Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Determinants of DMPA-SC self-care/self-injectable contraceptive uptake among modern contraceptive users in Burkina Faso: findings from the 2021 demographic and health survey.

Introduction: This study aimed to identify the determinants that influence the use of DMPA-SC/Sayana Press among women who use modern contraceptive methods in Burkina Faso. Methods: This study used secondary data obtained from the 2021 Burkina Faso Demographic and Health Survey (EDSBF). The dependent variable is the use of DMPA-SC among women aged 15-49 who employ modern contraceptive methods. The descriptive analysis used percentages to describe the study variables. The Pearson chi-square test was used to assess the associations between the explanatory variables and the study variable of interest. Bivariate logistic regression was used to examine the crude odds ratios of each explanatory variable with respect to the dependent variable. The multivariate model was used to determine the net effect of each independent variable on the dependent variable. The significance levels were defined at p < 0.05, with corresponding confidence intervals. Results: The study revealed significant differences in the use of DMPA-SC according to age, marital status, region of residence, level of education, number of children, and involvement in contraceptive decision-making within the couple. Younger women (aged 15-29 aOR = 2.12, p < 0.001)) and women aged 30-39 (aOR = 1.51, p = 0.02) are also more likely to use DMPA-SC compared to those aged 40-49. Married women or those living with a partner [aOR = 1.93 (1.22, 3.05)] are more likely to use DMPA-SC. Women with 1-3 children are twice as likely to use DMPA-SC as those without children (aOR = 1.97, p = 0.02). Region and Wealth Index were significantly associated with DMPA-SC use. The Boucle du Mouhoun region showed a significantly higher likelihood of DMPA-SC use (aOR = 8.10) and women in the highest wealth group are significantly less likely to use DMPA-SC (aOR = 0.59, p = 0.001). Conclusion: These results demonstrated the importance of adapting interventions to account for socio-demographic, regional, and cultural differences. This will enable the provision of services to the entire female population in a fair and equitable manner, while also addressing the limitations and enhancing the understanding of the underlying factors influencing the use of DMPA-SC.

'They will be like a person with a disease': a qualitative investigation of variation in contraceptive side-effect experiences in Central Oromia, Ethiopia.

Contraceptive side effects are consistently given as the main reason why women are dissatisfied with contraception or choose not to use it. However, why some women suffer more from side effects remains unknown. Through inductive analysis of in-depth interviews and focus group discussions with 40 contraceptive users and 3 key informants in Central Oromia, Ethiopia, we explored women's rationales for variation in side-effect experiences. The data first reveal the wide diversity in type and severity of side-effect experiences reported by users of contraception. Second, we found that women's rationales for why some individuals suffer more side effects from contraception invoke economic and physical hardship (food insecurity and heavy workloads), as well as interindividual differences in biology (one's blood must 'fit' with contraception). Finally, the analysis revealed the tension many women face in trying to negotiate the trade-off between the consequences of these side effects and those of an unwanted pregnancy. The results show the value of using a biosocial approach, which centres women's voices and experiences, for informing the measurement of contraceptive side effects within population health surveys and clinical trials. Additionally, the findings help gain an understanding of how an individual's social, biological, and cultural contexts drive variation in when and why different side effects manifest.

Male contraceptive acceptability versus male acceptance of contraceptive responsibility.

