Pregnancy Prevention Services Research Articles

The prevalence of unplanned pregnancy among women attending antenatal primary care clinics in Qatar

Background: Currently, 40% of pregnancies worldwide are unplanned and leading to approximately 42 million induced abortions per year, and 34 million unintended births. Objectives: This study aims to ascertain the prevalence of unintended pregnancies among antenatal women attending antenatal clinics in Primary Care in Qatar and to establish any demographic differences among antenatal women around the choice of pregnancy. Methodology: A cross-sectional descriptive study with convenience sampling was used to recruit the participants. A validated questionnaire (the London Measure of Unplanned Pregnancy (LMUP)) was used to look at the prevalence and hence the size of the problem. Results: Among 107 participants, scores on the LMUP ranged from 0-12 with a median of 10. Most pregnancies 79.4%, (n=85) were categorized as planned, 17.8% (n=19) as ambivalent, and 2.8% (n=3) as unplanned. 71% of women (n=76) described their current pregnancy as ‘wanted’, and 20.6% (n=22) as ‘mixed feelings’ and 8.4% of women (n=9)defined their pregnancy as ‘unwanted’. Women who are married for more than 5-years (:-1.50, 95%CI -2.47 to -0.52, p=0.003) tended to have significantly lower LMUP scores, and hence a higher risk of having a more unplanned pregnancy. However, women who are non-Qatari’s (:6.30, 95%CI 3.30 to 9.30, p<0.001) and have more than 5-years since last delivery (:2.32, 95%CI 0.95 to 3.68, p=0.001) have significantly higher LMUP scores and hence a lower risk of having a more unplanned pregnancy. Conclusion: Unplanned pregnancies in this population are rare among women attending antenatal clinics. Less planned pregnancies tended to be more prevalent among Qatari women compared to expatriates. Unplanned pregnancy prevention services need to be included within pregnancy care services in primary care settings to offer preferred contraception on time to effectively maintain the low rate of unplanned pregnancies in the country. Key words: Prevalence, unplanned pregnancy, antenatal clinics, primary care, Qatar

Evaluating user-centered interventions in optimizing utilization of HIV and pregnancy prevention services among adolescent girls and young women (AGYW) in Kenya: a study protocol

Background: Globally, HIV/AIDS is the leading cause of morbidity and mortality among adolescents; sub-Saharan Africa contributes more than two-thirds of all HIV-related adolescent deaths. In Kenya, HIV incidence remains high among youth (15–24 years), with women disproportionately affected. Morbidity and mortality are compounded by a high rate of early and unwanted pregnancies. Existing prevention efforts to reduce youth vulnerabilities overwhelmingly focus on HIV alone, with limited efforts made to address concurrent factors that increase vulnerability of adolescent girls and young women (AGYW) to HIV infection and unplanned pregnancies. Jilinde, is a Bill and Melinda Gates Foundation funded large-scale project that supports the provision of pre-exposure prophylaxis (PrEP) in Kenya. This manuscript presents a protocol for a study that seeks to evaluate the effectiveness of a comprehensive package of user-centered interventions to optimize uptake of HIV and pregnancy prevention services among AGYW in four Kenyan counties. Methods: The study employed a concurrent mixed-methods design including two parallel before and after population-based cross-sectional surveys, focus group discussions, and in-depth interviews. Study participants included 1,280 AGYW, 1,080 individuals from the general population, 80 health service providers, and 32 county health managers. The study involved a formative, implementation phase and endline assessment. Survey data was collected using Research Electronic Data Capture and analyzed using regression modelling while adjusting for confounders. Qualitative data will be analyzed using grounded theory techniques using NVivo 12.0. Discussion: This study will uncover useful insights on the effectiveness of user-centered interventions in increasing concurrent utilization of blended HIV and pregnancy prevention interventions in a routine low resource setting. The findings will be disseminated through technical briefs, manuscripts, conferences, and workshops. The consolidated evidence could inform the scale-up of integrated HIV prevention and sexual and reproductive health interventions targeting AGYW.

Missed Opportunities to Address Pregnancy Prevention With Young Men in Primary Care.

