Use Of Long-acting Reversible Methods Research Articles

Uso de métodos contraceptivos de longa ação e principais preocupações de suas usuárias

Abstract Objectives: to assess factors associated with the use of long-acting reversible methods (LARC) and women’s concerns about them. Methods: this is a cross-sectional study conducted in a digital environment from April to June 2021, with the use of a structured instrument disseminated through social networks. The study included women of reproductive age (18 to 49 years old), who were not pregnant, not hysterectomized, not sterilized and whose partners were not vasectomized. Data were analyzed using logistic and multinomial regression. Results: the study population consisted of 1596 women aged 18 to 49 living in all regions of the country, 22% of whom were using LARC. Aspects associated with LARC use were younger age, having health insurance, being in a relationship and not wanting to get pregnant. Half of LARC users reported having some kind of concern about the method, the most frequent being the risk of becoming pregnant (36.2%). The aspects associated with having concerns about using LARC were the type of method, not being in a relationship and not wanting to get pregnant. Conclusions: LARC users are not a homogeneous group. Current experience of using LARC is lived with concerns, including some about its efficacy.

Learning from success cases: ecological analysis of potential pathways to universal access to family planning care in low- and middle-income countries.

Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed to this goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabled those advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 in Egypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women’s education, and women’s age. We also explored contextual differences in terms of women’s empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced an important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women’s education and women’s age. All countries managed to increase coverage over recent years, especially among women from the more disadvantaged groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most disadvantaged in recent years. Policies involving primary health care services, provision of various methods, and high quality training of health providers are crucial to increase coverage.

Learning from success cases: ecological analysis of pathways to universal access to family planning care in low- and middle-income countries.

Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed tothis goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabledthose advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 inEgypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recentyears, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of variousmethods, and high quality training of health providers are crucial to increase coverage.

Learning from success cases: ecological analysis of pathways to universal access to reproductive health care in low- and middle-income countries.

Background Universal access to family planning services is a well-recognized human right and several countries and organizations are committed tothis goal. Our objective was to identify countries who improved family planning coverage in the last 40 years and investigate which contexts enabledthose advances. Methods Analyses were based on data from publicly available national health surveys carried out since 1986 inEgypt, Ethiopia, Rwanda, Afghanistan, Brazil, and Ecuador, selected based on previous evidence. We estimated demand for family planning satisfied with modern methods (mDFPS) for each country and explored inequalities in terms of wealth, women's education, and women's age. We also explored contextual differences in terms of women's empowerment, percentage of population living in extreme poverty, and share of each type of contraceptive. To better understand political and sociocultural contexts, country case studies were included, based on literature review. Results Patterns of mDFPS increase were distinct in the selected countries. Current level of mDFPS coverage ranged between 94% in Brazil and 38% in Afghanistan. All countries experienced important reduction in both gender inequality and extreme poverty. According to the share of each type of contraceptive, most countries presented higher use of short-acting reversible methods. Exceptions were Ecuador, where the most used method is sterilization, and Egypt, which presented higher use of long-acting reversible methods. In the first years analyzed, all countries presented huge gaps in coverage according to wealth, women's education and women's age. All countries managed to increase coverage over recentyears, especially among women from the more vulnerable groups. Conclusions Family planning coverage increased along with reductions in poverty and gender inequality, with substantial increases in coverage among the most vulnerable in recent years. Policies involving primary health care services, provision of variousmethods, and high quality training of health providers are crucial to increase coverage.

Contraceptive use in the Nordic countries.

