Contraceptive Preferences Research Articles

Contraceptive values and preferences of adolescents and young adults: A systematic review

ObjectiveWe sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally. Study designWe searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old. ResultsFifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants’ access to and use of contraception. ConclusionVarious social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.

Impact of contraceptive counseling on Texans who can and cannot receive no-cost post-abortion contraception

ObjectiveTo assess optimal timing, patient satisfaction, and 1-year contraceptive continuation associated with contraceptive counseling among Texans who could and could not receive no-cost long-acting reversible contraception (LARC) via a specialized funding program. Study DesignIn this prospective study conducted between October 2014 and March 2016, we evaluated participants’ desire for contraceptive counseling during abortion visits, impact of counseling on change in contraceptive preference, satisfaction with counseling, and 1-year postabortion contraceptive continuation. We stratified participants into 3 groups by income, insurance status, and eligibility for no-cost LARC: (1) low-income eligible, (2) low-income ineligible, and (3) higher-income and/or insured ineligible. We examined the association between contraceptive counseling rating and 1-year method continuation by program eligibility and post-abortion contraceptive type. ResultsAmong 428 abortion patients, 68% wanted to receive contraceptive counseling at their first abortion visit. Counseling led to a contraceptive preference change for 34%. Of these, 21% low-income eligible participants received a more effective method than initially desired, 10% received a less effective method, and 69% received the method they initially desired. No low-income ineligible participants received a more effective method than they initially desired, 55% received a less effective method, and 45% received the method they initially desired. Five percent of higher-income eligible participants received a more effective method than they initially desired, 48% received a less effective method, and 47% received the method they initially desired. Highest counseling rating was reported by 51%. Compared to those providing a lower rating in each group, highest counseling rating was significantly associated with lower 1-year contraceptive discontinuation for low-income eligible participants (aHR 0.34, 95% CI 0.14, 0.81), but not for low-income ineligible (aHR 1.56, 95% CI 0.83, 2.91) and higher-income (aHR 0.73, 95% CI 0.47,1.13) participants. Additionally, 1-year contraceptive continuation was associated with highest counseling rating (OR 1.72, 95% CI 1.09, 2.72) and post-abortion LARC use (OR 11.70, 95% CI 6.37, 21.48) in unadjusted models, but only postabortion LARC in adjusted models (aOR 1.55, 95% CI 0.90, 2.66 for highest counseling rating vs. aOR 11.83, 95% CI 6.29, 22.25 for postabortion LARC use). ConclusionsIn Texas, where access to affordable postabortion contraception is limited, high quality contraceptive counseling is associated with 1-year contraceptive continuation only among those eligible for no-cost methods. ImplicationsState policies which restrict access to affordable post-abortion contraception limit the beneficial impact of patient-centered counseling and impede patients’ ability to obtain their preferred method.

From choice to agency in family planning services

Reproductive choice has been a central refrain in calls for women's sexual and reproductive health and rights and reproductive justice globally. 1 Dehlendorf C Reed R Fox E Seidman D Hall C Steinauer J Ensuring our research reflects our values: the role of family planning research in advancing reproductive autonomy. Contraception. 2018; 98: 4-7 Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 2 Gilliam ML Neustadt A Gordon R A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy. Contraception. 2009; 79: 243-246 Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar However, family planning programmes too often define reproductive choice on the basis of the availability and uptake of contraceptives. These indicators are not necessarily indicative of choice, nor do they ensure that choice leads to reproductive agency—ie, the ability and action to achieve one's own health, wellbeing, and fertility goals. Given the history of population control efforts under the flag of family planning, particularly against socially and economically vulnerable women and girls, emphasis on contraceptive targets and outcomes could impede reproductive choice and agency. 3 May JF The politics of family planning policies and programs in sub-Saharan Africa. Pop Develop Rev. 2017; 43: 308-329 Crossref Scopus (25) Google Scholar There is a need to change outcomes of success and prioritise women's and girls' fertility and contraceptive preferences (choice) and capacity to act on these preferences (agency). 4 Starrs AM Ezeh AC Barker G et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet. 2018; 391: 2642-2692 Summary Full Text Full Text PDF PubMed Scopus (190) Google Scholar Furthermore, we call for a gendered perspective in recognising the value of women's and girls' choice and agency in family planning and elimination of the sexism, classism, and ethnocentrism that can persist in the field and sustain population control approaches in family planning.

