Patterns of contraceptive use among Thai women aged ≥40 and at risk of pregnancy.

OBJECTIVES: The aims of the study were to identify the patterns of contraceptive use among Thai women aged ≥40 years and the reasons for not using contraception. METHODS: This cross-sectional study included sexually active women aged 40-49 years in Khon Kaen, Thailand. Information on contraceptive practice and reasons for not using contraception was collected through a self-reported questionnaire. The unmet need for a modern method of contraception and the unmet need for any method of contraception were calculated based on the percentage of participants who were not using contraception but who wanted to postpone or prevent pregnancy. RESULTS: Of 400 women, 75.5% were currently using some form of contraception, with female sterilisation being the most used (35%). The main reasons for not using contraception included perceived low risk of pregnancy, health concerns, infrequent sexual intercourse and wish to become pregnant. The unmet need for a modern method of contraception was 23.3% (95% confidence interval [CI] 0.20%, 0.29%). Having children was a significant protective factor (adjusted odds ratio [OR] 0.18; 95% CI 0.08, 0.37; p = 0.000). The unmet need for any method of contraception was 12% (95% CI 0.09%, 0.16%). Previous abortion was a significant risk factor for not using any contraception (adjusted OR 2.23; 95% CI 1.12, 4.44; p = 0.022). CONCLUSION: Although the use of contraception was common, some participants displayed a lack of knowledge and/or did not practise family planning. Our findings address the importance of improving knowledge about the risks of pregnancy and the need for effective contraception in this population.

Use of contraceptive implants at 12 months in women who intended to undergo immediate versus delayed postpartum insertion following high-risk pregnancy.

OBJECTIVE: To assess the correlation between the intention to undergo immediate versus delayed postpartum contraceptive implant insertion following high-risk pregnancy, and the proportion of utilization and adverse effects. METHODS: We conducted a retrospective cohort study of women who gave birth after a high-risk pregnancy (according to the criteria defined by the Society for Maternal-Fetal Medicine) and intended to use contraceptive implants. The participants were classified into two groups based on whether they underwent immediate or delayed insertion. The primary outcome was the proportion of utilization of contraceptive implants at 12 months postpartum. We performed multivariate analyses to determine the relationships between the timing of insertion, characteristics, and methods used. RESULTS: Of the 482 women classified as having high-risk pregnancies, 103 intended to use contraceptive implants (54 immediate and 49 delayed insertions). Women in the immediate group were more likely to use contraceptive implants than those in the delayed group at 6 (95.2% vs. 26.2%, P<0.01) and 12 months (92.7% vs. 26.2, P<0.01). A higher proportion of participants in the immediate group reported spotting and prolonged bleeding at 12 months (51.1% vs. 23.8%, P=0.01 and 26.8% vs. 7.1%, P=0.01; respectively). However, satisfaction at 12 months was higher in the immediate group than in the delayed group. CONCLUSION: Intention to undergo implant insertion during the immediate postpartum period appears to improve the utilization of highly effective contraception. Patients who underwent immediate implantation experienced more spotting, prolonged bleeding, and dysmenorrhea. This study supports the recommendation to provide immediate postpartum contraceptive implants to women following high-risk pregnancies.