Unintended Pregnancy Research Articles

The changing landscape of emergency contraception.

NPs play a pivotal role in preventing unintended pregnancies in the US. This article provides a comprehensive update on emergency contraception (EC) trends, emphasizing the persistent challenge of reducing unintended pregnancies-a key health priority in the Healthy People 2030 initiative. Despite a declining trend in unintended pregnancy rates from 2010 to 2019, national goals have not been met, and healthcare disparities persist. NPs should be aware of EC methods and prescribing implications. In addition, NPs should be aware of ongoing research focusing on EC options such as levonorgestrel intrauterine devices and the promising addition of cyclooxygenase-2 inhibitors to oral EC options.

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

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

Factors Associated With Low Childbirth Self-Efficacy for Vaginal Birth in High-Risk Pregnant Women.

Low childbirth self-efficacy is a significant indicator of vaginal birth and is closely related to adverse perinatal outcomes. This study aimed to evaluate factors associated with low childbirth self-efficacy for vaginal birth in high-risk pregnant women. This descriptive study was conducted between July and December 2022 in Van, Turkey, with a total of 200 participants. Data collection instruments included a Socio-demographic Questionnaire and the Self-Efficacy Regarding Vaginal Birth (SEVB) scale. Independent t-test, chi-square test and multivariable binary logistic regression were employed for data analysis. The mean age of the participants was 27.74 ± 5.12 years, and the mean gestational age was 33.22 ± 4.28 weeks. Unplanned pregnancy status (p = 0.002), a history of caesarean section (p = 0.013), multiparity (p = 0.001), age (p < 0.01) and gestational age (p = 0.001) were associated with low childbirth self-efficacy for vaginal birth. In multivariate analysis, only age (B: 1111; 95% CI: 1038-1189; p = 0.002) and gestational age (B: 1120; 95% CI: 1034-1214; p = 0.004; and p = 0.005) were independently associated with low childbirth self-efficacy. Low childbirth self-efficacy for vaginal birth was associated with higher maternal age and gestational ages. Identifying high-risk pregnant women with low childbirth self-efficacy will improve the care process for women and their newborns.

A good start for all children: integrating early-life course medical and social care through Solid Start, the Netherlands’ nationwide action programme

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Factors Influencing Modern Family Planning Utilization and Barriers in Women of Reproductive Age in the Iringa Region, Tanzania: A Mixed-Methods Study.

Preventing unwanted pregnancies, achieving optimal child spacing, and improving quality of life are benefits of modern family planning (FP). This study aimed to assess modern FP use, identify the factors influencing its use and determine the barriers to FP use among women of reproductive age. A mixed-methods approach was conducted in the Iringa Region between March and July 2022. Conveniently, 368 women of reproductive age were included in the quantitative study, and 48 were purposively selected for the qualitative study based on reported barriers to using modern FP. Interviewer-administered questionnaires and interview guides were used for data collection. The factors of modern FP use were determined using multivariable logistic regression analysis. The p < 0.05 was considered to be significant. For qualitative data, all interviews were recorded and transcribed. Data were analyzed manually through thematic analysis. The prevalence of modern FP use was 181 (49%). Being married (adjusted odds ratio [AOR] = 5.44, 95% confidence interval [CI] = 1.77-16.73, p = .003), parity of 6 and more (AOR = 2.43, 95% CI = 1.99-5.95, p = .052), availability of modern FP methods (AOR = 1.71, 95% CI = 1.03-2.85, p = .038), and women with primary education level (AOR = 2.99, 95% CI = 1.03-3.25, p = .001), women with secondary and higher education (AOR = 3.53, 95% CI = 1.41-4.38, p = .001), were predictors for modern FP utilization. Four main themes merged (1) individual barriers, (2) hospital barriers, (3) cultural barriers, and (4) knowledge of modern FP methods. The use of modern FP increases with women's education. There is a need for the government to invest in women's education and raise awareness and knowledge of the benefits of modern FP methods.

