% had never used any contraceptives. Non-hormonal IUCD was the most commonly used method. There was a statistically significant association between the use of hormonal IUCD and women's age, marriage duration, education and number of children (p < 0.0001). Tubal ligation was adopted by only 44 (3.22%) participants. 19.68% of participants declined tubal ligation merely due to religious issues. Women who completed only high school level of education underwent tubal ligation significantly more than those with university (Bachelor) and post-university (Master or PhD) degrees (p < 0.0001 and 0.026, respectively). Only 1.83% of women's partners underwent vasectomy, the majority of these vasectomies (72.0%) were done because of the need for lifelong contraception. Around 17% of women's partners had poor knowledge about vasectomy. Further, women's employment status (housewives or full-time employees) was found to be the only variable that affected acceptance of vasectomy (p = 0.0047).ConclusionsWomen endured a heavy burden of contraception. Cultural and religious taboos influenced tubal ligation. Vasectomy was still very rarely adopted by men due to the lack of knowledge about the procedure. Our results raised the need for further dissemination of contraception knowledge and counselling through the primary care and maternity centers, mosques and media in official, comprehensive and integrated programs. Future research is needed in the field of permanent contraceptive methods.

Vasectomy Training in Family Medicine Residency Programs: A National Survey of Residency Program Directors.

Vasectomy is considered a permanent contraceptive method with fewer associated harms than bilateral tubal ligation. However, the number of vasectomy-trained providers may not be meeting the demand for vasectomy in the United States. We describe the vasectomy training landscape in family medicine residencies and factors related to increased procedural training. Program-specific data were collected from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2019. Program characteristics, vasectomy training (eg, time spent, procedural numbers), as well as direct and specific faculty support are described, with bivariate analyses for factors related to procedural competency, defined as more than five vasectomy procedures per resident. We received responses from 250 program directors (response rate=39.8%), with representation across all US regions, and program types. Nearly half (47.5%) offered less than 1 day of vasectomy didactics and/or procedural training; 38.9% of programs reported having a family medicine faculty champion for vasectomy. Only 16 programs (6.8%) reported that their average graduating residents performed more than five vasectomies. Programs with a faculty champion (OR 28.1, CI 3.6-216.4) or family medicine faculty as primary trainer (OR 17.6, CI 2.2-138.2) were more likely to graduate residents who had performed more than five vasectomies. Fewer than 10% of surveyed family medicine residency programs offer adequate vasectomy procedural training. Family medicine faculty who serve as primary trainers and act as faculty champions can increase vasectomy training opportunities for residents, and thereby increase the supply of vasectomy providers in the United States.

Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response

The coronavirus disease 2019 (COVID-19) pandemic has posed a burden to healthcare systems around the world and has changed the way people access health services, including contraception. This document sets forth guidance from the Society of Family Planning for providing contraceptive care in the context of the COVID-19 pandemic, including when access to healthcare is restricted due to pandemic response. It also outlines the role of telehealth for providing contraceptive care beyond the pandemic. Clinicians can use synchronous telemedicine visits and other forms of telehealth to provide many aspects of contraceptive care. Both audio-video and audio-only visits are acceptable forms of telemedicine. Access to permanent contraception should be maintained, especially in the postpartum period. Combined hormonal contraceptive (CHC) users who have asymptomatic or mild COVID-19 infection may continue their contraceptive method, while those admitted to the hospital with severe infection should suspend CHC use until they are clinically recovered. CHC users who take Paxlovid for mild-moderate COVID-19 infection can consider a back-up contraceptive method for the duration of therapy, but clinically relevant drug interactions are unlikely. Future research should examine contraceptive outcomes in people who receive care via telemedicine; and access to telemedicine among historically excluded populations such as adolescents, people of color, people of low socioeconomic status, disabled people, or people who do not speak English as a primary language.

The role of female permanent contraception in meeting the demand for family planning in low- and middle-income countries,

ObjectiveOur aim was to describe the reliance on female permanent contraception among women with demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries (LMICs) and to describe socio-economic and demographic patterns of permanent contraception in countries with high use. Study DesignUsing data from the latest national health survey carried out in LMICs, we estimated mDFPS and the share of each contraceptive method used. Countries with a share of more than 25% of female permanent contraception were further explored for differences by wealth, number of living children, woman's age, and by the intersection of woman's age and number of living children. ResultsIn the 20 countries studied, between 6% and 94% of the contracepting population used modern methods. Female permanent contraception accounted for more than half of women using modern contraceptives in India, Dominican Republic, El Salvador, Mexico, and Colombia. In India and Tonga, more than 20% of women using contraceptives with fewer than 2 living children were using female permanent contraception. Among women with 2 living children, countries with the highest reliance on permanent contraception were India (79%), El Salvador (61%), Cuba (55%), Colombia (52%), and Thailand (51%). Dominican Republic, El Salvador, India, and Mexico presented high levels of permanent contraception among younger women, with reliance higher than 30% among women aged 25 to 29 and 50% or more among women aged 30 to 34. ConclusionsReliance on permanent contraception was high in several countries and among women aged less than 35 years. ImplicationsOur results may help policymakers and health managers improve family planning services in low- and middle-income settings. We identified high use of female permanent contraception among modern contraceptive users in several countries, even among young women with fewer children.

