Use Of Reversible Contraception Research Articles

Factors Associated with the Uptake of Long-Acting Reversible Contraception and Contraceptive Use in Postpartum People with HIV at a Single Tertiary Care Center.

This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV). A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020. Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan. Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV. · Contraceptive use among PWHIV is poorly understood.. · Having insurance and increased parity are associated with long-acting reversible contraception use.. · Earlier GA at first prenatal care visit is associated with increased PPBC uptake..

Factors that influence the choice of long-acting reversible contraceptive use among adolescents post-abortion in Chongqing, China: a cross-sectional study

Background Induced abortion can seriously harm the physical and mental health of adolescent women. Long-acting reversible contraception (LARC) can effectively reduce unplanned pregnancies and prevent repeated abortions among adolescents. This study aimed to analyse the factors affecting the choice of LARC among adolescents in Chongqing of China. Methods A total of 555 adolescents who underwent induced abortions for unplanned pregnancies between January 2019 and October 2021 were selected as study subjects. Logistic regression analysis was used to determine the factors affecting adolescent LARC choices following induced abortions. Results The factors that affected adolescent LARC choices included an average monthly income ≥ ¥3000 (OR = 3.432, 95% CI: 1.429∼8.244), history of previous abortions (OR = 3.141, 95% CI: 1.632∼6.045), worrying about unplanned pregnancy (OR = 0.365, 95% CI: 0.180∼0.740), parental support for using LARC (OR = 3.549, 95% CI: 1.607∼7.839), sexual partners’ support for using LARC (OR = 2.349, 95% CI: 1.068∼5.167), concerns about using LARC (OR = 0.362, 95% CI: 0.176∼0.745), and willingness to use free IUDs (OR = 13.582, 95% CI: 7.173∼25.717). Conclusion Cost is one of the factors affecting LARC choices. Parents and sexual partners may play important role in the choice of LARC.

Empowering Women, Securing Futures: Contraception’s Role in Socioeconomic Progress in India

Introduction: It is necessary to empower women to enable them to make their own reproductive choices, including contraception as well as use of modern contraception. Our article aims to highlight the importance of women’s empowerment regarding contraceptive use in family planning and poverty eradication. Methods: Our literature search included data on family planning programs, contraceptive use, awareness of and access to contraception, and women empowerment regarding contraceptive use in India; approaches to policymaking regarding family planning; and international data on early legal access, women’s reproductive rights, and barriers to contraceptive use. Results: Despite the introduction of oral contraceptives, 38% of currently married women in the 15–49 age group use sterilization as a method of contraception. Only 28% of married Indian adolescents use contraception. The highest reliance on sterilization is found in women married off early, conceiving early, and with little access to education and information. There are barriers to both use of contraceptives and reversible contraceptives. Discussion: Family planning programs in India can focus on women’s reproductive rights, rather than population control, to bridge the gap in the unmet need for family planning, apart from making information and resources on contraception available to women from all socioeconomic strata.

Is There Still a Role for Sterilization by Tubal Ligation as a Contraceptive Method?

Tubal ligation has been used since the late nineteenth century to control undesired fertility in women. Over the years, there have been many improvements to the surgical technique, and the procedure has become a lot safer. Some recent developments, however, appear to make this procedure obsolete. In the first instance, there is now ample evidence that removing the Fallopian tubes rather than ligating them or closing them provides protection against developing ovarian carcinoma. The many surgical approaches and closure methods are therefore no longer appropriate. In the second instance, the use of long-acting reversible contraception has been shown to be as effective in preventing future pregnancy, more cost-effective and with even more health benefits than tubal ligation or tubectomy. This is especially true of the use of intrauterine levonorgestrel. The problem of regret and request for tubal ligation reversal, where that was performed, is eliminated as is the surgical concern of operating on older women with increased body mass index and medical co-morbidities.

