RESUMEN
PURPOSE OF REVIEW: Women are particularly vulnerable to unintended pregnancy in the 12âmonths following a birth. Improving access to postpartum contraception within maternity settings can prevent unintended and closely spaced births, improving the health of mother and child. This review will summarize the recent research in postpartum contraception (PPC), building on existing knowledge and developments in this field. RECENT FINDINGS: Current models of postpartum contraceptive provision may not adequately meet women's needs. The COVID-19 pandemic led to changes in postpartum contraceptive provision, with an increasing emphasis placed on maternity services. Antenatal contraceptive discussion is associated with increased postpartum contraceptive planning and uptake of methods after birth. Digital health interventions may be a useful tool to support information about contraception. The most effective long-acting reversible contraceptive (LARC) methods, such as the intrauterine device (IUD) and implant, can be challenging to provide in the maternity setting because of availability of trained providers. Postpartum IUD insertion remains relatively under-utilized, despite evidence supporting its safety, efficacy and cost-effectiveness. SUMMARY: Antenatal information needs to be partnered with access to the full range of methods immediately after birth to reduce barriers to PPC uptake. Training and education of maternity providers is central to successful implementation of PPC services.
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Anticoncepción , Accesibilidad a los Servicios de Salud , Periodo Posparto , Humanos , Femenino , Anticoncepción/métodos , Anticoncepción/tendencias , Embarazo , COVID-19/prevención & control , COVID-19/epidemiología , Servicios de Planificación Familiar , Embarazo no Planeado , Dispositivos Intrauterinos , SARS-CoV-2RESUMEN
OBJECTIVES: The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN: Repeated cross-sectional study. METHODS: Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS: A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS: Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.
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Anticoncepción , Humanos , Femenino , Adulto , Estudios Transversales , Adulto Joven , Adolescente , Anticoncepción/estadística & datos numéricos , Anticoncepción/métodos , Anticoncepción/tendencias , Persona de Mediana Edad , Conducta Anticonceptiva/estadística & datos numéricos , Conducta Anticonceptiva/tendencias , Australia , Condones/estadística & datos numéricos , VictoriaRESUMEN
BACKGROUND: The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. OBJECTIVES: To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. DESIGN: Retrospective cohort review. METHODS: Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. RESULTS: The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). CONCLUSION: Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.
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COVID-19 , Anticoncepción , Servicios de Salud Materna , Femenino , Humanos , Embarazo , Anticoncepción/tendencias , Pandemias , Periodo Posparto , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
Women in the United States are much more likely to become mothers as teens than those in other rich countries. Teen births are particularly likely to be reported as unintended, leading to debate over whether better information on sex and contraception might lead to reductions in teen births. We contribute to this debate by providing causal evidence at the population level. Our causal identification strategy exploits county-level variation in the timing and receipt of federal funding for more comprehensive sex education and data on age-specific teen birth rates at the county level constructed from birth certificate natality data covering all births in the United States. Our results show that federal funding for more comprehensive sex education reduced county-level teen birth rates by more than 3%. Our findings thus complement the mixed evidence to date from randomized control trials on teen pregnancies and births by providing population-level causal evidence that federal funding for more comprehensive sex education led to reductions in teen births.
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Embarazo en Adolescencia/prevención & control , Embarazo en Adolescencia/psicología , Educación Sexual/tendencias , Adolescente , Tasa de Natalidad/tendencias , Anticoncepción/tendencias , Femenino , Humanos , Modelos Teóricos , Embarazo , Educación Sexual/estadística & datos numéricos , Conducta Sexual/psicología , Estados Unidos , Adulto JovenRESUMEN
The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.
