Permanent Contraception Research Articles

Unmet need for long-acting and permanent contraceptives and associated factors among married women in Southern Ethiopia

BackgroundLong-acting and permanent methods (LAPMs) prevent women from having unintended pregnancies. Globally, unintended pregnancies, both mistimed and unwanted, occur every year. In developing countries, maternal mortality and unsafe abortions result from unintended pregnancies. This study aimed to assess the unmet need for LAPMs of contraceptives and associated factors among married women of the reproductive age group (15–49 years) in Hosanna Town, Southern Ethiopia, in 2019.MethodsA community-based, cross-sectional study was conducted from March 20 to April 15, 2019. Data were collected on 672 current married women in the reproductive age group (15–49) through face-to-face interviews using a structured questionnaire. Study participants were selected using a multi-stage sampling method. Data were entered into the computer using EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were performed to identify factors associated with the unmet need for LAPMs. An odds ratio with 95% CI was used to assess the association between the independent and dependent variables.ResultsThe unmet need for LAPMs for contraception in Hossana town was 234 (34.8%) (95% CI: 29.8, 39.8). Factors significantly associated with the unmet need for LAPMs of contraception were: women’s age 35–49 [AOR = 9.01, 95% CI: 4.21, 19.32]; education of women [AOR = 8.64, 95% CI: 1.65, 45.42]; lack of discussion between partners [AOR = 4.79, 95% CI: 3.11, 7.39]; lack of proper counseling for women [AOR = 2.13, 95% CI: 1.41, 3.23]; having a daily laborer occupation [AOR = 7.08, 95% CI: 2.44, 20.51]; and attitude of women toward LAPMs of contraception [AOR = 1.62, 95% CI: 1.03, 2.56].ConclusionsThe unmet need for LAPMs was high in the study area. Age of women, discussions with partners, women ever counseled by health professionals, respondents’ educational status, husband’s educational status, women’s attitude toward LAPMs, and respondents’ occupational status were contibutes for high unmet need. High unmet need contributes to an unintended pregnancy and risky abortions. Proper counseling of women and women’s discussions with their husbands is fundamental areas of intervention.

Knowledge on, Attitude Toward, and Practice of Contraceptive Methods Among Females of Reproductive Age in Al-Qunfudah Governorate, Saudi Arabia.

Background One of the main goals of Vision 2030 in Saudi Arabia is to increase the participation rate of Saudi females in the workforce. This adjustment may have a big impact on how they use contraception and increase the tendency to space out their children's births appropriately to help them balance their home and work lives. The purpose of this study was to assess the knowledge on, attitude toward, and practice of contraceptive methods among females of reproductive age (15-49 years) in Al-Qunfudah governorate, Saudi Arabia. Methods A cross-sectional study was carried out among a convenient sample of 400 females of reproductive age in Al-Qunfudah governorate, Saudi Arabia. The necessary data were obtained over a period of two months (from November to December 2022) by using a self-administered online survey that was applied on different electronic platforms. Both knowledge and attitude scores were divided into two categories using the median as a cutoff point (e.g., good knowledge and poor knowledge, as well as positive and negative attitude). Many sociodemographic variables, such as age, residence, and education, were independent variables. Logistic regression analysis was done to determine the magnitude of associations between independent and dependent variables, and the odds ratios (OR) were presented with 95% confidence intervals (CI) at a significance level of P = 0.05. Results Good knowledge of the different contraceptive methods was observed among 69.8% of the females, where contraceptive pills and the intrauterine device (IUD) were the most well-known contraceptive methods to them (85.25% and 57.75%, respectively). Family and friends were their main sources of information (38.75%). Almost 85% of the participants showed a positive attitude towardcontraceptive use. Contraceptive pills (32.39%) and IUDs (29.95%) were the most commonly used contraceptive methods. The determinants of good knowledge of contraception were being younger in age (P = 0.01, OR = 0.14, 95% CI = 0.03-0.65) and living in an urban area (P = 0.01, OR = 0.24, 95% CI = 0.09-0.68). Females holding middleor high school educational degrees (P = 0.02, OR = 0.17, 95% CI = 0.04-0.75 and P = 0.03, OR = 0.23, 95% CI = 0.06-0.88, respectively) and having a low monthly income (P = 0.04, OR = 0.44, 95% CI = 0.20-0.96) were likely to have positive attitudes towardcontraceptive methods. Conclusion This study concludes that females of reproductive age had satisfactory knowledge and a positive attitude toward various contraceptives; however, there is a big gap in their knowledge regarding two important contraceptive procedures (emergency and permanent contraceptives). Oral contraceptive (OC) pills and IUDs were the most utilized methods of contraception among them. Sustained efforts are needed to raise females' awareness about contraception methods, especially emergency contraceptives and permanent ones. This study was done on a convenient sample of females in reproductive age that may limit the generalization of data; using an online survey has its constraints, such as the ignorance of the illiterate females and those who did not possess internet connections in addition to recall bias; therefore, we recommend further research on this topic through an interactive interview among a random sample of females to overcome such pitfalls.