Short-notice cancellations of laparoscopic permanent contraception

ObjectivePermanent contraception through tubal sterilization is the preferred contraceptive method for 25% of women in the United States. Laparoscopic permanent contraception has an anecdotally high cancellation rate. Cancellations affect operating room utilization and may reflect barriers to care. We aimed to identify the short-notice cancellation (≤7 days from scheduled surgery) rate for laparoscopic permanent contraception, reasons for cancellation, and postcancellation outcomes. Study DesignWe performed a retrospective chart review of patients aged 18 to 50 who canceled or no-showed a scheduled laparoscopic permanent contraception surgery between May 2016 and May 2019 at an academic tertiary care hospital and academic county hospital in Denver, Colorado. We reviewed electronic health records to determine the time between cancellation and surgery date and documented reasons for cancellation. We evaluated contraceptive methods used and pregnancies within a year after the canceled surgery. ResultsThe overall surgery cancellation rate for scheduled laparoscopic permanent contraception was 22% (123 of 558). Short-notice cancellation occurred for 71.5% of patients and 32.5% (40 of 123) canceled same day. The most common reason for cancellation was patient choice (74%) followed by financial/insurance issues (11.4%). In the year after their canceled surgery, 22% (27 of 123) of patients obtained permanent contraception and 5.7% (7 of 123) had a subsequent pregnancy. ConclusionsAmong patients who canceled their laparoscopic permanent contraception, the vast majority canceled their surgery a week or less from their scheduled date. These short-notice cancellations may adversely affect both patients and the health care system. More research is needed on institutional policies to reduce laparoscopic permanent contraception cancellations while helping patients who want effective contraception find an option that works best for them. ImplicationsOur retrospective cohort study found that laparoscopic permanent contraception surgeries have an overall high cancellation rate at both an academic tertiary and an academic county hospital, with most cancellations occurring less than 7 days prior to surgery. Future research will be used to reduce barriers to permanent contraception while developing clinical tools to reduce surgery cancellation rates.

The Relationship between Body Mass Index and Operative Complications in Patients undergoing Immediate Postpartum Tubal Ligation.

The objective of this study is to examine the relationship between body mass index (BMI) and complications for patients undergoing postpartum permanent contraception. Retrospective cohort study of patients aged 18 or older who had a vaginal delivery at an academic hospital between 2011 and 2016 and underwent a postpartum tubal ligation during the delivery admission. There were three comparative groups: nonobese (BMI ≤ 29 kg/m2), obese (BMI 30-39 kg/m2), and morbidly obese BMI (≥40 kg/m2). The outcome of interest was composite operative complications which included any occurrence of an intraoperative, postoperative, or anesthesia complication. A total of 921 patients were included for analysis. Average operative time was statistically longer for patients in the morbidly obese group (33 minutes) vs. the nonobese (25 minutes) and obese (29 minutes) groups (p < 0.0001). Composite complications were greater for the obese groups, but not statistically significant (5.1 vs. 6 vs. 16%, p = 0.06). Wound complications were significantly greater for the obese groups (0.8 vs. 1.5 vs. 5.5%, p = 0.01). A logistic regression model demonstrated that only operative time was predictive of operative complications. Overall complications of postpartum tubal complications are low; however, our study did demonstrate significantly longer operative time and wound complications for patients with obesity. The findings of our study indicate that postpartum permanent contraception can remain as an option for these patients. Further studies may help identify the best practices to decrease operative time and subsequent wound complications. This study contributes to the limited data regarding obesity and postpartum permanent contraception. We found increased operative time and wound complications for obese patients. Additional studies may identity best practices to decrease these complications. Given our findings of overall low operative complications, postpartum permanent contraception can remain an option for obese patients.

