Prevention Of Unintended Pregnancy Research Articles

The place of abortion in the pregnancy decision-making process in young adult women in Catalonia, Spain.

Induced abortion is one option to control fertility in Spain. Young adult women (25-34years old) show a different abortion pattern compared to women in other age groups, being less likely to seek abortions than younger women and having one of the lowest proportions of unintended pregnancies. We aimed to analyse the factors involved in the pregnancy decision-making process to better understand why young adult women seek abortions in Catalonia, Spain. In-depth semi-structured interviews with 25 nulliparous pregnant young adult women and one focus group discussion with healthcare providers were conducted in 2008/2010. We found that inconsistent contraceptive use prior to an unintended pregnancy was due to ambivalence and weighing of priorities during sex. The quality of the relationship was paramount to the abortion decision whereas other reasons (financial/employment status, fulfilling aspirations, support networks) were less important. We conclude that the motivations for the abortion decision are interrelated and based on the current life stage of women and that there is pressure on young adult women in Spain to become mothers. Induced abortion is perceived as the last resort to postpone motherhood. Our findings reinforce the unequal societal burden placed on women to take responsibility for prevention of unintended pregnancy.

High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda

BackgroundThe use of implants and Intra-uterine devices (IUD) during the post-partum period is very low in Uganda especially in rural settings. Long-acting reversible contraceptives (LARC) are known to be the most cost-effective for prevention of unintended pregnancy and unsafe abortions. This study aimed at determining the factors associated with long-acting reversible contraceptive use among women in the extended postpartum period in rural Uganda.MethodsWe conducted a household-based, cross-sectional study among 400 women in two rural communities in Mityana district, central Uganda. Eligible women were aged 15 to 45 years who had childbirth within 12 months of study enrollment in September 2014. The outcome variable was self-reported use of a LARC method, either IUD or implants in the extended postpartum period. The main independent variables were previous childbirths (parity), fertility desire, willingness to use modern contraception, duration of postpartum period and previous pregnancies (gravidity). A logistic regression model was run in STATA v12.0 to compute adjusted odds ratios (AOR) for factors that predicted LARC use statistically significant at p < 0.05.ResultsFour hundred respondents had a mean age of 27 years (SD = 12) and only 8.5% reported using a LARC method. Use of IUD and implant was 1.8% and 10.4% respectively. Most women using LARC (44.1%) had five or more childbirths (p = 0.01), 70.8% of non-LARC users were willing to use modern contraceptives (p = 0.07) and 2.5% ever had an induced abortion. Having five or more childbirths was independently associated with LARC use in the extended postpartum period (AOR = 4.07, 95%CI 1.08–15.4). Willingness to use modern contraception, desire for more children and postpartum duration had no significant association with LARC use in the extended postpartum period.ConclusionThis study revealed low use of LARC within twelve months of child birth despite women’s willingness to use them. High parity (≥5 childbirths) predicted LARC use. The next logical step is to identify barriers to using LARC in the extended postpartum period and design appropriate interventions to increase access and use especially in multi-parous women.

Prevalence, and Pattern of LARC Use in Immediate Postpartum Period at Jimma University Medical Center, Ethiopia [18F

INTRODUCTION: Postpartum family planning (PPFP) is defined as the prevention of unintended pregnancy and closely spaced pregnancies through the first twelve months following childbirth. Immediate postpartum period is particularly favorable time to provide LARC methods and postpartum provision of LARC is safe and effective. Despite the advantages of LARCs, they are infrequently used in Ethiopia. METHODS: A cross-sectional study was conducted on 393 women who gave birth at Jimma University Medical Centre (JUMC) from November 12, 2016 to January 21, 2017. Data were collected by face-to-face interview and record review using pre-tested questionnaire and analysed using SPSS 20. Logistic regression was used to identify associated factors for LARC method use. RESULTS: Prevalence of LARCs use among immediate postpartum mothers was 53.2% and more than three quarter (78.0%) of participants used Implanon. The most common reported reasons for not using LARC were preference of other method (25.5%). Having more than four alive kids (95% CI: 1.15-5.95), high monthly income (95% CI: 1.08-7.20), planning to delay next pregnancy by more than two years (95% CI: 1.60-9.28), previous experience of LARC use (95% CI: 1.30- 7.20), completed family size (95% CI:1.12- 3.15), and most importantly receiving counselling during antenatal care (ANC) follow up and before delivery (95% CI 1.01- 4.73) were associated with immediate postpartum LARC use. CONCLUSION: Utilisation of immediate postpartum LARC methods use among counselled mothers was high compared to other low income countries reviewed. The need for providing counselling during ANC follow up and delivery to increase utilisation of immediate postpartum LARC use is emphasised.