Efficacy of Tubal Surgery for Permanent Contraception: Considerations for the Clinician.

Permanent contraception meets the needs of many people certain in their decision to never become pregnant in the future. Female permanent contraception procedures became more common than male procedures during the 1970s and 1980s, when laparoscopic surgery became widely available. To better understand the efficacy of these new procedures, the US Centers for Disease Control and Prevention conducted a prospective cohort study, known as the Collaborative Review of Sterilization (CREST). For decades, results of this study have defined perioperative counseling around failure risks of such surgeries. However, laparoscopic technology and techniques have changed significantly in recent decades and evidence has emerged supporting noncontraceptive benefits of tubal excision. Therefore, we present here a review of updated information regarding permanent contraception failure in the modern context and implications for clinical practice and future research directions.

Child-free by choice: providing permanent contraception to a nulliparous population

Child-free by choice: providing permanent contraception to a nulliparous population

Reproductive justice in post-Roe America: Impact of restricted abortion access on patients seeking permanent contraception

Anecdotally, clinicians have reported an increase in demand for permanent contraception procedures since the Dobbs v. Jackson Women's Health Organization (Dobbs) decision, which may reflect patients' fear of losing reproductive autonomy. In this commentary we rely upon the history of bias and discrimination in permanent contraception access in the United States to interpret and predict potential outcomes following the Dobbs decision. These findings can shape clinical practice as clinicians aim to balance meeting a patient's contraceptive goals while upholding a commitment to avoid reproductive coercion. We provide recommendations for clinicians' contraceptive counseling to ensure equitable access to permanent contraception for all patients.

Catholic sole community hospitals are associated with decreased receipt of postpartum permanent contraception among Medicaid recipients

ObjectivesTo examine the association of Catholic hospitals with receipt of postpartum tubal ligation and long acting, reversible contraception among Medicaid recipients. Study designWe conducted a retrospective cohort study of live births from January 1, 2016 to October 31, 2016 to female Medicaid beneficiaries in the United States between ages 21 and 44. Our main exposure was the presence of a Catholic-affiliated sole community hospital, and our primary outcome was highly effective postpartum contraception. We examined rates of postpartum permanent contraception, along with the use of a long acting, reversible form of contraception (LARC) at 3 and 60 days are postpartum. We compared counties that had only a Catholic-affiliated hospital with counties with only a non-Catholic hospital. ResultsOur study population included 14,545 postpartum Medicaid beneficiaries. Study participants came from 88 counties across 10 United States states. Only 7.7% of women in counties with Catholic sole community hospitals received permanent contraception by 3 days postpartum, compared to 11.3% in counties with non-Catholic sole community hospitals (RD: -3.92%; 95% CI: -6.01%, -1.83%). This difference was not mitigated by receipt of outpatient procedures or long-acting, reversible contraception. Importantly, women residing in counties with Catholic sole community hospitals were much less likely to return postpartum for an outpatient visit between 8 and 60 days postpartum than women in counties with non-Catholic sole community hospitals (35.4% vs 45.4%, RD: -9.29%; 95% CI: -16.71%, -1.86%). ConclusionsIn counties where the only hospital was Catholic, Medicaid recipients giving birth were significantly less likely to receive permanent contraception and to return for postpartum care. ImplicationsCatholic hospitals are increasing in the United States, which may restrict access to postpartum contraception, particularly in rural areas. We found that Medicaid recipients giving birth at a Catholic sole community hospital were less likely to receive permanent contraception and to return for care.