Prevalence and predictors of use of long-term and short-acting reversible contraceptives among women of reproductive age in Wakiso and Hoima districts, Uganda: A cross-sectional study

Modern contraceptive use has increased globally, but unmet needs persist in low- and middle-income countries. This study in Uganda aimed to examine the prevalence and factors influencing the use of short-acting reversible contraceptives (SARC) like pills and long-term methods such as intrauterine devices. Limited evidence exists on the use of SARC and long-term methods in Uganda. Data from the Africa Medical and Behavioural Sciences Organization (AMBSO) Population Health Surveillance (APHS) in Hoima and Wakiso districts were analysed. Among the 1642 women aged 15–49 years, the prevalence of modern contraceptive use was 30% for SARC, and 18% for long-term method. Women with formal education were three times more likely to use long-term methods than those without formal education, relative risk ratios (RRR), 3.1–3.4, (95%CI 1.2–8.2). Joint decision-making for contraceptive use increased SARC usage, RRR 1.4 (95%CI 1.1–1.8). Urbanization played a role, with women in more urbanized Wakiso district less likely to use any modern contraception, RRR 0.6–0.7 (95%CI 0.5–0.9) compared to those living in the less urbanized Hoima. About half of the women in the study used modern contraceptives and the use of SARC was almost twice that of long-term methods. Increased access to contraception education for all women of reproductive age could significantly improve the use of long-term methods which offer more reliable protection against unintended pregnancies. The findings shed light on the need to strengthen both general and sexuality education to girls and women and to tailor contraception access for all in need, for mobile semi-urban as well as rural women. Well-informed strategies that engage young men and male partners in informed decision-making for contraceptive use could enhance progress.

The Impact of Get It? on Long-Acting Reversible Contraception Use Among Adolescents and Young Adults

Long-acting reversible contraceptives (LARCs) are the most effective contraceptive method to decrease pregnancy rates among adolescents and young adults (AYAs). Get It? (www.getitnobaby.com) is an innovative peer-based digital intervention that aims to increase LARC awareness and use among AYAs. The purpose of this study was to describe the impact of Get It? on LARC awareness and use among AYAs after exposure. A randomized controlled trial was conducted between 2 different Baylor College of Medicine Teen Health Clinics. Using a block randomization method, clinics were randomized to either the intervention or control group by week. Baseline and post-intervention surveys were conducted in addition to a 6-month post-intervention chart review to determine the primary outcome of LARC uptake and secondary outcomes including other LARC-specific behaviors and LARC attitudes. A total of 233 AYAs agreed to participate in the study, of which 134 were randomized to the control group and 99 to the intervention group. Initiation of LARC discussion with the provider was significantly higher in the intervention group than in the control group. Additionally, LARC uptake within 6 months after study was almost significantly higher in the intervention group than in the control group. Finally, intervention group respondents exhibited strong positive attitudes toward Get It? with regard to specific intervention components. This study supports Get It? as a tool to educate and motivate AYA girls to use the most effective form of birth control available to them. The digital format of this novel peer-based approach also contributes to the potential of this educational intervention by decreasing barriers to both dissemination and uptake. We recommend a larger multi-institutional study to confirm these results and determine the most efficient method of dissemination to reach at-risk AYAs before coitarche.

Impact of the Affordable Care Act on Prescription Contraceptive Use and Costs Among Privately Insured Women, 2006–2020

BackgroundIn the years immediately following the Affordable Care Act (ACA)'s contraceptive coverage requirement, out-of-pocket costs fell for all Food and Drug Administration–approved contraceptive methods and use of long-acting reversible contraception (LARC) increased. This analysis examines whether these trends have continued through 2020 for privately insured women. MethodsUsing 2006–2020 MarketScan data, we examined trends in prescription contraceptive use and out-of-pocket costs among women 13 to 49 years old. Multivariable analyses model the likelihood of contraceptive use and paying $0 post-ACA requirement (vs. pre-ACA requirement) for contraception, controlling for age group, U.S. region, urban versus rural, and cohort year. ResultsThe likelihood of LARC insertion increased post-ACA requirement (adjusted odds ratio [aOR] 1.127, 95% confidence interval [CI] 1.121–1.133), with insertion rates peaking at 3.73% for intrauterine devices (IUDs) and 1.08% for implants in 2019, before declining with the onset of the COVID-19 pandemic in 2020. Although the likelihood of paying $0 for LARC increased after the ACA requirement (IUD: aOR 5.495, 95% CI 5.278–5.716; implant: aOR 7.199, 95% CI 6.992–7.412), the proportion of individuals paying $0 declined to 69% for IUDs and 73% for implants in 2020, after having peaked at 88% in 2014 and 90% in 2016, respectively. For oral contraceptives, both use (aOR 1.028, 95% CI 1.026–1.030) and paying $0 (aOR 20.399, 95% CI 20.301–20.499) increased significantly after the ACA requirement. ConclusionWith the exception of oral contraceptives, the proportion of individuals paying $0 for all contraceptive methods declined after peaking in 2014 for IUDs, 2016 for the implant, and 2019 for non-LARC methods. Future monitoring is needed to understand the continuing impact of the ACA requirement on prescription contraceptive use and costs.

Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment.

A 6-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first 3 years of Choose Well. Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p<.001), with IUD use increasing from 4.3% to 5.2% (p<.001) and implant use increasing from 4.6% to 6.0% (p<.001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval,0.311-0.675). The effect was stronger among women 20 to 25years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval,0.006-0.020) per month beyond expected values. At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.

A reusable, low-cost model to improve resident confidence in performance of postpartum tubal ligation

Proficiency in postpartum abdominal sterilization is a core objective that residents must acquire during residency as outlined by the Council on Resident Education in Obstetrics and Gynecology. Surgical sterilization remains a popular and effective form of contraception in the United States; however, many women requesting immediate postpartum tubal ligation are unable to have the procedure given institutional barriers and variations in practice. Additionally, increasing use of long-term reversible contraceptives has contributed to declining immediate postpartum sterilization rates, which may ultimately impact an Obstetrics and Gynecology resident’s ability and confidence to perform this procedure. Our goal was to develop a reusable, low-cost model to improve resident familiarity and confidence with postpartum tubal ligation. A 3-dimensional model was developed that represents key anatomic structures encountered during tubal ligation and allows residents to perform all procedure steps. Materials and costs were determined. The model was piloted during scheduled simulation time. Residents evaluated the model’s realism and reported confidence in performing the tubal ligation pre- and post-simulation with a 5-point Likert scale . Four reusable models were created for $21.56 each. All PGY level residents (n=12) successfully performed the procedure with most having performed less than 5 postpartum tubal ligations previously. Resident confidence in performing postpartum tubal ligation improved significantly post-simulation (2.58 vs 3.42/5, p=0.005). Residents strongly agreed that the model replicated the steps (4.83/5), resembled the abdominal wall (4.58/5) and peritoneal cavity (4.73/5), and was similar in difficulty to a live procedure (3.2/5). All residents strongly agreed practicing on this model could improve surgical technique (5/5). This model fills a gap in sterilization simulation and resident training. It is low-cost and easily reproducible, closely resembles the pelvic anatomy, allows for completing the steps of the procedure and can be used for resident education to improve confidence with immediate postpartum sterilization.

Comparing maternal factors associated with postpartum depression between primiparous adolescents and adults: Alarge retrospective cohort study.

This study aimed to estimate the prevalence of diagnosed postpartum depression (PPD) and the likelihood of PPD among primiparous women. We also evaluated differences in the influence of various maternal factors associated with PPD in adolescent versus adult mothers. We conducted a retrospective cohort study using electronic health records linked to birth certificates to evaluate the associations between maternal factors and PPD diagnosis. The study population was stratified into adults and adolescents based on age at delivery. We evaluated socioeconomic, demographic, psychological, and clinical factors associated with PPD in each of the age-defined maternal cohorts using multivariable logistic regression analyses. A total of 61,226 primiparous women, including 6435 (11%) mothers younger than 20 years old, were included in the study. The overall PPD rate was 4.0%, with the age-specific PPD rate measuring 1.6 times higher in adolescents than in adult women (6.1% vs. 3.8%). Compared with adults, adolescents were less likely to obtain firsttrimester prenatal care (33% vs. 16%), more likely to have recent tobacco use (11% vs. 6%), and more likely to have had an infection during pregnancy (5% vs. 1%). In adjusted models, significant factors for PPD in both groups included a history of depression or anxiety, tobacco use, and long-acting reversible contraception use. In this cohort of first-time mothers, adolescents had higher rates of PPD diagnosis as well as PPD-associated maternal factors than adults. Increased awareness of PPD risk in adolescents and early intervention, including integrating mental healthcare into prenatal care, may help benefit adolescents and reduce the risk and severity of PPD.