Do health promotion messages integrate unintended pregnancy and STI prevention? A content analysis of online information for adolescents and young adults

ObjectiveRecently there have been calls to strengthen integration of unintended pregnancy and sexually transmitted infection (STI) prevention messages, spurred by increasing use of long-acting reversible contraception. To assess the extent to which public health/clinical messages about unintended pregnancy prevention also address STI prevention, we conducted a content analysis of web-based health promotion information for young people. Study DesignWebsites identified through a systematic Google search were eligible for inclusion if they were operated by a United States-based organization with a mission related to public health/clinical services and the URL included: 1) original content; 2) about sexual and reproductive health; 3) explicitly for adolescents and/or young adults. Using defined protocols, URLs were screened and content was selected and analyzed thematically. ResultsMany of the 32 eligible websites presented information about pregnancy and STI prevention separately. Concurrent discussion of the two topics was often limited to statements about (1) strategies that can prevent both outcomes (abstinence, condoms only, condoms plus moderately or highly effective contraceptive methods) and (2) contraceptive methods that confer no STI protection. We also identified framing of condom use with moderately or highly effective contraceptive methods for back-up pregnancy prevention but not STI prevention. STI prevention methods in addition to condoms, such as STI/HIV testing, vaccination, or pre-exposure or post-exposure prophylaxis, were typically not addressed with pregnancy prevention information. ConclusionsThere may be missed opportunities for promoting STI prevention online in the context of increasing awareness of and access to a full range of contraceptive methods. ImplicationsStrengthening messages that integrate pregnancy and STI prevention may include: describing STI prevention strategies when noting that birth control methods do not prevent STIs; promoting a full complement of STI prevention strategies; and always connecting condom use to STI prevention, even when promoting condoms for back-up contraception.

The association of sociodemographic characteristics and sexual risk behaviors with health literacy toward behaviors for preventing unintended pregnancy among university students

PurposeThe aim of this study was to determine whether there is an associated effect between sociodemographic characteristics and sexual risk behaviors with health literacy in preventing unintended pregnancy among university students in Chon Buri province, Thailand.Participants and methodsA cross-sectional study design was used. The data were collected between February and May, 2017. A self-administered questionnaire was developed by the Ministry of Public Health and supported by the evolving concept of health literacy of Nutbeam. This questionnaire was then applied to collect data from 418 university students. Descriptive statistical and binary logistic regression methods were used for data analysis in this study.ResultsHalf the students exhibited inappropriate behaviors to prevent unintended pregnancies. However, half the respondents had been educated to prevent unintended pregnancies. Nearly one-third of the students had experienced sexual intercourse. Binary logistic regression was used to analyze an association between the behavior for unintended-pregnancy prevention with sociodemographic characteristics and the health literacy of university students. The factors assessed were current residence type (the adjusted odds ratio [aOR]=1.897, 95% CI=1.123–3.205), previous sexual intercourse (aOR=3.263, 95% CI=1.735–6.139), cognitive health to prevent unintended pregnancy (aOR=1.095, 95% CI=1.019–1.176), decision skills in choosing appropriate practices to prevent unintended pregnancy (aOR=1.289, 95% CI=1.182–1.405), and self-management to prevent unintended pregnancy (aOR=1.113, 95% CI=1.005–1.232).ConclusionThis study indicated that university students who had experienced sexual intercourse and had low health literacy were more likely to exhibit inappropriate behaviors concerning the lack of prevention of unintended pregnancies. The results will provide health professionals with information to develop more effective prevention and intervention programs.