U.S. physicians’ perspectives on the complexities and challenges of permanent contraception provision

ObjectivesEvidence shows many misconceptions exist around permanent contraception, and there are numerous barriers to accessing the procedure. This qualitative study explored physician perspectives regarding patients’ informational and decision-support needs, the complexities and challenges of counseling and access, and how these factors may differ for people living on lower incomes. Study designWe conducted 15 semistructured, telephone interviews with obstetrician-gynecologists in three geographic regions of the United States to explore their perspectives on providing permanent contraception counseling and care. We analyzed the interviews using content analysis. ResultsPhysicians discussed a tension between respecting individual reproductive autonomy and concern for future regret; they wanted to support patients’ desire for permanent contraception but were frequently concerned patients did not have the information they needed or the foresight to make high-quality decisions. Physicians also identified barriers to counseling including lack of time, lack of continuity over the course of prenatal care, and baseline misinformation among patients. Physicians identified additional barriers in providing a postpartum procedure even after thedecision was made including lack of personnel and operating room availability. Finally, physicians felt that people living on lower incomes faced more challenges in access primarily due to the sterilization consent regulations required by Medicaid. ConclusionsPhysicians report numerous challenges surrounding permanent contraception provision and access. Strategies are needed to support physicians and patients to enhance high-quality, patient-centered sterilization decision making and ensure that patients are able to access a permanent contraceptive procedure when desired. ImplicationsThis qualitative study demonstrates the various challenges faced by physicians to support permanent contraception decision making. These challenges may limit patients’ access to the care they desire. This study supports the need to transform care delivery models and improve the federal sterilization policy to ensure equitable patient-centered access to desired permanent contraception. DisclaimerAlthough the term permanent contraception has increasingly replaced the word sterilization in clinical settings, we use sterilization in some places throughout this paper as that was the standard terminology at the time the interviews were conducted and the language the interviewed physicians used.

Knowledge, Attitude and Associated Factors Towards Vasectomy Among Married Men in Arba Minch Town, Southern Ethiopia, 2021; A Cross-Sectional Study.

Vasectomy is a safe and effective permanent contraceptive method. In Ethiopia, this method underutilized since the focus has been on contraceptive methods available for women rather than men. Few studies have examined this method in Ethiopia so far, so it is important to note that there is a lack of data about the method in the study area regarding married men's knowledge and attitudes toward vasectomy. A community-based cross-sectional study conducted from May 2 to June 2, 2021, at Arba Minch town. A simple random sampling technique used to select 624 study participants. Data collected via the face-to-face interview technique using a semi-structured and pretested questionnaire. Data entered in EpiData 3.1, cleaned, and analyzed using SPSS for Windows version 25.0. Descriptive statistics and bivariable and multivariable logistic regression analyses were performed. An adjusted odds ratio (AOR) with 95% CI and a p-value < 0.05 estimated to identify statistically significant variables associated with knowledge and attitude towards vasectomy. From the total of 624 study subjects, 600 had completed the questionnaire, giving a response rate of 96.2%. From those who heard about vasectomy (36.8%), only 60.6% of men had good knowledge, and 48.4% had a positive attitude towards vasectomy. Men's knowledge of vasectomy was significantly associated with college or university attendance (AOR = 4.05, 95% CI: 1.720-9.521), age 31-40 years (AOR = 2.308, 95% CI: 1.081-4.929), and age ≥41 years (AOR = 2.671, 95% CI: 1.159-6.156). Age ≥41 years (AOR=4.735 95% CI 2.015-11.129), age of last child (AOR=3.868 CI 1.554-9.632) and discussing family planning with wife (AOR=2.821 95% CI 1.559-5.105) were significantly associated with attitude of men towards vasectomy. In this study area, six out of ten and half of the married men had good knowledge and a positive attitude towards vasectomy, respectively.

Nonfulfillment of desired postpartum permanent contraception and resultant maternal and pregnancy health outcomes