Preference of Contraceptive Methods of Married Women Between 18-49 and Reasons for Quitting

Objective: The purpose of this study was to determine the contraceptive preferences of married women between the ages of 18-49 and the causes of contraceptive discontinuation. Methods: The research was conducted descriptive type with 200 married women who applied to a Family Health Service between March-July 2019. The data were collected through the participant introduction form created by the researchers. Results: It was determined that the mean age of the women was 35.80 ± 7.35, 93% of them used a contraceptive (modern method: 63.9%, traditional method: 36.02. It was found that the withdrawal and condom were the most preferred contraceptives by women due to the ease of use (46.2% -37.5%) and the IUD because of high protection (62.5%). It was found that 22.5% of the women were not satisfied with the contraceptive they used, and 56.5% of them discontinued using contraceptive. It was determined that condom was discontinued due to partner request (discomfort) (82.5%), combined oral contraceptive and IUD due to health problems (48.5% -70%), and withdrawal due to unwanted pregnancy (60%). A statistically significant relationship was found between the use of the method and economic status, unwanted pregnancy, and counseling (p <0.05). Conclusion: Among the reasons for women to prefer a contraceptive are mostly; ease of use and high protection. Women discontinued using the contraceptive method or methods they used many times due to health problems, unwanted pregnancy, and desire to become pregnant. Therefore, contraception counseling should be provided to couples by health professionals in order to increase the effective use of contraceptive methods.

Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi

BackgroundProvision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi.MethodsWe used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes.ResultsSome SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found.ConclusionsWe documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it.

User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial

BackgroundTo achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices.ObjectiveWe conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women’s contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women’s contraceptive preferences and choices.MethodsMarried women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women’s stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling.ResultsA total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021.ConclusionsThe results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women’s stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women’s willingness to use and continue contraception to realize their contraceptive preferences.Trial RegistrationAmerican Economics Association’s Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823.International Registered Report Identifier (IRRID)DERR1-10.2196/24884

Latina contraceptive decision-making and use: The importance of provider communication and shared decision-making for patient-centered care

BackgroundPoor patient-provider communication, among other reasons, is a notable barrier to contraceptive decision-making among Latinas. Patient-centered approaches to contraceptive counseling that optimize communication align with shared decision-making (SDM) –which is associated with satisfaction and continued contraceptive use among various populations. ObjectiveTo examine associations of patient-provider communication and importance of SDM tenets with consistent contraceptive use among a population of Latinas. Patient involvementFormative work for this study included prior qualitative and quantitative research with Latinas who expressed the importance of patient-provider communication during contraceptive counseling and therefore were instrumental in problem definition. MethodsCross-sectional surveys were administered to Latinas ages 15–29 years. Patient-provider communication, patient-reported importance of specific SDM tenets, and consistent contraception use were measured and analyzed for associations. Results103 Latinas (mean age = 21.4) participated. 33% of participants<21 years were using contraception consistently vs. 67% for those ≥ 21 (p = 0.003). Among participants ≥ 21, consistent users reported higher communication scores compared to inconsistent users and non-users (p = 0.042). For participants< 21, consistent users were more likely than inconsistent users and non-users to report that 2 SDM tenets (discussion of contraceptive preferences and avoidance of race/ethnic-based judgement) are important (p = 0.052, 0.028, respectively). DiscussionPatient-provider communication was especially important for Latinas ≥ 21 while using an SDM approach during counseling was highly valued by those<21. Patient-centered approaches to contraceptive counseling provide opportunities to optimize healthcare delivery for this vulnerable population. Practical valueResults from this research demonstrate that patient-centered communication is highly valued by Latina study participants and is an important consideration in their contraceptive counseling. Clinicians should consider employing techniques such as SDM as they seek to provide patient-centered care during contraceptive counseling for this patient population.

