Rates Of Contraceptive Use Research Articles

The Contraceptive Care Gap: Women with CKD Report Lower Rates of Contraception Use

The Contraceptive Care Gap: Women with CKD Report Lower Rates of Contraception Use

Improving Linkages Between Sexual and Reproductive Health and Substance Use Providers: The Partnership to Advance Integrated Referrals.

Women of reproductive age with substance use (SU) disorders have lower rates of contraceptive use and higher rates of unintended pregnancy than women without SU disorders and are less likely to access treatment than men. Integration of SU and sexual and reproductive health (SRH) services, using a model known as Screening, Brief Intervention, and Referral to Treatment (SBIRT), has been proven effective in reducing SU and improving health care equity. The SBIRT model includes screening, brief intervention (a short client-centered conversation providing an opportunity to identify/discuss concerns), and referral to treatment. The purpose of this study was to test whether an established quality improvement (QI) learning collaborative model could be used to support SU and SRH sites in implementing an SBIRT/SBIRT-like model to improve health outcomes for women. Five SRH sites and 4 SU sites across New York State participated in the Partnership to Advance Integrated Referrals (PAIR), an 18-month QI learning collaborative designed and implemented by Public Health Solutions. Six standardized mixed-methods data collection tools were used over 18months to gather process and outcome data from over 130 QI team members and site staff and over 5000 clients. By the end of PAIR, QI team members and site staff showed a reduction in bias, increased knowledge and comfort, increased rating of organizational practices related to client-centered care, and increased access to peer learning, information about best practices, and training and technical assistance. SU sites increased SRH screening from 47.9% in the first quarter of data collection to 67.4% in the final quarter and increased brief interventions from 92.5% in the first quarter to 100.0% in the final quarter. Similarly, SRH sites increased SU screening from 51.6% to 75.6% and increased brief interventions from 81.3% to 85.1%. The processes and outcomes were very different for the SU and SRH sites, and their varying successes and challenges are discussed. Making and verifying referrals remained challenging. The results of PAIR demonstrated the feasibility of SU and SRH sites implementing an SBIRT/SBIRT-like model when supported by a QI learning collaborative. Larger community and organizational challenges (COVID-19, staff turnover) still present barriers to improved reproductive health and SU outcomes for women.

“I probably have access, but I can’t afford it”: expanding definitions of affordability in access to contraceptive services among people with low income in Georgia, USA

BackgroundDisparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals’ lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access–affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South.MethodBetween January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access.ResultsAffordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A “poor fit” between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance.ConclusionsAffordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.

Use of contraceptives and associated factors among male adolescents in rural secondary schools, Coast Region, Tanzania: a school-based cross-sectional study

BackgroundTeenage pregnancy is still one of the reproductive health concerns facing adolescents in Tanzania. The problem has been associated with physiological, psychological, and social changes and increases the risk of unsafe abortion and adverse maternal, fetal, and neonatal outcomes among adolescents. Low utilization of contraceptive methods among adolescents is one of the key causes. The strategy of involving male adolescents in sexual and reproductive health programs can increase the rate of contraceptive use among adolescents, thereby preventing teenage pregnancy.ObjectiveTo examine factors associated with the uptake of contraceptives among male secondary school adolescent students.MethodsThis was a cross-sectional study conducted in rural secondary schools in Kisarawe District, Coast Region, Tanzania. Multi-stage sampling methods were used to recruit participants. Descriptive and multiple regression analyses were conducted to assess the prevalence and factors associated with contraceptive use. 95% confidence interval and p-value < 0.05 were considered statistical significance. Univariate and multivariate logistic regression were tested for the Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) respectively.ResultsThe study involved 422 male students with the majority of them 58.1% aged 17–19 years, 50.2% were Muslim, 76.3% were studying in government schools, 62.3% were from households size of 4–6 members, 87.4% were not in a relationship, and 64.2% were living with both parents. Less than half (38.9%) of male students reported ever having sex in their lifetime, and among them, very few (29.8%) used any method of contraceptive. The reported lowest age for the first sex was 10 years. The male condom was the most method used (69.4%) and Pharmacy/Chemist Shops were the common source of contraceptive services (55.1%). Students who had adequate knowledge of contraceptives were more likely to report the use of contraceptive methods compared to those who had inadequate knowledge (AOR = 2.704, 95% CI: 1.220–5.995, p = 0.014). Participants in Private schools were 4.3 times more likely to report the use of contraceptives than those in government schools (AOR = 4.347, 95% CI: 1.758–10.762, p = 0.01). Students in a relationship were 3.5 times more likely than those not in a relationship to report the use of a contraceptive method (AOR = 3.51, 95% CI: 1.421–8.670, p = 0.006).ConclusionThe study found the low use of contraceptives among male adolescents who ever had sex in their lifetime. Thus, it’s suggested that age-tailored comprehensive sexual and reproductive health education should start to be taught from a very young age as adolescents initiate sex at an early age. Also, Teenage pregnancy prevention programs should involve males as the key players during the development and implementation of the program as most of the decisions among partners are from men.

Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020.

Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.

Preferências contraceptivas entre mulheres com doença falciforme durante um acompanhamento de 12 meses: um estudo longitudinal

Abstract Objectives: to analyze the choice and continuation rate of contraceptive methods in women with sickle cell disease (SCD). Methods: an exploratory prospective study was conducted at a hospital enrolling 44 women with SCD aged 15-40 years old. After contraceptive counseling, the women selected one of the available contraceptive methods and separated into two groups, and were followed up at one, three, six, and 12 months. To analyze the continuation rate of contraceptive use, the two groups were: group (G1) using progestin-only contraceptives, through any route of administration and group (G2) using other contraceptive methods (combined hormonal and non-hormonal contraceptives). The continuation rate was analyzed using Kaplan–Meier survival analysis, considering a p&lt;0.05. Results: after contraceptive counseling, most women opted for any progestin-only methods: injectable contraceptives (n=18; 40.9%), oral contraceptives (n=7; 15.9%), or intrauterine devices (n=3; 6.8%). The continuation rate decreased in both groups during the 12-months follow-up period. In the G1, the continuation rate was 60.7% (CI95%=40.4-76.0), while that in the G2 was 68.7% (CI95%= 40.5-85.6) with no significant difference between the groups (p=0.641). Conclusions: the overall continuation rates in both groups were satisfactory. No significant difference in the continuation rate of contraceptive methods was observed between the groups, although most women preferred progestin-only methods.

Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Contraception and abortion in times of crisis: results from an online survey of Venezuelan women.

In the last decade, Venezuela has experienced a complex humanitarian crisis that has limited access to healthcare. We set out to describe Venezuelan women's experiences accessing sexual and reproductive health services, including abortion, which is heavily restricted by law. We fielded an online survey in July of 2020 among Venezuelan women recruited through social media advertisements. We conducted descriptive statistical analyses using Excel and STATA SE Version 16.0. We received 851 completed survey responses. Almost all respondents experienced significant hardship in the last year, including inflation (99%), worries about personal safety (86%), power outages (76%), and lack of access to clean water (74%) and medications (74%). Two thirds of respondents used contraception in the last two years, and almost half (44%) of respondents had difficulty accessing contraception during that same time period. About one fifth of respondents reported having had an abortion; of these, 63% used abortion pills, and 72% reported difficulties in the process. Half of those who had an abortion did it on their own, while the other half sought help - either from family members or friends (34%), from providers in the private health sector (14%), or from the Internet (12%). Venezuelan women who responded to our survey describe a harsh context with limited access to sexual and reproductive health services. However, they report relatively high rates of contraceptive use, and abortion seems to be common despite the restrictive legal setting.