Up to half of the patients requesting postpartum permanent contraception do not undergo the desired procedure. Although nonfulfillment of desired postpartum permanent contraception is associated with increased risk of pregnancy within 12 months of delivery, its long-term reproductive and maternal health outcomes are less clear. This study aimed to determine the association of fulfillment of postpartum permanent contraception with number and timing of subsequent pregnancies and maternal health outcomes. This was a retrospective single-center cohort chart review study of health outcomes in the 4 years following delivery (2016-2018) for 1331 patients with a documented contraceptive plan of female permanent contraception at time of postpartum discharge from 2012 to 2014. Rates of permanent contraception fulfillment within 90 days of delivery and clinical and demographic characteristics associated with permanent contraception were calculated. We determined number of and time to subsequent pregnancies, and diagnoses of medical comorbidities (hypertension, diabetes mellitus, depression, anxiety, asthma, anemia), sexually transmitted infection, and pregnancy comorbidities (preterm birth, gestational diabetes mellitus, gestational hypertension, preeclampsia, postpartum hemorrhage, low birthweight, intrauterine fetal demise) in the 4 years following delivery. Of the 1331 patients desiring permanent contraception postpartum, 588 (44.1%) had their requests fulfilled within 90 days of delivery and 743 (55.8%) did not. Patients who achieved permanent contraception fulfillment tended to have attended more outpatient prenatal visits, delivered via cesarean delivery, and were older, married, college-educated, and privately insured. Patients who received their desired postpartum permanent contraception were less likely to have subsequent intrauterine pregnancies (P<.001). In those who did not achieve permanent contraception, 22 (9.0%) subsequent pregnancies occurred within 6 months of previous deliveries, and 223 (91.0%) occurred after short interpregnancy intervals (within 18 months). Of 178 continued pregnancies, 26 (14.6%) were delivered preterm. There were no differences between the 2 groups in terms of ever attending an outpatient, preventive, or emergency room visit, or in most nonreproductive health outcomes investigated. Nonfulfillment of desired postpartum permanent contraception is associated with subsequent maternal reproductive and nonreproductive health ramifications. Given the barriers to permanent contraception, alternative plans for contraception should be discussed proactively if permanent contraception is not provided.

Utilization of long-acting contraceptive methods and associated factors among married women in Farta Woreda, Northwest Ethiopia: a community-based mixed method study

BackgroundAlthough long-acting contraceptive methods are highly effective, safe, and provide uninterrupted protection from unintended pregnancy compared to short-acting methods, evidences suggest that majority of women were relayed on short-acting contraceptive methods. Thus, this study aimed to determine the level of long-acting contraceptive methods utilization and associated factors among married women in Farta Woreda, Northwest Ethiopia, 2021.MethodsA community-based cross-sectional study supplemented with qualitative data was performed among 556 married women from March 1 to 31, 2021. A semi-structured interviewer-administered questionnaire and interview guides were used to collect the data. The data were entered into Epi data version 4.6 and analyzed by SPSS version 23 software. The association between variables was analyzed using bivariate and multivariable binary logistic regression. The level of statistically significant association was determined at a P-value < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.ResultsThe magnitude of long-acting contraceptive methods among married women in Farta Woreda was found to be 14.3% [95% CI 11.5–17.6]. Previous use of long-acting contraceptive methods (AOR = 5.83, 95% CI 3.03, 11.21), positive attitude towards long-acting contraceptives (AOR = 2.74, 95% CI 1.48, 5.07), having formal education for husbands’ (AOR = 3.05, 95% CI 1.5, 6.21), and poor wealth index (AOR = 3.39, 95% CI 1.33, 8.67) were positively associated with utilization of long-acting contraceptive methods. Moreover, fear of side effects, misconceptions, and partner opposition were the most commonly identified barriers by the qualitative data.ConclusionUtilization of long-acting contraceptives among married women in Farta Woreda was low as compared to the 2020/21 national reproductive health strategy plan to increase the long-acting reversible and permanent contraceptive methods use to 50%. Previous use of long-acting contraceptives, positive attitude towards long-acting contraceptives, husband education, and household wealth index was found to be significantly associated with long-acting contraceptive utilization. Hence, it is better to work more on changing women's attitudes and increasing husband education.

CASE SERIES: HUMAN ERRORS AND TUBECTOMY FAILURE- REPORT OF FIVE CASES

Female sterilization is the most common permanent method of contraception in India. Most of those procedures are performed in various levels of public health facilities. Tubectomy failures due to spontaneous tubo-pertineal stula formation and recanalization is known in the literature. The human errors are also reported. However, the nature and frequency of human errors leading to failure are addressed in very few reports. This case series addressed the issues of preventable human errors, which helps physicians to revisit the procedure to prevent litigations.

The use and impact of contraceptives in women: a critical review

&lt;p class="abstract"&gt;Around 40% of the 210 million human conceptions occurring globally each year are unplanned. Contraception involving the use of devices, medications, and sexual techniques have been the bail out. This has empowered women to make positive decisions about their life and sexual health. Various methods of contraception in use today include the barrier method, the fertility awareness method, hormonal method and permanent contraception. In the United States and in most parts of the world, oral contraceptives (OC) have been the most used contraceptive method. Their use however comes with its pros and cons. OC failure is already an issue of concern in the reproductive health of women. More serious concerns are the impact of the use of these OC's on the woman's quality of life. Women all over the world are becoming increasingly conscious of the ability of OC to either aid or interfere with their health and overall well being. There is paucity of data in recent times looking critically at how OC has been a factor in altering the quality of life of women. Hence this review highlights contraceptive preferences of women, Success and failures of OC use, perception of women towards OC and how the use of OC has impacted their quality of life. Overall, contraceptives have a positive impact on the quality of life of women due to many other benefits it offers apart from contraception including relief of menstrual blood loss, dys-menorrhea, and premenstrual syndrome.&lt;/p&gt;

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa

BackgroundThe proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA.MethodsSecondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05.ResultsThe prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03–1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41–1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure.ConclusionThe study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA.

