Contraceptive Counseling Research Articles

Patient Preferences or Provider Pressure? The Relationship Between Coercive Contraceptive Care and Preferred Contraceptive Use

Background/Objectives: Coercion in contraceptive care occurs when healthcare providers unduly influence patients to use or not use birth control. Contraceptive coercion is antithetical to quality patient-centered care. However, it is unclear how experiencing contraceptive coercion relates to patients’ lives and contraceptive outcomes. In this study, we examined associations between contraceptive coercion and a patient-centered outcome: preferred contraceptive use. Methods: In 2023, we used the Prolific panel to recruit reproductive-aged people in the USA who were assigned female at birth. Our analytic sample included surveyed participants who had ever talked to a healthcare provider about contraception (N = 1197). We conducted chi-square and regression analyses to investigate associations between contraceptive coercion and preferred contraceptive use. We added context by mapping the current and preferred contraceptive method(s) for participants who experienced coercion and were not using their preferred method(s). Results: After adjusting for potential confounders, participants who reported downward coercion (pressure to not use birth control) at their last contraceptive counseling were less likely to be using their preferred contraceptive method(s). The odds of using preferred contraception did not differ significantly based on whether participants experienced upward contraceptive coercion (pressure to use birth control). Patterns in unmet contraceptive preference for patients experiencing coercion include use of the pill when it is not the desired method and unmet desire for permanent contraception. Conclusions: In this study, patients who perceived pressure from a provider to not use birth control were less likely to be using their preferred contraceptive method(s). Promoting reproductive autonomy requires comprehensive, patient-centered, and unbiased contraceptive care.

Knowledge, attitude and acceptability for long-acting reversible contraceptive (LARC) methods among women attending contraception counselling sessions: A cross-sectional study

ABSTRACT Aims: To study the knowledge, attitude, and acceptability of Long-acting Reversible Contraceptive (LARC) methods among women attending contraception counselling sessions. Settings and Design: A cross-sectional study conducted in the family planning clinic of a tertiary care hospital. Methods and Material: Women aged 18–45 years attending contraception counselling sessions were included. Baseline knowledge about LARC methods was assessed. They were given information about LARC methods. Acceptability was assessed on a scale of 0–10. Results: Among four LARC methods, awareness about copper intrauterine devices (CuIUD), DMPA injection, subdermal implant and Mirena was 95%, 55.50%, 27% and 3%, respectively. Around 4% were unaware of the LARC method. Of total, 76.50% women procured the LARC methods information from health care workers, whereas 40% attained from friends, family members, neighbors, or colleagues. After counseling, the majority (58%) were willing for subdermal implant. About 27.50% and 13.50% were willing for copper IUD insertion and injection DMPA, respectively. None was willing for Mirena. Acceptability of various LARC methods was scaled on an acceptability score from 0 to 10. For Cu IUD, implanon and DMPA, the acceptability score was 10 in 50%, 40.17% and 25%, respectively. Conclusions: There are still gaps of knowledge about benefits and safety of available LARC methods. To improve wide coverage and more acceptability of LARC methods, involvement of health care workers and addition of subdermal implants to contraceptive counseling should be considered.

Prenatal and Postpartum Home Visits and Postpartum Contraceptive Use: A Cross-Sectional Analysis.

Background: The postpartum period is a time of unmet contraceptive need for many women. Home visits by a health care worker during pregnancy or after delivery could increase postpartum contraceptive use and decrease barriers to accessing postpartum care. This study investigated the association between prenatal or postpartum home visits and postpartum contraceptive use using a large sample of U.S. women from 41 states. Subjects and Methods: We conducted a cross-sectional analysis using weighted survey data from the 2012-2015 Phase 7 Pregnancy Risk Assessment and Monitoring Systems Core and Standard Questionnaires. Descriptive statistics and multivariate logistic regression models estimated the association between having a prenatal or postpartum home visit and self-reported postpartum contraceptive use. Results: Of 141,296 women, approximately 21% received prenatal or postpartum home visits and 79% used postpartum contraception. After controlling for sociodemographic, reproductive, and health-related factors, women who received prenatal or postpartum home visits had a higher odds of postpartum contraception use (adjusted odds ratio 1.08, 95% confidence interval 1.02-1.15, p = 0.009). Women who were older, were minority race, had less than a high school education, received inadequate prenatal care, experienced partner abuse during pregnancy, or experienced multiple stressors during pregnancy had a lower odds of postpartum contraception use in adjusted analyses controlling for home visitation. Conclusion: Given the benefits of recommended interpregnancy intervals to both the mother and the baby, adding formal contraceptive counseling and offering a variety of postpartum contraceptive methods in the home could further strengthen home visitation programs in the United States and may support women in achieving their reproductive goals.