Exploring knowledge, attitudes, and the use of modern contraceptive methods among women of reproductive age in Abuja, Nigeria

Contraceptive use in Sub-Saharan Africa, including Nigeria, is critically important for reducing unintended pregnancies, unsafe abortions, and maternal mortality. This study investigates the knowledge, attitudes, and practices regarding modern contraceptive methods among women of reproductive age (15–49 years) in Gwarinpa, Abuja, Nigeria. Using a descriptive cross-sectional design, data were collected from 206 women through a semi-structured electronic questionnaire. The study found that 71% of participants used modern contraceptive methods, with oral contraceptives being the most popular. A majority (85%) had favourable attitudes towards contraceptive use, and 88.3% were aware of the benefits of modern contraceptives. However, cultural and religious opposition (42%) posed significant barriers. Despite concerns about side effects, the study revealed that access to contraception was generally not a major issue. Health facilities played a major role in providing information, though other sources, such as the Internet and social networks, were also influential. The study suggests that targeted interventions are needed to overcome cultural barriers and improve contraceptive uptake, particularly in rural and underserved areas, contributing to better maternal health outcomes in Nigeria.

Case report: Holistic approach to pregnant adolescents

Introduction: Teenage pregnancy is a global health problem with significant impacts on physical, mental, social, and economic health. In Indonesia, the prevalence of teenage pregnancy reaches 10%, with East Java recording a higher rate (12%). Factors such as lack of sexual education, limited access to contraceptives, social stigma, and low family support exacerbate this condition. Case Report: A 14-year-old adolescent girl in Surabaya experienced an unplanned pregnancy and faced limited family support and economic problems. During pregnancy, she experienced eating disorders, anxiety, and limited access to health services. A holistic approach was taken by a midwife, nutritionist, and psychologist, including family counseling, nutrition education, and planning for delivery by caesarean section to prevent complications. Discussion: Teenage pregnancy involves biological, psychosocial, and economic factors. Family and health professional support is essential to reduce the risk of complications such as anemia, preterm labor, and mental health disorders. 5 A holistic approach includes nutrition education, psychological counseling, and family and community support to improve the quality of life of mothers and babies. Continuity of Care (COC) ensures continuity of care from pregnancy, labor, to postpartum. Conclusion: A holistic approach and COC are effective in addressing the challenges of teenage pregnancy with a focus on the following aspects keywords.

Outcome of Unintended Pregnancy and Associated Factors Among Rural Women of Reproductive Age

Background: Unintended pregnancy is well recognized reproductive health problem in developing countries like Bangladesh. It is more problematic in rural Bangladesh where illiteracy, poverty and empowerment crisis of women are common scenarios. Methods: This cross-sectional study was conducted at Shahdaulatpur village in Mainamati union of Comilla District during the period from July 2017 to June 2018. The study enrolled 317 rural women selected by systematic random sampling technique. Mixed method approach was introduced for data collection to find out the determinants and outcomes of unintended pregnancy among rural women. Focus group discussions and in-depth interviews were arranged for qualitative data and quantitative data were collected through face to face interview by pretested questionnaire. Ethical issues were considered in all aspect of the study. Results: Mean age of the rural women was 22.1 years with standard deviation of (SD) ± 3.6 years. The average monthly income of the family was 10732 ± 3228 Taka. Among the respondent more than half (55.2%) used contraceptive methods. Oral contraceptive pill (OCP) was their first choice (40.9%) and injections (19.8%) were common among the users of invasive family planning methods. Male participation in contraceptive use was only 8.8%. More than one-third (35.6%) had history of unintended pregnancy and among them majority (70.8%) had mistimed pregnancy and rest of them (29.2%) had unwanted pregnancy. The outcomes of the unintended pregnancy were mostly unplanned birth (93.4%) with (2.6%) miscarriages and termination of pregnancy by (4.4%) menstrual regulation (MR) or abortion. Age and educational status and monthly family income of rural women showed very high significant association with unintended pregnancy (p&lt;0.001). Conclusion: As the quality of future human resource depends on healthy mother and safe motherhood, improvement of family planning knowledge should be given top priority. Hence, care should be taken to improve the status of knowledge and awareness about family planning. JOPSOM 2023; 42(2): 29-35