Fertility preferences and unmet need for family planning in women with multiple sclerosis.

Most women with multiple sclerosis (MS) have childbearing potential. Although fertility and pregnancy are not affected by MS, the fertility preferences of women with MS can change due to the risk of complications for the mother and/or adverse pregnancy outcomes resulting from the disease or its treatment. To describe fertility preferences (FPs) and their associated factors, to estimate the Unmet Need for Family Planning (UNFP), use of contraceptives, and history of exposure to disease-modifying therapies (DMTs) during pregnancy in women with MS. In a cross-sectional observational study, a random sample of women with MS were surveyed with the FP subset of the Demographic and Health Survey of Colombia. Factors associated with FP were evaluated through bivariate and logistic regression analysis. The proportion of pregnancies exposed to DMTs, UNFP, and use of contraceptives was estimated. Of the 141 women interviewed, 101 women had childbearing potential, of whom 49 did not want to have children, 38 were sterilized, 33 wanted to have more children, 19 were undecided, and 2 stated they were unable to bear children (menopause or hysterectomy). No MS-related variables were associated with the preference to have more children. Age (OR 0.91; 95% CI 0.84-0.98) and the number of children (OR 0.23; 95% CI 0.09-0.58) decreased the likelihood of desire for children. Of 116 sexually active women, 87.06 % (101) were using contraceptives, and among them, four were using fertility awareness methods and withdrawal. The UNFP was estimated at 6.03% and was not significantly different from the general population. Eighty-two pregnancies were identified, of which 48 occurred after diagnosis, and 25 were exposed to DMTs. Fertility preference in women with MS is not associated with clinical variables. A large proportion of women choose not to have children and prefer to use permanent contraceptive methods. Although the frequency of contraceptive use was high, some women have the UNFP and use low-efficacy contraceptive methods, which may result in unplanned pregnancies.

An Analysis of Contraceptive Method Choice among Married Women of Kanchanaburi Demographic Surveillance site in Thailand

Introduction: The Fertility of Thailand declined to 1.6 in 2014 compared to 6.5 in the early sixties. This fertility revolution was accompanied by a concurrent revolution of contraceptive behavior among Thai people. This study examined the role of individual and geospatial factors to explain the variation in contraceptive method choice among married in two selected districts of Kanchanaburi Province, Thailand.&#x0D; Methods: The sample size in this study was 1468. The study population was currently married women of reproductive age (15-49 years) who were residing in two selected districts of Kanchanaburi province, Sai Yok and Muang districts, collected under the Kanchanaburi Demographic Surveillance Site (KDSS) project from 2004 to 2006. The study performed multinomial logistic regression for statistical analysis and Arc view GIS for spatial analysis to identify the factors associated with contraceptive method choice.&#x0D; Results: The women in the middle age group and urban women were more likely to use permanent methods over non use and temporary methods compared to young and rural women respectively. Women having higher than secondary education used both temporary and permanent contraceptive methods 2.5 times more than uneducated women (AOR 2.43; 95% CI 1.33– 4.46 for temporary versus none and AOR 2.54; 95% CI 1.29 – 5.01 for permanent versus none respectively). If women has no children, they were significantly less likely to use permanent method over non-use as well as over temporary methods. Geo-spatial analysis results showed transportation facilities determine the contraceptive choice.&#x0D; Conclusion: The better transportation network facilitated women to use a permanent contraceptive method rather than the temporary method. It is necessary to establish a better transportation system and education system in the areas, especially in the mountainous regions to improve accessibility and to realize reproductive health services. Further, investments in increasing women's access to various contraceptive options are urgently needed.

Building Blocks for the Long-acting and Permanent Contraceptives Coordinated Registry Network

ObjectivesA multistakeholder expert group under the Women’s Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives....

