Sociodemographic Characteristics Of Women Research Articles

Maternal and fetal outcomes of unattended pregnancies in Lubumbashi, Democratic Republic of Congo

IntroductionLes grossesses non suivies se caractérisent par leur morbi-mortalité et maternelle et fœtale importante. Cette étude s'est fixée comme objectifs de déterminer la fréquence des grossesses non suivies, décrire le profil sociodémographique et évaluer la morbi-mortalité materno-fœtale lors de l'accouchement chez les femmes n'ayant pas suivi de consultations prénatales (CPN) dans la ville de Lubumbashi.MéthodesUne étude transversale analytique des accouchées d'une grossesse monofoetale de décembre 2013 à mai 2014 a été mené dans 10 maternités de référence à Lubumbashi. Les femmes n'ayant pas suivi les CPN ont été comparées aux femmes qui les avaient bien suivies (CPN≥4). Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. L'odds ratio et son intervalle de confiance ont été calculés. Le seuil de signification a été fixé à une valeur de p<0,05.RésultatsNous avons trouvé que la fréquence de l'absence de suivi de grossesses était de 21,23% et le nombre moyen de consultations prénatales était de 2,6 ± 1,9. L'analyse de la relation entre les consultations prénatales et les caractéristiques sociodémographiques des accouchées montre que l'absence de suivi était 2,29 fois plus élevée chez les adolescentes que chez les femmes adultes (OR=2,29 [1,54-3,41]), 4 fois plus élevée chez les femmes vivant seules que chez celles vivant en union (OR=4,00 [2,05-7,79]) et 4,08 fois plus élevée chez les femmes de bas niveau de scolarité (analphabète ou primaire) que chez celles ayant un niveau de scolarité élevé (OR=4,08 [3,08-5,40]). Comparées à celles les ayant bien suivis, nous avons constaté que les femmes n'ayant pas suivi de consultations prénatales présentaient un risque élevé d'évacuation obstétricale (OR=1,90 [1,26-2,95]), de rupture de membranes fœtales à l'admission (OR=1,31 [1,02-1,68]), de mal présentation fœtale (OR=1,89 [1,03-3,44]), d'accouchement par césarienne (OR=1,78 [1,21-2,63]), d'éclampsie (OR=3,00 [1,09-8,70]), de rupture utérine (OR=4,76 [1,00-47,19]) et d'anémie (OR=2,33 [1,06-5,13]). Les taux de prématurité (OR=1,93 [1,33-2,80]), de post-maturité (OR=1,47 [1,00-2,30]), de faible poids de naissance (OR=2,33 [1,56-3,46]), de dépression néonatale (OR=3,89 [2,52-6,02]), de transfert en néonatologie (OR=1,60 [1,11-2,32]) et de mortalité périnatale (OR=2,70 [1,59-4,57]) étaient significativement plus élevés chez les nouveau-nés issus des femmes n'ayant suivi de consultations prénatales que chez ceux de celles les ayant bien suivis.ConclusionIl ressort de notre étude que l'absence de suivi des consultations prénatales est associée à une forte morbidité maternelle et une morbi-mortalité périnatale élevée dans notre milieu.

Knowledge, Attitude and Seeking Care Behaviors of Women about Leucorrhea

Background: Leucorrhea (vaginal discharge) is a condition of persistent and excessive vaginal discharge it is one of the most common chief compliant in the world. The aim of the study is to assess knowledge, attitude and seeking care behaviors of women about Leucorrhea in Al-Azhar University Hospital, in Damietta city. The sample size was 500 women their Age between 15-45 years and all women married and un married, the tools for data collections included 2 questionnaire sheets, first one included three parts. Part I: Patients' socio demographic characteristics. Part II: Questions about knowledge of women about Leucorrhoea, and Part III: Questions about Leucorrhoea seeking care behaviors. Second questionnaire sheet based on Likert scale, it included: Questions about women attitude about leucorrhea, Resultsshows that most of studied women had unsatisfactory level of knowledge. Most of them had positive attitude towed vaginal care during discharge. And most of them had satisfactory level of seeking care behavior regarding leucorrhea care. There is significant statistically relation or correlation between studied women's socio-demographic characteristics and their total score of knowledge or total score of seeking. The study recommended that improved women’s knowledge and clinical practices regarding leucorrhea care and design heath teaching programs according their needs. Continue research in this topic.

