Unintended Pregnancy Rates Research Articles

Contraceptive Choice and Sexual Behaviors in Both-Sex Attracted Adolescents: A Retrospective Cohort Study.

Bisexual adolescents have higher rates of unintended pregnancy than their heterosexual peers and increased rates of high-risk sexual behaviors. They may be less likely to use effective contraception, though limited data is available. This study sought to compare contraceptive choice and sexual risk behaviors of both-sex attracted and opposite-sex attracted adolescents and young adults (AYA) presenting to a contraception clinic. A retrospective chart review of AYA aged 14-24 years who presented for an initial visit to a contraception clinic from 2014 to 2020. The primary outcome was contraceptive choice (long-acting reversible contraception (LARC), non-LARC, or nothing). Secondary outcomes included sexual behaviors. Results were analyzed using Pearson's chi-square and Wilcoxon tests. 2369 AYA were included in this study. Both-sex attracted and opposite-sex attracted patients were similar in age, race, and ethnicity. There was no difference between groups in percent selecting LARC (71% vs 66.1%, p=0.11). Both-sex attracted patients reported a younger age at first sex (14.6 years vs 15.5 years, p < .001), more lifetime sexual partners (4.1 vs 2.8, p < .001), and a higher prevalence of forced intercourse (21.9% vs 8.8%, p < .001). Both-sex attracted and opposite-sex attracted AYA patients chose LARCs at similar rates in a setting with standardized contraceptive counseling. Both-sex attracted patients had more sexual risk behaviors. Healthcare providers should be inclusive in their approach to obtaining sexual health histories and providing contraceptive counseling and be cognizant that adolescents with both-sex attraction may be at higher risk of forced intercourse.

Effects of Condom Availability on Their Use: A Field Experiment in a Peruvian Hostal

Perú has a high rate of unintended pregnancies. STI rates grow. New policies are needed. Contextual factors in the condom use decision are understudied. Self-reported measures of use have proven unreliable. I used a hostal (love-motel) to conduct a field experiment. 102 couples were randomly allocated to three groups with different levels of condom availability. Instead of using self-reported measures, after a couple left, I searched their room for used condoms. Couples in rooms with a condom on the nightstand were 268% more likely to use one than the control group. For couples with a condom available at the reception desk, the increase was 176%. Facilitating condoms in hostales is a suitable strategy to decrease unprotected sex in the country.

Planning postpartum contraception for women with substance use disorders: Utilisation of the birth admission.

Women with substance use disorders (SUD) use less contraception, and experience higher rates of unintended pregnancy, compared to women without SUD. Contraception is discussed at the six-week postnatal appointment, which many women with SUD do not attend. Therefore, it is important women have the opportunity to formulate contraception plans before discharge from the birth admission. To assess postpartum contraception plans, including initiation and method of interest, among women with SUD and compare these to women without SUD. All births from January 2011 to September 2019 from one New South Wales local health district were analysed. Data included maternal demographics, SUD, and contraception plans. Chi-squared statistics and multivariate multinomial regression analyses were used to compare outcomes for women with and without SUD. Of 59 195 mothers, 429 (0.7%) had a SUD. There were 50.1% of women with SUD and 56.2% without SUD (P = 0.03) who had no documented plan for contraception. There were 37.3% of women with SUD and 42.4% without SUD (P = 0.06) who had a prescription for contraception or a referral to discuss contraception. There were 12.5% of women with SUD and 1.4% without SUD (P < 0.001) who initiated contraception in hospital. Although postpartum contraception initiation was higher among women with SUD, half of all women (with or without SUD) were discharged without a plan for contraception initiation. Embedding provision of postpartum contraception into maternity care, or investigating other opportunities, may improve access for all women, including those with SUD.

Spatial heterogeneity in unintended pregnancy and its determinants in India

BackgroundUnderstanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India.MethodsWe analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran’s I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts.ResultsThe national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran’s I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level.ConclusionOur analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the country.