Postpartum long-acting reversible contraceptives use in sub-Saharan Africa. Evidence from recent demographic and health surveys data.

In developing countries, most women want to avoid pregnancy for two years after giving birth. However, 70% do not use contraceptives during this time. Unintended pregnancies may occur for couples who delay contraceptive use during the postpartum period. The most effective form of contraceptive methods for postpartum women is long-acting reversible contraceptive (LARC). Therefore, this study aimed to assess long-acting reversible contraceptive use and associated factors among postpartum women in Sub-Saharan Africa. Secondary data analysis was performed using the recent Demographic and Health Surveys (DHS). Stata version 14 was used to analyze the data. A multilevel mixed-effect logistic regression model was used to identify factors associated with long-acting reversible contraceptive use. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with long-acting reversible contraceptives. The magnitude of long-acting reversible contraceptive use among postpartum women was 12.6% (95% CI: 12.3, 12.8). Women primary (aOR = 1.51; 95% CI: 1.41, 1.63) and secondary education (aOR = 1.62; 95% CI: 1.32, 1.71), media exposure (aOR = 1.73; 95% CI: 1.51, 1.85), place of delivery (aOR = 1.54; 95% CI: 1.43, 1.67), number of ANC visit; 1-3 (aOR = 2.62; 95% CI: 2.31, 2.83) and ≥4 (aOR = 3.22; 95% CI: 2.93, 3.57), received PNC (aOR = 1.34; 95%CI: 1.13, 1.58), and income level; low middle income (aOR = 2.41; 95% CI: 2.11, 2.88) and upper middle income (aOR = 1.83; 95% CI: 1.56, 1.24) were significantly associated with long-acting reversible contractive use. Nearly one in 10 postpartum women used long-acting reversible contraceptives. Hence, we suggest that the concerned bodies should promote family planning messages in mass media and give the well-documented benefits of postpartum long-acting contraceptive use. Promote the integration of postpartum LARC methods into maternal health care services and give better attention to postpartum women living in low-income countries and uneducated women.

Determinants of contraceptive continuation among women in sub-Saharan Africa

BackgroundContraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes, like unintended pregnancies. Therefore, it is imperative to understand the factors that influence women’s decision to continue the use of contraceptives. The present study examined the determinants of contraceptive continuation among women in sub-Saharan Africa (SSA).MethodsData for the study were extracted from the most recent Demographic and Health Surveys (DHS) of twenty-four (24) countries in SSA. Descriptive and multivariable binary logistic regression analysis were conducted. Frequencies, percentanges, and an adjusted odds ratio with 95% confidence intervals were used to present the results.ResultsCompared to adolescents, adult women aged 45–49 years [aOR: 1.24; CI: 1.13–1.37] had higher odds of contraceptive continuation. The odds of contraceptive continuation were lower among those working [aOR: 0.96; CI: 0.93–0.98] compared to those not working. Also, the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed [aOR: 0.91; CI: 0.88–0.93]. Compared to women who used LARCs, women who used pills [aOR: 0.34; CI: 0.33–0.36], injectable [aOR: 0.42; CI: 0.40–0.43], other modern contraceptives [aOR: 0.72; CI: 0.68–0.75] or traditional methods [aOR: 0.50; CI: 0.478–0.523] were less likely to continue with their contraception. Women with one birth [aOR: 0.86; CI: 0.83–0.90] and those with 2 + births in the last five years [aOR: 0.54; CI: 0.512–0.56] reported lower odds of contraceptive continuation as compared to those with no births. Compared to women with no children living, those with 4 + children living had lower odds of contraceptive continuation [aOR: 0.62; CI: 0.57–0.67]. The study also found that the likelihood of contraceptive continuation was higher among those with secondary education [aOR: 1.08; CI: 1.04–1.12] as compared to those with no formal education. Contraceptive continuation was also higher among those who have information on choice [aOR: 3.91; CI: 3.82–4.01], and also higher among those who were undecided about having an additional child [aOR: 1.39; CI: 1.33–1.46]. Compared to West AfricaAngola, women from all other sub-regions were less likely to continue using contraceptives Comoros were more likely to continue with contraception [aOR: 1.49; CI: 1.24–1.78].ConclusionTo improve contraceptive continuation among women of reproductive age, countries in SSA must invest heavily in advocacy and dissemination of family planning messages, and information of choice. Also, much commitment should be directed towards enhancing the use of long-acting reversible contraceptive use.