Contraceptive methods and fertility testing in young adult survivors of childhood cancer

PurposeReproductive health is important, but often neglected in cancer survivorship care. This study explored contraceptive use and factors associated with fertility testing among young adult survivors of childhood cancer in Germany.MethodsYoung adult survivors of childhood cancer were identified through the German Childhood Cancer Registry and completed a mailed survey. Survivors were queried regarding contraceptive use, reproductive goals, uncertainty about fertility, and completion or interest in fertility testing. Multivariable stepwise logistic regression models were used to calculate Odds Ratios (OR) and 95% confidence intervals (CI) as a means of identifying factors associated with completion of and interest in fertility testing.ResultsSurvivors (N = 472; 57.8% female; aged 23.3 ± 1.5 years, and 14.9 ± 5.0 years from diagnosis), reported high rates of contraceptive use, including 61.2% using a single method, 30.6% dual methods, and 8.1% no/less effective methods. Few survivors had completed fertility testing (13.0%), although 58.8% were interested. Having been diagnosed during adolescence (OR = 2.66, 95%CI: 1.39–5.09), greater uncertainty about fertility (OR = 1.16, 95%CI: 1.03–1.31), and use of dual contraceptive methods (OR = 1.94, 95%CI: 1.02–3.69) were associated with having completed fertility testing. Factors associated with interest in fertility testing included goals of wanting to have children (OR = 7.76, 95%CI: 3.01–20.04) and greater uncertainty about fertility (OR = 1.19 95%CI: 1.06–1.33).ConclusionIn this sample of young adults who survived childhood cancer, most reported contraceptive use. Few survivors had completed fertility testing, although more than half were interested. Interventions are needed to address potential barriers to fertility testing and help survivors manage fertility-related uncertainty.

Contraceptive Adoption and Changes in Empowerment in Kenya, Nigeria, and Senegal.

Women's empowerment and contraceptive use are critical to achieving gender equality. The positive association between more empowered women and higher rates of contraceptive use has been well-established by cross-sectional research. However, there remains a gap in understanding the longitudinal relationship between contraceptive adoption and changes to women's empowerment. This study represents a novel approach to understanding the relationship between contraceptive adoption and women's empowerment longitudinally, at the individual level. To the authors' knowledge, this is the first attempt to measure the relationship between contraceptive adoption and women's empowerment using more than one wave of panel data. We leverage the longitudinal design of the Urban Reproductive Health Initiative data to code empowerment items by change over time (e.g., more empowered, no change, less empowered). We use sparse principal component analysis to establish empowerment change domains and calculate individual scores standardized by country-level averages. We estimate mixed effects models on these change domains, to investigate the link between contraceptive adoption and empowerment. We find common themes in empowerment across contexts-but contraceptive adoption has both positive and negative effects on those domains, and this varies across context. We discuss the need for cohort studies to examine this relationship.

A Review of Contraceptive Prevalence Rates in Afghanistan

Background and Objective: Family planning programs and the use of contraceptives are among the priorities of maternal and child health. Adequate information about the prevalence of family planning programs and contraceptive use in Afghanistan is not readily available. This review attempts to provide an appropriate perspective on the prevalence rates of contraceptive use based on existing data and suggests practical measures to improve the prevalence of contraceptive usage.&#x0D; Research Method: In this review, data from Google Scholar, PubMed, the Ministry of Public Health website, the World Health Organization, and the National Family Planning Program were utilized. Seven articles published between 2001 and 2023 were selected and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.&#x0D; Findings: A narrative summary of the results of the selected articles is presented in this paper. According to studies conducted in the country, statistics on the prevalence of contraceptive use show significant differences in comparison to demographic structures. The lowest figure reported in these studies is 10.4%. The utilization of contraceptives is reported as follows: oral contraceptives 38.5%, condoms 30.3%, medroxyprogesterone 17.0%, intrauterine contraceptive devices (IUCD) 15.6%. Overall, the prevalence rate of contraceptive use in the entire country reaches 15.4%.&#x0D; Conclusion: In Afghanistan, due to numerous barriers, the use of contraceptives and the gap between pregnancies have not been promoted. Conversely, according to the conservative beliefs of the illiterate segments of society, the use of contraceptives is considered contrary to their religious beliefs and even in conflict with divine instructions. Therefore, it is imperative for policymakers to develop comprehensive and inclusive programs in this regard and seek assistance from religious leaders to align the community with these programs. Ultimately, the entire society needs to be mobilized.