Knowledge and perception of bilateral tubal ligation among women of reproductive age attending antenatal clinic at Hue University of Medicine and Pharmacy Hospital

Introduction: Bilateral tubal ligation (BTL) is the most reliable form of permanent surgical contraception for women who have achieved their desired number of children or are limited due to medical conditions. Objectives: Assess the level of knowledge of women on this issue and identify related factors affecting knowledge, and awareness as well as the decision to use the BTL method. Methodology: A cross-sectional descriptive study with a convenient sampling method on 189 married and reproductive-age women who visited Hue University of Medicine and Pharmacy Hospital from June 2022 to October 2022. The toolkit includes 17 questions divided into 2 areas: knowledge and perception when using this method. The data were processed and analyzed using SPSS 20.0 software. Results: 32% of women have good knowledge and 68% have bad knowledge. The factors related to knowledge include age, education level, occupation, current number of children alive and status of sexually transmitted diseases (p &lt; 0.05). The percentage agreeing to use this method is 66% and disagreeing is 34%. Factors related to women’s decision to have BTL include The benefit of bilateral tubal ligation, the Husband’s consent, the difficulties of giving a decision, fear of surgery, fear of regret, and lack of information about this method (mean &gt; 3). Conclusion: It is necessary to determine the level of knowledge, awareness, and related factors of women of reproductive age about the BTL method, from which there are timely interventions and counseling for women in the antenatal period so they can make the most appropriate decision. Key words: Knowledge and perception of bilateral tubal ligation, women of reproductive age.

The Interest in Permanent Contraception Peaked Following the Leaked Supreme Court Majority Opinion of Roe vs. Wade: A Cross-Sectional Google Trends Analysis

Introduction With the leaked Supreme Court draft regarding Roe vs. Wade, substantial public reactions followed as the horizon of abortion laws within the United States of America have been changing. We sought to compare internet searches for vasectomy and tubal ligation seven days following the leaked draft on May 2, 2022. Methods We used public data provided by Google Trends to investigate the interest and geographic distribution of searches for the two forms of permanent contraception: Vasectomyand tubal ligation. We calculated the mean Search Volume Index (SVI) of these terms. Data analysis was performed with Microsoft Excel Version 16.60 (Redmond, USA), and comparisons between groups were performed using paired t-tests. Results The term 'vasectomy' saw a 121% increase (p=0.0063), and 'tubal ligation' had a 70% (p=0.029) increase compared to the week prior. 49/50states had increased search inquiries for each term. However, the North and Southwestern regions of the U.S. had increased relative surge for vasectomyand the Midwest region for tubal ligationprocedures, respectively.South Dakota and Idaho, with trigger laws that banned abortion immediately following the overturn of Roe vs. Wade, had the greatest surge in SVI for tubal ligation and vasectomy, respectively. Conclusion Our study indicates that with the potential overturn of Roe vs. Wade, there was a significantly increased interest in these two forms of permanent contraception. Future studies should investigate specific concerns and questions patients may have when it comes to the different options of contraception.

Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties.

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Endometrial receptivity during hormonal therapy in women of reproductive age with abnormal uterine bleeding due to ovulatory disorders

Background. After an episode of abnormal uterine bleeding, it is of critical importance to restore endometrial receptivity to prevent the recurrence of abnormal uterine bleeding and implement reproductive plans.&#x0D; Aim. To study endometrial steroid receptor expression in women of reproductive age after an episode of abnormal uterine bleeding due to ovulatory dysfunction during micronized progesterone or combined oral contraceptive therapy with bioidentical estrogen and dienogest.&#x0D; Materials and methods. A cohort prospective study was conducted. The study included 70 females aged 1840 years who were observed with abnormal uterine bleeding due to ovulatory dysfunction at the Department of Obstetrics and Gynecology of Ural State Medical University based at the Yekaterinburg Municipal Hospital №40 from 2016 to 2018. After a bleeding episode, the patients received a combined oral contraceptive with bioidentical estrogen and dienogest or micronized progesterone.&#x0D; Results. During therapy, variable changes in the expression of estrogen and progesterone receptors in the stromal and glandular components of the endometrium during the 6-month follow-up were observed.&#x0D; Discussion. Changes in steroid receptor expression and endometrial receptivity during hormone therapy are similar, although certain trends are identified which can guide the choice of hormone therapy.&#x0D; Conclusion. Due to the lack of complete recovery of steroid receptor expression and endometrial receptivity, even 6 months after hormonal treatment, short courses of hormonal rehabilitation after abnormal uterine bleeding due to ovulatory dysfunction are not sufficient, and permanent hormonal contraception or periodic courses of progestogens are required to prevent a relapse of the endometrial proliferation.