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COVID-19/psicología , Fertilidad/fisiología , Conducta Reproductiva/psicología , Adulto , COVID-19/metabolismo , Condones/tendencias , Anticoncepción/tendencias , Conducta Anticonceptiva/tendencias , Composición Familiar , Servicios de Planificación Familiar/provisión & distribución , Servicios de Planificación Familiar/tendencias , Femenino , Humanos , Renta , Dispositivos Intrauterinos/tendencias , Masculino , Moldavia/epidemiología , SARS-CoV-2/patogenicidad , Encuestas y CuestionariosRESUMEN
BACKGROUND: Vasectomy remains a safe, simple, and effective contraceptive option. Conflicting data on the trend of vasectomy use among men have been described previously at various snapshots in time over the last two decades. OBJECTIVES: This paper seeks to describe the trend of vasectomy utilization in the last 15 years using a nationally representative US survey. MATERIALS AND METHODS: We analyzed data from male respondents aged 18 to 45 years of the Cycle 6 (2002), 2006-2010, 2011-2013, 2013-2015, and 2015-2017 National Survey of Family Growth (NSFG) surveys. Population estimates are calculated based on the official NSFG instructions, accounting for the complex survey design. Multivariate logistic regression models are used to study demographic and socioeconomic factors associated with vasectomy use in men. RESULTS: Baseline characteristics for men undergoing vasectomy do not differ significantly across survey years. Increased age, White race, marital status, higher education level, birthplace within the United States, higher household income, non-Catholic affiliation, and higher number of biological kids have significant positive associations with vasectomy use. After accounting for factors associated with vasectomy utilization, there was a significant temporal decline in vasectomy utilization rates in all age groups across survey years which remained in subgroup analyses of all men greater than 25, 30, and 35 years of age. DISCUSSION: This is the first population-based analysis of US data to observe a decline in vasectomy utilization over the past two decades. The decline was statistically significant after accounting for all demographic and socioeconomic factors. CONCLUSION: There is a steady decline in the prevalence of vasectomy use in men from 2002 to 2017. Given the limited contraceptive options for men and the importance of contraception and family planning in the United States, further research is needed to understand the temporal decline.
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Aceptación de la Atención de Salud/estadística & datos numéricos , Vasectomía/tendencias , Adolescente , Adulto , Anticoncepción/tendencias , Servicios de Planificación Familiar/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception. Design, Setting, and Participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover postpartum care. The study used 2 distinct assumptions to conduct the analyses: first, preintervention differences in postpartum visit attendance and contraceptive use would have remained constant if the policy expanding coverage had not been passed (parallel trends assumption), and second, differences in preintervention trends would have continued without the policy change (differential trend assumption). Data analysis was performed from September 2020 to October 2021. Exposures: Medicaid coverage of postpartum care. Main Outcomes and Measures: Attendance at postpartum visits and postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery. Results: The study population consisted of 27â¯667 live births among 23â¯971 women (mean [SD] age, 29.4 [6.0] years) enrolled in Emergency Medicaid. The majority of all births were to multiparous women (21â¯289 women [76.9%]; standardized mean difference [SMD] = 0.08) and were delivered vaginally (20â¯042 births [72.4%]; SMD = 0.03) and at term (25â¯502 births [92.2%]; SMD = 0.01). Following Oregon's expansion of postpartum coverage to women in Emergency Medicaid, there was a large and significant increase in postpartum care visits and contraceptive use. Assuming parallel trends, postpartum care attendance increased by 40.6 percentage points (95% CI, 34.1-47.1 percentage points; P < .001) following the policy change. Under the differential trends assumption, postpartum visits increased by 47.9 percentage points (95% CI, 41.3-54.6 percentage points; P < .001). Postpartum contraception use increased similarly. Under the parallel trends assumption, postpartum contraception within 60 days increased by 33.2 percentage points (95% CI, 31.1-35.4 percentage points; P < .001). Assuming differential trends, postpartum contraception increased by 28.2 percentage points (95% CI, 25.8-30.6 percentage points; P < .001). Conclusions and Relevance: These findings suggest that expanding Emergency Medicaid benefits to include postpartum care is associated with significant improvements in receipt of postpartum care and contraceptive use.