Healing at Home: Impacting Postpartum Outcomes Utilizing Clinical Practice Changes and Augmented Intelligence [ID: 1379350

INTRODUCTION: The fourth trimester is a time of great physical and emotional challenge. To help patients navigate this period, we created the Healing at Home (H@H) program, which combined expedited discharge with a 24/7 bidirectional postpartum support chatbot. METHODS: Clinical outcomes, abstracted from medical record and patient report via text message, were evaluated for patients enrolled in H@H (March 2020 to September 2021) compared to patients delivering prior to program implementation (July to December 2019). Enrolled patients had a full-term singleton vaginal delivery of a non-small-for-gestational-age infant without postpartum hemorrhage (&gt;1,000 cc), a low-risk sepsis risk score, a low- to intermediate-risk bilirubin, and lack of significant maternal comorbidities (eg, preeclampsia, preexisting diabetes). Institutional review board waiver for this quality improvement study was obtained. RESULTS: There were 490 patients enrolled in H@H versus 309 in preintervention group. The groups were similar in parity, race, ethnicity, and insurance status. There was no difference in the primary outcome, postpartum visit attendance (76.9% versus 76.1%, P=.77). H@H patients had a shorter postpartum length of stay (33.3 versus 46.7 hours, P&lt;.001), higher rates of exclusive breastfeeding at 1 week (59.2% versus 57.0%, P=.02), and a higher rate of contraceptive use (55% versus 44%, P=.01), with no difference in maternal unscheduled visits or hospital readmissions. CONCLUSION: This innovative postpartum program was associated with a shorter length of stay and improvement in contraceptive acceptance and breastfeeding without increasing unscheduled visits. Future studies should evaluate the cost-effectiveness of this program and expansion to higher-risk patients including those with cesarean delivery and medical comorbidities.

A determination of the influence of birth control among minority women in thailand: a qualitative study

Contraception information and services are the basis of the health and human rights of everyone. Young girls who become pregnant are at greater risk for problems arising from early child deliveries. Contraception in older women likewise results in increased risk. It was found from the particulars of contraception use that the male partner has a great deal of influence, and that the same is true of the perspectives and experiences of the people surrounding his partner, the expectations of her family and her desire for more children. In Thailand, there are ethnic groups of numerous tribes, among whom are the Karen, who make up the largest of any such group. The Karens have a low rate of contraception use and low incomes with reduced resources. Thus, family planning is an important key in reducing their population growth and the impact on their economy, environment and development. The purpose of this study was to explore the determining influence of contraception among minority women in Thailand in the form of descriptive qualitative research. Data were analyzed using Colaizzi's method. The research showed that the use of contraceptive services by Karen women was restricted by the culture, beliefs and social conditions characteristic of their ethnic origin. The husband and extended family influenced their contraceptive decisions. The prevailing belief was that contraception is the duty of women. Some women used herbs for contraception. They had difficulty communicating when receiving contraceptive services. Karen people have little income; so they cannot afford expenses related to contraceptive services requiring them to pay for travel costs. Furthermore, the road conditions make the trip awfully difficult, and their houses are situated far from the hospitals. In conclusion, determining the influence of birth control among minority women in Thailand must be based on their beliefs, society and ability to access health services.

Improving the Health and Readiness of Military Women.

