Risk Of Unintended Pregnancy Research Articles

Prevalence and Determinants of Unintended Pregnancy among Married Women Seeking Antenatal Care at Bwaila District Hospital in Lilongwe, Malawi

In many countries, women fall pregnant much sooner than desired and have more pregnancies and bear more children than they want. Pregnancies are usually associated with an array of negative health, economic, social and psychological outcomes for women and children. Preventing unintended pregnancies through family planning is an integral component in limiting associated consequences and population growth. However, despite widely available contraceptives, the demand for family planning among married women is still high. A quantitative study was conducted to explore the prevalence and determinants of unintended pregnancy among married women seeking antenatal care at Bwaila District Hospital in Lilongwe, Malawi. Permission was granted by the relevant authorities to conduct the study. Between July and August 2019, 413 married pregnant women were interviewed. The women gave written consent before joining the study and all the completed questionnaires were personally collected daily. Descriptive statistics were used to analyse the data while nonparametric tests were used to explore associations amongst the variables. The mean age of the participants was 23 years and 43.1% of the participants reported that their most recent pregnancy was unintended. Multivariate analysis revealed that young age (18–25 years), low education level and preference for the sex of the child were significant determinants of unintended pregnancy. Inconsistent use of family planning methods increased the risk of unintended pregnancy. Unintended pregnancy among married women indicates the need for improving education among women to delay marriage to the universal minimum of 18 years, and increasing access to long-term family planning methods to avoid failure and discontinuation of contraceptives.

Who uses covertly and what is the impact on contraceptive dynamics? Evidence from a national cohort of women in Uganda

Background: Little is known regarding the specific role of covert use (i.e., use of contraception without partner knowledge) in contraceptive discontinuation and switching. Among a nationally representative cohort of women in Uganda, we sought to: 1) compare characteristics of covert, overt, and non-users of contraception at baseline; 2) assess the effect of using contraception covertly on switching and discontinuation over a one-year period. Methods: Analyses utilized PMA2020 Uganda Round 6 (April–May 2018), with longitudinal analyses incorporating data from a one-year follow-up survey (May–June 2019). Both cross-sectional (n=1,764) and longitudinal (n=616) samples included women in need of contraception. For cross-sectional analyses, multinomial regression compared risk of overt/covert use vs. non-use by user characteristics and logistic regression compared the odds of covert vs. overt use among contraceptive users. For longitudinal analyses, multinomial regression examined risk of contraceptive switching and discontinuation by baseline covert vs. overt use status. Results: Among contraceptive users, 14.1% reported using covertly. In cross-sectional analyses, higher wealth (aRRR=1.74; 95% CI=1.19-2.54), secondary or higher education (aRRR=2.52; 95% CI=1.42-4.49), and middle parity (aRRR=1.24; 95% CI=1.00, 2.28) were associated with an increased risk of overt use, and higher wealth (aRRR=2.08; 95% CI=1.09-3.98) and polygyny (aRRR=1.60; 95% CI=1.01-2.54) with covert use, compared to non-use. Among contraceptive users, women within polygynous unions had double the odds of using covertly compared to those with monogamous partners (aOR=1.97; 95% CI=1.28-3.03). Longitudinal analyses revealed large proportions of overt and covert users switched (30% overt, 26% covert) or discontinued methods (32% overt, 37% covert) at one-year follow-up, however, neither switching nor discontinuation was significantly related to overt/covert use status at baseline. Conclusions: Though significant differences by covert use status were not detected, approximately 33% of users discontinued over one year; these women represent important beneficiaries of family planning programming as they may remain at risk for unintended pregnancy.

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

Condom use among women of reproductive age (18–49 years) in Puerto Rico during the 2016 Zika virus outbreak: secondary analysis of data from a cross-sectional, population-based, cell-phone survey

ObjectivesZika virus (ZIKV) can be sexually transmitted, and ZIKV infection during pregnancy can cause birth defects. Contraception is a medical countermeasure to reduce unintended pregnancy and ZIKV-associated birth defects. We...