Young men (aged 15-24 years) have pregnancy prevention needs, yet little is known about whether they perceive they learn about pregnancy prevention in primary care. A sample of 190 young men seen in primary care in one city from April 2014 to September 2016 were assessed on perceived learning about pregnancy prevention, background and visit characteristics, pregnancy prevention care receipt, and contraception needs at last sex. The majority of participants were non-Hispanic black (92%), aged 15 to 19 years (54%), seen for a physical examination (52%), and established patients (87%). Few participants perceived they learned about pregnancy prevention (32%), regardless of sexual activity (33% among sexually active participants, 26% among never sexually active). Poisson regression models determined that perceived learning about pregnancy prevention was independently associated with young men's pregnancy prevention care receipt and contraception needs at last sex. Findings highlight the need to improve providers' delivery of pregnancy prevention services to young men.

Healthcare workers\u2019 beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study

BackgroundAdolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa.MethodsTwenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses.ResultsSRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area.ConclusionsNurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved.

Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy

To determine pregnancy risk and receptiveness to emergency department (ED)-based pregnancy prevention interventions among adolescents accessing care in the ED. Cross-sectional electronic survey of adolescent females in a pediatric ED used to calculate the Pregnancy Risk Index, a validated measure estimating the annual risk of becoming pregnant based on recent sexual activity, contraceptive method(s), method-specific contraceptive failure rates, and interest in receipt of ED-based contraceptive services. Of 229 participants, 219 were not pregnant, and 129 reported sexual experience. Overall, 72.4% (n = 166) endorsed negative pregnancy intentions. The overall Pregnancy Risk Index for the 219 nonpregnant participants was 9.6 (95% CI 6.8-12.4), and was 17.5 (95% CI 12.8-22.2) for the 129 sexually experienced participants. A Pregnancy Risk Index greater than the national average of 5 was associated with older age (aOR 3.0; 95% CI 1.5-5.85), nonprivate insurance (aOR 7.1; 95% CI 1.6-32.1), prior pregnancy (aOR 2.7; 95% CI 1.2-6.0), and chief complaint potentially related to a reproductive health concern (aOR 2.6; 95% CI 1.4-5.1). In this cohort, 85.1% (n = 194) believed that the ED should provide information about pregnancy prevention, the majority of whom (64.9%; n = 148) believed that pregnancy prevention services should be offered at all ED visits. This study demonstrates a high unintended pregnancy risk among adolescents accessing care in the ED. Adolescents report interest in receiving pregnancy prevention information and services in the ED, regardless of reason for visit. Strategies to incorporate successfully the provision of reproductive health services into ED care should be explored.

A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP).

BackgroundAdolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps.ObjectiveThis review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support.MethodsWe developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist.ResultsOur search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22).ConclusionsThe quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes.

Delivering post-rape care services: Kenya's experience in developing integrated services

Comprehensive service delivery models for providing post-rape care are largely from resource-rich countries and do not translate easily to resource-limited settings such as Kenya, despite an identified need and high rates of sexual violence and HIV. Starting in 2002, we undertook to work through existing governmental structures to establish and sustain health sector services for survivors of sexual violence. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. A standard of care and a simple post-rape care systems algorithm were designed. A counselling protocol was developed. Targeted training that was knowledge-, skills- and values-based was provided to clinicians, laboratory personnel and trauma counsellors. The standard of care included clinical evaluation and documentation, clinical management, counselling and referral mechanisms. Between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$ 27, with numbers increasing each year. Almost half (43%) of these were children less than 15 years of age. This paper describes how multisectoral teams at district level in Kenya agreed that they would provide post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. The paper outlines which considerations they took into account, who accessed the services and how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.

Reproductive Health in Eight Navies: A Comparative Report on Education, Prevention Services, and Policies on Pregnancy, Maternity/Paternity Leaves, and Childcare

As occupational cultures, navies are remarkable for an ability to achieve far-reaching cultural and behavioral effects by both sweeping and incremental policy changes. Therefore, navy policies for reproductive health education and services, childcare, and maternity and paternity leaves have potential to be at the vanguard of gender parity efforts to successfully integrate women into once male-only occupations. This article provides summaries of reproductive health education programs, pregnancy prevention services, and policies currently in effect in eight navies where women work alongside male peers as sailors and officers. Our objective is to bring together comparative data that is hard to find by other means, which may prove useful to researchers, policy-makers, and naval personnel. Project methodology involved questionnaires sent to naval attaches stationed in embassies in Washington, DC, who referred sections to their appropriate departments. The results are quotations from completed questionnaires and policies sent from the navies of Germany, Latvia, the Netherlands, Norway, South Africa, Spain, the United Kingdom, and the United States. Policies under review include sexual conduct, pregnancy, and maternity and paternity leaves. We also report the latest available statistical data regarding women in these navies, such as numbers of women, percentages of navy women vs. total military women, and dates of women's inclusion as naval personnel.

Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits.

To describe prevention counseling on pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), received by sexually experienced youth in the primary care setting and to test associations between recent sexual risk behaviors and preventive counseling. Using data from the 1999 Youth Risk Behavior Surveillance survey, a nationally representative survey (N = 15 349) of high school students, we analyzed responses to questions about sexual experience, time since last preventive health care visit, and discussion of STD, HIV, or pregnancy prevention with a doctor or nurse during their last preventive health care visit. Logistic regression was used to test associations; students' demographic characteristics were controlled. More than half of the US high school students surveyed reported a preventive health care visit in the 12 months preceding the survey: 60.4% (95% confidence interval [CI]: 57.2%-63.6%) of female students and 57.5% (95% CI: 53.9%-61.1%) of male students. For female students, sexual experience was positively associated with a preventive health care visit (odds ratio [OR]: 1.3; 95% CI: 1.1-1.6), but for male students, sexual experience had a negative effect (OR: 0.8; 95% CI: 0.7-0.9). Of the students who reported a preventive health care visit in the 12 months preceding the survey, 42.8% (95% CI: 38.6%-47.1%) of female students and 26.4% (95% CI: 22.7%-30.2%) of male students reported having discussed STD, HIV, or pregnancy prevention at those visits. Sexual experience was associated with a higher likelihood of engaging in a dialogue about sexual health once a student entered the health care system: female students (OR: 3.8; 95% CI: 3.0-4.9) and male students (OR: 1.9; 95% CI: 1.3-2.7). Primary care providers miss opportunities to provide STD, HIV, and pregnancy prevention counseling to high-risk youth.

Reasons for delay in contraceptive clinic utilization: Adolescent clinic and nonclinic populations compared

Because delay in accessing contraceptive services is a serious obstacle to prevention of unintended pregnancy in adolescence, reasons for delay are probed in a junior and senior high school population and compared with results obtained among 435 young black women previously surveyed in 32 U.S. clinics. The 388 students surveyed before exposure to pregnancy prevention services are compared with 422 surveyed after ≥2 years exposure to a successful educational/clinical intervention program. Particular attention is paid to reasons cited by those who never utilized services important reasons cited by all groups include fear that contraception is dangerous (cited by 40.0% at baseline), fear of parental discovery (30.5%), and awaiting “closer” partner relationships (31.3%). The last reason was often cited a year or more after initiating coitus. That the perception of birth control as dangerous is a barrier to contraception is confirmed by the large proportions who cited it among those who had never used clinical services. Programmatic implications of the findings are discussed.

Adolescent Pregnancy Prevention Services in High School Clinics

In 1973 the St. Paul Maternal and Infant Care (MIC) Project opened a health clinic in a local junior-senior high school. This article describes the evolution of the program and services offered and discusses the impact of its birth control activities on the adolescent population served. Wide use of services and high rates of contraceptive continuation led fertility rates to decline by 56% between 1973 and 1976 from 79 to 35 births per 1000. A retrospective review of the records of all students who received family planning services and prenatal care between 1973 and 1979 showed that 403 students had received initial family planning educational medical and counselling services in the 3 MIC school clinics. By the end of the 3rd year 92% of pregnant students had obtained prenatal services and the school dropout rate after delivery declined from 45% to 10%. The 12-month contraceptive continuation rate for 1973-76 calculated by the life-table method was 86.4 per 100 women and the continuation rate for the later years of the project increased to 92.8 per 100 women. Comparison of the high school clinic group with the overall MIC adolescent population served shows a higher proportion in the school group belonging to minority races and a lower proportion of never-pregnant contraceptors. Significantly fewer patients were lost to follow-up in the school group than in the overall MIC teen clinic group. Factors contributing to the effectiveness of the program in the schools included consistency of staff offering personalized services with guaranteed confidentiality accessibility of free services and provision of educational and social as well as medical services.