Use Of Long-acting Contraception Research Articles

Predictors of long-acting contraceptive utilization hot spots in Ethiopia: using geographical weighted regression analysis.

The use of long-acting contraceptives is a common health challenge in Ethiopia. Therefore, the current study aimed to assess the determinants of using long-acting contraceptive hot spots in Ethiopia using data from the Ethiopian Mini Demographic and Health Survey for 2019. This study used data from the Ethiopia Mini Demographic and Health Survey 2019 and included a total weighted sample of 8,885 women in the analysis. The geographical variation of long-acting contraceptive usage was initially observed using hot spot analysis. Arc GIS version 10.7 was used for geographically weighted regression. Ordinarily, least squares regression was performed to identify predictors that explain the geographical variation in the use of long-acting contraceptives. Geographic weighted regression was used to predict the hot spot area of long-acting contraceptive methods. The overall prevalence of long-acting contraceptive utilization use was 6.9% (95% confidence interval: 6.4-7.45). Most of the statistically significant hot spots for long-acting contraceptives were found in lactated areas of the Oromia part of Amhara and Dire Dawa. Primary education, followers of the Muslim religion, marital status, and women with >4 children were the determinants of spatial variation use of hot spot areas for long-acting contraceptive methods. A detailed map of long-acting contraceptive use hot spots and their determinants will enable decisions to target their sociodemographic-related predictors of women.

Health care and contraceptive decision-making autonomy and use of female sterilisation among married women in Malawi.

Female sterilisation is the most common contraceptive method used globally. The use of female sterilisation is disproportionately low in sub-Sahara Africa (SSA) at just 1%. Nonetheless, the prevalence of sterilisation among married women in Malawi is quite high at about 11%. While a few recent studies in SSA have examined the relationship between women's decision-making autonomy and use of long-acting contraceptives, very few have investigated whether different dimensions of decision-making autonomy predict the use of female sterilisation differently. The objective of this study was therefore to examine the relationship between health care and contraceptive decision-making autonomy and the use of female sterilisation in Malawi. The study relied on secondary data from the 2015-16 Malawi Demographic and Health Survey. The sample comprised 9,164 married women in Malawi that were using a modern contraceptive. Multinomial logistic regression analysis was used to examine the association between health care and contraceptive decision-making autonomy and the use of female sterilisation, controlling for key socio-demographic characteristics. The study revealed that the percentage of married women that made health care and contraceptive decisions independently was quite low. The main finding of this study was that contraceptive decision-making autonomy increased the relative likelihood of using female sterilisation while health care autonomy was associated with a lower likelihood of being sterilized. The socio- demographic characteristics that significantly predicted the use of female sterilisation included age, place of residence, household wealth and the number of children a woman had. This study demonstrates that health care and contraceptive decision making have different effects on the use of female sterilisation among married women in Malawi. Specifically, women with autonomy in health care decision making had a relatively lower likelihood of using female sterilisation while those with contraceptive decision-making autonomy had a higher likelihood of using female sterilisation. This suggests that intervention aimed at increasing the uptake of female sterilisation in Malawi need to focus on empowering women in the contraceptive decision-making domain.

ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study.

In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.

Determinants of postpartum long-acting reversible contraceptives in the extended postpartum period in Shashago district, Central Ethiopia: a cross-sectional study conducted in the community