Cell phone ownership and modern contraceptive use in Burkina Faso: implications for research and interventions using mobile technology

ObjectivesWith over 420 million unique cell phone subscribers in sub-Saharan Africa, the opportunities to use personal cell phones for public health research and interventions are increasing. We assess the association between cell phone ownership and modern contraceptive use among women in Burkina Faso to understand the opportunity to track family planning indicators using cell phone surveys or provide family planning interventions remotely. Study designWe analyzed data from a cross-sectional, nationally representative population-based survey of women of reproductive age in Burkina Faso, the Performance Monitoring and Accountability 2020 Round 4, which was conducted between November 2016 and January 2017. ResultsAmong the 3215 female respondents aged 15 to 49 years, 47% reported cell phone ownership. Overall, 22% of women reported current modern contraceptive use. Women who owned a cell phone were more likely to report modern contraceptive use than those who did not (29% versus 15%). Adjusted for covariates (age, wealth, education, area of residence and marital status), the odds of reporting modern contraceptive use were 68% higher among cell phone owners compared to nonowners (odds ratio=1.68, 95% confidence interval 1.3–2.1). Method mix was substantially more diverse among those who owned cell phones compared to their counterparts. ConclusionsThe study shows that cell phone ownership is significantly associated with modern contraceptive use in Burkina Faso, even after adjusting for women's sociodemographic characteristics. These results suggest that cell phone ownership selectivity and associated biases need to be addressed when planning family planning programs or conducting surveys using cell phones. ImplicationsCell phones can be used for myriad family planning purposes, from confidential data collection to contraceptive promotion and knowledge dissemination, but ownership bias is significant. A cell-phone-based intervention or population-based survey is unlikely to reach a critical mass of the population at highest risk for unintended pregnancy.

The influence of consanguinity on reproductive health in a population of western Algeria (SABRA)

Background Inbreeding refers to unions between two people with at least one common ancestor. The practice of this type of marriage in Algeria and in the Arab-Muslim world is still commonplace. The purpose of this study is to determine the prevalence of consanguinity and to examine the impact of this practice on a few health parameters, including reproductive health: fertility, prenatal, perinatal, neonatal and postnatal mortality. Methods A prospective cohort study was conducted on 123 people randomly recruited from the Sabra Public Health Proximity Institution (EPSP). The data were collected using a pre-established questionnaire, which included questions about women's clinical, sociodemographic, and reproductive history characteristics. These data were processed by the khideux test. Results The consanguineous unions all degrees combined in our population represent a proportion of 33.33% with a slight preference for unions between first cousins. Our results also show an early marriage age and increased fertility, as well as a significant association between consanguinity and reproductive health (abortion, mortality, and morbidity). Conclusion Consanguineous marriage seems to be a predictive risk factor for certain fitness parameters, which is why setting up a health education program is fundamental to targeting prevention in terms of risk, which can have adverse effects on health, particularly the reproductive health that can weigh heavily on the family and the community.

A case series on the use of levonorgestrel 52 mg intrauterine system after organ transplant

ObjectiveTo assess the clinical performance (pregnancy and occurrence of pelvic infection) of the levonorgestrel 52-mg intrauterine system (LNG IUS) in solid organ transplant recipients. Study designWe performed a retrospective chart review of all patients seen in the Family Planning Clinic at the University of Campinas Department of Obstetrics and Gynecology from 2007 to 2017 to identify women with solid organ transplantation using immunosuppression who received an LNG IUS. Our routine clinical practice for such patients is to perform initial follow-up 40–60 days after placement and then every 12 months. We analyzed women's sociodemographic characteristics, duration of use of the LNG IUS, continuation and discontinuation reasons, and complications. ResultsOf the 23 women evaluated, 21 had kidney transplantation and 2 had liver transplantation. One woman received an LNG IUS prior to solid organ implantation (1.7 years, renal transplant). The 22 other women received the LNG IUS a median of 6.3 years (interquartile [IQ25–75] range 1.7–15 years). Seventeen (74%) women primarily used the LNG IUS for contraception; the other 6 desired the LNG IUS for contraception and heavy menstrual bleeding (HMB) treatment. We observed no cases of pregnancy or pelvic infection. Over the median follow-up time of 49.3 months (IQ25–75 15–80 months), 7 women used the same IUS for more than 60 months and 8 women received a second IUS. ConclusionsDue to the fact that no pregnancies or pelvic infections were observed in this case series, we concluded that the LNG IUS is an option for transplanted women for contraception and for HMB treatment. ImplicationsWomen at reproductive age after solid organ transplantation needs contraception for long time and the LNG IUS is a safe and effective option.