Determinants of contraceptive use among women 0-23 months postpartum in Kitui County, Kenya: A cross-sectional study.

The risk of unintended pregnancy is high in the postpartum period, especially during the first year of delivery. Yet, short birth intervals are associated with increased risk of adverse maternal and infant outcomes. In Kenya, despite women having multiple contacts with healthcare providers during their pregnancy and postpartum journeys, uptake of contraceptives during the postpartum period remains low. We examine factors that determine contraceptive use among postpartum women in Kitui County, Kenya.A cross-sectional study was conducted in six sub-counties of Kitui County covering a random sample of 768 postpartum women in April 2019. Logistic regression was used to study the association between uptake of contraceptives among women 0-23 months postpartum and several explanatory variables that included socio-demographic characteristics and facility-level factors. Overall, 68% of women in Kitui County reported using contraceptives. The likelihood of contraceptive use increased with the increase in the number of known family planning methods. Women who discussed family planning with a health worker within the last 12 months were 2.58 (95%CI: 1.73, 3.89) times more likely to use contraceptives during the postpartum period compared to those who did not. There was an increased odds of contraceptive uptake among women who received family planning information or service during postnatal care than those who did not (aOR = 2.04, 95%CI: 1.30, 3.24). A positive association was also found between contraceptive use and receipt of family planning information or service during immunization visits or during child well visits. It is evident that facility-level factors such as discussing family planning with women; educating women about different family planning methods; providing family planning information or services during postnatal care, immunization, or well child visits are associated with increased likelihood of contraceptive uptake by women during postpartum period. Programs targeting enhancing women's attendance of postnatal care clinics should be encouraged.

Averting neonatal abstinence syndrome and treating addiction among rural, opioid-using young women.

America's opioid epidemic has spawned an epidemic of neonatal abstinence syndrome (NAS). Studies have not tested approaches to promoting contraceptive services for women with opioid use disorder(OUD) along with treatment for this disorder. This pilot study examined the promotion of medication for OUD(MOUD) treatment and contraception use, primarily long-acting reversible contraception (LARC), for women with OUD. In Appalachia, a peer-delivered contraception and MOUD promotion intervention was delivered to a sample of 30 women with OUD. Primary outcomes were attendance of initial appointments to receive MOUD and counseling about contraceptive options. Peer recovery coaches also offered to help the women schedule appointments and attend the appointment with them or give them a ride if necessary and requested by the patients. Two-thirds experienced all seven symptoms of opioid dependence. Within 30 days of a brief counseling session, over one-half of the women (56.7%) were referred to MOUD, with all of them initiating treatment within 30 days. Just under one-half of the women (46.7%) were referred to a contraception consultation, with 85.7% of those receiving a LARC implant. Study findings indicate the potential efficacy of a single-session, peer-delivered counseling intervention for linking women with OUD and at high risk of unintended pregnancy to MOUD and to services that provide women with highly reliable contraceptives. This study isunique inexploring the efficacy of linking high-risk opioid-using women to contraceptive options and treatment for MOUD to prevent NAS.

Etonogestrel contraceptive implant failure in a woman taking rifampin: a case report

BackgroundThe etonogestrel subdermal implant is the most efficacious hormonal contraceptive currently available and provides 99.7% effective contraception. However, similar to other hormonal contraception, its effectiveness is compromised with the use of cytochrome P450 inducing drugs resulting in an unplanned pregnancy. Despite this risk, little is known about the outcome of concomitant use of rifampin and contraceptive implants.Case presentationA 24-year-old woman was provided with an etonogestrel implant in September 2018. In July 2020, she was started with rifampin based anti-tuberculosis for tuberculosis of the lymph nodes. In December 2020, she presented to the family planning clinic of St. Paul’s Hospital Millennium Medical college with a diagnosis of failed implant and second-trimester pregnancy at a gestational age of 19 weeks. The etonogestrel implant was removed and the patient was linked to antenatal care follow up.ConclusionConcomitant use of hepatic cytochrome P450 enzyme-inducing medications with certain hormonal contraceptives may reduce effectiveness resulting in unintended pregnancy. Women should be given detailed counseling about the potential for drug interactions and a multidisciplinary approach with consultation or referral to reproductive health specialists is crucial for optimal management of women who are at increased risk of contraceptive failure and unintended pregnancy.

Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: a cross-sectional study

BackgroundConsidering the high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, and the unmet need for contraceptives prevalent among the Rohingya refugees, this study aims to explore the knowledge, attitude, and practice (KAP) of family planning (FP) and associated factors among Rohingya women living in refugee camps in Bangladesh.MethodsFour hundred Rohingya women were interviewed. Data were collected using a structured and pretested questionnaire, which included study participants’ socio-demographic characteristics, access to FP services, knowledge, attitude, and practice of FP. Linear regression analysis was performed to identify the influencing factors of FP-KAP.ResultsOf the 400 Rohingya refugee women, 60% were unaware that there was no physical harm brought by using a permanent method of birth control. Half of the women lack proper knowledge regarding whether a girl was eligible for marriage before the age of 18. More than two-thirds of the women thought family planning methods should not be used without the husband’s permission. Moreover, 40% were ashamed and afraid to discuss family planning matters with their husbands. Of the study participants, 58% had the opinion that a couple should continue bearing children until a son is born. Linear regression analyses found that study participants’ who have a profession, have less children, whose primary source of FP knowledge was through a physician/nurse, have had FP interventions in the camp, and talk with a health care provider on FP were found to have better FP-KAP.ConclusionThe study showed that Rohingya refugee women are a marginalized population in terms of family planning and their comprehensive FP-KAP capability was low. Contraceptives among the Rohingyas were unpopular, mainly due to a lack of educational qualifications and family planning awareness. In addition, family planning initiatives among Rohingya refugees were limited by a conservative culture and religious beliefs. Therefore, strengthening FP interventions and increasing the accessibility to essential health services and education are indispensable to improving improve maternal health among Rohingya refugees.

Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17.

This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016-17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4-1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.

Developing contraceptive services for immigrant women postpartum \u2013 a case study of a quality improvement collaborative in Sweden

BackgroundImmigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals’ (HCPs) counselling and a more effective choice of contraceptive methods.MethodsThe pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018–2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women’s choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year.ResultsThe participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women’s choice of contraceptive methods.ConclusionsThe QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women’s choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.

Let's Talk About Sex: Improving Measurement of Contraceptive Use in Cross-Sectional Surveys by Accounting for Sexual Activity Recency.

Standard measures of contraceptive prevalence have known biases given that they do not reflect sexual activity and true exposure to the risk of an unintended pregnancy. In this study, we aim to understand the extent to which women protect themselves against unintended pregnancy, taking into account exposure to sex, by examining contraceptive use patterns by marital status and recent sexual activity. Data come from population-based surveys of reproductive age women in 9 low-resource settings. We estimated contraceptive prevalence using (1) the standard current contraceptive use measure, (2) a new measure of contraceptive use at last sex, and (3) a comprehensive measure that combines current use and use at last sex. Analyses are stratified by site and examine patterns by marital status only, and by both marital status and sexual activity separately. We then examined method mix by each contraceptive measure. Study findings reveal distinct patterns in contraceptive use in relation to marital status and sexual recency across sites. Overall, married women tended to report higher levels of current contraceptive use compared to use at last sex, whereas unmarried women reported higher levels of contraceptive use at last sex. When examining these measures by sexual activity and marital status, results indicate lower levels of contraceptive use among women who had not had sex in the month prior to the survey, for both married and unmarried women. The comprehensive measure of contraceptive use yielded the highest estimates, by design. Method mix varied consistently by contraceptive measure, with current use tending to capture more permanent and long-acting methods and use at last sex more likely to capture short-acting and coital-dependent methods. These findings have important implications for how the family planning field evaluates unintended pregnancy risk and unmet need for contraception within low-resource settings, given different estimates yield discrepant estimates for who is "at risk."