Despite the projected impact of new male contraceptives, resources and investments directed at their development remain limited in part due to concerns that men would not actually use them. Now, more than 30 studies have been conducted over the last 30 years-regionally and internationally, within clinical trials, and across populations-examining men and women's attitudes towards new male contraceptive methods, all consistently demonstrating interest in and willingness to use new methods. Yet even these studies, inclusive of competitive contraceptive market projections, seem not to be convincing enough. Rather than study whether men would be willing to use male contraceptives, more resources should be devoted to developing the infrastructure and supporting the cultural changes needed to ensure that when new male contraceptives inevitably emerge, that they will be disseminated quickly and made readily accessible. Men's views on what their roles are in society, families, relationships, and pregnancy prevention are changing in ways that may impact what they consider to be acceptable contraceptive risks. As society moves toward more gender equitable beliefs, men's positive involvement in contraception might organically develop into an expected behavior. Interventions aimed at sensitizing men toward gender equitable beliefs may pay dividends in improving male contraceptive acceptability. The current lack of a reversible male contraceptive method prevents us from collecting data that might disprove presumptions that men would be unwilling to take on responsibility for pregnancy prevention. However, studies of men's involvement in (1) over-the-counter emergency contraception, (2) vasectomy, and (3) abortion offer case studies for men's increasing consciousness of opportunities for shared contraceptive responsibility, the structural and sociopolitical barriers that men face when trying to participate in family planning, and how these might translate into new male contraceptive interest and development.

Immediate versus delayed postpartum insertion of long-acting reversible contraception methods: meta-analysis of randomized controlled trials.

OBJECTIVE: We aimed to conduct a meta-analysis of randomized trials comparing the immediate versus delayed provision of long-acting reversible contraceptives in postpartum subjects, focusing on short-interval pregnancies, utilization rates, and adverse events. DATA SOURCES: Cochrane Central, Embase, PubMed and ClinicalTrials.gov were systematically searched from inception up to December 19, 2023, without filters or language limitation. STUDY ELIGIBILITY CRITERIA: We selected randomized controlled trials assessing the immediate insertion of long-acting reversible contraceptives in women during postpartum period in comparison with the delayed provision. STUDY APPRAISAL AND SYNTHESIS METHODS: We calculated relative risks (RR) with 95% confidence intervals to analyze the primary outcome of utilization rates and secondary endpoints, including initiation rates, pregnancy, any breastfeeding, exclusive breastfeeding, and serious adverse events. A random effects model was employed in the R software. Moreover, we assessed the risk of bias of selected RCTs using version 2 of the Cochrane Risk of Bias Assessment Tool. RESULTS: We included 24 randomized trials comprising 2,507 participants, of whom 1,293 (51.6%) were randomized to the immediate insertion. Postpartum women in the immediate group had lower risk of pregnancy (RR 0.16; 95% CI 0.04-0.71; P = 0.02) compared with delayed group, and higher rates of long-acting reversible contraceptives at 6 months of follow-up (RR 1.23; 95% CI 1.09-1.37; P < 0.01). CONCLUSIONS: Inserting long-acting reversible contraceptives before hospital discharge was associated with a reduction in the risk of pregnancy, and increased rates of its utilization at 6 months of follow-up. This intervention may be an effective contraception strategy for postpartum women.

Post pregnancy family planning in Latin America and the Caribbean analysis and strengths in training on immediate contraception post obstetric event by CLAP/PAHO.

Virtual courses developed by the Pan American Health Organization (PAHO) on family planning and immediate contraception post obstetric event (ICPOE) were launched in 2021 as training actions on ICPOE in the region. A total of 89,899 people enrolled in these courses; 36,494 (40.7%) of them enrolled in the course on ICPOE, and almost 60% of participants from Latin America passed the course. Moreover, 37% of participants were nurses, and 36% were physicians; most participants were from 20 to 39 years old. Eighty per cent completed the course in a week, and 89% had finished it by the 15th day. Students who passed the course expressed high overall satisfaction (95%), with ease of taking the course at home (63%) and at the workplace (33%) identified most frequently. Furthermore, practice training sessions (including simulation models) were conducted with 165 candidates to be trainers, physicians, and obstetricians. Approved trainers came from the Dominican Republic, Honduras, Bolivia, and Paraguay. CONCLUSION: There was evidence of the need for ICPOE training, and the innovative virtual courses developed by PAHO.

Contraception Use and Changes in Young Women with Newly Diagnosed Breast Cancer.