Rape incidence among children and teenagers in rural and urban communities in Nigeria

This study investigated the incidence of rape among children and teenagers in rural and urban communities in Nigeria. The study employed a cross-sectional survey design to describe the experiences of children and teenagers purposively selected from the six geopolitical regions of Nigeria. 445 participants between the ages of 9 and 19. Results revealed 10.7% rape incidence and 32.8% sexual experience two years before the study for respondents. Age, ethnicity, and community variations were found for rape incidence with 11.8% higher among teenagers aged 13 and above, 7.4% higher in urban communities and a high percentage of 27.2% among the Hausas. Advocating for strict legislative reforms to address the stringent procedures in establishing rape incidents in Nigerian law, comprehensive sexuality education programs in schools to promote awareness and healthy relationships, and preventive counselling interventions were recommended. The study provided an understanding of rape incidence among children and teenagers in Nigeria.

Discussion on the Legal Theory of Underage Minors' Harmful Behavior to Society

The legal regulation of minors' harmful social behavior has become a major problem in judicial practice. The core topic of this study is to understand and answer the challenges of the abnormal behavior of minors to the law, and explain the deep reasons behind it. Through comparative studies and case studies, it reveals legal contradictions including over-indexing penalties, undervaluing the functions of prevention and education, and age zoning. To truly achieve the expected effectiveness of legal regulation, it is necessary to focus on prevention and psychological counseling, especially the establishment of multi-directional defense mechanisms and intervention measures. At the same time, it is suggested that the age of criminal responsibility should be set rationally according to the cognitive ability and socialization level of minors, and the protection system of family, school and society should be strengthened. This study has important theoretical and practical significance for perfecting the legal regulation system of underage minors and preventing and reducing their harmful social behaviors.

The extent of sexual and reproductive health services utilization among adolescents in Abuja, Nigeria: A cross-sectional study

Background: Access to Sexual and Reproductive Health Services (SRHS) is crucial for adolescent health, yet their utilization remains low in many regions. In Abuja Municipal Area, the extent of SRHS use among female adolescents is unclear, prompting this study to assess the utilization level. Objective: This study aimed to evaluate the extent of SRHS utilization among female adolescents in Abuja Municipal Area, Nigeria. Methods: A cross-sectional descriptive study was conducted involving 214 female adolescents. Data were collected from February to July 2023 using a structured questionnaire, with responses analyzed to determine the extent of SRHS utilization. Statistical analysis was done using means, t-tests, and ANOVA to assess the impact of marital status, educational level, and other factors. Results: The overall SRHS utilization among adolescents was low, with an average weighted mean of 1.50, categorized as "Not Extensive." Married adolescents used more SRHS than single adolescents, with a significant difference (t = -7.07, p <0.001) in services such as antenatal care (mean = 2.22 for married vs. 1.37 for single, p <0.001), contraceptive counseling (mean = 1.92 for married vs. 1.33 for single, p <0.001), and postnatal care (mean = 2.10 for married vs. 1.35 for single, p <0.001). Educational level did not significantly influence SRHS utilization, with p-values for contraceptive counseling (p = 0.287) and STI counseling (p = 0.155) showing no significant differences across primary, secondary, and tertiary education groups. Psychological, socio-cultural, and economic factors were major barriers to accessing SRHS. Conclusion: The SRHS utilization among female adolescents in Abuja is insufficient, with marital status being a significant factor in service usage. To improve access, there is a need for targeted interventions, including education on SRHS and the development of informational materials, such as brochures, to enhance awareness and reduce barriers to access.

A randomized controlled trial of Native CHOICES: Impact on alcohol-exposed pregnancy risk reduction among American Indian and Alaska Native women.

