Use Of Long-acting Contraceptive Methods Research Articles

Literature Review: The Relationship of Knowledge and The Selection of Long-Acting Contraceptive Methods

The participation or involvement of Birth control program acceptors in selecting and using long- acting contraceptive methods (LACMs) in Indonesia still needs to be higher. The factors contributing to the minimal participation of KB acceptors in the selection or use of LACMs include the low level of knowledge among acceptors regarding the use of LACMs. The objective of the study was to explain the relationship between KB acceptors' knowledge and the selection of LACMs. This literature review used a systematic literature review of 10 articles related to the topic, which have been screened. Ten journals that had been selected say that all agree that there is a relationship between knowledge and LACMs. According to the researcher and the data obtained, it could be concluded that there was a match between the researcher's literature review results and current theory, as well as previous research results

Utilization of long-acting contraceptive methods and associated factors among female healthcare providers in South Wollo Zone hospitals, Northeast, Ethiopia. A cross-sectional multicenter study.

In Ethiopia Long-acting contraception method utilization was found low (22.7%) among female healthcare providers. However, there is no study has been conducted on the utilization long-acting contraception methods among female healthcare providers in the study area. These studies addressed important variables such as socio-demography and individual factors that might affect the use of long-acting contraceptive methods among female healthcare providers. We assessed the utilization of long-acting contraceptive methods and associated factors among healthcare providers in South Wollo Zone public hospitals, Amhara Region, Ethiopia, in 2021.An institutional-based cross-sectional study was conducted among 354 female healthcare workers in the South Wollo Zone hospitals from March to April, 2021. The participants were selected using a systematic random sampling technique. The data were collected using self-administered questionnaires entered into Epi-data version 4.1 and exported to SPSS version 25 for analysis. Bi-variable and multi-variable logistic regression analyses were performed. The adjusted odds ratio (AOR), along with a 95% confidence interval (CI), was estimated to measure the association. The significance level was set at a P- value under 0.05. The current utilization of long-acting contraceptive methods among female healthcare providers was found to be 33.6% [95%, CI 29-39)]. Discussion with a partner [AOR = 2.277,95% CI, (1.026-5.055)], method shift/switched [AOR = 4.302,95% CI, (2.285-8.102)], knowledge of the respondent [AOR = 1.887,95% CI, (1.020-3.491)], and ever birth [AOR = 15.670,95% CI, (5.065-48.49)] were significant factors toward the utilization of long-acting contraceptive methods. The current utilization of long-acting contraceptive methods was found to be low. Therefore, encouraging partner discussions through a targeted information education communication intervention strategy should be intensified to improve long-acting contraceptive methods utilization.

Utilization of long-acting contraceptive methods and associated factors among married women in Farta Woreda, Northwest Ethiopia: a community-based mixed method study

BackgroundAlthough long-acting contraceptive methods are highly effective, safe, and provide uninterrupted protection from unintended pregnancy compared to short-acting methods, evidences suggest that majority of women were relayed on short-acting contraceptive methods. Thus, this study aimed to determine the level of long-acting contraceptive methods utilization and associated factors among married women in Farta Woreda, Northwest Ethiopia, 2021.MethodsA community-based cross-sectional study supplemented with qualitative data was performed among 556 married women from March 1 to 31, 2021. A semi-structured interviewer-administered questionnaire and interview guides were used to collect the data. The data were entered into Epi data version 4.6 and analyzed by SPSS version 23 software. The association between variables was analyzed using bivariate and multivariable binary logistic regression. The level of statistically significant association was determined at a P-value < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.ResultsThe magnitude of long-acting contraceptive methods among married women in Farta Woreda was found to be 14.3% [95% CI 11.5–17.6]. Previous use of long-acting contraceptive methods (AOR = 5.83, 95% CI 3.03, 11.21), positive attitude towards long-acting contraceptives (AOR = 2.74, 95% CI 1.48, 5.07), having formal education for husbands’ (AOR = 3.05, 95% CI 1.5, 6.21), and poor wealth index (AOR = 3.39, 95% CI 1.33, 8.67) were positively associated with utilization of long-acting contraceptive methods. Moreover, fear of side effects, misconceptions, and partner opposition were the most commonly identified barriers by the qualitative data.ConclusionUtilization of long-acting contraceptives among married women in Farta Woreda was low as compared to the 2020/21 national reproductive health strategy plan to increase the long-acting reversible and permanent contraceptive methods use to 50%. Previous use of long-acting contraceptives, positive attitude towards long-acting contraceptives, husband education, and household wealth index was found to be significantly associated with long-acting contraceptive utilization. Hence, it is better to work more on changing women's attitudes and increasing husband education.