OBJECTIVE: To evaluate contraception use and change among young women with early breast cancer. DESIGN: Secondary analysis of a cluster randomized trial. SUBJECTS: Patients with newly diagnosed breast cancer age ≤45 years enrolled from 54 U.S. oncology practices. EXPOSURE: Sites were randomized to the Young Women's Intervention, an educational intervention for young women with newly diagnosed breast cancer and their oncologists addressing issues specific to this population, including contraception, or a contact-time control Physical Activity Intervention. Participants completed surveys in follow-up, including a 3-month survey regarding contraceptive practices before and after diagnosis. MAIN OUTCOME MEASURES: Outcomes of interest included young women's contraceptive use and methods before breast cancer diagnosis and 3 months after study enrollment. Logistic regression models assessed factors associated with use of less than highly effective contraceptive methods categorized according to WHO effectiveness tiers and changes in contraceptive methods. RESULTS: Of 312 women included, 258 (83%) reported contraceptive use before breast cancer diagnosis, and 275 (88%) reported contraceptive use after diagnosis. Use of highly effective methods (e.g, vasectomy, non-hormonal intrauterine devices) increased from 39% before diagnosis to 52% after diagnosis. Use of moderately effective methods (e.g., hormonal methods), decreased from 22% before diagnosis to 3% after diagnosis. Use of less effective methods (e.g, condoms, withdrawal) increased from 22% before diagnosis to 34% after diagnosis. On multivariable analysis, factors associated with using less than highly effective contraception after diagnosis included desire for additional children (odds ratio (OR) 6.33, 95% confidence interval (CI) 3.76-10.66, p<0.001) and discussing contraception with a provider (OR 1.96, 95% CI 1.12-3.40, p=0.018). After breast cancer diagnosis, 207 patients (66%) reported no change in contraceptive methods. On multivariable analysis, factors associated with contraceptive method change after diagnosis included age <35 years (OR 2.96. 95% CI 1.57-5.58, p-value <0.001) and provider discussion (OR 3.59, 95% CI 1.91-6.78, p<0.001). There was no association in either analysis with study arm. CONCLUSION: Although most patients used contraception after breast cancer diagnosis, nearly half reported using less than highly effective contraceptive methods with higher failure rates, highlighting the need for early and improved contraceptive counseling for young women with breast cancer.

"A sweet in a polythene is not sweet": men's perceptions of their roles and experiences with family planning in East Uganda.

The significance of men's influence as partners in contraceptive decision-making and family size is often understated, particularly in patriarchal societies. Understanding men's experiences and perceptions of family planning is necessary to address women's unmet needs for contraception. This study examined men's involvement in contraceptive use and decision-making in the Busoga region of east Uganda. Twenty-four in-depth interviews were conducted with both male users and non-users of contraception living in urban and rural areas. Among participants, differences in preferred family size were influenced by competing norms valuing large families and economic wellbeing as reflections of men's role as a provider. Although the majority of interviewees were not opposed in principle to contraception, some men felt contraceptives undermined their own desire for a larger family. Men who supported family planning cited the economic benefits of smaller, healthier families and being able to fulfil their role as the primary breadwinner. Resistance to vasectomy and perceptions of condom use as protection against unwanted pregnancies and STIs/HIV in casual relationships, meant participants were unlikely to use male contraceptives. Efforts to increase contraceptive uptake among men should recognise the socio-cultural context of men's place within Ugandan society, to design reproductive health initiatives that engage men effectively.

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review.

BACKGROUND: Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia. METHODS: The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care. RESULTS: A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling. CONCLUSIONS: There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

Contraceptive counseling training experiences and behaviors among obstetrics and gynecology residents in California and Florida.