Z-CAN: prevention of unintended pregnancy in an emergency setting

Z-CAN: prevention of unintended pregnancy in an emergency setting

Barriers Facing Postpartum Family Planning among Women Attending Family Medicine Units in 6th of October City

Background: Globally, family planning (FP) is a key life-saving intervention for mothers and their children; Postpartum Family Planning (PPFP) aims to prevent the high risk of unintended and closely spaced pregnancies during the first year following childbirth. Given the high unmet need for family planning during the post­partum period, this has raised the need to identification of the main barriers to provide methods of solutions. One of which is the need to integrate information and service provision during post natal care, child health care visits, and all levels of the health system. Objectives: This study aims to measure the rate of PPFP among women attending family medicine units in 6th October city and to identify the effect of PPFP on pregnancy spacing as well as the main barriers facing its continuation. Methods: This study is a cross-sectional analytic study; it was conducted between July and October 2017 on married women in reproductive age attending three family medicine centers. Data were collected through a structured interviewed questionnaire based on concept definition of Postpartum Family Planning (PPFP) ; the prevention of unintended pregnancy and closely spaced pregnancies through the first 12 months following childbirth Results: About Sixty percent (59.4%) of women were between 25-35 years with a mean age of 30± 6.4 years. The rate of PPFP is 51.8%, more than half of studied women reported that lack of knowledge on FP is the main barrier to contraception use, followed by desire to get more children 42.2%. Conclusion: Family physicians should be committed to clarify the concept of PPFP aiming at increasing women's awareness and compliance to the best contraceptive methods.

Birth control: Contraceptive drugs/pills and methods in the last decades

Man had always tried to regulate births through various means involving the use of one or more actions such as medications, agents, sexual practices, or surgical procedures to prevent conception or pregnancy. The existing birth control methods include traditional and modern. The traditional methods are celibacy or sexual abstinence and withdrawal or coitus interruptus while the modern methods include male and female condoms, spermicide, contraceptives, sponge, diaphragm, pills, and vasectomy. Research has shown that hormonal approach to male contraception may be effective, reversible, and even safe. Efforts are ongoing to develop newer male contraceptives that will allow men to become full partners in the prevention of unintended pregnancy. This work reviews existing methods of birth control including current researches in birth control especially in the male.

Fertility Desire and Associated Factors among People Living with HIV/AIDs at Selected Health Facilities of Wolaita Zone, Southern Ethiopia: Cross-sectional Study

Background: The Africa especially the region of Sub-Saharan remains the severely HIV affected region with nearly 1 in every 20 people. The majorities of people living with HIV are of reproductive age and face challenging choices concerning their sexuality, parenthood desires and family life. Despite the desire to avoid having children, many women with HIV experience unintended pregnancies. Prevention of unintended pregnancies among HIV infected women is one key strategies of prevention of mother to child transmission of the disease in the country. Methods: A non-experimental facility based cross sectional study design was used and the data was collected from all men and women attending care and treatment in ART clinics in selected health facilities giving ART service from January to February 2014. A pre-tested structured questionnaire was employed to collect information from respondents who fulfill inclusion criteria and after obtaining a verbal consent. Data was entered, cleaned, edited and analyzed using SPSS Version 20 statistical software package. Chi-square and binary logistic regression was carried out to assess the presence of association and the effect of independent predictors on fertility desire of the respondents. Result: A total of 410 Patients were included in the study giving the response rate of 97 percent. The median age of respondents was 33 and 254(62%) of clients were females. 43% (176) desire to bear child and of these 34 % were not using any modern FP method. The most commonly reported reasons for child bearing desire were desire to replace themselves 65.9 % followed by desiring a child from their partner 17.1%. Among respondents do not desire to bear child, 45.6 % were males and 55.4 % were females. It was found that sexual practice in the last six months [AOR: 2.07, 95% CI, 1.63-7.26], number of live children (AOR: 0.5, 95% CI, 0.105-0.217), and number of children alive [AOR: 4.61, 95% CI, 2.94-13.77], were found to be significantly associated with desire to bear children. Conclusion: Fertility desire is found to be high among HIV/AIDS patients living in the study area. Age, having sexual practice in the last six months, and having less number of children alive, were obtained to be the determinants of fertility desire. The current contraceptive utilization rate of the respondents was less and majority of them were using condom which is not a reliable method for the prevention of pregnancy so most of them especially those who does not desire more children will be exposed to unwanted pregnancy. The most common reason of respondents who desire to have a child was to replace them followed by desiring a child from their partner.