Women’s empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries

BackgroundWith a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries.MethodsWe utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25.ResultsThe study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28–1.62) and short-acting (aOR = 2.00, CI 1.79–2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09–1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09–2.17) of using long-acting methods than their counterparts with low knowledge level.ConclusionOur findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women.

DETERMINANTS OF LACMS ON KB ACCEPTORS IN THE WORK AREA OF DEPATI TUJUH HEALTH CENTER KERINCI REGENCY

Family Planning Program (KB) using contraceptives is an effort to suppress the rate of population growth. In 2020, the proportion of LACMs (13.4%) in the working area of ​​the Depati Tujuh Health Center is smaller than the proportion of non-LACMs (86.6%) meaning that this achievement has not met the target of the 2020-2024 Strategic Plan (25.11%). The purpose of the research was to determine the determinants of the use of the Long-Acting Contraceptive Methods (LACMs) on family planning acceptors in the working area of ​​the Depati Tujuh Koto Tuo Health Center, Kerinci Regency. This type of research is quantitative research with a cross-sectional research design and an analytical survey research method. The number of research samples was 117 respondents who were taken using the proportional random sampling technique. Data collection in April-May 2021. The dependent variable is the use of LACMs while the independent variables are work status, knowledge, attitudes, husband's support, and the role of health workers. Data analysis using chi-square and cox regression. The results showed that the proportion of LACMs was 17.9%. There was a relationship between working status (PR=1.33; 95% CI=1.01-1.75), knowledge (PR=1.23; 95% CI=1.06-1.42), husband's support (PR= 1.30; 95% CI=1.10-1.53), and the role of health workers (PR=1.40; 95% CI=1.17-1.67) with the use of LACMs. There was no relationship between attitude (PR=1.15; 95% CI=0.98-1.36) with the use of LACMs. The dominant factor in the use of LACMs in the working area of ​​the Depati Tujuh Health Center in 2021 is the role of health workers (RR=6.34; 95% CI=1.45-27.71).

Intention to shift from short-acting to long-acting methods of contraceptives and its associated factors in Gondar city, northwest Ethiopia: Using the theory of planned behavior.

BackgroundDespite its effectiveness, the intention, and utilization of long-acting contraceptive methods are very low in many developing countries, and the use of long-acting contraceptive methods has not kept pace with that of short-acting methods such as oral contraceptives and injectables. Therefore, this study aimed to assess the intention of using long-acting contraceptive methods and associated factors among women currently using short-acting contraceptive methods.MethodsInstitution-based cross-sectional study was conducted from March 19 to April 19, 2017. The study included 515 short-acting contraceptive users found in Gondar city who were selected from the study population using a systematic random sampling technique. A structured pre-tested questionnaire based on the theory of planned behavior was used to collect data. Both descriptive and analytical statistical procedures were used. Simple and multiple linear regression analyses were carried out. SPSS version 20 was used for the analysis of the data. Multiple linear regression was carried out to see the association between intention and sociodemographic variables, past contraception experience, attitude, subjective norm, and perceived behavioral control, and with 95% CI and a p-value of <0.05 was used to detect statistical significance.ResultsThe magnitude of intention to use long-acting contraceptive methods was 39.8%. Intention to use long-acting contraceptive methods was higher for women whose husbands were farmers when compared to women whose husbands were government employees (β =0.49, 95% CI: 0.41, 0.72). Number of children wanted (β = −0.19, 95% CI: −0.28, −0.1), attitude (β = 0.34, CI: 0.23, 0.46), subjective norm (β = 19, 95% CI: 0.12, 0.27) and perceived behavioral control (β = 0.18, 95% CI: 0.06, 0.3) were factors significantly associated with intention to use long-acting contraceptive methods.ConclusionsIntention to use long-acting contraceptive methods was low. Interventions that focus on women's attitudes toward long-acting contraceptive methods and support groups, peer education, social mobilization, and persuasive communication could promote the intention to use long-acting contraceptive methods.

Correlates of Adherence to the Dapivirine Vaginal Ring for HIV-1 Prevention.