75. “Being Out” in a Pre- and Pandemic World: Does Sexual Orientation Disclosure to a Healthcare Provider Impact Receipt of Sexual and Reproductive Health Services in Youth Assigned Female Sex at Birth?

Sexual minority women and transmasculine youth in the U.S. experience disparities in sexual and reproductive health (SRH) outcomes and service receipt, including increased risk of unintended pregnancy. Limited research in predominantly non-Hispanic White (White) adult populations shows that disclosing one’s sexual orientation or behaviors to one’s healthcare provider (HCP disclosure) is associated with higher rates of HPV vaccination and PAP testing. No studies have evaluated disclosure and receipt of HIV testing or contraceptive services.

Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support.

Housing instability and intimate partner violence (IPV) compromise women’s sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.

Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion

Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. Incidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. The full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79.4%]). There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, 3.25%-3.73%) for breastfeeding women and 4.57% (95% CI, 4.22%-4.95%) for nonbreastfeeding women; the adjusted HR for breastfeeding vs not breastfeeding was 0.71 (95% CI, 0.64-0.78). In this study of real-world data, IUD expulsion was rare but more common with immediate postpartum insertion. Breastfeeding was associated with lower expulsion risk.

Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis

BackgroundUnintended pregnancies (UPs) are a global health problem as they contribute to adverse maternal and offspring outcomes, which underscores the need for prevention. As psychiatric vulnerability has previously been linked to sexual risk behavior, planning capacities and compliance with contraception methods, we aim to explore whether it is a risk factor for UPs.MethodsElectronic databases were searched in November 2020. All articles in English language with data on women with age ≥ 18 with a psychiatric diagnosis at time of conception and reported pregnancy intention were included, irrespective of obstetric outcome (fetal loss, livebirth, or abortion). Studies on women with intellectual disabilities were excluded. We used the National Institutes of Health tool for assessment of bias in individual studies and the Grading of Recommendations Assessment, Development and Evaluation method for assessment of quality of the primary outcome.FindingsEleven studies reporting on psychiatric vulnerability and UPs were included. The participants of these studies were diagnosed with mood, anxiety, psychotic, substance use, conduct and eating disorders. The studies that have been conducted show that women with a psychiatric vulnerability (n = 2650) have an overall higher risk of UPs compared to women without a psychiatric vulnerability (n = 16,031) (OR 1.34, CI 1.08–1.67) and an overall weighed prevalence of UPs of 65% (CI 0.43–0.82) (n = 3881).InterpretationStudies conducted on psychiatric vulnerability and UPs are sparse and many (common) psychiatric vulnerabilities have not yet been studied in relation to UPs. The quality of the included studies was rated fair to poor due to difficulties with measuring the outcome pregnancy intention (use of various methods of assessment and use of retrospective study designs with risk of bias) and absence of a control group in most of the studies. The findings suggest an increased risk of UPs in women with psychiatric vulnerability. As UPs have important consequences for mother and child, discussing family planning in women with psychiatric vulnerabilities is of utmost importance.

Twelve-month supply of short-acting contraception methods: Pharmacists’ perspectives on implementation of new state law

BackgroundOral contraceptives and other short-acting reversible contraceptive (SARC) methods such as the patch, vaginal ring, and medroxyprogesterone injections are used by approximately 30% of people using contraception. People may face barriers in obtaining a timely and adequate supply of their SARCs. It is well established that dispensing more than 1-month supply at a time is more convenient for patients, improves continuation, and decreases the risk of unintended pregnancy. Given the potential for public health impact, 20 states, including Massachusetts, have expanded access to a 12-month supply of SARCs. ObjectivesThe goal of this qualitative study was to explore Massachusetts pharmacists’ general awareness and specific knowledge of the state’s 2017 Act Advancing Contraceptive Coverage and Economic Security in Our State (ACCESS) law, explore barriers to the implementation of the law, and elicit recommendations to improve uptake of this practice. MethodsSemistructured interviews were conducted with a purposeful sample of community pharmacists in Massachusetts between September 2020 and May 2021 using a pretested interview guide. Interviews were audio recorded and professionally transcribed. Data collection ceased when theoretical saturation was achieved. Data were analyzed using modified grounded theory, including code book development and line-by-line and axial coding. ResultsSixteen pharmacists from diverse practice settings participated in the interviews. All the pharmacists (100%) reported that they had received no training on the ACCESS law, and only 1 pharmacist reported having complete knowledge of the specifics of the law. We identified key themes and subthemes related to pharmacists’ concerns about implementation of the law at the system, pharmacy, and patient level, including insurance coverage, communication of new laws, stocking, supply, and misuse by patients. ConclusionAddressing the need for pharmacist training and communication regarding new regulations may improve provision of an extended supply of SARC methods.