Prevention of alcohol-exposed pregnancy (AEP) involves reducing risky alcohol consumption among women at-risk for pregnancy, using effective contraception among women drinking at risky levels to prevent pregnancy, or both. This study presents the outcomes of a randomized controlled trial assessing the efficacy of Native CHOICES, a culturally tailored adaptation of the CHOICES intervention, among American Indian/Alaska Native (AI/AN) women. AI/AN women aged 18-44 who were at-risk for an AEP were randomly assigned in a 1:1 ratio to either the Native CHOICES intervention or a waitlist control group. Native CHOICES comprised two sessions of motivational interviewing and an elective contraception counseling session. Data were collected at baseline, and 6 weeks, 3 months, and 6 months postbaseline. Due to the pandemic, the intervention was at times delivered remotely. A total of 404 women participated: 199 in the control group and 205 in the intervention group. Sixty-seven percent of the intervention group received the intervention in-person, and 33% participated by telephone or video call. Sixty-four percent of women completed all follow-up visits. At the six-month follow-up, the intervention did not demonstrate a significant impact on AEP risk compared with the control arm when analyzing all the data (RR = 0.94; 95% confidence interval [CI]: 0.83-1.07). However, an exploratory subgroup analysis showed evidence of a reduction in AEP risk among participants who completed the study in-person before the COVID-19 pandemic (RR = 0.79; 95% CI: 0.63-0.98), which was not observed during or after the pandemic (RR = 1.06; 95% CI: 0.91-1.24). The Native CHOICES intervention did not show evidence of effectiveness overall. However, exploratory analyses offer some evidence that the intervention was effective prior to the pandemic.

Association between non-melanoma skin cancer, psoriasis, and immunomodulatory therapy: a national epidemiologic study.

The association between psoriasis and non-melanoma skin cancer (NMSC) remains inconsistent despite biologic plausibility. Immunosuppressive effects of systemic psoriasis treatments have also been hypothesized to contribute to the development of NMSC as well. However, data assessing the risk of NMSC associated with immunomodulatory psoriasis medications, particularly newer biologic therapies, are limited.Our objective was to quantify the association between psoriasis, systemic psoriasis therapy, and NMSC accounting for other relevant factors such as smoking status and ultraviolet (UV) light exposure.We performed a cross-sectional, case-control study of 413,457 adults containing 7,478 psoriasis and 9,756 NMSC cases taken from the National Institutes of Health All of Us Research Program database (queried July 2024). NMSC, psoriasis, UV-light exposure, and drug exposures were defined using disease or drug classification codes. Smoking exposure was defined using survey data. Multivariable logistic regression models were used to assess relationships, providing adjusted odds ratios with 95% confidence intervals (aOR with 95% CI).After adjustment for UV-light exposure, coal tar exposure, smoking status, race, ethnicity, gender, age, income, and insurance status, psoriasis history was a significant predictor for NMSC (aOR 1.37 95% CI 1.22-1.52). Psoriasis patients exposed to immunomodulatory medications were also at higher odds of NMSC compared to psoriasis patients who were never exposed (aOR 1.26 95% CI 1.01-1.57). Of these drugs, IL-23 inhibitors (aOR 2.47 95% CI 1.17-5.18), Janus kinase inhibitors (aOR 2.32 95% CI 1.09-4.92), and azathioprine (aOR 2.16 95% CI 1.18-3.96) were the only classes that significantly contributed to increased NMSC risk in psoriasis patients.Psoriasis is independently associated with NMSC. While treatment with some classes of systemic medications is also associated with increased NMSC risk, therapeutic benefits are significant and should be weighed against this risk. NMSC is treatable and high-risk patients may benefit from increased surveillance or preventative counseling. Further prospective studies that assess medication dose and length of exposure should validate our findings.