Understanding characteristics associated with adherence to pre-exposure prophylaxis (PrEP) methods for HIV-1 prevention may assist with optimizing implementation efforts. The dapivirine vaginal ring is a novel topical PrEP delivery method. Using data from a randomized, double-blind, placebo-controlled, phase III trial of the dapivirine vaginal ring conducted in four African countries, generalized estimating equation models were used to evaluate correlates of ring adherence. Two levels of quarterly dapivirine blood plasma, and dapivirine released from returned rings defined measures of adherence for recent and cumulative use, respectively. Time on study, calendar time, primary partner knowledge that the participant was taking part in the study, and use of long-acting contraceptive methods were associated with ring adherence whereas younger age, ring worries, condom use, episodes of menstrual bleeding and vaginal washing were associated with non-adherence. These findings may be useful for recruitment into future clinical studies and dapivirine ring implementation efforts.

Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

ObjectiveTo explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. Study DesignWe conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. ResultsParticipants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. ConclusionWhen choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. ImplicationsOur data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.

Rural-Urban Differentials of Long-Acting Contraceptive Method Utilization Among Reproductive-Age Women in Amhara Region, Ethiopia: Further Analysis of the 2016 EDHS.

BackgroundThe sharp fertility drop-off in the Amhara region between 2000 and 2011 was due to an increase in modern contraceptive utilization of rural women. However, long-acting contraceptive method utilization was higher among urban than rural women. Therefore, this study aimed to assess rural–urban differentials of long-acting contraceptive method utilization and the contributing factors among reproductive-age women in the Amhara region: analysis of the 2016 EDHS.MethodsThe 2016 EDHS data were used. A weighted sample of 2188 (1675 rural and 513 urban) fecund reproductive-age women was used, and a mixed-effects logistic regression model was fitted. Multivariable logistic regression analysis at a P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to declare significant associations.ResultsThe overall long-acting contraceptive method use was 13.3% (95% CI=11.6–15.8), and it was 14.8% (95% CI=12.4–17.2) among rural and 8.3% (95% CI=4.5–12.4) among urban women. Among urban women, the odds of long-acting contraceptive method use was higher for women living with a partner (AOR=6.83; 95% CI=1.23–37.84), married women (AOR=5.21; 95% CI=1.95–13.89), women living in a male-headed household (AOR=5.29; 95% CI=1.26–22.38), and women whose partner wanted fewer children (AOR=11; 95% CI=3.46–16.2). Among rural women, the odds of long-acting contraceptive use was higher for women in the richest wealth index (AOR=6.69; 95% CI=3.02–14.83), married women (AOR=30.26; 95% CI=8.81–42.9), women with good knowledge of LACMs (AOR=1.75; 95% CI=1.25–2.46), and women who had no correct knowledge of their ovulatory cycle (AOR=1.93; 95% CI=1.16–3.19).ConclusionLong-acting contraceptive method use was lower than the national target. LACM use was 8.3% (95% CI=4.5–12.4) among urban and 14.8% (95% CI=12.4–17.2) among rural women. Overall, marital status, educational level, the total number of children, knowledge of LACMs, and correct knowledge of the ovulatory cycle were significantly associated with LACM use.

Determinants of Long-Acting Reversible Contraceptive Method Utilization among Married Women in Assosa Town in Western Ethiopia: A Case-Control Study

Background & aim: The prevalence rate of contraceptive use in Ethiopia is 42%; however, only 5% of Ethiopians use the long-acting contraceptive methods. This rate is 4.8% in Benishangul Gumuz Region in this country. Regarding this, the present study aimed to assess the determinants of long-acting reversible contraceptive method use among married women in Assosa town, Ethiopia. Methods: This community-based unmatched case-control study was conducted on 384 married women from April 26 to May 10, 2016. The study population consisted of the users (case group; n=128) and none-users (control group; n=256) of one of the long-acting methods. Multivariate logistic regression analysis was performed to identify the variables having a significant association. Results: A total of 382 women participated in this study with a response rate of 99.5%. The determinants of long-acting contraceptive use were identified as the lack of decision-making power (OR=0.29, 95% CI: 0.11-0.80), poor attitude toward such birth control methods (OR=0.13, 95% CI: 0.06-0.29), wrong expectation regarding method availability (OR=0.23, 95% CI: 0.07-0.73), low level of knowledge about long-acting contraceptive methods (OR=0.19, 95% CI: 0.08-0.47), future intention to get pregnant (OR=0.39, 95% CI: 0.18-0.82), and walking distance of more than 30 min from associated health facilities (OR=0.36, 95% CI: 0.15-0.85). Conclusion: Women’s decision-making power, knowledge and attitude regarding contraceptives, expectation regarding method availability, distance from associated facilities, and intention to get pregnant in the future were identified as the independent predictors of long-acting contraceptive method use.