Meeting Summary: State and Local Implementation Strategies for Increasing Access to Contraception During Zika Preparedness and Response - United States, September 2016.

Zika virus infection during pregnancy is a cause of microcephaly and other serious brain abnormalities (1). To support state and territory response to the threat of Zika, CDC's Interim Zika Response Plan outlined activities for vector control; clinical management of exposed pregnant women and infants; targeted communication about Zika virus transmission among women and men of reproductive age; and primary prevention of Zika-related adverse pregnancy and birth outcomes by prevention of unintended pregnancies through increased access to contraception.* The most highly effective,† reversible contraception includes intrauterine devices and implants, known as long-acting reversible contraception (LARC). On September 28, 2016, the Association of Maternal and Child Health Programs (AMCHP) and CDC facilitated a meeting in Atlanta, Georgia, of representatives from 15 states to identify state-led efforts to implement seven CDC-published strategies aimed at increasing access to contraception in the context of Zika virus (2). Qualitative data were collected from participating jurisdictions. The number of states reporting implementation of each strategy ranged from four to 11. Participants identified numerous challenges, particularly for strategies implemented less frequently. Examples of barriers were discussed and presented with corresponding approaches to address each barrier. Addressing these barriers could facilitate increased access to contraception, which might decrease the number of unintended pregnancies affected by Zika virus.

Novel multipurpose pod-intravaginal ring for the prevention of HIV, HSV, and unintended pregnancy: Pharmacokinetic evaluation in a macaque model.

Globally, women bear an uneven burden for sexual HIV acquisition. Results from two clinical trials evaluating intravaginal rings (IVRs) delivering the antiretroviral agent dapivirine have shown that protection from HIV infection can be achieved with this modality, but high adherence is essential. Multipurpose prevention technologies (MPTs) can potentially increase product adherence by offering protection against multiple vaginally transmitted infections and unintended pregnancy. Here we describe a coitally independent, long-acting pod-IVR MPT that could potentially prevent HIV and HSV infection as well as unintended pregnancy. The pharmacokinetics of MPT pod-IVRs delivering tenofovir alafenamide hemifumarate (TAF2) to prevent HIV, acyclovir (ACV) to prevent HSV, and etonogestrel (ENG) in combination with ethinyl estradiol (EE), FDA-approved hormonal contraceptives, were evaluated in pigtailed macaques (N = 6) over 35 days. Pod IVRs were exchanged at 14 days with the only modification being lower ENG release rates in the second IVR. Plasma progesterone was monitored weekly to determine the effect of ENG/EE on menstrual cycle. The mean in vivo release rates (mg d-1) for the two formulations over 30 days ranged as follows: TAF2 0.35–0.40; ACV 0.56–0.70; EE 0.03–0.08; ENG (high releasing) 0.63; and ENG (low releasing) 0.05. Mean peak progesterone levels were 4.4 ± 1.8 ng mL-1 prior to IVR insertion and 0.075 ± 0.064 ng mL-1 for 5 weeks after insertion, suggesting that systemic EE/ENG levels were sufficient to suppress menstruation. The TAF2 and ACV release rates and resulting vaginal tissue drug concentrations (medians: TFV, 2.4 ng mg-1; ACV, 0.2 ng mg-1) may be sufficient to protect against HIV and HSV infection, respectively. This proof of principle study demonstrates that MPT-pod IVRs could serve as a potent biomedical prevention tool to protect women’s sexual and reproductive health and may increase adherence to HIV PrEP even among younger high-risk populations.

Contraception counseling for adolescents.