Women comprise approximately one-fifth of the total force in the U.S. Military. Gynecologic and reproductive health issues not only affect the health and wellness of individual servicewomen but may also impact the mission of the DoD. Unintended pregnancies can result in adverse maternal and infant outcomes and can negatively impact the careers of military women and mission readiness. Gynecologic conditions such as abnormal uterine bleeding, fibroids, and endometriosis can also limit women's optimal health and performance, and a significant proportion of military women have indicated their desire to manage and/or suppress menstrual cycles, especially when deployed. Access to the full range of contraceptive methods is an important strategy to allow women to achieve their reproductive goals and address other health concerns. This report reviews rates of unintended pregnancy and contraceptive utilization among servicewomen and examines factors that influence these measures of health. Overall rates of unintended pregnancy are higher among servicewomen than the general population and rates of contraceptive use among servicewomen are lower than the general population. Congress mandates that servicewomen have access to contraceptive options, but the DoD has not established target measures for contraceptive access and use, unlike that present for the civilian population. Four potential courses of action are proposed to improve the health and readiness of military women.Recommendation 1: The Military Health System (MHS) should develop and maintain reliable sources of data to assess the gynecologic health of servicewomen, including rates of unintended pregnancy.Recommendation 2: When menstrual suppression, treatment for a medical condition, or contraception is desired, servicewomen should have ready access to the information they need to select the option that is best suited for their personal preferences and situation.Recommendation 3: In order to ensure that servicewomen have optimal access to the full range of contraceptive methods, the MHS should determine true access at all their facilities and identify actions to address any barriers.Recommendation 4: The MHS should establish service delivery targets for use of women's preventive health services, particularly contraception, to prevent unintended pregnancies.

Contraceptive Experiences of Women of Procreation Age Who Attended Two HealthCenters in the City of Abidjan (Cote d’Ivoire)

Introduction: Maternal mortality, which is estimated at 614 deaths per 100,000 births in Côte d’Ivoire, is associated with a low national contraceptive prevalence rate of 13.9%. In this study, we are interested in the contraceptive experiences of women who attend health centers to estimate their rate of contraceptive use and to assess the factors involved in the use of modern contraceptive methods among women of childbearing age who are exposed to the risk of pregnancy. Method: A descriptive cross-sectional study was conducted from December 2018 to September 2019 among 423 women, who attended two health centers in Abidjan. A bivariate analysis identified factors associated with contraceptive use by these women. A descriptive analysis determined the means for the quantitative variables and the frequencies and percentages of qualitative variables. Interpretation of results was based on significance (α = 5%, 95% CI). Results: Contraceptive prevalence was 37%. There was a significant relationship between contraceptive use and the socio-demographic and reproductive characteristics of women (p < 0.001). Conclusion: Women who were over 35 years age, uneducated, primary school graduates, housewives, unemployed, in the informal sector, Muslims, nulliparous, and lacking information and decision-making power were less likely to use modern contraceptive methods. They are the target population for strategic interventions to improve contraceptive prevalence.

Household Poverty-Wealth and Decision-Making Autonomy as Predictors of Reproductive and Maternal Health Services Utilization among Rural Women in Nigeria: Evidence from a National Survey.

Adequate reproductive and maternal healthcare services utilization are significant in reducing maternal deaths, however, the prevalence rate of contraceptive use remains low, with inadequate maternal health services utilization among rural women in Nigeria. This study examined the influence of household poverty-wealth and decision-making autonomy on reproductive and maternal health services utilization among rural women in Nigeria. The study analyzed data from a weighted sample of 13,151 currently married and cohabiting rural women. Descriptive and analytical statistics including multivariate binary logistic regression were conducted using Stata software. An overwhelming majority of rural women (90.8%) have not used modern contraceptive methods, with poor utilization of maternal health services. About 25% who delivered at home received skilled postnatal checks during the first 2 days after childbirth. Household poverty-wealth significantly reduced the likelihood of using modern contraceptives (aOR: 0.66, 95% CI: 0.52-0.84), having at least four ANC visits (aOR: 0.43, 95% CI: 0.36-0.51), delivering in a health facility (aOR: 0.35, 95% CI: 0.29-0.42) and receiving a skilled postnatal check (aOR: 0.36, 95% CI: 0.15-0.88). Women's decision-making autonomy regarding their healthcare significantly increased the use of modern contraceptives and the number of ANC visits, while women's autonomy on how their earnings are spent positively influenced the use of maternal healthcare services. In conclusion, the use of reproductive and maternal health services among rural women was associated with household poverty-wealth and decision-making autonomy. Government should formulate more pragmatic policies that will create awareness and promote universal access to reproductive and maternal healthcare services.