Do young men's reports of hormonal and long-acting contraceptive method use match their female partner's reports?

ObjectiveTo assess whether young men's reports of hormonal and long-acting contraceptive methods match their female partner's reports. Study designWe analyzed a sample of 1096 heterosexual couples (aged 18–26) from the National Longitudinal Study of Adolescent to Adult Health Romantic Pair subsample. We compared male and female partner reports of hormonal/long-acting method use using class of method (hormonal/long-acting) rather than type (e.g., intrauterine device). Regression analyses linked men's reports of individual and relationship characteristics with alignment of reporting. ResultsSixteen percent of young men reported hormonal/long-acting method use at last sex differently than their female partner, that is, had a mismatched report. Men who had fewer lifetime sexual partners, had greater relationship satisfaction, believed their partner was monogamous and had a matched report of condom use at last sex were more likely to match their partner's report of hormonal/long-acting contraceptive use. Men living with children (from either partner) were less likely to have a matched report. Hispanic men were more likely to have a matched report than black men. ConclusionsMen are an increasingly important part of pregnancy prevention efforts. Pregnancy prevention and healthy relationship programs that incorporate communication skills may also indirectly improve young men's knowledge of their partner's contraceptive use and engagement in contraceptive decision making. ImplicationsAnalyses showed that nearly two thirds of the 16% of young men that did not accurately report their partner's hormonal/long-acting method use at last sex underreport method use. Men at increased risk of misreporting may benefit the most from targeted pregnancy prevention programs.

Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants

The use of long-acting contraceptive methods is on the rise. The aim of this study was to describe the main variables (effectiveness, tolerability, menstrual bleeding) associated with the use of subdermal contraceptive implants and to investigate the influence of age on these variables. This was a descriptive, retrospective, observational study of 221 cases of contraceptive implants inserted at a Spanish hospital between 2006 and 2015. The mean age of implant users was 31.2 ± 7.5 years. Effectiveness was 100% and good tolerability was recorded for 86.5%. Infrequent bleeding was the most common bleeding pattern, followed by amenorrhoea. Of the 221 implants inserted, 47.5% were removed. The main reasons were expiration (54.3%) and discomfort due to bleeding alterations and other adverse effects (25.7%). Nulliparity and weight gain were significantly associated with an increased probability of implant removal. This study shows that implants were highly effective, safe and well-tolerated in our population. The age of users had no influence on any of the study variables analysed.Impact StatementWhat is already known on this subject? Subdermal contraceptive implants are long-acting reversible contraceptives which are both safe and effective.What do the results of this study add? The age of users had no influence on any of the study variables analysed. Nulliparity and weight gain were significantly associated with an increased probability of implant removal.What are the implications of these findings for clinical practice and/or further research? Subdermal contraceptive implants were a safe and effective long-acting progestin contraceptive method for women from all age groups in our series because no significant age-related differences were observed for the tolerability, vaginal bleeding patterns, the effectiveness, the adverse effects or any other variables.

Women’s empowerment and short- and long-acting contraceptive method use in Egypt

Egypt is ranked one of the most gender unequal countries, and fertility is at a two-decade high of 3.5 births per woman. Women’s empowerment is a strategy used to promote contraceptive use and lower fertility, yet evidence from the Middle East is limited. This study uses 2005, 2008 and 2014 Egyptian Demographic and Health Survey data to examine recent patterns of contraceptive method choice and how women’s empowerment is associated with contraceptive method type: none, short-acting or long-acting reversible contraceptive (LARC) methods. Using a nationally representative sample of 47,545 married women in their childbearing years, multinomial logistic regression models examine women’s agency, specifically household decision-making and attitudes towards intimate partner violence and contraceptive method type. In 2014, LARC use significantly declined and short-acting method use was higher than in 2008. Women who made household decisions and were less accepting of intimate partner violence were more likely to use LARC (vs. no method). Women who made more joint decisions with spouses were more likely to use LARC (vs. no method) compared to those making individual decisions. Findings have implications for family planning programmes, and efforts involving men to increase household gender equality and lower the acceptance of intimate partner violence may promote LARC use in Egypt.