In recent years, pregnancy and birth rates among adolescents in the United States have declined to all-time lows, although adolescents in the United States continue to have the highest rate of unintended pregnancy among developed countries. Contraception is a key component in the prevention of unintended pregnancy. In this review, we outline unique barriers to reproductive healthcare for adolescents and strategies to optimally address the contraceptive needs of adolescents. Adolescents face barriers such as confidentiality, cost, and access when seeking contraception. Counseling about options for contraception may involve parents or guardians when appropriate, but an adolescent's autonomy should be respected in the decision-making process. Contraceptive counseling for adolescents must not be coercive in nature. Adolescents are at an increased risk for acquisition of sexually transmitted infections, and dual use, the use of condoms and an additional method of contraception, is highly recommended. Initiatives that remove the common barriers of cost and access have demonstrated significant success in increasing the use of long-acting reversible contraceptive methods and reducing the rates of unintended pregnancy among adolescents. Counseling adolescents about contraception requires acknowledgement of the unique barriers that adolescents face and facilitating decision-making about contraceptive methods in a manner that prioritizes the adolescent's autonomy.

Trends in contraceptive use according to HIV status among privately insured women in the United States

There is limited information on the patterns and trends of contraceptive use among women living with HIV, compared with noninfected women in the United States. Further, little is known about whether antiretroviral therapy correlates with contraceptive use. Such information is needed to help identify potential gaps in care and to enhance unintended pregnancy prevention efforts. We sought to compare contraceptive method use among HIV-infected and noninfected privately insured women in the United States, and to evaluate the association between antiretroviral therapy use and contraceptive method use. We used a large US nationwide health care claims database to identify girls and women ages 15-44 years with prescription drug coverage. We used diagnosis, procedure, and National Drug Codes to assess female sterilization and reversible prescription contraception use in 2008 and 2014 among women continuously enrolled in the database during 2003 through 2008 or 2009 through 2014, respectively. Women with no codes were classified as using no method; these may have included women using nonprescription methods, such as condoms. We calculated prevalence of contraceptive use by HIV infection status, and by use of antiretroviral therapy among those with HIV. We used multivariable polytomous logistic regression to calculate unadjusted and adjusted odds ratios and 95% confidence intervals for female sterilization, long-acting reversible contraception, and short-acting hormonal contraception compared to no method. While contraceptive use increased among HIV-infected and noninfected women from 2008 through 2014, in both years, a lower proportion of HIV-infected women used prescription contraceptive methods (2008: 17.5%; 2014: 28.9%, compared with noninfected women (2008: 28.8%; 2014: 39.8%, P < .001 for both). Controlling for demographics, chronic medical conditions, pregnancy history, and cohort year, HIV-infected women compared to HIV-noninfected women had lower odds of using long-acting reversible contraception (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86 compared to no method) or short-acting hormonal contraception method (adjusted odds ratio, 0.59; 95% confidence interval, 0.50-0.70 compared to no method). In 2014, HIV-infected women using antiretroviral therapy were significantly more likely to use no method (76.8% vs 64.1%), and significantly less likely to use short-acting hormonal contraception (11.0% vs 22.7%) compared to HIV-infected women not using antiretroviral therapy. Those receiving antiretroviral therapy had lower odds of using short-acting hormonal contraception compared to no method (adjusted odds ratio, 0.45; 95% confidence interval, 0.32-0.63). There was no significant difference in female sterilization by HIV status or antiretroviral therapy use. Despite the safety of reversible contraceptives for women with HIV, use of prescription contraception continues to be lower among privately insured HIV-infected women compared to noninfected women, particularly among those receiving antiretroviral therapy.

Postpartum Family Planning: Missed Opportunities across the Continuum of Care

Postpartum family planning is defined as the prevention of unintended pregnancies and closely spaced pregnancies during the first 12 months following childbirth. To assess the practice of family planning (FP) by postpartum mothers in the Regional Director of Health Services (RDHS) division, Kalutara, Sri Lanka. A community-based, descriptive, cross sectional study was carried out among mothers, 8 to 12 weeks postpartum, in the RDHS division, Kalutara in 2014. Calculated sample size was 1200 and the participants were recruited using cluster sampling method. They were interviewed at their residence about their practice of FP methods using an interviewer administered questionnaire. The response rate was 93.7% (n=1112) of which 730 (65.6%) were practicing a FP method at 8-12 weeks after delivery. Condoms were the most popular modern FP method (30.4%, n=222) followed by intrauterine device (26.7%, n=195) and depot medroxyprogesterone acetate (DMPA) injections (22.9%, n=167). Approximately 80% had utilized government sector FP services. Women with higher level of education (p< 0.05), lower family income (p< 0.01), parity more than 3 (p< 0.001) and more than three living children (p<0.01) were significantly more likely to use a FP method. Prevalence of postpartum FP is not satisfactory. Therefore, FP services should consider reaching postpartum mothers with unmet needs as a priority and ensure that a wide range of contraceptive options are available to them. Postpartum FP should be considered as a continuum of maternal care.