BackgroundWomen who fail to initiate contraceptive use within the first year after childbirth face an increased likelihood of experiencing unintended pregnancies in close succession. In regions with limited resources, the use of postpartum contraceptives, particularly long-acting reversible contraceptives, remains notably low. Consequently, this study sought to assess the prevalence and determinants of postpartum long acting reversible contraceptives in the extended postpartum period in the Shashago district, Central Ethiopia.MethodsThis study employed a community-based cross-sectional design, conducted between March 1, 2021, and April 15, 2021, involving a total of 617 women of reproductive age. The selection of study participants was performed using a multistage stratified sampling technique. Data collection was carried out through the use of a structured interviewer-administered questionnaire. Subsequently, the collected data were entered into Epi-data version 3.1 and exported to SPSS version 25 for further analysis. Bivariate and multivariable logistic regression analyses were conducted, and statistical significance was determined using a P value of 0.05, along with adjusted odds ratios (AORs) and their corresponding 95% confidence interval (CI).ResultsA total of 224(36.3%) women used long-acting contraceptives after giving birth. Among these women, 31.1% used Implanon, while 5.2% used an intrauterine device (IUD). Factors significantly associated with the use of long-acting contraceptives after childbirth included age 25–29 years (AOR: 1.8, 95% CI: 1.1-3.0), age ≥ 35 years (AOR = 8.7, 95% CI: 3.6–21.5), primary education (AOR = 3.3, 95% CI: 1.6–6.7), secondary education and above (AOR = 3.5, 95% CI: 1.5–8.3), and history of abortion (AOR = 2.7, 95% CI: 1.3–5.4). Additionally, having good knowledge of long-acting contraceptives after childbirth (AOR: 2.4, 95% CI: 1.5–3.9) was significantly associated with their use.ConclusionThis study revealed that a small number of women opt for long-acting contraceptives after childbirth, with Implanon being more popular than IUDs. Factors such as age, education level, abortion history, pregnancy counseling, and knowledge about long-acting contraceptives were linked to their usage. Integrating contraceptive counseling into routine antenatal and postnatal care is essential for ensuring access to postpartum contraception. Tailored interventions based on age and education level could also help promote long-acting contraceptive use. More research and targeted interventions are needed to overcome these barriers and improve access to these methods for postpartum women.

P768 Appropriateness of small molecule agents for patients with IBD of childbearing age – a RAND appropriateness panel

Abstract Background Many women of childbearing age with IBD require advanced therapies. While biologics are largely low risk during pregnancy, the novel small molecules Tofacitinib, Filgotinib, Upadacitinib and Ozanimod (TFUO) have shown concerning reproductive results in animal studies. Therefore, their use in women of childbearing age needs careful consideration. Methods We convened a RAND appropriateness panel of 6 gastroenterologists, 2 IBD nurses, 1 IBD pharmacist and 3 expert patients. Following a literature review, 13 statements were drafted and voted upon in 2 rounds. Results 13 statements were voted on in two rounds. All statements were deemed appropriate after one round of revisions. Here we present a selection of key statements: 1. Women with IBD of childbearing age who wish to commence therapy with TFUO, need to use effective contraception. Counselling regarding the risk of TFUO in unplanned pregnancies should be provided. 2. For women using contraception while on JAK therapy, we suggest the preferred use of progesterone-only or non-hormonal long-acting contraception over combined oestrogen-progesterone formulations to reduce the risk of venous thromboembolism. 3. TFUO are contraindicated during pregnancy due to serious teratogenicity concerns. 4. Regardless of physical wash out periods, we recommend that women currently receiving TFUO cease therapy with enough time to establish clinical remission ideally for at least 3 months prior to conception. This window allows to safely establish whether the alternative (or no) therapy can maintain remission. 5. Therapies other than TFUO should be considered as first line therapy in women with IBD of childbearing age, with the exception of select individual social or medical circumstances, or women who have completed family planning and agree to use effective contraception. 6. TFUO may be appropriate choices for women of childbearing age after failure of, intolerance of or contraindications to one biological agent licensed for IBD. 7. In women who wish to have children in the future, a minimum treatment period for TFUO should be considered. Where the wish to start a family is less than 1 year in the future it is recommended to consider agents other than TFUO. 8. TFUO are contraindicated during breastfeeding. 9. If a woman conceives while taking TFUO, the medication should be ceased, she should receive counselling about potential known and unknown maternofoetal complications, and alternative IBD therapy may be commenced if required. Conclusion We developed 13 practice statements derived from a RAND appropriateness panel of clinicians and patients to guide decision making for women of childbearing age regarding TFUO small molecules therapies for IBD.