The aim was to compare contraceptive use in the Nordic countries and to assess compliance with recommendations from the European Medicines Agency regarding the use of combined oral contraception containing low-dose estrogen and levonorgestrel, norethisterone or norgestimate. Data on hormonal contraceptive prescriptions and sales figures for copper intrauterine devices were obtained from national databases and manufacturers in Denmark, Finland, Iceland, Norway and Sweden in 2010-2013. Contraceptive use was highest in Denmark (42%) and Sweden (41%), followed by Finland (40%). Combined oral contraception was the most used method in all countries, with the highest use in Denmark (26%). The second most used method was the levonorgestrel-releasing intrauterine system, with the highest use in Finland (15%) and ≈10% in the other countries. Copper intrauterine devices (7%) and the progestin-only pill (7%) were most often used in Sweden. Combined oral contraception use decreased with increasing age and levonorgestrel-releasing intrauterine system and progestin-only pills use increased. The use of long-acting reversible methods of contraception (=levonorgestrel-releasing intrauterine system, copper intrauterine devices, and implants) increased with time and was highest in Sweden (20%) and Finland (18%). The highest use of European Medicines Agency recommended combined oral contraception was in Denmark, increasing from 13 to 50% between 2010 and 2013. In Finland, recommended combined oral contraception remained below 1%. Contraceptive use was highest in Denmark and Sweden, levonorgestrel-releasing intrauterine system use was highest in Finland and all long-acting methods were most common in Sweden. The use of combined oral contraception recommended by the European Medicines Agency was highest in Denmark.

Family planning knowledge and contraceptive use among resettled African refugee women

Objectives: We aimed to compare demographic characteristics, family planning knowledge and method use among Somali and Congolese refugee women after third country resettlement. Methods: After conducting focus groups to evaluate baseline family planning conceptualizations, a quantitative survey was developed. Community leaders and snowball referrals were used to recruit participants. The survey was administered to resettled Somali and Congolese refugee women aged 18–55 via telephone. Bicultural, externally located interpreters carried out the survey in participants' native languages. Results: We surveyed 148 women; 81 participants (55%) self-identified with the resettled Somali population and 67 (45%) self-identified with the resettled Congolese population. There were no significant differences in age, gravidity, household size, marital status or time since resettlement. Method knowledge was lower among Somali than among Congolese participants (27% vs. 61% were able to name a method, p<.001). Congolese participants were more likely to be using (32% vs. 11%, p=.004) or have ever used (50% vs. 40%, p<.001) contraceptives, utilized a broader method mix (nine vs. four method types) and were more willing to consider use of long-acting reversible methods. Congolese participants cited delay of first birth, birth spacing and birth limiting as appropriate uses for contraception; Somali women cited only birth spacing. Commonly identified barriers to modern method use included inability to obtain methods and religious reasons. Conclusions: Resettled African refugee women demonstrate limited knowledge and use of modern family planning methods. Development of culture-specific education materials and counseling modalities that respect cultural beliefs is paramount to increasing modern family planning access and utilization among these populations.

Optimizing Subsequent Pregnancy Outcomes for Women with a Prior Preterm Birth.

Women with a prior preterm birth are at increased risk of recurrent preterm delivery in a subsequent pregnancy. Interventions during the preconception and prenatal periods can decrease this risk. Review of the circumstances of the prior delivery can elucidate whether delivery was spontaneous or indicated, anticipate recurrence risk, and guide management in a subsequent pregnancy. Preconception interventions for women with prior preterm birth should include cessation of tobacco and substance abuse, control of underlying maternal comorbidities, and encouraging a healthy body mass index. Effective contraception, including use of long-acting reversible methods, should be encouraged to facilitate planned pregnancies with optimal interpregnancy intervals. Interventions during prenatal care include screening and treatment of infections, nutritional supplementation, and enhanced prenatal care. Women with prior spontaneous preterm birth may benefit from progesterone supplementation and serial cervical length screening, while women with prior indicated preterm birth may benefit from daily aspirin.