Inequality in modern contraceptive use and unmet need for contraception among women of reproductive age in Zambia. A trend and decomposition analysis 2007–2018

BackgroundAccess to contraception can be a transformational intervention towards advancement of education, health, and freedom of choice. Countries have committed to improving access to contraception enshrined in the sustainable development goals (SDGs), indicator 3.7.1. Our study seeks to investigate the level of inequality in current use of modern contraception and unmet need for contraception among sexually active women of reproductive age in Zambia during 2007, 2013/14 and 2018 to inform family planning policy.MethodsWe use three rounds of Zambia demographic and health survey datasets for the years 2007, 2013/14 and 2018, which are nationally representative surveys. We included a total of 19,973 sexually active women of reproductive age from 15 to 49 years living in Zambia. The level of inequality was assessed using concentration curves, and indices. The concentration indices were decomposed to identify the causes of the inequality.ResultsOur analysis shows that there was inequality in the current use of modern contraception across the years 2007, 2013/14 and 2018. The concentration curves showed that current use of modern contraception was higher among the wealthy than the poor. This pro-rich trend was consistent throughout the study period. Erreygers concentration Index (EI) values were 0.2046 in 2007, 0.1816 in 2013/14, and 0.1124 in 2018. The inequality in current use of modern contraception was significantly influenced by having access to contraceptive counselling, education level and being in a union (living with a partner). In addition, there was inequality in unmet need for contraception with concentration curves showing that unmet need for modern contraception was experienced more among the poor compared to the wealthy. Unmet need was thus pro poor. The EI values were – 0.0484 in 2007, – 0.0940 in 2013/14 and – 0.0427 in 2018. This inequality was significantly influenced by education, employment status, being in a union, and having health insurance.ConclusionInequality in modern contraceptive use and unmet need for contraception exists and has persisted over the years in Zambia. Such inequality can be addressed through a multipronged approach that includes encouraging women to visit health facilities, access to contraceptive counselling, and promoting formal education.

Формирование мотивационных установок приобщения к табаку и никотинсодержащей продукции у студенческой молодёжи.

Monitoring of smoking as a global modifiable behavioral risk factor for chronic pathologies, tumors and premature mortality should begin in childhood and adolescence, when the first smoking attempt is made, subsequently becoming a part of the adult lifestyle. Research objective: to study the features of the formation of motivational attitudes of medical university students to initiate the consumption of tobacco or nicotine-containing products. Material and methods. A one-stage open uncontrolled study with random non-repeated selection of respondents in the form of an online survey was conducted to study motivational attitudes to initiate the consumption of tobacco or nicotine-containing products and to assess the degree/severity of smoking and the intensity of physical dependence on nicotine in the student environment of the medical university. Results. 455 questionnaires were analyzed: 328 (71.9%) women and 127 men (27.9%), average age 23.55 ± 4.33 years. The most consumed products were electronic cigarettes – 44.1%, traditional cigarettes – 38.3%, electronic nicotine delivery systems 14.7%. Regardless of the method of nicotine delivery to the body, the main factor in the initiation of smoking was the first try (16.52 ± 3.7 years), which was liked and brought pleasure in 47–100%. The second most important factor in the initiation of smoking for consumers of traditional cigarettes was the ability to cope with stress, anxiety – 51.1%. The majority of respondents (86%) did not have or had a mild degree of nicotine addiction according to the Fagerstrom test (0–2 points). The identified features of smoking initiation require interdepartmental cooperation to develop and implement evidence-based programs aimed at developing competencies in medical students and practicing doctors to ensure smoking screening, short-term intervention and preventive counseling skills using the potential benefits of mobile health.

Contraception Use in Cancer Survivors, Clinical Practice and Patients' Preferences.

Current literature suggests that emergency contraception, defined as a therapy aimed at preventing an unwanted pregnancy after unprotected or insufficiently protected intercourse, is used more by cancer survivors than by the general population. This may be related to reduced use of contraception in women after cancer diagnosis and, when it is used, to a choice of less effective methods, even in the absence of contraindications to hormonal options. The purpose of this review is to analyze the use of contraception in these patients, its predictors and the preferred methods, as well as to try to define timing and characteristics of an effective contraception counseling. Factors identified as predictors of contraception usage were younger age, having a partner and better sexual function, having children, past use and having received contraception counseling by a gynecologist, especially in the previous year. Contraception counseling should start before oncological therapies, together with information regarding fertility and sexual health, preferably by the gynecologist of the oncofertility unit, with a specific expertise in dealing with cancer patients. Increased awareness of oncologists and family medicine doctors is fundamental to optimize contraception use and compliance with the prescribed method. Major guidelines regarding oncological care in women of fertile age already recommend contraception counseling, but optimal timing and mode of the consultation(s) options should be further researched, to be better detailed in all relevant documents.