The effect of osteoporosis knowledge levels and personal characteristics on osteoporosis health beliefs in women in the menopausal period

This cross-sectional study was conducted to determine the correlation between osteoporosis knowledge and osteoporosis health beliefs of menopausal women. The study was conducted in cross-sectional design. The data were collected between 15 August and 15 November 2014. The population of the study consisted of women aged between 40 and 45 years registered in Veli Gunduz Sahin FHC in Mamak region of Ankara. The population of 40-45 year-old women in FHC is 5235 people. The study was completed with 335 women. A socio-demographic questionnaire, Osteoporosis Health Belief Scale (OHBS) and Osteoporosis Knowledge Test (OKT) were used for data collection. This study was conducted by face to face interview technique. In the study, Kr-20 reliability coefficient, Mann Whitney U Test Kruskal Wallis H test, One-Way Anova and Independent t test and PearsonÂ’s Correlation were used to investigate. The following results were obtained from this study conducted to determine the effect of osteoporosis knowledge levels on osteoporosis health beliefs in women in the menopausal period. In the study, a statistically significant difference was found between the socio-demographic characteristics of women and OHBS, OHBS and their subscales.

Women sociodemographic characteristics, lifestyle habits and the use of medications during pregnancy: a cohort study

Women sociodemographic characteristics, lifestyle habits and the use of medications during pregnancy: a cohort study

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women

ObjectiveTo contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts. Study designCross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014–June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics. ResultsAmong 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28–0.91), PROMIS GSF-derived utility (0.66–0.75), SG (0.985–1.00) or TTO (0.9990–0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. ConclusionsUnintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. ImplicationsDecision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.

Sociodemographic characteristics of women in a public hospital in Campinas who underwent legal abortion due to sexual violence: cross-sectional study.

Sexual violence is increasingly frequent worldwide. The aim here was to evaluate the sociodemographic and psychological characteristics of women who requested legal abortion, at a public healthcare service, after sufering sexual violence. Retrospective descriptive study on 131 women who underwent legal abortion at the University of Campinas between 1994 and 2014, consequent to sexual violence. The sociodemographic and psychological characteristics of women who were victims of sexual violence were evaluated from their medical records. The tests used to evaluate possible associations were the chi-square and/or Fisher's exact test. The women's mean age was 23 ± 9.2 years; 77.9% were white and 71.8% were single; 32.8% were students and 58.6% had employment outside of their homes. The majority reported that they did not know the aggressor (62.3%), but among the adolescents, 58% of the aggressors were known. The majority asked for abortion up to the 12th weeks of gestation (63.4%). Only 2.3% presented curettage complications. The psychological situation most frequently encountered was determined, in 34.4% of the cases before the abortion; and good in 32.8% after the abortion. There was greater occurrence of sexual violence among students and women who worked outside. Among the students, most of these were adolescents and had no previous sexual life. The teenagers were raped by a known aggressor.

Epidemiology of dysmenorrhea among workers in Upper Egypt; A cross sectional study

Abstract Objective To investigate the epidemiology of dysmenorrhea amongst women in two textile factories in Beni-Suef, Egypt compared to non-working controls. Study design A cross sectional study. Setting Beni-Suef, Egypt. Materials and methods The study was conducted on 554 working women in two textile factories in Beni-Suef and 1081 non-working women, matched for age and residence. A structured questionnaire was used and a team of data collectors interviewed the women. The questionnaire included questions about the socio-demographic characteristics of women, history of dysmenorrhea during the past 12 months, associating symptoms, pain relief methods, and sources of information. Results The study reported higher rates of dysmenorrhea during the past 12 months (94.6%) amongst the working women, compared to their controls (90.7%) (p Conclusions Dysmenorrhea is highly prevalent among women working in the textile factories in Beni-Suef. Further research should focus on the adaptive strategies used by women to avoid the negative impacts of dysmenorrhea. Structuring occupational health programs that handle the menstrual disorders amongst the working women, especially in the industrial settings, should be considered.