Theory of Planned Behavior on the Determinants of Participation in the Long-Term Contraceptive MethodAmong Women of Reproductive Age, in Nganjuk, East Java

Background: Unintended pregnancies remain a substantial global public health issue despite considerable advances in contraceptive technologies. The global trend shows that the use of permanent contraception to prevent unintended pregnancy is high. Although the trend also shows a rise in the use of long-acting reversible methods, these are still underutilized despite having contraceptive as well as non-contraceptive benefits. This study aimed to examine the determinants of participation in long-term contraceptive method among women of reproductive age in Nganjuk, East Java, using Theory of Planned Behavior.Subjects and Method: This was an analytic observational study, using case control design. This study was conducted in Bagor, Nganjuk, East Java. A total of 100 women of reproductive age was selected for this study by fixed disease sampling. The independent variables were constructs in the Theory of Planned Behavior, i.e. attitude, subjective norm, and perceived behavior control. The dependent variables were intention and participation in long-term contraceptive use. The data were collected by a set of questionnaire, and analyzed by path analysis.Results: Intention had direct and positive effect on participation in long-term contraceptive use (b=2.07; CI 95% 0.78-3.36; p=0.002). Attitude (b=1.40; CI 95% 0.41-2.40 p=0.006), subjective norm (b=1.64; CI 95% 0.76-2.53; p<0.001), and perceived behavior control (b=1.22; CI 95% 0.32-2.12; p=0.008) had indirect positive effect on participation in long-term contraceptive use through intention. Conclusion: There are direct and indirect effect of Theory of Planned Behavior constructs on participation long-term contraceptive use among women of reproductive age.Keywords: Theory of Planned Behavior, long-term contraceptive method, women of reproductive ageCorrespondence: Joeliatin. School of Midwifery, AKBID Wiyata Mitra Husada, Kertosono, Nganjuk, East Java. Email: yulisuyitno77@gmail.com.Journal of Health Promotion and Behavior (2016), 1(3): 171-179https://doi.org/10.26911/thejhpb.2016.01.03.04

Global trends in use of long-acting reversible and permanent methods of contraception: Seeking a balance.

The global trend shows that the use of permanent contraception to prevent unintended pregnancy is high. Although the trend also shows a rise in the use of long-acting reversible methods, these are still underutilized despite having contraceptive as well as non-contraceptive benefits. Lack of knowledge among women, dependence on the provider for information, and provider bias for permanent contraception are cited as reasons for this reduced uptake. Training of healthcare providers and increased patient awareness about the effectiveness of long-acting reversible contraceptive methods will increase their uptake and help prevent unintended pregnancies.

Contraceptive adherence among women Veterans with mental illness and substance use disorder

ObjectiveEmerging data suggest that mental illness and substance use disorder (SUD) are important risk factors for inconsistent contraceptive use. We investigated whether mental illness without or with SUD is associated with contraceptive adherence and continuation of hormonal methods among women Veterans. Study designWe conducted a retrospective analysis of national Veteran’s Administration data among women aged 18–45 with a hormonal contraceptive prescription (pill/patch/ring/injectable) during the first week of fiscal year 2013. We tested associations between mental illness diagnoses (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia, adjustment disorder) without or with SUD diagnoses (drug/alcohol abuse) and 12-month contraceptive adherence (number and length of gaps ≥7 days between refills and months of contraceptive coverage) using multivariable regression models. ResultsAmong 9780 Veterans, 43.6% had mental illness alone, 9.4% comorbid mental illness and SUD, and 47.0% neither diagnosis. In adjusted analyses, compared to women with neither diagnosis, women with mental illness alone had a similar rate of gaps but increased odds of having gaps longer than 30 days [odds ratio (OR): 1.35, 95% confidence interval (CI): 1.10–1.52] and fewer months of contraceptive coverage (β_coefficient: −0.39, 95% CI: −0.56 to −0.23). Women with mental illness and SUD experienced more gaps (incidence rate ratio: 1.12, 95% CI: 1.03–1.21), increased odds of gaps longer than 30 days (OR: 1.46, 95% CI: 1.10–1.79), fewer months of contraceptive coverage (β_coefficient: −0.90, 95% CI: −1.20 to −0.62) and reduced odds of continuous 12-month coverage (adjusted OR: 0.76, 95% CI: 0.63–0.93). ConclusionsMental illness, particularly with comorbid SUD, is associated with reduced contraceptive adherence and continuation among women Veterans. Women with these risk factors could potentially benefit from use of long-acting reversible methods. ImplicationsWomen Veterans have a high burden of mental illness and SUD, which we found are associated with inconsistent contraceptive use. Efforts to improve adherence to hormonal contraceptives and to increase availability of long-acting reversible methods in this vulnerable population are warranted.