Socioeconomic determinants of male contraceptive use in South Africa: a secondary analysis of the 2016 SADHS data

BackgroundHistorically, family planning discussions have predominantly centred on women, overlooking the crucial role men play in contraception. This is particularly concerning in regions like Sub-Saharan Africa (SSA), where reproductive health challenges are pronounced. South Africa, a key country within SSA, continues to grapple with issues such as high unintended pregnancy rates and increasing pregnancy-related mortality. Understanding the factors that deter male contraceptive use is essential for achieving universal access to sexual and reproductive health (SRH) services. This study investigates the socioeconomic disparities influencing male contraceptive use in South Africa, drawing on data from the 2016 South Africa Demographic Health Survey.MethodsThe study utilised data from the 2016 South African Demographic and Health Survey, which employed a stratified, two-stage sampling design across all provinces based on the 2011 Census. The survey focused on men aged 15–59 using the “Man’s Questionnaire.” Various socio-demographic and attitudinal variables were analysed using STATA 17. The analysis included multinomial logistic regression to identify determinants of male contraceptive use and the Erreygers Normalized Concentration Index to assess socioeconomic inequalities in contraceptive uptake.ResultsAmong the surveyed men, 47% reported not using any contraception, 40% used male methods, and 13% relied on their partners’ contraceptive use. A majority began sexual activity between the ages of 14–17 (54%), resided in urban areas (56%), were unmarried (67%), and had attained secondary education (70%). Notably, 78% disagreed that contraception is solely a woman’s responsibility, and 64% expressed positive attitudes toward contraception. Age, marital status, and education level emerged as significant factors influencing contraceptive use. The study revealed a slight pro-rich inequality in male contraception use, with socioeconomic status (SES) being the most significant contributor to this disparity (223.22%). This suggests that higher SES is associated with increased inequality in the adoption of modern male contraceptive methods.ConclusionThese findings highlight the impact of socioeconomic disparities and entrenched cultural beliefs on male contraceptive use in South Africa. To address these challenges, comprehensive strategies that prioritise education, expand family planning media campaigns and ensure equitable access to contraception are urgently needed.

Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings.

Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services. Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites. At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies. Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

Awareness, attitude, and acceptance of post placental intra uterine contraceptive device (PPIUCD) among women in Jordan.

To assess the awareness, attitude, and acceptance of the Post Placental Intra Uterine Contraceptive Device (PPIUCD) as an immediate long-acting contraceptive method among Jordanian women. A cross-sectional observational study was conducted at King Abdulla University Hospital among women attending antenatal clinics after 20 weeks of gestation between January 2020 and May 2021. One thousand and 30 women had completed a structured questionnaire in Arabic. Only 41.4% of the sample was aware of the PPIUCD. The attitude toward PPIUCD after a brief introduction was 56.3%. Women who had used interval IUCD were 5.82 times more likely to express a positive attitude toward PPIUCD, while postgraduate women were 1.35 times more prone to show the same attitude. Only 34% accepted PPIUCD if offered, whereas the main barrier to acceptance was the false fear of extra complications in 34.5% of the sample. The rate of unintended current pregnancy was 35.8%, where 53.4% were using natural methods. The rate of awareness of PPIUCD is low among women in Jordan. Antenatal introduction encourages attitude toward PPIUCD.

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

IntroductionDespite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. We aimed to study the evolving...