Contraceptive Method Preferences of Women and Related Factors in Karabuk Province

Aim: The aim of this study was to investigate the contraceptive choices of women in Karabuk between the ages of 15-49 and explore the factors affecting the contraceptive method preferences. Methods: A total of 2018 women who applied to Family Planning Polyclinic between January 2016 and 2018 were included in this study. Patients’ age, place of residence, education status, marital status, obstetric history, and family planning preferences were recorded. While evaluating the study data, percentage, average, and Chi-square test were used and p &amp;lt;0.05 was considered as the value of significance. Results: The mean age of the study group was 32.31 ± 7.78 (15-49) years. 84.5% of the participants used contraceptive methods and 27.6% of them were traditional and 56.9% were modern methods. The most used method was Intrauterine devices (IUD) with 32.2% and it was most preferred at the age of ≥25. The most used method under the age of 25 was the withdrawal method with 27.6 % (p = 0.000). Conclusion: The most frequently used contraceptive method in our region is the IUD which long-acting reversible method. Family planning is an important health service offered in all health institutions, especially in the primary health care centers for the prevention of unwanted pregnancies.

\u2018Every medicine is part poison\u2019: a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia

BackgroundIn Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way.MethodsA qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method.ResultsFour major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’; ‘intrauterine device, a device used in the past for married women’; ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’; and ‘it is not necessary to seek medical advice in choosing contraceptive methods’.ConclusionsOur findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.

Setting global standards: The paramount importance of considering contraceptive values and preferences of clients and providers

Universal access to sexual and reproductive health services and information, including access to the full range of safe and effective contraceptive methods, is fundamental to the rights and well-being of adolescents and adults of all genders [1,2]. The benefits to society and life-saving consequences when quality contraceptive services and information are available, accessible, and acceptable cannot be understated. In developing regions alone, use of modern contraception prevents an estimated 308 million unintended pregnancies each year, and estimates indicate that satisfying the unmet need for modern contraception would result in 76,000 fewer maternal deaths worldwide each year [3].

Incorporating Method Dissatisfaction into Unmet Need for Contraception: Implications for Measurement and Impact.

While unmet need for contraception is commonly used to assess programmatic needs, it inadequately captures the complexity of fertility and contraceptive preferences, including women's satisfaction with their contraceptive method. In their 2019 commentary, Sarah Rominski and Rob Stephenson propose reclassifying dissatisfied current users as having an unmet need for contraception. As revising the current definition based on their proposal would require significant investment to update survey and monitoring systems, understanding the potential impact on current estimates of unmet need is critical. We estimated the impact of this approach in a Kenyan cohort of modern contraceptive users. We found the prevalence of method dissatisfaction ranges from 6.6% (95% confidence interval [CI] 5.6–7.8%) to 18.9% (95% CI 17.1–20.9%); if applied nationally, this results in a large (approximately 25–70%) increase in Kenya's current estimate of unmet need for any contraception. Our findings suggest a large impact on unmet need estimates for equivalent populations. Overall, we advocate for better measurements of method satisfaction and acceptability, with metrics developed that are robust to socioeconomic gradients and validated in low‐ and middle‐income settings to ensure women's contraceptive needs are captured equitably.

Contraceptive and Abortion-Related Practices Among Females of Lower Income Group in District Lahore

Introduction: Reproductive age females in Pakistan are still having poor access to adequate contraceptive information and difficulty in decision making, resulting in abortions many times.&#x0D; Aims &amp; Objectives: To identify contraceptive and abortion-related practice among married reproductive age females of lower income group in District Lahore.&#x0D; Place and duration of study: Study was conducted in 30 union councils (UCs) of District Lahore, Pakistan in 2011-2016.&#x0D; Material &amp; Methods: A cross sectional descriptive study was carried out on a sample of 210 married females of reproductive age in 30 UCs of District Lahore. 30 UCs were randomly selected out of 150 followed by random selection of one village/ward which was considered as a cluster and 7 females were recruited through convenience sampling in each cluster. Data was collected on contraceptive use, preferences, decision making and abortion-related practice and their associations with socio-demographics of these females.&#x0D; Results: The survey was carried out among 210 females with mean age 29 ± 5.28. 97.6% were Muslims, 23.3% were illiterate and 96.2% were housewives. Per capita per month income was ? PKR 3000 in 99 % of the respondents. 20% females used contraception. 39% women were delivered by untrained birth attendants, 95.7% females breast fed and amongst them only 15.7% fed for two years. 33(15.7%) of respondents had 48 abortions and amongst them 27% got it done by a Dai while female neighbors did it in 4.2% cases so a total of 31.2 % abortions were conducted at home. Place of abortion and delivery was decided by husbands in 87.4% respondents. Lower age and age at marriage were found to be associated with higher contraceptive use and abortions (P&lt;0.001).&#x0D; Conclusion: Contraceptive use is very low and abortion-related practices are poor. Respondent’s age and age at marriage are the determinants showing significant association with contraceptive use and abortion.

Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy

BackgroundWe sought to assess racial/ethnic differences in choice of postpartum contraceptive method after accounting for clinical and demographic correlates of contraceptive use.MethodsThis is a secondary analysis of a single-center retrospective cohort study examining postpartum women from 2012 to 2014. We determined the association between self-identified race/ethnicity and desired postpartum contraception, receipt, time to receipt, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery.ResultsOf the 8649 deliveries in this study, 46% were by Black women, 36% White women, 12% Hispanic, and 6% by women of other races. Compared with White women, Black and Hispanic women were more likely to have a postpartum contraception plan for all methods. After multivariable analysis, Hispanic women (relative to White women) were less likely to receive their chosen method (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.64–0.87). Women of races other than Black or Hispanic were less likely to experience a delay in receipt of their desired highly-effective method compared to White women (hazard ratio [HR] = 0.70, 95% CI 0.52–0.94). There were no differences between racial/ethnic groups in terms of postpartum visit adherence. Black women were more likely to be diagnosed with a subsequent pregnancy compared to White women (OR 1.17, 95% CI 1.04–1.32).ConclusionRacial/ethnic variation in postpartum contraceptive outcomes persists after accounting for clinical and demographic differences. While intrinsic patient-level differences in contraceptive preferences should be better understood and respected, clinicians should take steps to ensure that the observed differences in postpartum contraceptive plan methods between racial/ethnic groups are not due to biased counseling.

Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria

BackgroundMisconceptions about the usefulness of condoms and other contraceptives still expose many unmarried adolescents to the risk of unwanted teenage pregnancies and sexually-transmitted infections (STIs). This study explored beliefs and misconceptions about condoms and other contraceptives among adolescents in Ebonyi state, south-east Nigeria.MethodA qualitative study was undertaken in six local government areas in Ebonyi state, southeast Nigeria. Data were collected within a period of one month from in and out-of-school adolescents aged 13–18 years using twelve focus group discussions (FGD). The data were analyzed using the thematic framework approach.ResultMajority of the adolescents were knowledgeable about methods of contraception, how they are used and their modes of action. They were also knowledgeable about the dual effects of condoms in prevention of pregnancy and STIs. However, some misconceptions that were expressed by some adolescents were that pregnancy could be prevented by the use of (i) hard drugs, (ii) laxatives, (iii) white chlorine, and (iv) boiled alcoholic beverages. Condoms were described by some adolescent boys as reusable. Condoms were also perceived by some adolescents to reduce sexual pleasure, and this opinion was mostly held by boys. Coitus interruptus (withdrawal method) was therefore considered more preferable than condoms for prevention of pregnancy.ConclusionAlthough majority adolescents have knowledge about contraception and condom use, some misconceptions still persist. These misconceptions put many adolescents at increased risk for pregnancy and STIs which are detrimental to their health and wellbeing. Concerted efforts should be made through educational and behaviour change interventions in schools and within communities to debunk persisting misconceptions about contraception including the use of condom, and properly educate adolescents on safe sex practices.Plain English summaryAdolescents engage in unprotected sexual intercourse and other risky sexual behaviours because of some mistaken beliefs and wrong impressions about how to prevent unwanted pregnancy. These risky sexual behaviours predispose adolescents to sexually transmitted infections, unsafe abortion and other reproductive health problems.In this qualitative study, we explored some of these mistaken beliefs about condoms and other methods of preventing pregnancy. During focus group discussions, adolescents identified modern contraceptive methods, and described their modes of action and how they are used. They also discussed their contraceptive preferences and perceived effects of condoms on sexual pleasure.Although some of these adolescents were able to correctly mention various types of contraceptives and their modes of action, there were numerous wrong impressions. Hard drugs, laxatives, white chlorine and boiled alcoholic beverage were listed as emergency contraceptive methods. Emergency pills were perceived to work by flushing away spermatozoa from a girl’s system after sexual intercourse. Male condoms were perceived to be potentially dangerous because they could break and enter into the body of the female sexual partner. Some adolescent boys had the notion that particular brands of male condoms could be washed and reused. Notions about condom use and sexual pleasure varied for girls and boys. Some adolescent girls perceived that condom use during sex increases sexual pleasure because of the assurance of being protected from STIs and pregnancy. Adolescent boys were of the opinion that condoms interfere with the pleasure of direct ‘flesh to flesh’ contact during sex. There was a general belief that contraceptive use in early age reduces fertility prospects for boys and girls.Mistaken beliefs about methods of preventing pregnancy persist among adolescents, and this raises concerns about the quality of information they receive. Concerted efforts should be made to debunk these wrong beliefs and properly educate adolescents on safe sex practices.