Continuation and satisfaction of reversible contraception: A preliminary analysis from the Contraceptive CHOICE project

The primary objectives of the Contraceptive CHOICE Project are to promote the use of long-acting reversible methods of contraception (LARC) and to determine continuation rates and levels of satisfaction with all reversible methods.

The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception

To introduce and promote the use of long-acting reversible methods of contraception (LARC; intrauterine contraceptives and subdermal implant) by removing financial and knowledge barriers. The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women 14-45 years who want to avoid pregnancy for at least 1 year and are initiating a new form of reversible contraception. Women screened for this study are read a script regarding long-acting reversible methods of contraception to increase awareness of these options. Participants choose their contraceptive method that is provided at no cost. We report the contraceptive choice and baseline characteristics of the first 2500 women enrolled August 2007 through December 2008. Sixty-seven percent of women enrolled (95% confidence interval, 65.3-69.0) chose long-acting methods. Fifty-six percent selected intrauterine contraception and 11% selected the subdermal implant. Once financial barriers were removed and long-acting reversible methods of contraception were introduced to all potential participants as a first-line contraceptive option, two-thirds chose long-acting reversible methods of contraception.

Correlates of use of long-acting reversible methods of contraception among adolescent and young adult women

Background Most pregnancies among adolescent and young adult women are unintended, and adolescent birth rates have risen. Use of long-acting reversible contraception may be an effective strategy to reduce the rate of unintended pregnancy. Study Design We conducted a secondary data analysis of nationally representative, cross-sectional data from the 2002 National Survey of Family Growth. Our sample included 1722 sexually active women aged 15–24 years. We used multivariable logistic regression to identify correlates of ever-use of depot-medroxyprogesterone acetate (DMPA) or the intrauterine device (IUD). Results One-quarter of our sample had ever used DMPA, and less than 2% had ever used the IUD. In multivariable analysis, increasing parity was associated with ever-use of DMPA (OR 2.07, 95% CI 1.55–2.77) and ever-use of the IUD (OR 4.57, 95% CI 1.60–13.03), but age and measures of socioeconomic status were not. Having ever been married (OR 5.54, 95% CI 1.23–24.82) and current cohabitation (OR 4.89, 95% CI 1.10–21.71) were associated with ever-use of the IUD. A history of an adolescent pregnancy was associated with ever-use of DMPA (OR 1.79, 95% CI 1.19–2.70) but not of the IUD. Conclusions While similarities exist between the correlates of use of DMPA and the IUD, we discovered important differences, some of which may reflect provider biases regarding IUD provision.

Attitudes towards long-acting reversible methods of contraception in general practice in the UK

Introduction Recently published national guidance in England recommended that increased use of long-acting reversible methods of contraception could reduce unintended pregnancy rates. Usage rates of long-acting reversible methods of contraception in the UK are currently low. Since these methods require medical intervention, attitudes of professionals are important determinants of prevalence of use. Study Design A questionnaire survey was conducted of 321 health professionals working in general practice which sought practitioner views on safety, efficacy and acceptability of contraceptive methods, and on the feasibility and desirability of prescribing long-acting methods. Results A high proportion of practitioners (80.2%) endorsed the role of LARC in preventing teenage pregnancy, but fewer than half (47.1%) saw them as returning to favor. The combined oral contraceptive pill is still the mainstay of prescriptions. Lack of skill in providing was seen by 60.6% as a barrier to provision of long-acting methods of contraception. Half of respondents (50.3%) thought that irregular bleeding deterred women from using LARC and 20.6% were concerned about high discontinuation rates. Misconceptions about side effects of contraceptive methods were common. Conclusion Investment in professional education and training is needed for health professionals in general practice if the goal of increased provision of long-acting contraceptive methods is to be realized.