Asunto(s)
Conducta Anticonceptiva/tendencias , Anticoncepción/economía , Emigrantes e Inmigrantes , Cobertura del Seguro/legislación & jurisprudencia , Medicaid/legislación & jurisprudencia , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Posnatal/economía , Adulto , Anticoncepción/psicología , Anticoncepción/tendencias , Emigrantes e Inmigrantes/psicología , Femenino , Estudios de Seguimiento , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Humanos , Cobertura del Seguro/tendencias , Medicaid/tendencias , Oregon , Atención Posnatal/legislación & jurisprudencia , Atención Posnatal/tendencias , Estudios Retrospectivos , South Carolina , Estados UnidosRESUMEN
OBJECTIVE: Examine patterns of contraceptive use and contraceptive transitions over time among an Australian cohort of women through their later reproductive years. STUDY DESIGN: Latent Transition Analysis was performed using data on 8,197 women from the Australian Longitudinal Study on Women's Health's 1973-78 cohort to identify distinct patterns of contraceptive use across 2006, 2012 and 2018. Women were excluded from the analysis at time points where they were not at risk of an unintended pregnancy. Latent status membership probabilities, item-response probabilities, transitions probabilities and the effect of predictors on latent status membership were estimated and reported. RESULTS: Patterns of contraceptive use were relatively consistent over time, particularly for high efficacy contraceptive methods with 71% of women using long-acting reversible contraceptives in 2012 also using long-acting reversible contraceptives in 2018. Multiple contraceptive use was highest in 2006 when women were aged 28-33 years (19.3%) but declined over time to 14.3% in 2018 when women were aged 40-45 years. Overall, contraceptive patterns stabilised as the women moved into their late 30s and early 40s. CONCLUSIONS: Although fertility declines with age, the stability of contraceptive choice and continued use of short-acting contraception among some women suggests that a contraceptive review may be helpful for women during perimenopause so that they are provided with contraceptive options most appropriate to their specific circumstances.
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Conducta Anticonceptiva/tendencias , Anticoncepción/métodos , Mujeres/psicología , Adulto , Australia , Estudios de Cohortes , Anticoncepción/tendencias , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
INTRODUCCIÓN: El embarazo en las adolescentes ha persistido como un problema de salud pública y social en Chile, afectando a las adolescentes más vulnerables y reflejando las desigualdades. OBJETIVO: Describir los cambios en el uso de anticonceptivos, embarazos no planificados e hijos en adolescentes chilenas entre 1997 y 2018. MÉTODO: Estudio ecológico de series temporales entre los años 1997 y 2018. Se midió la asociación entre variables sociodemográficas y efectividad del método anticonceptivo para los años 2006 y 2018, mediante la prueba estadística de Rao-Scott. Se estimaron tendencias del porcentaje de uso de métodos anticonceptivos según su eficacia y presencia de embarazos no planificados e hijos con modelos de regresión lineal (método de Prais-Winsten). RESULTADOS: Se observó un aumento en la frecuencia de adolescentes sexualmente activas y en el uso de anticonceptivos, especialmente píldoras e inyectables. La serie temporal de uso de anticonceptivos fue no estacionaria, la tendencia fue creciente (coeficiente: 4,59; intervalo de confianza del 95% [IC95%]: 3,43-5,74; p = 0,001), aumentando 4,59% cada 3 años. Las series de embarazos no planificados y tener hijos fueron series temporales no estacionarias y ambas presentaron una tendencia decreciente (coeficiente: −4,78; IC95%: −6,32 a −3,24; p = 0,002; y coeficiente: −3,93; IC95%: −6,18 a −1,68; p = 0,008), disminuyendo un 4,78% y un 3,93%, respectivamente, cada 3 años. CONCLUSIONES: El aumento en el uso de anticonceptivos en adolescentes ha ido unido a una importante disminución en los embarazos no planificados y los hijos en esta población.