OBJECTIVE: To describe experiences with contraception counseling training and provision of obstetrics and gynecology residents training in California and Florida. STUDY DESIGN: We conducted a mixed-methods study of obstetrics and gynecology residents training across 19 programs (with approximately 428 residents) in California and Florida from September 2022 through February 2023. We asked participants how often they use tiered-effectiveness counseling, their satisfaction with contraception counseling practices, and experiences with witnessing and recognizing contraception coercion. We asked about personal disappointment when patients decline long-acting reversible contraception (LARC) and pressure from faculty to prescribe LARC. To further explore resident contraception counseling education and behaviors, we conducted semi-structured telephone interviews with a subset of 20 survey volunteers. RESULTS: We received survey responses from 155 (36.2%) participants. Most (n = 113 [76.4%]) often or always reported using tiered-effectiveness counseling. While few participants (n = 17 [11.3%]) reported feeling pressure from faculty to convince a patient to keep a LARC, some (n = 34 [22.1%]) reported they often or always feel disappointed when a patient chooses LARC removal, with more Florida participants reporting disappointment (n = 19 [37.3%]) compared to California (n = 15 [14.6%], p = 0.01). We identified two main themes from the telephone interviews. First, residents feel they have limited formal education on how to provide contraceptive counseling and commonly learn these practices by emulating supervising faculty or peer counseling styles. Second, residents are informally taught, through feedback and interactions with supervising faculty and peers, that successful contraception counseling is the ability to convince patients to use highly effective contraception. CONCLUSION: When residents lack formalized contraception counseling education, they adopt counseling behaviors that may not be patient centered. IMPLICATIONS: When obstetrics and gynecology residents lack formalized contraception counseling education, they learn practices that may lead to coercive counseling behaviors during training. Resident education should include recognition and mitigation of contraception coercion and patient-centered counseling both through a formalized curriculum and socialization of trainees during their medical education.

FIGO and ICM joint statement on contraception: 2024.

Contraception, and the opportunity and ability to decide the timing, number, and spacing of one's pregnancies, is not just critical for maternal and infant health, but necessary for the attainment of basic reproductive rights. Short inter-pregnancy intervals have significant consequences for both maternal and newborn mortality, including preterm birth and maternal anemia, and they are a key cause of preventable deaths worldwide. Addressing the unmet need for contraception could have widespread implications for health equity and access. Integrating comprehensive contraceptive services into various health settings including antenatal care, postpartum care, and child immunization visits is vital. Contraceptive counseling should be holistic, and should involve shared decision-making and patient autonomy. Contraceptive counseling is particularly important in the post-pregnancy period, where loss to follow-up may be high, and for adolescents and other vulnerable populations who are often overlooked in these discussions. Addressing the unmet need for contraception requires collaboration and teamwork among healthcare professionals, particularly midwives and physicians, who have the opportunity to amplify one another's efforts, share best practices, advocate for broader contraceptive services, and strengthen training among midwifery and medical trainees. Members of FIGO and ICM have worked together to produce this joint statement, identifying priorities within contraceptive provision and underlining key collaborative strategies to address the unmet need for contraception.

Contraceptive risk events among family planning specialists: a cross sectional study.

BACKGROUND: Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women's Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. "Risk events" are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. METHODS: This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. RESULTS: Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. CONCLUSIONS: The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access.