Abortions Outcomes of People with Sickle Cell Disease

Introduction People with sickle cell disease (SCD) are at risk for SCD-associated complications with routine procedures. Whether people with SCD seeking abortions require special consideration is unknown. At our center, 28% of surveyed women with SCD reported having had an abortion, and 32% believed abortion to be unsafe for people with SCD. This cohort also reported low rates of long-acting contraception use. Information about abortion outcomes among people with SCD is important to inform care and minimize unnecessary delays, particularly as people in the U.S. face barriers to abortion access. The purpose of this study is to describe a single-center experience with abortions for people with SCD. Methods This single-center JHU IRB-approved study included people with SCD ages 18-55 years who had a medication or procedural abortion between April 1, 2013, and December 31, 2022. Systematic data collected from electronic health records included patient demographics, pregnancy information (e.g., gravidity), SCD characteristics (e.g., genotype), healthcare utilization, and abortion information, including the type of abortion, anesthesia and steroid use, pre- and post-abortion transfusion use, and the number and type of post-abortion complications. These complications included SCD complications (e.g., pain crises and acute chest syndrome) and non-SCD complications (e.g., infections and hemorrhage). SAS was used to generate descriptive statistics. Results There were 19 subjects with 27 abortions between 2013 and 2022. The median age at the time of abortion care was 24 years (IQR: 20-29). About half of the subjects with known genotypes (10/18, 56%) had HbSS/HbSβ0 thalassemia and accounted for an equal proportion of abortions (15/27, 56%). The nearest median hemoglobin level to abortion was 8.9 g/dL (IQR: 8.1-10.6). In 15/27 (56%) abortions, the subject was on disease-modifying therapy (hydroxyurea or chronic transfusions) before pregnancy, and two subjects stopped taking hydroxyurea during pregnancy. Six subjects who had 11/27 (41%) abortions in the cohort had ≥ five hospitalizations for pain crises in the year before abortion. Most abortions (24/27, 96%) were managed with a &amp;lt;30-minute dilation and curettage or dilation and evacuation. The median gestational age at the time of abortion care was 10 weeks (IQR: 8-14). Among procedural abortions (N=24), seven were treated with steroids. The rates of 7-day and 30-day complications for procedural abortions were 6/24 (26%) and 10/24 (42%), respectively, of which a majority were SCD pain crises (Table 1). Baseline pain crisis frequency was six times higher in subjects with post-abortion pain crises compared to those without. There was no difference in pain crisis after abortion between those with steroid use (4/7, 56%) compared to those without steroid use (8/16, 50%). Conclusions In this cohort, most abortions were procedural and required brief anesthesia. This does not routinely require prophylactic transfusion. Steroids, a risk factor for pain crises, were commonly used in procedural abortions. The high rate of baseline pain crises in this cohort confounded the association between abortions and post-abortion pain crises. People with HbSS/HbSβ0 thalassemia were underrepresented in our cohort when compared to the general SCD population. This may reflect differences in pregnancy rates or abortion decision-making within this group. Limitations include that this study is single-center and did not capture abortions performed outside our healthcare system. Larger studies are needed to define management and inform abortion care for people with SCD.

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

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

Применение современного пролонгированного гормонального контрацептива: актуальность, востребованность и опасения. Развенчание мифов