Efficacy and safety of intrauterine device placement during a planned cesarean section

ObjectiveApproximately 79% of pregnancies conceived within the first year after delivery are unintended and 50% of the couples report having unprotected intercourse before the first routine postpartum appointment. Unintended pregnancies are associated with unsafe abortions and other poor outcomes. We aimed to determine the efficacy and safety of intrauterine device (IUD) placement during a planned cesarean section (CS) at one year after insertion. Study DesignA survey-based retrospective cohort study conducted at a university teaching hospital. The study cohort included term pregnant women delivered by a planned CS between December 2016 and July 2020, and data collection and questionnaires were completed in July 2021. In the study group, copper or Levonorgestrel IUDs were placed through the uterine incision after delivery of the fetus and placenta, while women in the control group did not receive an IUD. Other perioperative managements were similar. The primary outcome was unintended pregnancy rate during the first year after delivery. ResultsThe study comprised a total of 150 women, with 50 and 100 in the study and control groups, respectively. None of the women in the study group became pregnant, compared with nine (9%) in the controls (p = 0.03), of them eight (88.9%) were unplanned. Perioperative outcome was comparable between groups. The rate of contraceptive use one year after delivery was significantly higher in the study group compared to the control group (86.0% vs. 35.0%, respectively, p < 0.001). ConclusionIUD placement during CS is effective in preventing unintended pregnancies within the first year after delivery, with operative outcomes unaffected. ImplicationsIntrauterine device (IUD) placement during a planned cesarean section prevented unintended pregnancies within one year after birth. Additionally, the rate of contraceptive use at one year was significantly higher compared to women who elected not to have an IUD inserted during the cesarean. IUD placement did not affect perioperative outcomes.

Assessing the relationship between knowledge and the actual use of contraceptives among childbearing women in South-South Nigeria: evidence from the 2018 Nigeria demographic and health survey

BackgroundNigeria has one of the world's highest fertility rates, which is detrimental to its public health and socioeconomic growth. Despite several efforts by the country and other development partners to reduce high fertility by increasing contraceptive use, the contraceptive prevalence rate among childbearing women remains low, particularly in the South-South compared to other Southern regions. This study, therefore, assessed the relationship between knowledge of and actual use of contraception among women in South-South Nigeria.MethodsThe study employed a cross-sectional analysis of a nationally representative weighted sub-sample of 4,553 South-South childbearing women extracted from the 2018 National Demographic and Health Survey dataset. The dataset was weighted and examined for missing values that were excluded during the analyses at univariate, bivariate, and multivariate levels. The analyses involved a baseline descriptive analysis, a chi-square test, and logistic regression models using Stata software. The results of the explanatory variables were presented as odds ratios (OR) and 95% confidence intervals (CI).ResultsEighty-two per cent of the respondents knew at least one form of contraception, while approximately 82% never used any contraceptive method. The likelihood of using any contraceptive method increased among those who knew about contraceptives (aOR: 1.40; CI: 0.93–2.11). Also, contraceptive use was significantly higher among women and their partners who had post-primary education (aOR: 1.34; CI: 1.25–2.43 and aOR: 1.74; CI: 1.25–2.43, respectively). Furthermore, the prevalence of contraceptive use among women significantly increased with an increase in the household wealth index. Similar results were recorded among women who had five or more living children, who were residents of Rivers State, were married or lived with their partners, were aged 35 years or older, and were currently working.ConclusionsContraceptive knowledge was high but did not translate into actual practice among childbearing women in South-South Nigeria. The use of any contraception was highly influenced by contraceptive knowledge, education, age, marital status, place of residence, and household wealth index, among others. Therefore, some policy issues relating to contraceptive knowledge and actual adoption must be addressed to improve the low rate of contraceptive use in Nigeria.