INTRODUCTION: Adolescent pregnancy has persisted as a public and social health problem in Chile, affecting the most vulnerable adolescents and reflecting inequalities. OBJECTIVE: To describe the changes in the use of contraceptives, unplanned pregnancies and children in Chilean adolescents between 1997 and 2018. METHOD: Ecological study of time series between the years 1997 and 2018. The association between sociodemographic variables and the effectiveness of the contraceptive method for the years 2006 and 2018 was measured using the Rao-Scott statistical test. Trends in the percentage of use of contraceptive methods were estimated according to their efficacy and presence of unplanned pregnancies and children with linear regression models (Prais-Winsten method). RESULTS: An increase in the frequency of sexually active adolescents and the use of contraceptives, especially pills and injectables, was observed. The time series of contraceptive use was non-stationary, the trend was increasing (coefficient: 4.59; 95% confidence interval [95% CI]: 3.43-5.74; p = 0.001), increasing 4.59% every three years. The time series, unplanned pregnancies and having children were non-stationary time series, both showed a decreasing trend (coefficient: −4.78; 95%CI: −6.32 to −3.24; p = 0.002; and coefficient: −3.93; 95% CI: −6.18 to −1.68; p = 0.008), decreasing 4.78% and 3.93%, respectively, every 3 years. CONCLUSIONS: The increase in the use of contraceptives in adolescents has been linked to a significant decrease in unplanned pregnancies and children in this population.
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Humanos , Femenino , Embarazo , Adolescente , Embarazo en Adolescencia , Conducta Sexual , Anticoncepción/tendencias , Paridad , Embarazo no Deseado , Factores Socioeconómicos , Chile , Encuestas y Cuestionarios , Anticonceptivos , Embarazo no Planeado , Estudios Ecológicos , Efectividad AnticonceptivaRESUMEN
From 1995 to 2014, intrauterine devices (IUDs) rose from ranking 10th (out of 11) among contraceptive methods to being the fourth most popular, outnumbered only by the pill, sterilization, and condoms. In 1995, the IUD had been largely abandoned by American doctors; two decades later, major medical associations promoted it as a "first line" method for prospective users of all ages. This paper explains the rapid and dramatic increase in intrauterine contraception by exploring three influential factors from the 1970s-1980s - the Dalkon Shield disaster, the lack of innovation in contraceptive research and development, and the moral panic over teen pregnancy in America - that created circumstances by the early 2000s in which health care providers became more receptive to long-acting reversible contraception. Key thought leaders in obstetrics and gynecology took it upon themselves to rehabilitate the IUD in the court of medical opinion and succeeded in securing professional approval of the device as the initial step in its resurrection.
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Actitud del Personal de Salud , Anticoncepción/historia , Conocimientos, Actitudes y Práctica en Salud , Dispositivos Intrauterinos/historia , Anticoncepción/psicología , Anticoncepción/tendencias , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Dispositivos Intrauterinos/efectos adversos , Dispositivos Intrauterinos/tendencias , Estados UnidosRESUMEN
The COVID-19 pandemic has substantially strained health systems across the globe. In particular, documented disruptions to voluntary family planning and reproductive health care due to competing health priorities, service disruptions, stockouts, and lockdowns are significantly impacting reproductive, maternal, newborn, and child health. As governments and family planning programmes grapple with how best to respond to the direct and indirect effects of the pandemic on family planning and reproductive health (FP/RH), the implementation and adaptation of evidence-based practices is crucial. In this commentary, we outline applications of the High Impact Practices in Family Planning (HIPs) towards COVID-19 response efforts. The HIPs are a set of evidence-based family planning practices which reflect global expert consensus on what works in family planning programming. Drawing upon preliminary COVID-19 data, documented experiences from prior health emergencies, and recommended programme adaptations from a variety of global health partners, we outline situations where specific HIPs may assist family planning programme managers in developing context-specific and evidence-based responses to COVID-19-related impacts on FP/RH, with the ultimate goal of ensuring the accessibility, availability, and continuity of voluntary family planning services across the world.