ANTECEDENTES: Los que apoyan la restricción del aborto citan los avances en la tecnología anticonceptiva como una razón en contra de la necesidad de la atención del aborto hoy en día, más recientemente a través de los argumentos orales en el caso de la Corte Suprema de los Estados Unidos, Dobbs v. Jackson Women's Health. Sin embargo, el uso sistemático y indicado de los anticonceptivos requiere unos conocimientos sobre salud reproductive. Nuestros objetivos eran cuantificar los eventos de riesgo anticonceptivo y evaluar los antecedentes y las preferencias entre una población bien equipada para eludir los riesgos anticonceptivos, los especialistas en planificación familiar tras el inicio de su formación médica. Los "eventos de riesgo" se definen como episodios reportados de fallo anticonceptivo, uso de anticoncepción de emergencia y/o relaciones sexuales sin protección o con protección insuficiente. MéTODOS: Este fue un estudio transversal entre miembros actuales de una organización profesional de especialistas en planificación familiar. Los criterios de inclusión incluyeron: condición de clínico/a en activo/a o jubilado/a, relaciones sexuales consentidas pene-vagina desde el inicio de la formación médica y capacidad personal o de la pareja para quedarse embarazada. Se realizaron estadísticas descriptivas. Este estudio estaba exento de IRB. RESULTADOS: De las 229 encuestadas, 157 (69%) declararon haber sufrido un evento de riesgo anticonceptivo desde la formación. Veintinueve (13%) encuestadas declararon haberlo sufrido un incidente en el último año. Por categoría, el 47% (108/229; 3 informaron de forma desconocida) informaron de relaciones sexuales sin protección o con poca protección, el 35% (81/229) informaron del uso de anticonceptivos de emergencia y el 52% de los participantes (117/227; 2 informaron de forma desconocida) informaron de un fallo anticonceptivo conocido o sospechado. El promedio de métodos anticonceptivos utilizados fue 3,7 (DE 1,7) de los 13 métodos enumerados. Casi todas las participantes (97%) informaron de que al menos un método no era una opción aceptable, con un promedio de 5,6 (DE 2,7) de los 13 métodos enumerados. CONCLUSIONES: La mayoría de los especialistas en planificación familiar han experimentado eventos de riesgo anticonceptivo en momentos de prevención activa del embarazo desde su formación médica. El cambio de método anticonceptivo es frecuente y la mayoría de los encuestados tenían un número limitado de métodos que les resultaban personalmente aceptables. El diálogo que idealiza el papel de la planificación familiar a la hora de minimizar o eliminar la necesidad de abortar es simplista y representa de forma inexacta las realidades vividas por las personas con capacidad de embarazo y sus parejas, incluso entre aquellas con conocimientos y acceso excepcionales a la anticoncepción.

Knowledge and Attitudes Regarding Family Planning Options in Armenia.

Objective: In many Transcaucasian and Middle Eastern populations, research in women's sexual and reproductive health remains limited, especially in Armenia despite recent political and cultural changes. This study explores the current state of family planning in Armenia while both highlighting the recent progress and identifying current barriers to reproductive health. Study Design: We conducted a mixed-methods study using both a quantitative survey and qualitative interviews with women and key informants in the field of women's sexual and reproductive health. Results: Armenian women are familiar with many types of contraception. The use of modern methods has increased but remains low. Sexual education for women is uncommon and often sought through independent online searches or books. We found no significant access barriers, however, a prevailing distrust in hormonal contraceptive methods left many women to rely on condoms and withdrawal. Although the majority of surveyed women (72%) believed having access to safe abortions was an important right, only 42% would consider having an abortion in the case of an unintended pregnancy. Interviewees highlighted the lack of sexual education, discrepancies in sexual and reproductive services between rural provinces and the urban capital city of Yerevan, as well as the need for information and the government's responsibility in this field. Conclusions: The lack of comprehensive sexual education in Armenia fuels misinformation regarding family planning options. One option we recommend is a government-funded sexual education program which begins as culturally sensitive, sex-positive education in schools and continues with counseling and support for women within the health care system.

Injection Depot Medroxyprogesterone Acetate as an Early Postpartum Contraceptive Measure: Evaluation of Its Acceptability, Efficacy, and Impact on Lactation.

Introduction Through its National Family Planning Programme, India has been relentlessly working to decrease society's unmet contraception needs. The postpartum period is of paramount importance for addressing these contraceptive needs owing to alterations in fertility and coital behavior associated with childbirth. Depot medroxyprogesterone acetate (DMPA), a long-acting reversible contraceptive, is one of the safe options available in the early postpartum period. In this study, we aimed to evaluate its efficacy and acceptability among postpartum women delivering in Guru Gobind Singh Medical College and Hospital. Methodology We recruited 206 early postpartum women for the study. After thorough counseling and ensuring establishment of lactation, we administered DMPA 150mg by injection intramuscularly and repeated it at intervals of three months in willing patients. We then evaluated them for their symptoms, side effects, and lactation status using a predesigned proforma either during their follow-up visits or telephonically. Results We found DMPA to be 100% efficacious as an early postpartum contraceptive measure. The main reasons for acceptance were its ease of use, long-term effects of a single dose, and noninterference with lactation. However, the continuation rate for the second dose was only 18% in our study, highlighting the need for better counseling and improving awareness among our patients. Ninety-nine percent of our patients were satisfied with their lactation. Conclusion We found injectable DMPA used as a contraceptive in the immediate postpartum period to be a safe and effective alternate method with no deleterious effect on lactation and an acceptable side effect profile. However, more awareness programs are necessary to encourage women, especially those in low-resource areas, to continue using DMPA.