Reasons why women have induced abortions: a synthesis of findings from 14 countries

ObjectiveMany reasons inform women's reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. Study designWe examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women's sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. ResultsIn most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women's sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. ConclusionThis study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women's decisions to have abortions. ImplicationsFuture research should examine in greater depth the personal, social, economic, and health factors that inform a woman's decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women's lives.

Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014- 2015: A cross-sectional study

Human papilloma virus (HPV) is one of the major public health problems and the main causes of cervical cancer. The prevalence HPV infection in developing countries with low financial resources is high. This study aimed to determine the relative frequency of HPV genotypes and its sociodemographic characteristics in women referred to a general hospital in Tehran, Iran from 2014-2015. This cross-sectional study was performed in 400 women with Pap smear samples, referring to to a general hospital in Tehran, Iran from 2014-2015. The detection of 28 HPV genotypes was performed by using the Multiplex PCR technique. The sociodemographic survey was conducted for each HPV positive woman. HPV-positive infection was detected in 155 (38.75%) women aged 17-85 years. HPV 16 (19.1%) was the most prevalent type, followed by HPV 39 (12.5%) and HPV 18 (8.9%). The highest rate of HPV infection was observed at the age of 36 years (7.7%). The level of education and economic situation of each woman were showed most of HPV-positive women had a high school diploma (34.6%) and average economic situation (67,9%). 60.9% of these women were a housewife, and 67.3% lived in the capital . Determination of HPV genotype and risk factor related to HPV infection in each geographical region can lead to the production of effective vaccines against the HPV virus. It can also be useful for disease management and high sensitivity diagnosis of cervical intraepithelial neoplasia.

Childhood family structure and women's adult overweight risk: A longitudinal study.

The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

Prevalence of anemia and its associated factors among pregnant women receiving antenatal care at Aymiba Health Center, northwest Ethiopia.

IntroductionAnemia is a global public health problem in both developing and developed countries; ~1.62 billion people suffer from anemia, and pregnant women are the most susceptible to it. The main aim of the present study was to assess the prevalence of anemia and associated risk factors among pregnant women receiving antenatal care at Aymiba Health Center, northwest Ethiopia.Methods and materialsAn institution-based cross-sectional study was conducted at Aymiba Health Center from January to March 2015. Hemoglobin level and intestinal parasitic infections in pregnant women were assessed. Sociodemographic data were collected using a structured questionnaire. The data were entered and analyzed using the SPSS version 20. Odds ratio, p<0.05, and binary logistic regression were used to assess the association of pregnant women’s sociodemographic characteristics with their hemoglobin levels and the prevalence of anemia.ResultsThe mean with ±2 standard deviation of hemoglobin value was 12±1.3 (95% confidence interval [CI] =11.9–12.5), and the prevalence of anemia from a total of 206 study subjects was 52 (25.2%). Of this anemic group, 50 (24%) were in the second and third trimesters. Anemia was significantly associated with rural residence and intestinal parasitic infections (adjusted odds ratio [AOR] =9.17, 95% CI =2.15–40, p<0.001) and (AOR =55.091, 95% CI =6.88–441.19, p<0.001), respectively.ConclusionIn the present study, the prevalence of anemia was lower than in previous studies conducted in various countries, including Ethiopia. More studies are needed regarding the importance of regular maternal care and health education promotion programs, which have the potential to play a more significant role in health care.

Depressive Symptoms in Women with Gestational Diabetes Mellitus: The LINDA-Brazil Study.