The Lived Experience of Women Using Bilateral Tubal Ligation Service in Rural Southern Ethiopia: A Phenomenological Study

BackgroundBilateral tubal ligation is a highly safe and effective form of permanent contraception for couples who want no more children. However, it is the least known and used form of contraception in Ethiopia.ObjectiveTo explore the lived experience and perception of women using the bilateral tubal ligation method in Southern Ethiopia.MethodsQualitative phenomenological study design was employed. The study participants were recruited by purposive sampling. The data were collected through in-depth interviews and supportive field notes from March 25 to April 24, 2021. All Interviews with the participants were recorded using a digital audio recorder. Inductive thematic analysis was done using Colaizzi’s (1978) seven-step phenomenological analysis framework. Data coding was done using Open code software version 4.03.ResultsA total of fifteen participants were included in the study. Women’s satisfaction, male partner involvement, perception of women using bilateral tubal ligation, socio-cultural influences, client follow-up, and socio-economic impact of bilateral tubal ligation use are the major themes identified in the study. Findings revealed that most of the participants are satisfied with the method and became more productive and got the freedom to participate income-generating activities. The dominance of socio-cultural influences, male partner’s involvement, and client follow-up after the procedure are the common themes that emerged which determine the user’s experience.ConclusionLack of supportive involvement of partners, community pressure, lack of women’s decision-making capacity and inadequate follow-up of women in the post bilateral tubal ligation use by healthcare workers are emergent experiences in the current study. Hence, promoting behavioral change communication for community members regarding bilateral tubal ligation use, empowerment of women’s economic, educational, and decision-making capability and healthcare workers’ follow-up of women in the post bilateral tubal ligation period are recommended.

Knowledge, Attitude, and Practice of Contraception in Rural Area of Vidarbha

Knowledge of use of contraceptives is necessary to prevent unwanted pregnancies and for optimal spacing, especially when it comes to rural populace. It is essential to create awareness and educate them regarding the proper usage of contraceptives and facilitate their usage. Family planning has two main objectives; firstly, to have only the desired number of children and secondly, proper spacing of pregnancies. India has undergone fertility transition and important feature of this transition is the fact that contraceptive use has spread to even uneducated women. Family planning is widely discussed topic on the national stage, with lot of government machinery to help implement it, yet there exist lot of disparity in its execution. In our study, the knowledge of contraception was upto 60%, while its acceptance was seen in 50% of the population, knowledge of contraceptives was very much likened to the level of education the populace has received as well as due to efforts of mother and child health and family planning services in the rural area, lack of use contraceptives was mainly attributed to fear of side-effects, which were mainly due to hearsay. Our study highlights the fact that even though our study was based in rural area, it involved women belonging to all stratas of society, and women had more predilection towards temporary methods of contraception rather than going for permanent contraception. It is concluded from the present study that 60% women had knowledge and were aware of the contraceptives but lacking information about their availability at health care centers.

FSFI score and timing of tubal ligation in patients: preliminary results of an online survey

IntroductionTubal ligation is the most common contraceptive method worldwide. Apart from a very low pearl index and anxiety relief, other benefits are not commonly recognised. In young patients, there is the post-operative risk of regretting the decision with the need for In-Vitro-Fertilisation or refertilising surgery. Positive side effects have not been widely published. In our study we investigated the change in the female sexual function index score after tubal ligation.Material and methodIn this survey the FSFI score of participants around the time of the tubal ligation was compared with the FSFI score of intermediate and long-term time distance to the ligation.ResultsThe data indicate an increase in younger women seeking information on permanent contraception and whilst the FSFI score of the early group indicates a risk of female sexual dysfunction, the intermediate and long-term FSFI scores are comparable to published control groups.DiscussionBesides the obvious benefit of a low pearl index, tubal ligation may contribute to reduce the risk of female sexual dysfunction in the mid and long term. Informed consent is essential for the surgeon and patient to weigh up the risks and benefits individually including possible future perspectives on family planning.

Women's intention to use long acting and permanent contraceptive methods and associated factors among family planning users in Addis Ababa, Ethiopia: A Cross sectional study.

The main objective of the study was to assess the magnitude of women's intention to use long-acting and permanent contraceptive methods and associated factors among short term family planning users in Addis Ababa public health centers, Ethiopia, 2020. A Facility-based cross-sectional study design was implemented in Addis Ababa public health center and data was collected using a pretested structured questionnaire on 504 participants, which was selected by multistage cluster sampling methods among family planning users in selected public health centers from March to April 2020. Collected data were coded and entered into EPI INFO version 4.6.0.0 and exported to SPSS version 25.0 for analysis. Multivariate logistic regression model was used to determine independent predictors at a 95% confidence interval and p <0.05 was considered significant. This study found the prevalence of contraception intention to use long acting and permanent methods (LAPMs) among participants were 60%. Predictors of LAPM desired number of children (AOR: 14.55, 95%CI (3.29-6.42), respondent's education (AOR: 0.36, 95%CI (0.20-0.64) and participant's occupation status (AOR: 8.75, 95% C I (1.31-5.84) were significantly associated with contraception intention.