Введение. Современными методами предохранения от нежелательной беременности в России пользуются 68% женщин, что выше среднемирового показателя (57%) и сопоставимо с показателями развитых стран (62%). Также исследователи констатируют, что в РФ достаточно высокий показатель использования современных обратимых средств контрацепции (46%), из которых 30% составляют комбинированные оральные контрацептивы, а на долю внутриматочных систем (и медьсодержащих, и левоноргестрел-содержащих) приходится 14%. Прочим гормональным рилизинг-системам пролонгированного действия с различными способами введения отдают предпочтение лишь 1% заявляющих о желании использовать тот или иной метод гормональной контрацепции. По мнению исследователей, столь малый процент связан с невысоким уровнем информированности пациентов о существующих передовых методах контрацепции – гормональных рилизинг-системах. При этом современные исследования не позволяют усомниться в том, что эффективность гормональных рилизинг-систем достигает самого высокого уровня не только за счет действующего компонента, но и за счет приверженности методу, исключения фактора «невынужденной ошибки пользователя», т. е. в связи с отсутствием необходимости контроля за применением со стороны женщины. Результаты. В статье приведены доводы в пользу пролонгированной гормональной контрацепции, а также данные, свидетельствующие о преимуществах применения подкожного этоногестрел-содержащего одностержневого имплантата – обратимого высокоэффективного метода контрацепции длительного действия. Представлены данные о сложностях, возникающих при приобретении практики установки, извлечения имплантата, и мифах, бытующих в том числе и в медицинской среде в отношении применения подкожного этоногестрел-содержащего одностержневого имплантата у различных групп пациентов. Background. 68% of women in Russia use modern methods of preventing unintended pregnancy, which is higher than the world average (57%) and comparable to indicators in developed countries (62%). Researchers also state that in the Russian Federation there is a fairly high rate of use of modern reversible contraceptives (46%), of which 30% are combined oral contraceptives, and intrauterine systems (both copper-containing and levonorgestrel-containing) account for 14%. Other long-acting hormonal releasing systems with various methods of administration are preferred by only 1% of those declaring a desire to use one or another method of hormonal contraception. According to researchers, such a small percentage is associated with a low level of patient awareness of existing advanced methods of contraception - hormonal releasing systems. At the same time, modern research leaves no doubt that the effectiveness of hormonal releasing systems reaches the highest level not only due to the active component, but also due to adherence to the method, eliminating the factor of ″unforced user error″, i.e. due to the lack of need for control over use by the woman. Results. The article presents arguments in favor of long-acting hormonal contraception, as well as data demonstrating the benefits of using a subcutaneous etonogestrel-containing single-rod implant – highly effective long-acting reversible contraception (LARC). Data are presented on the difficulties that arise when acquiring the practice of installing and removing an implant, and the myths that exist, including in the medical environment, regarding the use of a subcutaneous etonogestrel-containing single-rod implant in various groups of patients.

Utilization of Long-Acting Reversible Contraceptive (LARC) and its determinants in multiparous women in a Tertiary Hospital

Background: The world population of 7.8 billion with multiparous women are encumbered with unmet need for contraceptives. Long-acting reversible contraceptive (LARC) is one of the interventional tool in curtailing the myriads of complications associated with unwanted pregnancies and its sequalae. Objective: This study aimed to determine the pattern of long-acting contraceptive use and sociodemographic characteristics of the multiparous users of family planning services in a teaching hospital in Lagos. Methodology: A retrospective comparative cross-sectional study of 1296 parous women who had sought contraceptive services at the Family Planning Clinic of LASUTH between January 1, 2019 to December 31, 2021 and 1,177 women opted for LARC during the period under review were identified from the clinic register. Their case notes were retrieved and data on clients’ socio-demographic characteristics, and uptake of Long acting reversible contraceptives was extracted using a standardized pro forma Data analysis was done using relevant descriptive and inferential statistics with level of statistical significance set at p &lt;0.05. Results: A total of 1296 multiparous women opted to use a form of contraception in the study, within an age range of 18–52years and with mean age of 37.5± 7.1 years. Majority (92.6%) having parity of 2 or more with a greater proportion (67.3%) having at least a tertiary level of education. A large proportion of the women (45.3%) preferred IUCD which was closely followed by implant (45.2%) while the least used method was the IUS (0.2%). There is an association between uptake of LARC and number of years since last pregnancy, parity, desire for more children and previous use of LARC. Conclusion: Contraceptive is of a necessity in reducing poverty and empowering women to improve women's and their children's lives. Educating and implementing of policies that would meet the unmet need for contraceptives.