The role of pediatric subspecialists in adolescent contraceptive care: knowledge, attitudes, and barriers.

Adolescents and young adults (AYA) with chronic medical conditions (CMC) have similar sexual behaviors to their healthy peers but are less likely to use contraception. Provision of CMC-specific sexual and reproductive health (SRH) care within pediatric subspecialty clinics may improve access for this population, although system and provider level barriers exist. The purpose of this cross-sectional study was to assess the attitudes, practices, and knowledge of SRH among providers in a variety of pediatric subspecialities. Listservs were used to recruit pediatric subspecialists caring for pregnancy capable AYA (12-24 years-old) who use teratogenic medications or have CMC that pose significant pregnancy health risk, as defined by the World Health Organization. Participants completed an online survey about their contraceptive attitudes and practices and rated their knowledge and comfort discussing contraception. A total of 510 pediatric subspecialists participated. Although 92% said addressing SRH is important for pediatric subspecialists, most believed their role included SRH discussion(78.1%) and referral(82.2%) rather than provision(12.1%). Only 4.3% felt totally comfortable with contraceptive counseling. Identified facilitators included time(64.2%), referral resources(67.5%), and training in contraceptive options(62.9%). Most participants would recommend long-acting reversible contraception if medically appropriate, but few reported confidence in their knowledge and ability to counsel about them. SRH is an important part of comprehensive care for youth with CMC. Discomfort and lack of knowledge decrease a provider's ability to confidently provide SRH care in subspecialty clinics. Expanding collaborations between subspecialty and SRH providers may increase access to quality SRH tailored to these young people's unique medical needs.

Patient and OBGYN Perspectives on Considering Long-Acting Reversible Contraception for Postpartum Patients Who Desire Permanent Contraception

Objective(s)We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference. Study DesignWe interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n=67) from four U.S. institutions to explore patient and OBGYN perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software. ResultsOur analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body. Conclusion(s)These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.

Counselling and prescription of contraception related to pregnancy termination

INTRODUCTION. Even though Denmark has the highest contraceptive use (42%) of the Nordic countries, 19% of all pregnancies in Denmark end in termination. Various contraceptive options are available, and unwanted pregnancies therefore ought to be avoidable. This study aimed to investigate if women received counselling and prescriptions for contraception during their termination and if this or other factors impacted their risk of repeat termination. METHODS. This was an analytical, historical and retrospective cohort study. Data were collected manually from 310 medical records at the Hospital of Southern Jutland between 2016 and 2019. RESULTS. A total of 82% of patients received contraceptive counselling during their termination, and 35% of these patients received a contraceptive prescription for future use. A total of 17% had a repeat termination within three years after receiving counselling; 23% of the women who did not receive contraceptive counselling experienced one or more repeat pregnancy terminations within the following three-year period. The risk of repeat termination during the follow-up period was significantly higher among the patients with a previous termination. CONCLUSIONS. The majority of the women received contraceptive counselling at the time of their termination. Women who previously had an abortion were twice as likely to undergo a repeat termination during the follow-up period. Further research is necessary to establish whether counselling and prescription of contraceptives have a significant impact on repeat terminations. FUNDING. None. TRIAL REGISTRATION. Approval R. no. 20/22908.

Healthcare provider communication and current contraceptive use among transgender men and gender-diverse people: Results from an online, cross-sectional survey in the United States.