P-04 A PATIENT WITH A GIANT ADRENAL MASS DETECTED DURING PREGNANCY

Abstract Introduction Although the frequency of adrenal incidentalomas is increasing, they are rarely detected due to lack of imaging during pregnancy. Here, we present a case of adrenal incidentaloma diagnosed during pregnancy. Clinical Case A 32-year-old female patient was diagnosed with a mass in the liver during obstetric ultrasonography performed in the 4th month of pregnancy and was referred to gastroenterology clinic for further examination, but any additional intervention could not be made because of patient’s refusion. She underwent an emergent caesarean section at 36th weeks of pregnancy. A mass approximately 15 cm in size, thought to be of adrenal origin, was detected in the retroperitoneal area posterior to the liver at the surgery. Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland, containing cystic necrotic areas, and not suppressed in fat-suppressed series (figure 1A). At initial assesment by endocrinology, the patient denied any paroxysmal or persistent hypertension, weakness, weight gain and hirsutism. Physical examination was found normal, no signs of Cushing’s syndrome was observed. Laboratory testing including 24-hour urine catecholamines, basal cortisol, dehydroepiandrosterone sulfate (DHEA-S), adrenocorticotropic hormone (ACTH) were in reference ranges. The cortisol levels were supressed following the low-dose dexamethasone test. Adrenal carcinoma was suspected based to radiological features of the lesion. FDG uptake of the mass with a SUVmax: 16.9 was reported at PET-scan (figure 1B). Laparotomy for right adrenal gland was planned, but the patient disapproved once again. She underwent to adrenalectomy 18 months later after the mass was detected. Surprisingly, the pathology resulted as adrenocortical adenoma. Ki67 labeling index was found to be 3-4%, immunohistochemical staining of tissue specimens showed that synaptophysin and chromogranin A negative ( - ), but CD56 positive (++). The patient was lost for approximately 1 year and then aplied to our clinic with another unplanned pregnancy. She is doing well at the 32nd week of her second pregnancy. Conclusion Large and non-adenomatous masses detected during pregnancy are likely to be malignant and these masses are usually known with poor-prognosis. Rarely, as seen in our patient, huge adrenal masses may exhibit a benign behavior compatible with an uncomplicated long process despite suspicious radiological imaging features.Figure 1A:Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland containing cystic necrotic areas. B:Increased uptake of FDG in the right adrenal region (SUVmax: 16.9)

Etonogestrel Subdermal Implant in Adolescents: Everything We Should Know to Conduct Proper Counseling, a Narrative Review

Background/Objectives: Comprehensive sexual education and access to contraceptives play a vital role in alleviating the economic, health, and social challenges associated with unplanned pregnancies in adolescents. According to the World Health Organization (WHO), adolescence refers to the transitional stage from childhood to adulthood, encompassing individuals aged 10 to 19. This period is critical for reproductive decision making, making it essential to closely observe patterns of sexual activity and contraceptive use among young people. Despite advancements, many adolescents still encounter significant barriers to accessing and effectively utilizing contraceptive methods. Methods: A bibliographic search was performed across three major biomedical databases: PubMed, Embase, and CINAHL. The research question was developed utilizing the PIO (Population, Intervention, Outcome) framework to guide the investigation. Results: Long-acting reversible contraceptives (LARCs), including the etonogestrel (ENG) implant, have been recognized for their ability to significantly reduce maternal and neonatal mortality and morbidity as well as decrease the incidence of unsafe abortions. Conclusions: Access to adequate counseling and effective contraceptive services can profoundly impact young people’s lives, preventing unplanned pregnancies and promoting optimal sexual and reproductive health.