This study aimed to assess the frequency and severity of depressive symptoms and their relationship with sociodemographic characteristics in women with gestational diabetes mellitus (GDM) who participated in the LINDA-Brazil study. We conducted cross-sectional analyses of 820 women with GDM who were receiving prenatal care in the public health system. We conducted structured interviews to obtain clinical and sociodemographic information and applied the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms. We classified the presence and severity of depressive symptoms using scores of ≥12 and ≥18, respectively. We used Poisson regression to estimate prevalence ratios (PR). Most of the women lived with a partner (88%), 50% were between 30 and 39 years old, 39% had finished high school, 39% had a family income of 1-2 minimum wages, and 47% were obese before their pregnancies. The presence of depressive symptoms was observed in 31% of the women, and severe depressive symptoms were observed in 10%; 8.3% reported self-harm intent. Lower parity and higher educational levels were associated with lower EPDS score. Depressive symptoms were common and frequently severe among women with GDM, indicating the need to consider this situation when treating such women, especially those who are more socially vulnerable. This trial is registered with NCT02327286, registered on 23 December 2014.

Access to a Skilled Birth Attendant in Bangladesh: What We Know and what Health System Framework can Teach Us

Despite some visible progress in some areas of health sectors, Bangladesh is still struggling to sustain efforts towards decreasing Maternal Mortality Rate (MMR). Evidence shows that there is lower access to skilled birth attendant in Bangladesh. Access to skilled birth attendants (SBAs) during delivery has been identified as an effective mechanism to significantly reducing MMR. Previous studies have focused on socio-demographic characteristics of women including cultural and religious dynamics with communities with limited attention to the health system. Using the World Health Organisation’s health system strengthening framework, this paper analyses how health system ‘architecture’ playing role in create fragile platform for the women to access skilled birth attendants. It draws emphasis on governance and policy, financing, health information, workforce, service delivery, medicines and commodities including infrastructure. As governance is the dominant factor and plays critical role in determining success of all facets of the health system, this paper further proposes a systematic strategy that seeks to mitigate the identified challenges. Lessons from this study are relevant to guiding policy makers in Bangladesh as well as in other resource-constrained settings in making evidencebased decisions regarding strengthening the health system to access a skill birth attendant to make birth safer for both mothers and newborns.

Tobacco consumption and spontaneous quitting at the first trimester of pregnancy

IntroductionThe purpose of this study was to examine the association between pregnant women's socio-demographic characteristics, smoking-related variables and psychological symptoms (anxiety and depression) and both tobacco consumption and spontaneous quitting at the first trimester of pregnancy. In particular, we wished to examine the contribution of depressive symptoms to tobacco consumption and spontaneous quitting, while controlling for anxiety symptoms, socio-demographic and smoking-related variables. MethodsThe sample was comprised of 901 Spanish pregnant women. Assessment included an ad hoc questionnaire with socio-demographic and tobacco consumption information, the Edinburg Postnatal Depression Scale (EPDS), and The State-Anxiety Inventory (STAI-S). Two multiple logistic regression analyses were performed, respectively to predict tobacco consumption and to predict spontaneous quitting. ResultsHaving a partner who smokes (OR=5.578), not having a college education (OR=2.803), higher scores on the EPDS (OR=1.073) and higher scores on the STAI-S (OR=1.027) increase the probability of continuing smoking. Being primiparous (OR=2.463), having a college education (OR=2.141), smoking fewer cigarettes before pregnancy (OR=1.175), and lower scores on the STAI-S (OR=1.045) increase the probability of spontaneously quitting smoking at the first trimester of pregnancy. ConclusionsDepressive symptoms were a predictor of tobacco consumption but not of spontaneous quitting; spontaneous quitting was better predicted by anxiety symptoms. These findings support recommendations that women with depressive symptoms are at risk for smoking during pregnancy and highlight that anxious symptoms should be targeted in interventions for smoking cessation during pregnancy.

Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women’s preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women’s sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

Trends and determinants of IUD use in the USA, 2002-2012.