LBSUN180 Preconception Counseling And Reproductive Education Program For People With Diabetes (PREPP'D) - An Educational Program For Underserved Women With Diabetes

Abstract Background Unintended pregnancy in women with diabetes is associated with high public cost, delay in initiating prenatal care, and maternal and fetal complications. One third of the women with diabetes in our underserved prenatal clinic present with an HbA1C &amp;gt;7.5%. Due to limited data regarding preconception counseling for women with diabetes, we developed PREPP'D, a quality improvement initiative and educational program aiming to improve women's and providers’ knowledge of diabetes and pregnancy, increase awareness of contraception options, and implement standard protocols in our diabetes clinic for underserved populations. Design: A questionnaire was developed to measure the rate of contraception use and assess women's knowledge regarding pregnancy planning. The questionnaire has two sections: general questions about the woman's reproductive health, contraception use, and current pregnancy plan and specific questions about the woman's current knowledge about pregnancy and diabetes including glycemic targets and glucose monitoring and medication safety during pregnancy. The latter part of the questionnaire was scored with 6 points indicating all questions answered correctly. Women aged 18-50 with pre-gestational diabetes were identified and given an English or Spanish questionnaire prior to seeing the provider. The providers were given a prewritten SmartPhrase to guide counseling and explaining the importance of pre-pregnancy planning, glucose targets during pregnancy, and medication optimization. After the visit, women were given an educational flyer. Results Thirty-six women aged 21-49 years with type 1 (n=16), type 2 (n=19), or steroid-induced (n=1) diabetes are included in this analysis. Women were from various backgrounds: Black/African American (n = 4), non-Hispanic White (n = 11), Hispanic (n =18), and other (n=3). Average diabetes duration was 10.2 (range 1-32) years. Mean HbA1C was 8.7% (range 5.3-14.7%). Only seven women met the HbA1C target goal for pregnancy (&amp;lt;6.5%). Complications of diabetes were reported in 23%, and one woman reported prior fetal cardiac anomalies. Of the three women planning pregnancies within the next year, only one had an HbA1c &amp;lt;6.5%. The mean questionnaire score was 1.6/6 points (±1.3, range 0-5) with nine women scoring 0 points. Documentation of pregnancy discussion was noted in 83% of records (compared to 38% prior to intervention). Conclusions Knowledge of pregnancy is limited for many women with diabetes. PREPP'D is a novel approach to standardize preconception counseling in the diabetes clinic. It also provides an opportunity to raise women's and providers’ awareness about diabetes and pregnancy. The next step of this project is to conduct follow-up surveys for both women and providers 3 to 6 months post initial survey to assess impact and improve future interventions including expansion to adolescents. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Novel Shared Decision-Making Tool Improves Contraceptive Screening and Right Care during Pregnancy in a Military Hospital: A Quality Improvement Report.

Unintended pregnancy rates in the military remain high compared with rates outside of the military in the United States (54%-60% vs 45%-50%, respectively). Contraceptive counseling in conjunction with shared decision-making is recommended to improve military unintended pregnancy rates. Best counseling practices and decision aids for contraceptive counseling are unknown in military and nonmilitary populations. Pregnancy may be an opportune time to complete contraceptive counseling because of regularly scheduled prenatal visits, and counseling during pregnancy is associated with higher postpartum contraception use. A quality initiative was implemented to improve contraceptive screening and counseling during pregnancy for servicewomen and nonservicewomen in a clinic setting. The initiative included 4 patient-centered core interventions: a patient screening, a shared decision-making tool, a right care checklist, and a team engagement plan, across 4 rapid plan-do-study-act cycles. Contraceptive screening rates and delivery of right care improved from 37% to 79% in the pregnant patients over 90 days; 81% of patients screened positive for contraception needs; 89% of patients made a same-day decision about their contraception plan after completing the tool; and 92% of patients had a contraception plan documented in the electronic health record by the health care provider prior to birth. Results demonstrated that contraception screening rates and right care improved with initiative interventions for servicewomen and nonservicewomen. A novel shared decision-making tool presented 18 contraception methods, risks and benefits, and tiered effectiveness that aided the majority of patients in a same-day decision with high patient satisfaction. Provider counseling was also simplified without delay in clinic time. Contraceptive counseling completed with a shared decision-making tool may benefit military and civilian populations during pregnancy. Additional research is needed to examine the best time to conduct counseling during pregnancy and the long-term rates of contraceptive use or unplanned pregnancy following counseling events.