Relationships matter: contraceptive choices among HIV-positive women in Tanzania

Efforts to eliminate mother-to-child transmission of HIV in Tanzania are guided by a four-prong strategy advocated by the World Health Organization (WHO). Prong 2, prevention of unintended pregnancies among women living with HIV, has, however, received the least attention and contraceptive use to prevent unintended pregnancies remains low. This study explored the perceived barriers to the use of modern methods of contraception, and factors influencing contraceptive choice among HIV-positive women in urban Dar-es-Salaam, Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and focus group discussions with 37 sexually active HIV-positive women aged between 20 and 44 years, attending three health facilities within Dar-es-Salaam. The theoretical framework was a patient centred model. Four barriers were identified: the influence of the women’s spousal relationships; personal beliefs and the relationship of these in understanding her disease; the influence of the social demands on the woman and her relationships; and the importance of a woman’s relationship with her healthcare provider/healthcare system. Being the bearers of bad news (HIV-positive status) the pregnant women experienced conflicts, violence, abandonment and rejection. The loss in negotiating power for the women was in relation to their intimate partners, but also in the patient–healthcare provider relationship. The role of the male partner as a barrier to contraceptive use cannot be understated. Therefore, the results suggest that healthcare providers should ensure patient-focused education and provide support that encompasses the importance of their relationships. Additional research is required to elucidate the functional association between contraceptive choices and personal and social relationships.

Clinical training and trainee follow-up systems to improve access to long-acting reversible contraception in conflict settings

Abstract Background Long-acting contraceptive methods (LARC)—intra-uterine device (IUDs) and contraceptive implants—are highly effective in the prevention of unintended pregnancy. However, access to LARC is limited, especially in developing countries where access is dependent on availability of medical doctors and midwives. Pre-service training for nurses does not usually include counselling about LARC methods, or insertion and removal of IUDs and implants. We aimed to improve access and availability of LARC in North Kivu, Democratic Republic of the Congo, by implementing a clinical training programme for nurses who had clinical experience in the public health system. The programme was implemented in collaboration with the Ministry of Health. The purpose of the programme was to increase access to all modern contraceptive methods, including LARC, at health centre level and to improve nurses' clinical skills in family planning counselling and insertion and removal of IUDs and implants. Methods From July, 2011, we delivered contraceptive commodities, installed data collection systems, and obtained approval to train nurses and midwives (mid-level health-care providers). Seventy-one nurses and midwives received competency-based clinical training for 3 weeks at a district hospital in Goma. The training curricula included counselling, practicum on anatomical models, and, finally, service provision to clients under observation and supervision by facilitators. Facilitators were mostly Congolese medical doctors who had received the 3-week clinical training and a certification on how to facilitate clinical trainings (trainers of training) at a centre managed by Marie Stopes Society in Kenya. Each health-care provider received trainee follow up, mentoring, and frequent supportive supervision by clinical supervisors throughout the implementation period. The programme was monitored via a monthly review of client data, supportive supervision reports, client exit interviews, and provider log books. Findings From January, 2012, to December, 2013, the number of clients seeking modern contraceptive methods increased by 54% (from 8301 in 2012 to 12 830 in 2013). The percent change of clients seeking IUDs was 127% (from 440 to 999) and the number of clients who had contraceptive implants increased by 46% (from 5124 to 7499). Client exit interviews of 415 women at 23 clinics showed a satisfaction rate of 80–90%. Interpretation Competency-based clinical training is feasible in a conflict setting such as the Democratic Republic of the Congo, and can be effective in improving provider skills and availability and use of LARC. Attention to the partnership with the Ministry of Health and establishment of clinical training centres at the start of the programme were crucial for success. Funding Donation from an anonymous private foundation that does not have commercial interests in the study topic. The donor did not participate in the design of the study, data analysis, or the interpretation of findings.