What factors and subgroups have propelled the recent increase in intrauterine device (IUD) use in the USA? The increase in IUD use, from 1.8 to 9.5% in the USA between 2002 and 2012, was driven primarily by a marked uptake among parous women who intended to have more children. Recent data suggest an unprecedented increase in IUD use among women in the USA, yet less is known about how this increase has affected the overall proportion of women, at risk of unintended pregnancy, who are using contraception and which social and economic groups are involved. Data are drawn from the 2002 and 2011-2013 National Surveys of Family Growth. The surveys were based on cross-sectional, national samples of women of 15-44 years of age in the USA. Women responded to in-person interviews, which lasted an average of 80 min. The response rate was 80% in 2002 and 73% in 2011-2013. The sample included 7643 completed interviews in 2002 and 5601 interviews in 2011-2013. This study was limited to women at risk of unintended pregnancy, i.e. women who were sexually active in the previous 3 months (using contraception or not); it excludes women who were sterile, currently pregnant or trying to conceive. Altogether, 5181 women were at risk in the 2002 sample and 3681 were at risk in the 2012 sample. We used descriptive statistics to investigate trends in contraceptive use patterns by women's sociodemographic characteristics between 2002 and 2012 and used logistic regression to identify current predictors of IUD use in 2012. IUD use increased from 1.8% in 2002 to 9.5% in 2012 (P < 0.001). The surge was especially marked among parous women who intended to have more children (4.2% in 2002 to 19.3% in 2012; P < 0.001); it occurred to a lesser extent among parous women who did not intend to have more children (2.0-9.7% P < 0.001), suggesting that IUDs are more often used for spacing than for ending childbearing in the USA. The most important predictors of IUD use in 2012 were age, parity and intent to have children. Dissatisfaction with a previous method was also associated with IUD use (adjusted odds ratio = 1.89, P < 0.001). As with all cross-sectional studies, causal inference is limited. Data are self-reported, but the survey had a high response rate and rigorous quality controls. This study shows promising trends in the use of highly effective contraceptive methods in the USA, which may help to explain recently reported declines in unintended pregnancy in the USA. Caroline Moreau was supported by the William Robertson endowment funds. The work of Hannah Lantos and William Mosher on this analysis was supported by the Department of Population Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health. The authors declare that no conflict of interest exists.

Community Dialogue to Shift Social Norms and Enable Family Planning: An Evaluation of the Family Planning Results Initiative in Kenya.

IntroductionUse of family planning (FP) is powerfully shaped by social and gender norms, including the perceived acceptability of FP and gender roles that limit women’s autonomy and restrict communication and decision-making between men and women. This study evaluated an intervention that catalyzed ongoing community dialogues about gender and FP in Siaya county, Nyanza Province, Kenya. Specifically, we explored the changes in perceived acceptability of FP, gender norms and use of FP.MethodsWe used a mixed-method approach. Information on married men and women’s socio-demographic characteristics, pregnancy intentions, gender-related beliefs, FP knowledge, attitudes, and use were collected during county-representative, cross-sectional household surveys at baseline (2009; n11 = 650 women; n12 = 305 men) and endline (2012; n21 = 617 women; n22 = 317 men); exposure to the intervention was measured at endline. We assessed changes in FP use at endline vs. baseline, and fitted multivariate logistic regression models for FP use to examine its association with intervention exposure and explore other predictors of use at endline. In-depth, qualitative interviews with 10 couples at endline further explored enablers and barriers to FP use.ResultsAt baseline, 34.0% of women and 27.9% of men used a modern FP method compared to 51.2% and 52.2%, respectively, at endline (p<0.05). Exposure to FP dialogues was associated with 1.78 (95% CI: 1.20–2.63) times higher odds of using a modern FP method at endline for women, but this association was not significant for men. Women’s use of modern FP was significantly associated with higher spousal communication, control over own cash earnings, and FP self-efficacy. Men who reported high approval of FP were significantly more likely to use modern FP if reporting high approval of FP and more equitable gender beliefs. FP dialogues addressed persistent myths and misconceptions, normalized FP discussions, and increased its acceptability. Public examples of couples making joint FP decisions legitimized communication and decision-making with spouses about FP especially for men; women described partner support as key enabler of FP use.ConclusionsOur evaluation demonstrates that an intervention that catalyzes open dialogue about gender and FP can shift social norms, enable more equitable couple communication and decision-making and, ultimately, increase use of FP.