Immediate postpartum intrauterine contraceptive device use among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, Ethiopia: Intentions and barriers.

This study aimed to assess the intention and barriers to the use of immediate postpartum intrauterine contraceptive devices among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia. A facility-based cross-sectional study design was conducted from 1 September to 30 October 2020 by using a systematic sampling technique. Data were entered into Epi-data 3.1 version and exported to Statistical Package for Social Sciences 23 for analysis. A binary logistic regression analysis was done to sort candidate variables for multiple logistic regression, and multivariable logistic regressions were done to identify factors associated with the intention to postpartum intrauterine contraceptive devices. Factors associated with intention to use immediate postpartum intrauterine contraceptive device declared at 95% confidence interval. This study finding showed that 37.6% (95% confidence interval (31.5, 43.7)) of pregnant women intended to use the immediate postpartum intrauterine contraceptive device after their delivery. The main reason women refused to use immediate postpartum intrauterine contraceptive devices was being satisfied with other methods to use after they gave birth (27.5 %), the concern of health harm (22.2%), and the fear of impaired future fertility (16.4%). The identified factors that were statically significant with the intention to use immediate postpartum intrauterine contraceptive devices among pregnant women were included: attended secondary education (adjusted odd ratio = 2.36; p = 0.03; 95% confidence interval (1.089, 5.128)), attended college and above (adjusted odd ratio = 2.99; p = 0.020; 95% confidence interval (1.189, 7.541)), have high knowledge on immediate postpartum intrauterine contraceptive devices ((adjusted odd ratio = 2.10; p = 0.006; 95% confidence interval (1.236, 3.564)), the previous history of LACM used (adjusted odd ratio = 6.85; p = 0.0001; 95% confidence interval (3.560, 10.021)), parity >4 (adjusted odd ratio = 1.86; p = 0.043; 95% confidence interval (3.99, 8.703)). The intention of pregnant women to use after they gave birth in the study area was low. Maternal educational level, high knowledge, history of previous long-acting contraceptive methods use, and parity were significantly associated with pregnant women's intention to use immediate postpartum intrauterine contraceptive devices. Healthcare providers should focus on delivering crucial information about immediate postpartum intrauterine contraceptive device benefits for postpartum women, particularly concerning reducing barriers during antenatal care follow-up as they plan to use it after their delivery.

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.

Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data

AimIncreasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh.MethodsIn this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors.ResultsNearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities.ConclusionThe proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus.

BackgroundWomen with human immunodeficiency virus (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time.MethodsWe examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cisgender women aged 18–45 years in care at Vanderbilt’s human immunodeficiency virus (HIV) clinic in Nashville, Tennessee, from 1998 through 2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy.ResultsOf the 737 women included, median age at clinic entry was 31 years; average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percentage of time on any contraception use among nonpregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted hazard ratio [aHR], 0.52 [95% CI {confidence interval}, .29–.93]) and increased likelihood of pregnancy (aHR, 1.77 [95% CI, .97–3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy.ConclusionsMost WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.

Impact of Coronavirus disease 2019 (COVID-19) on contraception use in 2020 and up until the end of April 2021 in France