Promoting the use of long-acting reversible contraceptives to reduce unplanned pregnancies

Promoting the use of long-acting reversible contraceptives to reduce unplanned pregnancies

Statement of Retraction [Effect of a mobile phone-assisted postpartum family planning service on the use of long-acting reversible contraception: a randomised controlled trial

Statement of Retraction [Effect of a mobile phone-assisted postpartum family planning service on the use of long-acting reversible contraception: a randomised controlled trial

Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers

Postpartum utilization of long-acting reversible contraception (LARC) has been found to be effective at increasing inter-pregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. (1) To quantify postpartum uptake of long-acting reversible contraception among U.S. Army active-duty female soldiers, and (2) to identify demographic and military-specific characteristics associated with utilization. This retrospective cohort study used longitudinal data on all digitally recorded health encounters for active-duty U.S. Army soldiers from 2014-2017. The servicewomen included in our analysis were aged 18-44 years with at least one delivery and a minimum of four months of total observed time post-delivery within the study period. We defined postpartum long-acting reversible contraception utilization as initiation in the delivery month or in the three calendar months following delivery, and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception utilization using multivariable logistic regression. Inclusion criteria were met by 15,843 soldiers. Of those, 3,162 (19.96%) received a method of long-acting reversible contraception in the month of, or within the three months following, delivery. Fewer than 5% of these women utilized immediate postpartum long-acting reversible contraception. Among women receiving a postpartum long-acting reversible contraceptive method, 1,803 (57.0%) received an IUD, 1,328 (42.0%) received an etonogestrel implant and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest utilization rates overall. Compared to these women, the adjusted odds of postpartum utilization among self-reported Black and Asian/Pacific Islander women were 18% and 30% lower, respectively (both p<0.001). There was also a trend of decreasing postpartum utilization with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential utilization of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older, as well as among Black-identifying women. Among active-duty U.S. Army servicewomen, one in five utilized postpartum long-acting reversible contraception, with fewer than 5 percent of these women utilizing an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of utilization and significant differences in uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.

Foreign bodies inside us - Trends and knowledge regarding long-acting reversible contraceptives (LARCs) use, factors influencing of contraceptives choice-making process, and the dual-method use among Polish college-aged women

Introduction: The choice-making process of the contraceptive method seems complex and influenced by many factors. Long-acting reversible contraceptives require mechanical interference with the woman's body. For some, it will be an insurmountable barrier whilst for others a chance to enjoy a successful sex life without fear of pregnancy. Recognizing the factors influencing their use will allow us to identify target groups, increase awareness, and spread knowledge about them.&#x0D; Purpose: This study aimed to assess contraceptive use trends and knowledge, focusing on long-acting reversible contraceptives (LARCs) and vaginal rings, also to identify predictors associated with their use and analyze the decision-making process for dual-method use (hormonal plus barrier method) among female college students in Poland.&#x0D; Materials and methods: A self-administered questionnaire including 44 questions in the form of a web-based survey distributed among peers in social media platforms and forums.&#x0D; Results: In the survey a total of 700 female students aged 19±25 took part. All the questions about LARC and vaginal rings were answered correctly by only 19 participants (2.71%). The most knowledgeable were medical students (p&lt;0.0001). Out of 55 LARC and vaginal ring users (7.86%), 47 female students (76.4%,) stated the improvement of their life. Of the methods interfering with the body, the study group most frequently chose the vaginal ring (38.1%) and least frequently the hormone injection (0.1%). &#x0D; Conclusions: Participants’ knowledge of LARC methods and vaginal rings is insufficient and its main influencing factors are faculty type and frequency of intercourse. LARC and vaginal disc are not the first contraception choice. Fear of pregnancy is the most common factor for dual method use.