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COVID-19/epidemiología , Servicios de Planificación Familiar/tendencias , Servicios de Salud Materna/tendencias , Calidad de la Atención de Salud/tendencias , Salud Reproductiva/tendencias , Anticoncepción/tendencias , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pandemias/estadística & datos numéricosRESUMEN
BACKGROUND: The advent of new methods of male contraception would increase contraceptive options for men and women and advance male contraceptive agency. Pharmaceutical R&D for male contraception has been dormant since the 1990s. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a contraceptive development program since 1969 and supports most ongoing hormonal male contraceptive development. Nonhormonal methods are in earlier stages of development. CONTENT: Several hormonal male contraceptive agents have entered clinical trials. Novel single agent products being evaluated include dimethandrolone undecanoate, 11ß-methyl-nortestosterone dodecylcarbonate, and 7α-methyl-19-nortestosterone. A contraceptive efficacy trial of Nestorone®/testosterone gel is underway. Potential nonhormonal methods are at preclinical stages of development. Many nonhormonal male contraceptive targets that affect sperm production, sperm function, or sperm transport have been identified. SUMMARY: NICHD supports development of reversible male contraceptive agents. Other organizations such as the World Health Organization, the Population Council, and the Male Contraception Initiative are pursuing male contraceptive development, but industry involvement remains limited.
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Anticoncepción , Anticonceptivos Masculinos , Anticoncepción Hormonal , Anticoncepción/historia , Anticoncepción/métodos , Anticoncepción/tendencias , Anticonceptivos Masculinos/aislamiento & purificación , Anticonceptivos Masculinos/uso terapéutico , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Anticoncepción Hormonal/historia , Anticoncepción Hormonal/métodos , Anticoncepción Hormonal/tendencias , Humanos , Masculino , National Institute of Child Health and Human Development (U.S.) , Embarazo , Estados UnidosRESUMEN
BACKGROUND: Contraceptive method choice is often strongly influenced by the experiences and opinions of one's social network. Although social media, including Twitter, increasingly influences reproductive-age individuals, discussion of contraception in this setting has yet to be characterized. Natural language processing, a type of machine learning in which computers analyze natural language data, enables this analysis. OBJECTIVE: This study aimed to illuminate temporal trends in attitudes toward long- and short-acting reversible contraceptive methods in tweets between 2006 and 2019 and establish social media platforms as alternate data sources for large-scale sentiment analysis on contraception. STUDY DESIGN: We studied English-language tweets mentioning reversible prescription contraceptive methods between March 2006 (founding of Twitter) and December 2019. Tweets mentioning contraception were extracted using search terms, including generic or brand names, colloquial names, and abbreviations. We characterized and performed sentiment analysis on tweets. We used Mann-Kendall nonparametric tests to assess temporal trends in the overall number and the number of positive, negative, and neutral tweets referring to each method. The code to reproduce this analysis is available at https://github.com/hms-dbmi/contraceptionOnTwitter. RESULTS: We extracted 838,739 tweets mentioning at least 1 contraceptive method. The annual number of contraception-related tweets increased considerably over the study period. The intrauterine device was the most commonly referenced method (45.9%). Long-acting methods were mentioned more often than short-acting ones (58% vs 42%), and the annual proportion of long-acting reversible contraception-related tweets increased over time. In sentiment analysis of tweets mentioning a single contraceptive method (n=665,064), the greatest proportion of all tweets was negative (65,339 of 160,713 tweets with at least 95% confident sentiment, or 40.66%). Tweets mentioning long-acting methods were nearly twice as likely to be positive compared with tweets mentioning short-acting methods (19.65% vs 10.21%; P<.002). CONCLUSION: Recognizing the influence of social networks on contraceptive decision making, social media platforms may be useful in the collection and dissemination of information about contraception.