To explore whether discussing contraceptive use with a healthcare provider is associated with current contraceptive use among transgender men and gender-diverse (TMGD) individuals. In 2019, we conducted a cross-sectional survey among transgender men and gender-diverse adults in the United States who were assigned female or intersex at birth. We measured whether respondents had ever discussed contraception with a healthcare provider as well as current use of contraception, reasons for use, and barriers to use. We described frequencies and ranges for key variables and implemented a series of nested logistic regression models to evaluate the association between ever having spoken to a provider about contraception and current use of contraception for any reason, overall and by method type. Among 1694 respondents, about half (48%) were currently using a method of contraception for any reason, most commonly barrier methods (17%) and long-acting-reversible-contraception (LARC) (17%). Compared to those who never had a conversation about contraception with a provider, respondents who spoke with a provider were more likely to be currently using contraception - particularly among those who self-initiated the conversation (aOR: 3.8, 95% CI: 2.5-5.6). Having discussed contraception with a healthcare provider was most strongly associated with current LARC use. Having had a conversation with a provider about contraception use was positively associated with current contraception use among a large, national sample of transgender men and gender-diverse people. Facilitating patient participation in contraception counseling for transgender and gender-diverse patients should be emphasized in provider training. Given formidable barriers to healthcare faced by TMGD people, training providers on how to initiate affirming and relevant conversations with TMGD patients about contraceptive needs and preferences is essential, as are efforts to educate and empower TMGD individuals to advocate for the information they need in these interactions.

Three Novel Pathogenic Variants in Unrelated Vietnamese Patients with Cardiomyopathy.

Background: Cardiomyopathy, including dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM), is a major cause of heart failure (HF) and a leading indication for heart transplantation. Of these patients, 20-50% have a genetic cause, so understanding the genetic basis of cardiomyopathy will provide knowledge about the pathogenesis of the disease for diagnosis, treatment, prevention, and genetic counseling for families. Methods: This study collected nine patients from different Vietnamese families for genetic analysis at The Cardiovascular Center, E Hospital, Hanoi, Vietnam. The patients were diagnosed with cardiomyopathy based on clinical symptoms. Whole-exome sequencing (WES) was performed in the Vietnamese patients to identify variants associated with cardiomyopathy, and the Sanger sequencing method was used to validate the variants in the patients' families. The influence of the variants was predicted using in silico analysis tools. Results: Nine heterozygous variants were detected as a cause of disease in the patients, three of which were novel variants, including c.284C>G, p.Pro95Arg in the MYL2 gene, c.2356A>G, p.Thr786Ala in the MYH7 gene, and c.1223T>A, p.Leu408Gln in the DES gene. Two other variants were pathogenic variants (c.602T>C, p.Ile201Thr in the MYH7 gene and c.1391G>C, p.Gly464Ala in the PTPN11 gene), and four were variants of uncertain significance in the ACTA2, ANK2, MYOZ2, and PRKAG2 genes. The results of the in silico prediction software showed that the identified variants were pathogenic and responsible for the patients' DCM. Conclusions: Our results contribute to the understanding of cardiomyopathy pathogenesis and provide a basis for diagnosis, treatment, prevention, and genetic counseling.

Principles of Outpatient Care of Patients With Heart Failure

These guidelines combine the key provisions for the management of patients with chronic heart failure (CHF) at the outpatient stage based on current data from clinical studies, new 2024 clinical guidelines of the Russian Society of Cardiology for the management of CHF patients, and the provisions of the current order of the Ministry of Health of the Russian Federation on the procedure for conducting dispensary observation. CHF is a progressive disease characterized by a high risk of death, rehospitalizations, and disability. Reducing the risk of CHF decompensation and improving the prognosis is possible only with regular monitoring of the patient's condition and timely correction of therapy. The priority task of the outpatient unit is to expand the coverage of dispensary follow-up of CHF patients, preventive counseling, and telemedicine monitoring for timely identification of the patients at a high risk of CHF progression, improving their quality of life, and prolonging their life duration.

Effect of pregnancy intention on completion of maternity continuum of care in Sub-Saharan Africa: systematic review and meta-analysis