Prevalence of suicidal ideation and associated factors among perinatal women living with HIV: a systematic review and meta-analysis

ABSTRACT Perinatal women living with HIV face increased susceptibility to mental health challenges, including suicidal ideation (SI). This study aimed to determine the prevalence of SI among perinatal women with HIV and identify associated factors. A systematic search was done across PubMed, Embase, Scopus, ScienceDirect, and Google Scholar. Data analysis was executed using R software. Publication bias was assessed via funnel plot and Egger's test, while heterogeneity was investigated using the I2 statistic. A total of 11 studies involving 4329 participants were included. The pooled prevalence of SI was 23.4% (95% CI: 16.3–32.4). Subgroup analysis showed higher prevalence in postnatal women (36.4%) than antenatal women (27.8%), although this difference was not statistically significant. Studies employing the Edinburgh Postnatal Depression Scale reported a higher prevalence (38.9%). Studies published between 2013–2017 showed a higher prevalence (37.6%) compared to those published between 2018–2022 (18.2%). Factors associated with SI included depression during pregnancy or postpartum, unplanned pregnancy, intimate partner violence, undisclosed HIV status, lack of social support, and recent diagnosis of sexually transmitted infections other than HIV. The high prevalence of SI emphasizes the need for mental health screening and interventions. Mental health assessments should be integrated into routine antenatal and postnatal care.

Neonatal near miss and associated factors among neonates delivered at East Gojjam zone public health hospitals, Northwest Ethiopia

Neonatal mortality and morbidity is a significant public health issue globally, particularly in low-income countries including Ethiopia. This study aimed to determine the proportion and associated factors of neonatal near misses among newborns delivered at public hospitals in the East Gojjam zone of Northwest Ethiopia. A facility-based cross-sectional study was conducted from April 21 to June 20, 2023, among 560 newborns and their mothers in randomly selected five public hospitals. Data was collected using an interviewer-administered questionnaire, medical record review, and a standard checklist with a systematic random sampling technique in each proportionally allocated hospital. The data was entered using 4.6 Epi-data software and exported to SPSS version 25. Bivariable and multivariable logistic regression analyses were performed using a backward stepwise approach method, and statistical significance was declared at a 95% confidence interval with a p-value < 0.05. A total of 552 participants responded to the study, with a response rate of 98.6%. The prevalence of neonatal near miss was 41.3% with a 95% confidence interval of 37.1–45.3. Unplanned pregnancy (AOR = 4.91, 95% CI: 2.43–9.94), current obstetric complications at birth (AOR = 5.48, 95% CI: 2.92–10.27), pregnancy-induced hypertension (AOR = 2.75, 95% CI: 1.23–6.12), premature rupture of membrane (AOR = 3.40, 95% CI: 1.71–6.78), mother referred from other healthcare facilities (AOR = 7.12, 95% CI: 4.01–12.63), delivered on-duty time (AOR = 5.04, 95% CI: 2.94–8.65), less than three ultrasound scans (AOR = 3.71, 95% CI: 2.11–6.53), and no ultrasound scan (AOR = 9.44, 95% CI: 2.55–34.99) were significantly associated with neonatal near miss. The prevalence of neonatal near-misses was 41.3% (95% CI: 37.1%, 45.3%). Unplanned pregnancy, obstetric complications at birth, ultrasound scan, premature rupture of membrane, pregnancy-induced hypertension, and mothers referred from other healthcare facilities, and delivered on-duty time were significant factors associated with neonatal near misses.

Knowledge of the ovulatory cycle and its determinants among adolescent females in Ghana

BackgroundGood knowledge about the ovulatory cycle plays an important role in reducing unwanted pregnancies and unsafe abortions among adolescent females. However, in Ghana, knowledge of the ovulatory cycle among adolescent females is not well studied. Thus, this study sought to assess adolescent females’ knowledge regarding the ovulatory cycle and its determinants in Ghana.MethodsThis study used data from the 2022 Ghana Demographic and Health Survey. It comprised a sample of 2,835 adolescent females (Mean age = 16.9, standard deviation ± 1.42). Multilevel multivariable logistic regression was used to analyse the determinants of ovulatory cycle knowledge among Ghanaian adolescent females. Four models were fitted incorporating individual and community levels. All associations were considered statistically significant at 95% confidence level in the fixed effect results. The random effects were quantified in terms of Intra-Class Correlation (ICC) and Primary Sampling Units (PSUs) variance.ResultsThe level of knowledge about the ovulatory cycle was 24.6% (95% CI=23.0-26.0%). Adolescent females with secondary/higher education (AOR = 2.36; 95% CI = 1.26–4.43), at least one child (AOR = 2.01; 95% CI = 1.40–2.89), used traditional contraceptives such as rhythm, withdrawal methods (AOR = 2.26; 95% CI = 1.52–3.67), menstruated in the last six weeks (AOR = 2.01; 95% CI = 1.08–3.57) and media exposure to family planning messages (AOR = 1.89; 95% CI = 1.52–2.35) had higher odds of having good knowledge about the ovulation cycle. At the community level, respondents who resided in communities with high literacy levels had higher odds of having good knowledge of the ovulatory cycle (AOR = 1.62; 95% CI = 1.14–2.31).ConclusionsKnowledge of the ovulatory cycle among adolescent females in Ghana is low and this may be contributing to unwanted pregnancies. Public health interventions on the ovulatory cycle should target adolescent females who have lower levels of education and those who do not use contraceptives.