Contraceptive Preference, Continuation Rates, and Unintended Pregnancies in Patients with Comorbidities: A Prospective Cohort Study.

Background: Patients with comorbidities are more susceptible to adverse pregnancy outcomes, morbidity, and mortality than healthy patients. The goal of this study was to evaluate how comorbidities influence contraceptive choice, continuation rates, and the unintended pregnancy rate in reproductive-age participants. Methods: We analyzed data from the Contraceptive CHOICE Project. Baseline data included demographic, reproductive, and medical history, including self-reported hypertension (HTN), venous thromboembolism (VTE), migraines, cerebrovascular accidents (CVA), transient ischemic attack (TIA), or stroke. Participants were provided contraceptive counseling and their method of choice at no cost. Results: Among 9253 participants included in our analysis, 659 participants reported a history of HTN (7%), 20 participants reported a history of CVA/TIA/stroke (<1%), 1803 participants reported a history of migraine (19%), and 85 reported a history of VTE (<1%). Compared to baseline, use of long-acting reversible contraceptive methods (long-acting reversible contraception [LARC]: intrauterine devices and implants) increased for participants with all comorbidities: HTN 2.3%-84.2%; CVA/TIA/stroke 0%-85%; migraines 1.7%-77%, and VTE 1.2%-88.2%. Participants with HTN, VTE, and migraines were more likely to choose LARC than those without those conditions: HTN: relative risk (RR) = 1.14, 95% confidence interval (CI) 1.10-1.18; migraines RR = 1.04, 95% CI 1.01-1.07; and VTE RR = 1.18, 95% CI 1.09-1.28. Twelve-month continuation and unintended pregnancy rates did not differ significantly based on comorbidity status. Conclusions: Participants with serious comorbidities were more likely to choose LARC than healthy participants. Contraceptive counseling should always be individualized to the patient. Clinical Trials.gov Identifier: NCT01986439.

Values and preferences of contraceptive methods: a mixed-methods study among sex workers from diverse settings

There is limited information on contraceptive values and preferences of sex workers. We conducted a mixed-method study to explore contraceptive values and preferences among sex workers. We conducted an online survey with individuals from 38 countries (n = 239), 6 focus group discussions (FGD, n = 68) in Zimbabwe, and 12 in-depth phone interviews (IDI) across 4 world regions, in June and July of 2019. Participants were asked about awareness of contraceptives, methods they had used in the past, and the determinants of their choices. Differences between respondents from high-, low- and middle- income countries were examined. Qualitative data were analysed thematically. Survey participants reported an awareness of modern contraceptive methods. FGDs found that younger women had lower awareness. Reports of condomless sex were common and modern contraceptive use was inconsistent. Determinants of contraceptive choices differed by setting according to results of the survey, FGD, and IDI. Regardless of country income level, determinants of contraceptive choices included ease of use, ease of access to a contraceptive method, and fewer side effects. Healthcare provider attitudes, availability of methods, and clinic schedules were important considerations. Most sex workers are aware of contraceptives, but barriers include male partners/clients, side effects, and health system factors such as access and clinic attitudes towards sex workers.

Experiences of a 'screen and treat' cervical cancer prevention programme among brothel-based female sex workers in Bangladesh: A qualitative interview study.