BackgroundThe maternity continuum of care is a strategy to provide timely and quality maternal and child healthcare through preconception, pregnancy, childbirth, postnatal, and the early childhood periods. The maternity continuum of care effectively reduces global maternal and neonatal deaths. However, several factors are reported to cause low completion of the maternity continuum of care in sub–Saharan Africa. There has been substantial debate in the literature as to whether pregnancy intention influences the completion of the maternity continuum of care. Although several studies have been conducted to determine the influence of pregnancy intention on the completion of the maternity continuum of care, findings are inconsistent and have not been systematically reviewed. Therefore, this review aims to determine the effect of pregnancy intention on the completion of the maternity continuum of care in sub–Saharan African countries.MethodsA systematic search of articles was performed from MEDLINE Complete, CINAHL Complete, PsycINFO, EMBASE, Maternity & Infant Care, Global Health, Scopus, and Web of Science. The identified articles were imported into Covidence and independently screened by two researchers for abstract and title, and then full-text. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The Cochran’s Q test and I2 were used for assessing the potential heterogeneity of the studies. Publication bias was assessed using Egger’s regression test and inspection of a funnel plot. A fixed-effects meta-analysis model was used to compute the effect of pregnancy intention on the completion of the maternity continuum of care.ResultsTen studies involving 343,932 participants were included in the final analysis. The pooled estimate of the meta-analysis found that women with intended pregnancy had 2.12 times higher odds of completing the maternity continuum of care (pooled odds ratio: 2.12, 95% CI: 1.33, 3.36) as compared to women with unintended pregnancy.ConclusionIntended pregnancy has a statistically significant positive effect on completing the maternity continuum of care. Policymakers and healthcare providers need to implement strategies to encourage women to plan their pregnancies through the strengthening of pre-conception care and contraceptive counselling to prevent unintended pregnancies.Systematic review registrationPROSPERO CRD42023409134.

“I am putting my fear on them subconsciously”: a qualitative study of contraceptive care in the context of abortion bans in the U.S.

BackgroundSince the Dobbs vs. Jackson Women’s Health Organization decision in June 2022, providers throughout the U.S. have been navigating the shifting legal landscape of abortion bans, which diminish the delivery of evidence-based healthcare. The Dobbs decision has had a detrimental impact on medical training, the physician–patient relationship, and provision of medical care. However, few studies have captured the effects on providers in adjacent fields, including contraceptive care. Our objective was to examine the impact of Dobbs on contraceptive care.MethodsWe conducted semi-structured in-depth interviews (August 2022–July 2024), with 41 contraceptive healthcare providers across the US, with the majority (63%) in abortion restrictive states. We utilized deductive thematic analysis to assess providers’ practice changes and experiences related to contraceptive services.ResultsIn reaction to the Dobbs decision, providers noted increased requests for contraception, especially for highly effective methods. Providers worried that certain methods, such as IUDs or emergency contraception, would become restricted, and mentioned advance provision of pills and other ways that they would try to ensure supplies. Providers also discussed that their patients were worried about threats to contraception, including for adolescents. Some expressed concern, however, that the abortion bans may prompt providers to overemphasize high-efficacy methods with directive counseling. Providers shared that it was stressful to practice in contexts of uncertainty, with shifting abortion policies affecting contraceptive care, including emergent needs such as providing contraceptive services to out-of-state patients before they go home. Several providers shared that they felt an increased importance of their role in their communities, and a deepened commitment to advocate for their patients.ConclusionsAbortion restrictions profoundly impact providers’ contraceptive counseling and care. The effects of Dobbs on providers and their clinical practices underscore providers' legally precarious position in today’s reproductive health landscape. Attention to contraceptive access and person-centered care has become a salient public health need across the U.S. The long-term impacts of limited reproductive rights may stretch an already under-resourced healthcare system and further emphasize moral pressures.

Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What’s My Method?

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New World Health Organization (WHO) and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals. Barbados currently supplements provider-based contraceptive counseling with analog materials (pamphlets and posters) and informational videos that play on a screen in the waiting room. As part of an implementation framework, this study seeks to conduct a formative evaluation of the What’s My Method? (WMM) game intervention as a tool to support contraceptive counseling and increase reproductive empowerment among childbearing persons in Barbados. We test-deployed the WMM game in Bridgetown, Barbados, conducting playtests and unstructured discussions with prototypes of the WMM game among three groups of stakeholders (youth contraception ambassadors: n=8; healthcare providers: n=7; and nursing students: n=27) to determine acceptability of the intervention, efficacy of the game as a learning tool, and willingness to adopt the tool in their healthcare context. Feedback on acceptability of the game was largely positive. Detailed constructive comments informed modifications and improvements to the game. The questionnaire used to assess contraceptive knowledge gain did not prove effective. Results indicate that the WMM game is well-received and accepted by the healthcare professionals who would be deploying it. This pilot testing has informed the design of the modified WMM for a randomized controlled trial (RCT) to test the deployment of the game in a healthcare setting.