Geographic distribution and demographic factors associated with use of a long-acting reversible contraceptive (LARC) in Ethiopia.

Increasing access to and utilization of long-acting reversible contraceptives (LARC) can prevent unintended pregnancies and reduce unmet need for family planning in Ethiopia However, LARC uptake lags behind less effective contraceptive methods. This study aimed to analyze the geographical distribution and demographic factors associated to LARC uptake. The 2019 Performance Monitoring For Action Ethiopia (PMA Ethiopia) survey data was used. Spatial autocorrelation was examined using Global Moran's I and Local Indicators of Spatial Association (LISA). Bivariate Moran's I and bivariate LISA (BiLISA), Spatial lag, and spatial error regression analyses were performed to assess the spatial correlation and association between LARC uptake and demographic factors. LARC uptake was 8% among the study population, with Afar and Somali regions having the lowest uptake. There was a statistically significant positive spatial autocorrelation for LARC uptake (Moran's I= 0.308, p<0.001). Additionally, an inverse correlation was observed between LARC uptake and the percentage of Muslims, rural population, no formal education, and low wealth quantile. The spatial lag model indicated that zones with higher Muslim populations and those with higher percentages of population with no formal education had lower LARC uptake. To expand access to LARC, the Ethiopian government, policymakers, and non-governmental organizations might implement programs targeting low-uptake areas (Afar and Somali regions). Muslim religious leaders could play an important role in promoting acceptance of LARC among their members. Tailored health education programs should be developed for Muslim populations and those with no formal education to enhance awareness and acceptance of LARC.

Motivations for Abortion or Continuation ofan Unwanted Pregnancy: A Scoping Review of the Global Literature.

The aim of this scoping review was to provide an overview of recent studies in peer reviewed journals investigating self-reported motivations to have an abortion or to continue an unwanted pregnancy in different countries and settings, including both qualitative and quantitative results. We searched for English language publications published between 2008 and 2023 indexed in four scientific databases. We included studies if they captured people's own motivations for abortion and/ or for continuing an unwanted pregnancy. Of the included 19 studies, all focused on abortion, and four also included motivations to carry an initially unwanted pregnancy to term. Motivations for abortion often related to family planning (e.g., complete family, no desire for children, not the right time), the relationship with the person involved in the pregnancy, and life or material circumstances (such as financial resources, housing or future plans), and sometimes with stigma, shame, or expected negative reactions. Motivations to continue an unwanted pregnancy were having a supportive partner and personal beliefs about the pregnancy. Despite different settings, different methods, and methodological limitations, studies showed similar multifactorial and interrelated motivations in decision making around unwanted pregnancies. This research showed that in different places throughout the world multiple interrelated motivations play a role in a decision to have an abortion or to continue an unwanted pregnancy. The findings mainly provide insight into retrospective explanatory accounts, which may be biased because respondents may feel the need to justify their choice. Future research should discontinue asking peopleto rationalize unwanted pregnancy decisions.