ObjectivesTo assess the impact of the COVID-19 pandemic on the use of reimbursed contraceptives in France after 15 months of the pandemic, according to age-group and updating previous data only pertaining to the first lockdown (2 months).Study designWe conducted a national register-based study by extracting all reimbursements of oral contraceptives (OC), emergency contraception (EC), intrauterine devices (IUD), and implants from the French National Health Insurance database (SNDS), which includes and covers 99.5% of the French population, in 2018, 2019, 2020 and from January 1, 2021 to April30, 2021. We calculated the expected use of contraceptives in 2020 and 2021 in the absence of the pandemic, based on 2018 and 2019 usage and taking annual trends into account. We assessed the difference between observed and expected dispensing rates by contraceptive type and by age-group (≤18 years old, 18< age ≤25, 25< age ≤35, >35).ResultsDispensing of all contraceptives decreased compared to expect dispensing numbers: −2.0% for OC, −5.3% for EC, −9.5% for LNG-IUS, −8.6% for C-IUD, and −16.4% for implant. This decrease in the dispensing of contraceptives was observed in all age-groups, but mainly concerned women under the age of 18 years (−22% for OC, −10% for EC, −37.2% for LNG-IUS, −36.4% for C-IUD, −26.4% for implant) and those aged 18 to 25 (−5.1% for OC, −11.9% for EC, −18.1% for LNG-IUS, −15.9% for C-IUD, −17.6% for implants).ConclusionsOur study showed that the dispensing of contraceptives in France was markedly impacted by the COVID-19 pandemic. Prescriptions for long-acting contraceptive use and women under the age of 25 years were the most substantially impacted. Ensuring access to contraceptive methods during health emergencies must be a public health policy priority.ImplicationsThe COVID-19 pandemic strongly impacted the dispensing of contraceptives in France with varying degrees of decreased dispensing according to the type of contraceptive, the age-group and the level of pandemic-related restrictions. The impact of these restrictions on unintended pregnancy at the population level remains undetermined.

Meta-Analysis: The Influence of Knowledge, Education, and Husband's Support on The Selection of Long Acting Contraception Methods

The population is expected to increase by 8,5 billion persons in 2030 and 10,9 billion persons in 2100, population is growing at a rate of around 1,1% per year. One of population growth control by birth control with contraception. The most effective contraception is long-acting contraception, however, on IDHS (Indonesian Health Demographic Survey) only 13% of currently married women use long-acting contraception. Many factors affect contraceptive use among married women, such as knowledge, education, and husband’s support. The purpose of this study was to determine the effect of knowledge, education, and husband's support on the selection of MKJP. This study used meta-analysis with the search engines by Google scholar, PUBMED, science direct, and ProQuest. The study was selected using PRISMA and it was evaluated by AMSTAR. Data synthesis was conducted by STATA 16.0. The results of this study obtained by knowledge [OR = 0,99; 95% Cl : 0,90-1,08, p = 0,000; I2 = 74,8%], education [OR = 0,84; 95% Cl : 0,77-0,92, p = 0,000; I2 = 86,3%], and husband’s [OR = 0,94; 95% Cl : 0,69-1,20, p = 0,000; I2 = 81,5%]. This means that knowledge, education, and husband’s support have an impact on the use of long-acting contraception.

Geographic variation and associated factors of long-acting contraceptive use among reproductive-age women in Ethiopia: a multi-level and spatial analysis of Ethiopian Demographic and Health Survey 2016 data

BackgroundHigh fertility rates and unintended pregnancies are public health concerns of lower and middle income countries such as Ethiopia. Long acting contraceptives (LACs) take the lion’s share in reducing unintended pregnancies and high fertility rates. Despite their numerous advantages, the utilization of LACs remains low in Ethiopia. This study is aimed to explore the geographic variation and associated factors of long acting contraceptive use among reproductive-age women in Ethiopia.MethodsThis is a secondary data analysis of 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of weighted sample sizes of 10,439 reproductive-age women were included in the final analysis. To clean and analyze the none-spatial data Stata 14 was used while ArcGIS 10.6 and SaTScanTM version 9.6 software were used for spatial analysis. Multilevel Mixed-effect Logistic regression model was used to identify associated factors of LACs utilization. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to identify significant variables.ResultsLong acting contraceptive utilization was non-random (Moran’s I: 0.30, p-value < 0.01). Statistically, clusters with significant low utilization of LACs were found in Somali, Afar, Gambela, northern Amhara, eastern Oromia and western part of Southern Nations Nationalities and Peoples (SNNP) regions. Adjusting for other factors such as being married (AOR = 2.51, 95% CI: 1.29–4.87), having one to two (AOR = 2.14, 95% CI: 1.43–3.22), and three to four children (AOR = 1.68, 95% CI: 1.02–2.76), urban (AOR = 1.59, 95% CI: 1.16–2.19), want no more children (AOR = 1.40, 95% CI: 1.08–1.83), working status of women (AOR = 1.33, 95% CI: 1.07–1.65) increased the odds of LACs utilization. While previous history of abortion (AOR = 0.56, 95% CI: 0.39–0.80), and living in the pastoralist community (AOR = 0.22, 95% CI: 0.14–0.35) reduced the odds of LACs utilization in EthiopiaConclusionsSignificant geographic variation of LACs utilization was observed in Ethiopia. Spots with Low LACs utilization were found in the eastern, north eastern and western part of the country. Socio-demographic and pregnancy related factors were significant determinants of LACs utilization. Designing intervention programs targeting the identified hot spot clusters, and variables that can hinder the utilization of LACs is very important to increase the utilization.