Folklore and Sexuality Education: A Review of the Pedagogical Value of “Tselane le Dimo”

South African youths experience high rates of HIV infections and unintended pregnancies. In an effort to mitigate these challenges, the Department of Basic Education introduced Comprehensive Sexuality Education in its syllabus with an intention to equip learners with the necessary skills to manage their sexual behaviours. Despite this intervention, educators in the townships have been reluctant to teach this topic. Teachers’ reluctance is informed by cultural and religious sensitivities towards discussing sexual topics with minors. This article proposes that the reluctance towards teaching sexual education topics can be managed by relying on alternative methodologies of knowledge impartment. Since time immemorial, African societies have used folktales to impart knowledge between generations. We use a functional approach to evaluate the pedagogical value of “Tselane Le Dimo” in teaching sexuality education. We are conscious of the fact that the folktale does not contain explicit references to sex, but we argue through a sociological evaluation that the language used in the folktale references sex when it is viewed through the lens of colloquial language that is commonly used by youth. This article employs a qualitative approach in the evaluation of the pedagogical value of the folktale “Tselane le Dimo.” An interpretive phenomenological analysis is used to analyse the folktale. We use this analysis approach with the view that this folktale can be used as a tool for making sense of lived experiences. The findings indicate that words used in this folktale carry euphemistic value, which makes it possible to make references to sexual activities without being blunt about it.

Testosterone and male contraception.

Rates of unintended pregnancy have remained relatively stagnant for many years, despite a broad array of female contraceptive options. Recent restrictions on access to abortion in some countries have increased the urgency for expanding contraceptive options. Increasing data suggest men are keen to utilize novel reversible male contraceptives. Despite decades of clinical research in male contraception, no reversible hormonal product currently exists. Nestorone/testosterone, among other novel androgens, shows promise to finally move to pivotal Phase 3 studies and introduction to the marketplace. Hormonal male contraception utilizes androgens or androgen-progestin combinations to exploit negative feedback that regulates the hypothalamic-pituitary-testicular axis. By suppressing release of gonadotropins, these agents markedly decrease endogenous testosterone production, lower intratesticular testosterone and suppress spermatogenesis. The addition of a progestin enhances the degree and speed of sperm suppression. The androgen component preserves a state of symptomatic eugonadism in the male. There is growing demand and acceptance of male contraceptive options in various forms. As these formulations progress through stages of drug development, regulatory oversight and communication with developers around safety and efficacy standards and garnering industry support for advancing the production of male contraceptives will be imperative.

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.

Using the Family Planning Estimation Tool (FPET) to assess national-level family planning trends and future projections for contraceptive prevalence and associated demand for HIV-infected women in sub-Saharan Africa.

The combination of low uptake of modern contraceptives, high rates of unintended pregnancies, and the pervasive HIV epidemic in Sub-Saharan Africa (SSA) poses a threat to maternal, newborn, and child health in the region. This study examined the prevalence, need, and demand satisfied by modern contraceptive methods for women who tested positive for HIV (both unmarried and married) in 10 countries in SSA. We used the Family Planning Estimation Tool (FPET) to generate national-level trends and projections from 1983 through 2030. Individual-level data from 30 DHS surveys conducted between 2004 and 2018 in 10 sub-Saharan Africa (SSA) countries were used to produce projections for 1) all women and 2) unmarried and married women who tested positive for HIV. Throughout the period, Ethiopian and Guinean women who tested positive for HIV had a higher %mCPR (utilization of modern family planning methods) vis-à-vis all women. Among women who tested positive for HIV, the highest percentage of family planning demand satisfied by modern methods was observed in Zimbabwe (85.27, CI: 76.32-91.69), Lesotho (82.75, CI: 71.80-89.86), Rwanda (80.17, CI: 70.01-87.62), Malawi (73.11, CI: 61.50-82.63), and Zambia (72.63, CI: 64.49-80.09). The highest unmet need for modern contraceptives was found in Senegal (25.38, CI:18.36-33.72), followed by Cameroon (23.59, CI:19.30-28.59) and Sierra Leone (23.16, CI:16.64-32.05). Zimbabwe had the lowest unmet need (10.61, CI:6.36-16.13) and achieved the highest change in %mCPR (49.28, SE:6.80). Among married women who tested positive for HIV, their unmet need for modern contraception will remain higher in 2030. Continuing existing policies until 2030 would result in significant coverage gain among married vis-à-vis unmarried women who tested positive for HIV. Our projections emphasize the importance of country-specific strengthening initiatives, programs, and services targeting unmarried women.