Adolescent Long-Acting Reversible Contraceptive Use, Same-Day Insertions, and Pregnancies Following a Quality Initiative

ObjectiveTo compare long-acting reversible contraceptive (LARC) use, pregnancy rate, and same-day LARC insertion among adolescents before and after a Kaiser Permanente Northern California quality initiative. MethodsA 2016 Kaiser Permanente Northern California initiative aimed to increase adolescent LARC access. Interventions included patient education resources, electronic protocols, and insertion training for pediatric, family medicine, and gynecology providers. This study examined a retrospective cohort of adolescents aged 15–18 years who used contraception before (2014–2015, n = 30,094) and after (2017-2018, n = 28,710) implementation. Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring. We reviewed a random sample of LARC users (n = 726) to identify same-day insertions. Multivariable analysis examined the effects of year of provision, age, race, ethnicity, LARC type, and counseling clinic. ResultsPreintervention, 12.1% of adolescents used LARC, 13.6% used injectable, and 74.3% used pill, patch, or ring. Postintervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively, with the odds of LARC provision of 2.57 (95% confidence interval (CI) 2.44–2.72). The pregnancy rate decreased from 2.2% to 1.4% (p < .0001). Higher rates of pregnancy were observed with injectable contraception and in Black and Hispanic adolescents. Same-day LARC insertion rate was 25.1% without significant variation post intervention (OR 1.44, 95% confidence interval 0.93–2.23). Contraceptive counseling in gynecology clinics increased the odds of same-day provision, while non-Hispanic Black race lowered odds. DiscussionA multifaceted quality intervention was associated with a 90% increase in LARC use and a 36% decrease in teenage pregnancy rate. Future directions may include promoting same-day insertions, targeting interventions in pediatric clinics, and focusing on racial equity.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017–2018 data

ObjectivesThis study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged...

Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria

BackgroundLong-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria.MethodsThis is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15–49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample.ResultsThe spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48–0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30–2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45–0.97)] compared to women with lower socioeconomic status.ConclusionsThis study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

Long-acting reversible contraception and condom use: A cohort study of female adolescents and young adults in New York City

ObjectivesThis study aimed to determine whether condom use varied between adolescents and young women using long-acting reversible contraception (LARC) vs non-LARC hormonal methods and assess if the initiation of LARC was associated with lower condom use. Study designThis study used data from a large longitudinal study of sexually active females aged 13–25 years. Questionnaires assessed contraception, condom use, sexual history, and partner characteristics at the baseline visit and every 6 months. Log-binomial regression analyses examined associations between hormonal contraceptive methods and condom use, and the moderating effects of age and number of sexual partners. Exploratory analyses compared condom use based on partner characteristics. ResultsOf 1512 participants, 1116 reported LARC or non-LARC hormonal method use during any study visit. Among baseline and new LARC users, 75.7% and 84.7% reported intrauterine device (IUD) use, respectively. Condom use at baseline among hormonal non-LARC users (37.5%) was significantly higher (p < 0.01) than LARC users (23.5%). Condom use among LARC vs non-LARC users was moderated by age in that LARC was associated with lower condom use among participants aged 13–18 years, but not those aged 19–25 years. Number of sexual partners was not a significant moderator. Among participants with increased sexually transmitted infection (STI) risk based on partner characteristics, LARC users had lower condom use compared to non-LARC users. ConclusionsCondom discontinuation was common following initiation of LARC and hormonal non-LARC methods. However, condom use was lower in LARC users at baseline, among younger adolescents, and if partners had risk factors for STIs. ImplicationsCondom discontinuation following initiation of highly effective contraception increases the risk of STI. Young women using LARC may be at greater risk than non-LARC users given lower condom use despite having partners with risk factors for STIs. Condom use counseling for STI protection is critical for adolescents.