Effect of distance to health facilities and access to contraceptive services among urban Turkish women

Objective Worldwide unmet need for contraception remains high at 21.6%. As access to health facilities is one of the potential barriers to contraceptive uptake, the aim of our study was to evaluate the effect of distance to a health facility, according to its service availability, on contraceptive uptake among married Turkish women. Methods To calculate respondents’ distance to a health facility, we used data from a household survey conducted among married women, as well as data from a health facility survey conducted among the facilities that were visited for contraceptive services by the respondents. The data were collected from the Istanbul area of Turkey under the Willows Impact Evaluation project in 2018. Health facilities were categorised according to contraceptive availability and the accurate distance from respondents’ homes to each type of health facility was calculated. Logistic regression was used to estimate the effect of distance to each type of health facility on uptake of each type of contraception. Results The prevalence of overall contraceptive use among urban Turkish women was 71.9%. The most common method was withdrawal (32.5%), followed by the intrauterine device (IUD) (14.9%) and male condoms (12.4%). Distance to a health facility that did not provide long-acting contraception was not associated with any type of contraceptive use. On the other hand, distance to a health facility that provided long-acting contraception was negatively associated with the use of long-acting methods such as the IUD but was positively associated with the use of short-acting contraception such as condoms. Conclusion The effect of distance to a health facility on contraceptive use significantly differed according to contraceptive availability at the facility. Further distance to a health facility that provided long-acting contraception decreased the use of long-acting contraception but had a substitute effect on the use of short-acting contraception. We conclude that when women face an accessibility barrier to the provision of long-acting contraception, they modify their behaviour by shifting from long- to short-acting contraception, which is less effective.

Assessment of Male Involvement in Long-Acting and Permanent Contraceptive Use of Their Partner in West Badewacho, Southern Ethiopia.

BackgroundMale involvement in family planning use particularly in long-acting and permanent contraceptive methods (LAPCM) is a key strategy to reduce fertility, and promote maternal and child health. Despite this, little is known about male involvement in LAPCM use of their partners in Africa, particularly in Ethiopia. This study aimed to assess male involvement in long-acting and permanent contraceptive method use in west Badewacho district, Southern Ethiopia.MethodsA community-based cross-sectional study was conducted among 564 participants from April 1 to 30/2019. A multi-stage sampling technique was used to select eligible participants. A pre-tested, structured, and interviewer-administered questionnaire was used. Binary and multivariable logistic regression analysis was done to identify associated factors. The adjusted odds ratio with 95% CI was estimated to show the direction and strength of the association. Variables with p<0.05 were considered statistically significant.ResultsAbout 108 (19.9%, 95% CI: (16.8, 23.2)) participants were involved in LAPCM use. Being urban dweller [AOR=3.13; 95% CI: (1.58, 6.19)], discussion with wives about LAPCM [AOR=2.81; 95% CI: (1.64, 4.8)], having good knowledge about LAPCM [AOR=2.55; 95% CI: (1.42, 4.57)], and positive attitude towards LAPCM [AOR=2.16; 95% CI: (1.16, 4.02)] were significantly associated factors.ConclusionOverall, the male involvement in LAPCM use was low. Enhancing male involvement in family planning use through creating community awareness, encouraging inter-spousal communication to enhance decision making, and increasing positive attitude towards LAPCM in the community is crucial to decrease the problem.