Objectives:Little is known about sex workers’ experiences of cervical cryotherapy. We sought to understand sex workers’ perspectives of ‘screen and treat’ programmes and their management of the World Health Organization post-treatment guidance to abstain from sex or use condoms consistently for 4 weeks. We explored contraceptive preferences and use of menstrual regulation services.Methods:We conducted semi-structured interviews with 16 sex workers and six brothel leaders in an urban brothel complex in Bangladesh between October and November 2018. All had undergone cryotherapy. We conducted a thematic analysis using deductive coding, informed by a priori themes, and inductive data-driven coding.Results:Most sex workers could not abstain from sex during the healing period. Consistent condom use was challenging due to economic incentives attached to condomless sex and coercive behaviours of clients. The implications of non-adherence among high-risk groups such as sex workers are not known. Use of short-acting methods of contraception was common, and discontinuation was high due to side effects and other perceived health concerns. The majority of sex workers and brothel leaders had utilized menstrual regulation services. Barriers to accessing timely menstrual regulation and other sexual and reproductive health services included limited mobility, economic costs, and discriminatory attitudes of health care workers.Conclusion:Service innovations are required to enable sex workers to abstain or use condoms consistently in the post-cryotherapy healing phase and to address sex workers’ broader sexual and reproductive health needs. Further research is required to assess the risk of HIV and other sexually transmitted infection transmission following cryotherapy among high-risk groups.

Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas

ObjectiveThe objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas. Study designUsing a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued. ResultsRoughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1–75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50–0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12–1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12–1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method. ConclusionsShort-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable. ImplicationsExpanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.

Contraception: awareness and choice of young users

Aim. To determine awareness about family planning and contraceptive preferences among young people.&#x0D; Materials and methods. Internet questioner about knowledge, preferences, personal experience of contraception usage. 1010 responders (935 from Russia, 75 from other countries) were processed by statistical methods in the IBM SPSS Statistics program. The group was a simple random sample.&#x0D; Results. 92.5% of foreign and 54.2% of Russian respondents with medical specialties do not consider a stroke as a contraindication to combined oral contraceptives COCs (p0.001); 45.3 and 42.2% respondents have similar views about breast cancer in the anamnesis. Uncomplicated varicose veins and uterine fibroids are mistakenly considered contraindications to COCs by 26.4 and 20.8% of foreign participants and 54.5 and 44.4% of Russian participants, respectively. 25.1% healthcare providers from Russia consider hormonal contraception (HC) a possible cause of infertility. Only 4% of Russians of non-medical specialties know about strokes and heart attacks as complications of COCs, 13.8% about arterial hypertension; almost half of foreign participants have such knowledge (p0.05). Every second respondent from Russia and every third from other countries does not know about the timing of use of emergency contraception. Russian and foreign participants, when they were using HC, respectively noted: decreased libido (29.1 and 13%), increased body weight (15.0 and 34.8%), headache (21.8 and 17.4%), mastalgia (20.6 and 13.0%). Every fifth participant did not want to have periods of menstrual bleeding when using HC. 86 women have had pregnancies before, from those 62.2% of Russian and 75% of foreign participants had unplanned pregnancies; 40.2% of respondents from Russia and 25% of foreign participants terminated pregnancy. The most popular contraceptive method among Russian and foreign respondents is male condom (92.7 and 84.6%; p=0.037). Second most popular in Russia is coitus interruptus (57.7%), in third place are COCs (33.1%); among foreign participants COCs are in second place (38.5%).&#x0D; Conclusion. Family planning awareness among young people is insufficient, which is reflected in their contraceptive preferences. Knowledge of family planning and highly effective methods of contraception should be popularized.

Birth Control Methods Used by Men and Their Attitudes towards the Male Birth Control Pill

The present study aims to determine the Turkish men’s knowledge level on family planning and contraceptive methods, contraception preferences, and their attitudes towards male contraceptive pills, which is not one of the contraceptive methods used in our country, among 18+-year-old men, who applied to family health center polyclinic. In this prospective study, a questionnaire consisting of 19 questions was conducted to 527 men over the age of 18. It was observed that 86.3% of the participants (53.8% of men, 32.8% of women and 13.4% of both genders) used contraceptive methods. The most commonly used contraceptive methods among men are as follows; condoms (57.8%), coitus interruptus (40.4%) and other methods (1.8%). Among the reasons for not wanting to use; the rate of side effects was 53.7%, the ease and success rate of other methods was 16.2%, the difficulty of use was 13.6%, and the rate of other reasons was 16.5%. There was a statistically significant relationship between educational status, use of the contraceptive method, and status of knowing that there is a male contraceptive pill (p=0.0001, p=0.0001). Male contraceptive pills can be an important option in family planning if Turkish men, who are concerned about the side effects of the contraceptive pill, are provided with the necessary information, and also have easy access to male contraceptive pills.