Barriers to Family Planning Among Women With Severe Mental Illness

The family planning experiences of women diagnosed with severe mental illness (SMI) have been understudied, despite increased risk for unintended pregnancy and barriers to accessing healthcare. We interviewed 17 English-speaking women aged 18 to 55 diagnosed with SMI who were receiving treatment at an outpatient mental health clinic to learn about their family planning experiences. Some major themes emerged: (1) pregnancy intention, decision-making, and coercion and (2) access and barriers to reproductive care. The results demonstrate an unmet need for family planning in women with SMI and how these needs could be addressed by a partnership between family planning and psychiatric providers.

Sexual Assault and Associated Factors among Women: A Cross-Sectional Study in Hawassa University Comprehensive Specialized Hospital, Ethiopia

Background: Sexual assault is a major form of sexual violence affecting one out of every five women in the world and it has many consequences including sexually transmitted infections, posttraumatic stress disorder and risk of unintended pregnancy. Thus, this study was aimed to assess the magnitude, complication and factors associated with sexual assault among women who visited gynecologic outpatient department of Hawassa University Comprehensive Specialized Hospital.Methods: Cross-sectional study was conducted from January 1 to October 30, 2019. Self-administered questionnaire developed from “WHO multi-country study on women health” and from “sexual violence medical evaluation certificate format” was used to collect data. Descriptive analysis was done on sexual assault related characteristics and binary and multivariate logistic regression analysis were done to identify factors associated with sexual assault.Results: The prevalence of sexual assault was 10.8% (n=43). Some 79.1% (n=34) of survivors were under the age of 18 years. 25% (n=7) of the survivors tested for pregnancy were positive and some 7% (n=3) of each were positive for Hepatitis B and Trichomonas vaginalis. Woman who was less than 18 years old [aOR=10.7, 95%CI (3.37, 33.85)], unmarried [aOR=9.2, 95% CI (2.11, 40.42)], had primary level of education [aOR=8.9, 95% CI (2.37, 33.06)] and a monthly income less than 1500 birr [aOR=6.7, 95% CI (1.54, 29.50)] had higher odds of experiencing sexual assault than their counterparts who were adult, married, secondary- or higher-level of education and a monthly income more than 1500 birr. Conclusions: In this study, Age, marital status, monthly income and educational level were significantly associated with sexual assault.Key words: Women, Pregnancy, Sexual assault, Sexually transmitted infection.

Contraception for Adolescents and Young Women with Type 2 Diabetes-Specific Considerations.

This article reviews how to address contraception in young women with type 2 diabetes (T2D). The presence of obesity and comorbidities associated with insulin resistance increases the risk of thromboembolic disease and adverse cardiovascular outcomes. Recent studies have shown that adolescents with T2D are at high risk of unintended pregnancy with poor outcomes for the mother and offspring. Adolescents with T2D without severe obesity, micro- or macrovascular disease, or other cardiovascular risk factors can use any contraceptive method. However, only nonhormonal or progestin-only methods may be used when morbid obesity, severe hypertension, micro- or macrovascular disease, or multiple cardiovascular risk factors are present. The medical team must provide preconceptional counseling and contraception to reduce adolescent pregnancies in young women with T2D. Progestin-only or nonhormonal long-acting reversible contraception (LARC) should be recommended for women with T2D with compliance issues or adverse cardiovascular risk profiles.

Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019.

Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusions: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.