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Actitud Frente a la Salud , Anticoncepción/psicología , Anticoncepción/tendencias , Opinión Pública , Medios de Comunicación Sociales , Toma de Decisiones , Femenino , Humanos , Masculino , Procesamiento de Lenguaje NaturalRESUMEN
OBJECTIVE: In Nigeria, unmet need for contraception is high despite improved access to modern contraception. To identify factors that support Nigerian women's contraceptive decisions to achieve their reproductive goals, in the presence or absence of their partner's support, we seek to identify individual/couple and community level determinants of a spectrum of contraceptive practices, from non-use to covert and overt use of contraception. METHODS: Data were drawn from a national probability survey conducted by Performance Monitoring and Accountability 2020 in Nigeria in 2017-2018. A sample of 12,948 women 15-49 years was included, 6433 of whom were in need of contraception at the time of the survey. We conducted bivariate and multivariate analysis to identify individual/couple and community level factors associated with covert use relative to non-use and to overt use of contraception. RESULTS: Altogether, 58.0% of women in need of contraception were non-users, 4.5% were covert users and 37.5% used contraception overtly. Covert users were more educated and wealthier than non-users, but less educated and less wealthy than overt users. Covert users were less likely to cohabitate with their partner compared to non-users [AOR = 4.60 (95%CI: 3.06-6.93)] and overt users [AOR = 5.01 (95%CI: 3.24-7.76)] and more likely to reside in urban areas. At the community level, covert users were more likely to live in communities with higher contraceptive prevalence and higher levels of female education relative to non-users. They were also more likely to live in communities with higher female employment [AOR = 1.62, (95%CI: 0.96-2.73)] compared to overt users. CONCLUSION: By identifying individual and community level factors associated with the spectrum from non-use to covert use and overt use of contraception, this study highlights the importance of integrating individual and community interventions to support women's realization of their reproductive goals.
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Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Anticoncepción/tendencias , Adolescente , Adulto , Conducta Anticonceptiva/tendencias , Anticonceptivos/provisión & distribución , Escolaridad , Empoderamiento , Composición Familiar , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Nigeria/epidemiología , Parejas Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Anticoncepción/métodos , Anticoncepción/tendencias , Desarrollo de Medicamentos , Necesidades y Demandas de Servicios de Salud , Salud Reproductiva/tendencias , Desarrollo Sostenible , Salud de la Mujer/tendencias , Condones , Anticoncepción/economía , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Femeninos/economía , Desarrollo de Medicamentos/economía , Industria Farmacéutica/economía , Femenino , Objetivos , Humanos , Invenciones/economía , Inversiones en Salud , Responsabilidad Legal , Masculino , National Institutes of Health (U.S.)/economía , Asociación entre el Sector Público-Privado/economía , Salud Reproductiva/economía , Estados Unidos , Salud de la Mujer/economíaRESUMEN
OBJECTIVE: To systematically review the literature regarding contraceptive use by sex workers in North America and to understand factors that limit reproductive agency and affect contraceptive use and decision making. DATA SOURCES: We searched PubMed, CINAHL, and Embase databases using the search terms "sex work(ers)," "transactional sex," "exchange sex," "prostitution," "contraception," "contraceptive agents," "birth control," "female," and "women." STUDY SELECTION: Articles were eligible for inclusion in this review if they (a) reported quantitative or qualitative studies based in North America, (b) were written in English, (c) included sex workers (self-identified sex workers or engaged in sex work behavior) as the primary or secondary population of the study, (d) included a population assigned female sex at birth, (e) reported contraceptive outcomes for sex workers, and (f) were published in peer-reviewed journals. The initial search yielded 2,455 articles, and seven met the inclusion criteria. DATA EXTRACTION: Two authors independently reviewed the articles and organized data in a table to capture study design, sample size and study population, study aims, and contraceptive use. We applied Connell's theory of gender and power as an analytic framework to further identify factors that limited reproductive agency. DATA SYNTHESIS: Condoms were the most common method of contraceptive used across studies. The use of contraceptives varied by partner type (client vs. nonpaying intimate partners). Access to highly effective contraception was limited by perceived stigma, financial constraints, and substance use. Reproductive and harm reduction services that were co-located where women worked improved contraceptive use. Contraceptive use was affected by factors that limited reproductive agency, including stigma, substance use, intimate partner violence, and condom coercion. CONCLUSION: The reliance of sex workers on partner-dependent contraception, such as condoms, combined with factors that limit reproductive agency over contraceptive use and decision making contribute to high potential for contraceptive failure and unintended pregnancy. More research is needed to understand the influence of different sexual partner types, pregnancy intention, and contraceptive decision making on the reproductive agency of sex workers.