Agency in young people’s unsafe abortion trajectories in Papua New Guinea

Unsafe abortion is a preventable contributor to maternal morbidity and mortality, particularly for young unmarried women in low resource settings. In Papua New Guinea, abortion is legally restricted and highly stigmatised, limiting access to safe abortion and post-abortion care, resulting in unsafe abortion. This paper explores young people’s lived experiences and agency in relation to unsafe abortion. We undertook qualitative research between 2019 and 2021 in rural, peri-urban and urban settings in Papua New Guinea and found that agency was enacted or constrained at different points along their abortion trajectories. Findings demonstrate the ways in which abortion was negotiated within (and outside of) young people’s intimate relationships, while highlighting the social, temporal and emotional dimensions of this agency. By considering what agency means, and the different forms it takes, it is possible to identify critical support mechanisms and socio-structural changes that could support young people at different stages of their abortion trajectories, from accessing modern contraceptives to prevent unintended pregnancy, to seeking support for safe abortion. Moving forward, we call for greater attentiveness to young people’s everyday lived experiences of sexual and reproductive health as a basis for understanding how to support them to safely prevent and manage unintended pregnancy.

Contraceptive use and pregnancy in cystic fibrosis: Survey findings from 10 cystic fibrosis centers.

Reproductive life planning is key, now that people with cystic fibrosis (pwCF) may live into their 60s. This study explores contraceptive use, pregnancy trends, and whether concomitant cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy reduces contraceptive effectiveness. Females with CF aged 18-45 years from 10 U.S. CF centers completed a self-administered web-based questionnaire. Pregnancy rates were calculated by linear-mixed models with a logit link detected associations with contraception and modulator use. A total of 561 pwCF (median age of 29 years [IQR 24.9-35.8] years) completed the survey. Most participants (n = 499, 89%) used modulators, and almost all (n = 555, 99%) used contraception. Condoms (n = 448, 80%) and oral contraceptive pills (n = 363, 65%) were the most prevalent methods used. One-third (n = 189, 34%) reported ever being pregnant. Of those reporting pregnancies (n = 319), about half (n = 151, 48%) were unintended. Pregnancy was significantly associated with age (20-29 years or 30-39 years), partner cohabitation (aOR 21.5, 95% CI 5.1 to 91.1), and non-hormonal contraceptive use (aOR 5.1, 95% CI 1.1 to23.0). Among pwCF cohabitating with a partner, modulator use was positively associated with pregnancy (OR 1.8, 95% CI 1.3 to 2.6) (p = 0.0008). Despite almost universal contraceptive use, unintended pregnancy among pwCF is common. Likelihood of pregnancy is increased among CFTR modulator users who are partnered, although CFTR modulators themselves do not appear to decrease hormonal contraceptive effectiveness. Patient education about contraception is an increasingly critical aspect of CF care.

Prevalence and Associated Factors of Long-Acting and Permanent Methods (LAPMs) of Family Planning Among Women of Reproductive Age: A Systematic Review and Meta-Analysis.

To examine the prevalence and associated factors of long-acting and permanent methods of family planning (LAPMs) in women of reproductive age. LAPMs reduce the rate of unwanted pregnancy. Understanding the prevalence and associated factors of LAPMs is the key to preventing unwanted pregnancies. In this systematic review and meta-analysis study, data from seven studies involving 1187 women, conducted between 2013 and 2022, were analysed by searching EBSCOhost, Google Scholar, Pubmed, Science Direct, Scopus, Web of Science, and ProQuest databases. PRISMA 2020 guidelines were followed in this study. Joanna Briggs Institute Critical Evaluation tools were used to evaluate the quality of the studies. The prevalence of LAPMs in women of reproductive age was 27.3%. Women with secondary education or higher, with three or more children, and who do not want to have more children use long-acting and permanent methods more. Our results can guide the development of strategies to be applied to prevent unintended pregnancies and to increase the use of LAPMs in women of reproductive age.