The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.

Introduction: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President’s Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. Discussion: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. Conclusion: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.

Males' Ability to Report Their Partner's Contraceptive Use at Last Sex in a Nationally Representative Sample: Implications for Unintended Pregnancy Prevention Evaluations.

Addressing and enabling the role of males in contraceptive choices may facilitate efforts to reduce unintended pregnancy rates and disparities in the United States, but little is known about males’ ability to report their partners’ contraceptive use. Data from the 2011-2013 National Survey of Family Growth from 2,238 males aged 15 to 44 years who had vaginal sex with a noncohabiting or nonmarital partner and were not seeking pregnancy were examined to tabulate the proportion of males able to report whether their partner used a specific contraceptive method use at last sex (PCM) by sociodemographic and sexual history characteristics. Logistic regression was used to assess odds of being unable to report PCM, adjusting for age and sexual history factors. Most (95.0%) were able to report PCM, with no difference by age group (chi-square = 7.27, p = .281) in unadjusted analyses. Males with a new sex partner (14.8% of the sample), compared with those with an established sex partner, had significantly higher odds of being unable to report PCM in bivariate (11.7% vs. 3.7%, chi-square = 39.39, p < .001) and multivariable (adjusted odds ratio [AOR]: 3.17, 95% confidence interval [CI: 1.74, 5.65]) analyses. Those whose last sexual encounter was more than 3 months ago also had higher odds of being unable to report in bivariate (OR: 1.74, 95% CI [1.05, 2.87]) and multivariable analyses (AOR: 2.04, 95% CI [1.04, 4.03]). Most men were able report PCM, but reporting was significantly lower among men with new sex partners. To inform future research and evaluation relying on male report, validation studies comparing male report with partner report, specifically among new couples, are needed.

Important considerations in adolescent health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding.

The present article addresses recent research related to three key facets of adolescent preventive care and health maintenance: long-acting reversible contraception, human papillomavirus vaccination, and heavy menstrual bleeding. Recent studies suggest that long-acting reversible contraception use results in significantly lower rates of unintended pregnancies, and is well tolerated by nulliparous adolescent females. Additionally, a strong recommendation from a pediatric primary care provider is extremely effective in ensuring human papillomavirus vaccination prior to sexual debut. Finally, heavy menstrual bleeding is often under-recognized in adolescents, and evaluation and treatment of these patients are variable. Based on the recent literature findings, the pediatric primary care provider should be encouraged to, first, recommend long-acting reversible contraception for prevention of unintended pregnancy in adolescent patients; second, strongly endorse vaccination to protect against human papillomavirus in all patients prior to sexual debut; and, third, screen adolescent females for signs and symptoms of heavy menstrual bleeding.

A randomized clinical trial on the effects of progestin contraception in the genital tract of HIV-infected and uninfected women in Lilongwe, Malawi: Addressing evolving research priorities

Hormonal contraception is central in the prevention of unintended pregnancy; however there are concerns that certain methods may increase the risk of HIV acquisition and transmission. Hormonal contraceptives may modify the genital mucosa in several ways, however the mechanisms are incompletely understood. Few studies have examined genital HIV shedding prospectively before and after initiation of hormonal contraception. The effects of hormonal contraception on genital HIV shedding in the setting of antiretroviral therapy (ART) are also unknown.We designed a pilot clinical trial in which HIV-infected and uninfected women were randomized to either depot medroxyprogesterone acetate (DMPA) injectable or levonorgestrel (LNG) implant in Lilongwe, Malawi. The objectives were to: 1) assess the effect and compare the impact of type of progestin contraception (injectable versus implant) on HIV genital shedding among HIV-infected women, 2) assess the effect and compare the impact of type of progestin contraception on inflammatory/immune markers in the genital tract of both HIV-infected and uninfected women, and 3) assess the interaction of progestin contraception and ART by examining contraceptive efficacy and ART efficacy. An additional study aim was to determine the feasibility and need for a larger study of determinants of HIV transmissibility and acquisition.As injectable contraception is widely used in many parts of the world with high HIV prevalence, this study will provide important information in determining the need for and feasibility of a larger study to address these questions that can impact the lives of millions of women living with or at risk for HIV.