‘It would have control over me instead of me having control’: intrauterine devices and the meaning of reproductive freedom

In the past decade, enthusiasm for intrauterine devices (IUDs) has rapidly grown in the United States. Messages from health care providers, pharmaceutical advertisements, and public health campaigns extol the freedom that women can experience using a long-term, internal, highly effective contraceptive method. Little research has investigated how young women conceptualize IUDs in terms of freedom and control. We conducted a thematic analysis of in-depth, individual interviews with 37 young Black and Latina women and explored their perspectives on IUDs as promoting and constraining freedom. Participants with favorable views of the IUD (n = 13) appreciated that it would allow them to live their day-to-day lives ‘normally’ without thinking about contraception and with minimal side effects. Four current IUD users found the method empowering because they could pursue their goals without fear of unintended pregnancy. In contrast, nearly two-thirds of participants (n = 24) had predominantly negative views and focused on temporal and physical features of IUD use. They expressed concern that IUDs would impinge on their personal agency by restricting their bodily autonomy since they would not be able to discontinue use without a health care provider; found the idea of a contraceptive method inside their body for years unsettling; and/or desired flexibility over their pregnancy plans. These results highlight a contradiction between IUD promotion discourses and some women’s views about the method and their approaches to pregnancy. Discursive and clinical practices that encourage the use of long-acting contraceptive methods like IUDs over other methods may unintentionally infringe upon reproductive autonomy.

ANALYSIS OF CLINICAL EXAMPLES WHEN USING LNG-IUS

The use of long-acting contraceptive methods of the Long-Acting Reversible Contraception (LARC), to which the LNG-IUS belongs, with adequate and rational counseling can exercise not only a contraceptive, but also a preventive task in the treatment of disseminated gynecological diseases. Three clinical cases with the analysis of errors in the management of the patients are considered.

Effect of a mobile phone-based intervention on post-abortion contraception: a randomized controlled trial in Cambodia.

ObjectiveTo assess the effect of a mobile phone-based intervention (mHealth) on post-abortion contraception use by women in Cambodia.MethodsThe Mobile Technology for Improved Family Planning (MOTIF) study involved women who sought safe abortion services at four Marie Stopes International clinics in Cambodia. We randomly allocated 249 women to a mobile phone-based intervention, which comprised six automated, interactive voice messages with counsellor phone support, as required, whereas 251 women were allocated to a control group receiving standard care. The primary outcome was the self-reported use of an effective contraceptive method, 4 and 12 months after an abortion.FindingsData on effective contraceptive use were available for 431 (86%) participants at 4 months and 328 (66%) at 12 months. Significantly more women in the intervention than the control group reported effective contraception use at 4 months (64% versus 46%, respectively; relative risk, RR: 1.39; 95% confidence interval, CI: 1.17–1.66) but not at 12 months (50% versus 43%, respectively; RR: 1.16; 95% CI: 0.92–1.47). However, significantly more women in the intervention group reported using a long-acting contraceptive method at both follow-up times. There was no significant difference between the groups in repeat pregnancies or abortions at 4 or 12 months.ConclusionAdding a mobile phone-based intervention to abortion care services in Cambodia had a short-term effect on the overall use of any effective contraception, while the use of long-acting contraceptive methods lasted throughout the study period.

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence.

BackgroundUS adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health.Materials and methodsThis review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants – sexual activity, number of sexual partners, condom use, and other contraceptive use – among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent–youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use.ResultsOur review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent–youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use).ConclusionFuture efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use.

The examination of a state's reimbursement policies on the use of Long-Acting Contraceptive methods (LARC) immediately after termination: truth or consequences?

The use of LARC immediately after elective termination reduces the risk of a subsequent unintended pregnancy when compared with other forms of contraceptive use post-termination. In Delaware, insurers have adopted the policy of not reimbursing for LARC immediately after termination, which has resulted in women opting for other forms of contraception. We sought to determine if this policy affects health care costs and the subsequent pregnancy rate among women undergoing elective termination.

Changes in use of long-acting contraceptive methods in the United States, 2007–2009

To examine trends in the use of long-acting reversible contraceptive (LARC) methods-the intrauterine device (IUD) and implant--and the extent to which these methods have replaced permanent sterilization and less effective short-acting methods. We tabulated data from female survey respondents overall and by demographic subgroups. We performed t-tests of the differences in the proportions of female contraceptors using LARC in 2007 and 2009. We also looked at use of LARC, sterilization, other methods, and no method among women at risk of unintended pregnancy. In-home survey. All female respondents to the surveys. None. Current use of LARC methods in 2009, and change in use from 2007. The proportion of contraceptors using LARC increased significantly from 2.4% in 2002 to 3.7% in 2007 and 8.5% in 2009. The increase occurred among women in almost every age, race, education, and income group. Among women at risk of unintended pregnancy, increases in LARC use more than offset decreases in sterilization. LARC methods (primarily IUDs) are contributing to an increase in contraceptive effectiveness in the United States.