Twelve-Month outcomes of a Cluster-Randomized Trial of Home-Based Postpartum Contraceptive Delivery in Southwest Trifinio, Guatemala.

We executed a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with three and 12-month contraceptive utilization, satisfaction, and pregnancy rates. Eight clusters were randomized to receive either the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit in addition to routine care, or routine care alone, which included comprehensive contraceptive counseling throughout antepartum care. 208 women were enrolled in the study, 108 in the intervention clusters and 100 in control clusters. 94 (87.0%) women in the intervention group and 91 (91%) of women in control clusters were evaluated 12 months post-enrollment. Likelihood of using contraception at that time was borderline increased in intervention clusters (RR 1.1 [1.0,1.3], p = 0.05) with an increased likelihood of long-acting contraceptive use (the implant; RR 1.6 [1.3,1.9], p < 0.001). Pregnancy rates were also borderline reduced in the intervention clusters (RR 1.0 [1.0,1.1], p = 0.07). There was no difference in satisfaction of women with contraceptive use between arms with about 95% of women very satisfied or a little satisfied in each arm. Continuation rates at twelve months of contraceptives in the intervention group were 0.0% for condom users, 80.0% for contraceptive pill users, 57% for injectable users, and 83% for implant users. Most women who discontinued their initial method chose a more long-term or permanent method. There was a trend toward a significant association with reduced short interval pregnancy. Our study had a borderline increase in overall use of contraception by 12 months, did have an increased likelihood of long-acting contraceptive use of the implant by 12 months, and resulted in a trend toward reduced short interval pregnancy in the intervention clusters as compared to control clusters.

Perceptions on Abortion and Long-acting Contraceptive Use among Women of Reproductive Age in Selected Nigerian States: A Cross-sectional Study

Background: It is estimated that over 210 million pregnancies occur each year, with almost half of these unplanned. The evidence further shows that about 76 million of these unplanned pregnancies occur in the developing world, with 19% ending in induced abortion and 11% of these abortions being unsafe. In sub-Saharan Africa, 2.2 unplanned pregnancies occur each year, with many of these in Nigeria. Reports show that 760,000 abortions occur each year in Nigeria, resulting in about 20,000 deaths. Abortion is greatly stigmatized in Nigeria, and the lack of a legal framework to support access to abortion services necessitates women to seek abortion services in unsafe places. This study, therefore, examines the perception of women regarding abortion (prevalence and stigma) and long-acting contraceptive (LARC) use in Nigeria. Methods: We performed secondary data analysis of round 5 of performance monitoring and accountability (PMA) in seven states of Nigeria for women in reproductive age (n = 11,284). Responses with regard to abortion incidence, perceptions on stigmatization and LARC use were examined using chi-square (χ2) analysis and binary logistic regression models. Results: Socio-demographic factors examined were found to be significantly associated with the perception that abortion was common; however, women who were educated to any level were twice more likely to report abortion being common in their communities compared to women who agreed that abortion was shameful. Place of residence was a significant factor and women resident in rural areas were more likely to undergo an abortion (OR = 1.34, 95% CI= 1.21 – 1.48). Further, married women (OR = 15.18, 95% CI=7.40 – 31.11) were 15 times more likely to use LARC. Conclusion: Perceptions that abortion is common and that it is a shameful practice were found to be underlying contributors to the use of LARC in Nigeria. However, the most significant influence was found to be exerted by respondents’ socio-demographic characteristics. Therefore, government and implementing agencies must develop an intervention to scale-up the use of LARC in Nigeria, and the framework should consider how to tackle socio-demographic barriers to access of contraceptive uptake as this would not only help increase the contraceptive prevalence rate but also reduce mortality from abortions.