Factors associated with adolescent pregnancy among girls aged between 15 and 19 years in Muhanga district, Rwanda

BackgroundAdolescent pregnancy, also known as teenage pregnancy, is an unwanted pregnancy affecting girls aged 15–19 years. With a global prevalence of 25%, Africa has 18.8% of female adolescents become pregnant, preventing them from a better standard of living, such as good education and parental care, and adolescent pregnancy, which poses health risks, educational and career disruptions, financial strain, and lower academic achievement, while also increasing public costs and social service demand. This study aimed to determine the prevalence and factors associated with adolescent pregnancy among girls aged 15–19 years in Muhanga district, Rwanda.MethodsThe study involved 392 female adolescents aged 15–19 years in Muhanga district, Rwanda. The participants were selected through a multistage sampling method, and the study ensured voluntary participation whereby the assent and consent forms were signed. Data were collected through questionnaires and analyzed via STATA v.18, and statistical analysis, including chi-square tests and multivariate logistic regression, was used to control for confounders. Ethical approval was obtained from Mount Kenya University and Muhanga district administration.ResultsThe study reported an adolescent pregnancy rate of 10.7% (95% CI: 7.7–13.7). Adolescents financially supported by others (not their parents or guardians) had higher odds of having pregnancy (AOR = 3.9, 95% CI: 1.431–10.467, p < 0.01). Those not in school and primary school showed higher odds of having a pregnancy (AOR = 23.76, 95% CI: 6.833–82.630, p < 0.001) and (AOR = 25.60, 95% CI: 7.224–90.741, p < 0.001), respectively, compared to those in secondary school. Receiving SRH education was associated with lower odds of having a pregnancy (AOR = 0.2, 95% CI: 0.80–0.514, p < 0.001). Experiencing peer pressure increased the odds of having a pregnancy (AOR = 4.12, 95% CI: 1.521–11.131, p < 0.01).ConclusionsThis study highlights a significant adolescent pregnancy rate in Muhanga district, emphasizing the need for targeted interventions. Addressing educational gaps, improving financial support systems, and enhancing sexual and reproductive health education are crucial steps. Policymakers should focus on these areas to reduce adolescent pregnancies and improve outcomes for young girls. Future efforts should also include strategies to counteract peer pressure and integrate comprehensive support programs.

Factors associated with the discontinuation of modern contraceptive methods among lactating women in nine West African high-fertility countries: findings of the most recent demographic and health surveys

IntroductionContraception discontinuation is a concern, especially if it occurs in breastfeeding women, thereby exposing them to a high risk of close and unwanted pregnancies. Our study aimed to measure the prevalence and identify the individual and community-level factors associated with the discontinuation of modern contraceptives among breastfeeding women.MethodsThis was a secondary analysis of retrospective data of the most recent Demographic and Health Surveys (DHS) data from nine high-fertility rate countries, conducted mostly between 2018–2021. We reported weighted frequencies of modern contraceptives discontinuation (binary variable, coded 1 and 0). The independent variables included individual-level variables, including sociodemographic characteristics, female reproduction and family planning history, the women and their households exposure to media, and community-level ones such as place of residence (urban and rural) and country. Multilevel-modified Poisson regression was used to identify associated factors at the 5% threshold.ResultsThe overall prevalence of modern contraceptives discontinuation was 13.1% among 5,599 lactating mothers, with wide variations between countries (prevalence ranging from 8.2% in Sierra Leone to 33.6% in Guinea). Women were more likely to discontinue contraception if they were the head of the household (adjusted prevalence ratio (aPR) = 1.71; 95% CI [1.17–2.50]; p = 0.006). In addition, compared to implant users, women using pills (aPR = 3.06; 95% CI [2.24–4.16]; p < 0.001), those using injectables (aPR = 2.80; 95% CI [2.16–3.62]; p < 0.001), and women whose partners used condoms (aPR = 2.30; 95% CI [1.47–3.59]; p < 0.001) were more likely to discontinue contraception. Moreover, women who were not sexually active (aPR = 2.11; 95% CI [1.75–2.54]; p < 0.001) and those who wanted children within two subsequent years (aPR = 1.84; 95% CI [1.36–2.48]; p < 0.001) were more likely to discontinue contraception. Finally, method discontinuation varied by country, with women in Gambia, Guinea, Mauritania, and Mali more likely to discontinue a modern contraceptive method than those living in Burkina Faso.ConclusionTo improve the retention of women using contraceptive, high-fertility rate countries need to focus on contraceptive education, communication about side effects, dissemination of family planning messages through the media, and regular monitoring of women taking contraceptives.