Asunto(s)
Conducta Anticonceptiva/psicología , Trabajadores Sexuales/psicología , Adolescente , Anticoncepción/métodos , Anticoncepción/psicología , Anticoncepción/tendencias , Conducta Anticonceptiva/tendencias , Anticonceptivos/uso terapéutico , Femenino , Humanos , América del Norte , Embarazo , Adulto JovenAsunto(s)
Anticoncepción/historia , Anticoncepción/tendencias , Aborto Inducido/historia , Aborto Inducido/legislación & jurisprudencia , Aborto Inducido/tendencias , Comercio , Anticoncepción/efectos adversos , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Hormonales Orales/efectos adversos , Política de Planificación Familiar/legislación & jurisprudencia , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Dispositivos Intrauterinos Medicados/historia , Legislación como Asunto/historia , Legislación como Asunto/tendencias , Masculino , Comprimidos , Estados UnidosRESUMEN
BACKGROUND: Despite high levels of pregnancy and childbearing among adolescents in Africa, contraceptive use remains low. Examining variations in contraceptive use among adolescent girls is vital for informing programs to improve contraceptive utilisation among this segment of the population. This study aimed to examine the patterns, trends, and factors associated with contraceptive use among adolescents in Zambia over the period 1996-2014. METHODS: The study involved an analysis of data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys focusing on adolescent girls aged 15-19 years. Analysis entailed descriptive statistics and estimation of multilevel logistic regression models examining variations in contraceptive use among adolescent girls over time. Estimates with p-values less than 0.05 were considered statistically significant. RESULTS: Results showed that contraceptive use remains low and ranged from 7.6% in 1996 to 10.9% in 2013/14, reflecting a change of 3.3 percentage points over 18 years. Over the 18 years, contraceptive use was significantly associated with age, level of education, and marital status. Older adolescent girls and those with higher levels of education were significantly more likely to use contraception compared to younger ones and those with lower levels of education. Although initially significant (AOR 0.556, 95% CI 0.317, 0.974 in 1996), rural-urban differences disappeared between 2001/2 and 2007 but re-emerged in 2013/14 (AOR 0.654, 95% CI 0.499, 0.859). Across all survey years, adolescents who were married or living with a partner were significantly more likely to use contraceptives compared to those who were not married. CONCLUSIONS: The findings suggest the need for targeted interventions to improve contraceptive use among sexually active adolescent girls in the country in general, and those who are disadvantaged in particular.
Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Adolescente , Anticoncepción/métodos , Anticoncepción/tendencias , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/tendencias , Estudios Transversales , Escolaridad , Femenino , Humanos , Análisis Multinivel , Embarazo , Adulto Joven , ZambiaRESUMEN
The affordability of pharmaceuticals has been a major challenge in US health care. Generic substitution has been proposed as an important tool to reduce the costs, yet little is known how the prices of more expensive brand-name drugs would be affected by an increased utilization of generics. We aimed to examine the trend of overall utilization and the total costs of brand-name oral contraceptive pills (OCPs), the most widely used form of contraception, and its association with the pharmaceutical market concentration among the OCPs. Data from the Medical Expenditure Panel Survey (MEPS) 2011-2014, a nationally representative survey of healthcare utilization, were extracted on the utilization of generic and brand-name OCPs. A multiple logit regression analysis was conducted to assess the trend in utilization of brand-name OCPs over time. Total costs, including the costs to the payers and consumers, were synthesized. The Herfindahl-Hirschman Index (HHI), an index describing market concentration, was constructed, and a multiple regression analysis was conducted to evaluate the association between the brand-name OCP prices and the market share of individual brand-name drugs. The odds of utilizing brand-name drugs decreased steadily in 2012, 2013, and 2014 compared to 2012 (AOR 0.87, 0.73, 0.55, respectively, p<0.05) controlling for patient mix. Despite significant decline in total utilization, there was a 90% increase in the price of brand-name OCPs, resulting an 18% increase in revenue from 2011 to 2014 for the industry. During this time, pharmaceutical market concentration for OCPs increased (HHI increased from 1105 in 2011 to 2415 in 2014). Each percentage point increase in the market share by a brand-name OCPs was associated with a $3.12 increase in its price. Market mechanisms matter. Practitioners and policy makers need to take market mechanisms into account in order to realize the benefits of generic substitutions.