WITHDRAWN: Comparing English- and Spanish-Reading Patients’ Comprehension of the Drug Facts Label for a New Over-The-Counter Oral Contraceptive

BackgroundHealth literacy is known to impact health outcomes in a multitude of ways and is impacted by language barriers. Lower health literacy is also associated with higher rates of unintended pregnancies. A progestin-only oral hormonal contraception product, norgestrel (Opill-Perrigo), was approved for over-the-counter (OTC) use in the United States in July 2023. Objective(s): The objective was to utilize a knowledge assessment survey to determine participants’ comprehension of norgestrel from its drug facts label and compare the comprehension between primarily English- and Spanish-reading participants. MethodsA 7-item knowledge assessment was developed and distributed to English and Spanish readers at one site within a network of federally qualified health centers. English-reading participants completed the English survey alongside use of an English copy of norgestrel’s drug facts label. Spanish-reading participants completed the Spanish survey and were randomized in a 1:1 fashion to either receive an English or Spanish copy of norgestrel’s drug facts label. ResultsThe English-reading/English label (E/E) group had a higher level of comprehension of norgestrel’s drug facts label compared to the Spanish-reading/English label (S/E) or Spanish-reading/Spanish label (S/S) groups. ConclusionDifferences exist in OTC label comprehension for norgestrel based on primary language able to be read. Advocacy for OTC labels to be readily available in languages other than English is imperative to mitigate unintended pregnancies associated with lower levels of health literacy.

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

BackgroundPregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate.MethodsIn-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.ResultsAn application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation.ConclusionsAmongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center.

This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

Identifying the Optimal Birth Control for Patients

Despite decreases in pregnancy and abortion rates over the past few decades, unintended pregnancy remains a personal and public health challenge.1 In the 1960s, the first birth control pills (progestin only and combined) revolutionized contraceptive effectiveness despite their high estrogen doses. In the 1980s, safety became front of mind, as older intra-uterine devices (IUDs) and implants were removed from the market, leading to the development of newer, safer options we enjoy today. In the 1990s, pill-related venous thromboembolism (VTE) scares led to surges in unintended pregnancy rates in the United Kingdom and Europe, only to be repeated in the 2000s. In the 2010s, long-acting reversible contraception (LARC) was hailed as the path forward for reducing pregnancy rates and, indeed, this has contributed to modest reductions in unintended pregnancy and abortion rates. This decade has seen two major shifts in contraceptive care: the transition to blended models of service delivery (especially virtual and subscription-based options) and a transition toward “needs-based” counselling.

"Breaking Bread" With Respondents: Strategies to Increase Response Rates and Create Long-Term Cooperation With Health Clinic Administrators.

To fully understand the impact of unintended pregnancy, as well as to evaluate the implementation and outcomes of programs targeted at reducing unintended pregnancy, it is critical that researchers be able to collect comprehensive data from health clinics that provide these services in vulnerable communities. Our paper details recruitment and incentive strategies, as well as the theories that guided them, which allowed us to achieve a high survey response rate among health clinic administrators in public health clinics in 2 Southeastern states-South Carolina and Alabama-both of which have high rates of unintended pregnancy. Grounded in organizational theory, and utilizing the Tailored Design Method, we achieved a 68% response rate utilizing paper and web survey administration with multiple contact modes. Our incentive structure comprised both traditional cash-based and food-based incentives. Findings indicate high response rates are achievable despite high survey burden (ie, detailed information, length of survey). We found that sample screening was critical and that food-based incentives made an impression on respondents that positively impacted the researcher-respondent relationship. Providing detailed methodology and additional literature will assist researchers working with similar populations-a gap in the applied methodological literature that was problematic at the project's onset.

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System.

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.

Depression, Contraception, and Ambivalence Concerning Fertility

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.