In vitro evaluation of oral contraceptives on long-tailed macaque (Macaca fascicularis) primary ovarian cells.

Hormonal contraception has been advocated as an alternative population control method for the long-tailed macaque population, which has increased exponentially due to anthropogenic changes and incidental food subsidies from human food waste. Risks of increased zoonosis and conflict are imminent if the population growth of long-tailed macaques is unchecked. However, there's a gap in the literature about the effect of hormonal contraceptives on long-tailed macaque reproductive tissues cell line. The present study aims to investigate the effect of oral contraceptives (Nordette, Noriday, and Ella) on long-tailed macaque ovarian cells. We determine the cell viability and cytotoxicity as well as the morphological changes of the drugs on long-tailed macaque ovarian cells using the MTT assay, Acridine orange/propidium iodide double staining method, morphological examination, and the 4, 6-diamidino-2-phenylindole (DAPI) staining method. For the MTT assay, The drugs were dissolved in culture media before use to have a concentration ranging from 0.5 µg/mL, 2.5 µg/mL, 0.125 µg/mL, 0.0625 µg/mL, and 0.0315 µg/mL to have three replicates for each treatment. In contrast, the concentration of 0.0315 µg/mL was used for the morphological and histopathological analysis. The result of the study indicates that human oral contraceptives (Nordette, Noriday, and Ella) inhibit the growth of long-tailed macaque ovarian cells and induce apoptosis in a concentration- and time-dependent manner (at a concentration of 0.0315 µg/mL and an IC50 lower than 10 µg/mL), With a statistically significant value of ****P < 0.001 for each drug compared to the negative control. The result of the present study contributes toward addressing the gap in the literature on the effect of oral contraceptives in long-tailed macaque ovarian cells. Hence, we conclude that human oral contraceptives (Nordette, Noriday, and Ella) are safe and effective in long-tailed macaque ovarian cells as such could be used to develop non-invasive oral contraceptives for controlling the population of long-tailed macaques as an alternative population control method.

An age-related nomogram for antral follicle count: an observational study of 3821 women.

RESEARCH QUESTION: What is the relationship between antral follicle count (AFC) and chronological age, and what are the expected values for AFC? DESIGN: This was a retrospective cohort study at a specialist gynaecological ultrasound centre in London, UK. Women presenting to a gynaecology diagnostic unit for investigation of symptoms or routine check-up, and undergoing transvaginal ultrasound (TVUS) examinations, between 1 January 2017 and 22 September 2022 were included in this study. RESULTS: In total, 8821 TVUS records from 7573 patients were analysed. The relationship between AFC and age was estimated to develop an AFC nomogram independent of the stage in the menstrual cycle. AFC corresponding to the 10th, 25th, 50th, 75th and 90th centiles for each patient and age group were calculated. Both nomogram and condition-specific populations displayed a Gaussian relationship between AFC and age. For the nomogram population (scans n = 4256, patients n = 3821), a peak median AFC of 30 was observed between 21-23 years of age. The AFC distribution of the group with previous ovarian cystectomy (scans n = 534, patients n = 443) was found to be significantly different compared with the nomogram population (P < 0.0001). However, the same did not hold true for those on hormonal contraception (scans n = 566, patients n = 534) (P = 0.43). CONCLUSIONS: An AFC nomogram reporting median and interquartile values for AFC by chronological age across the reproductive years was developed. This is a useful tool for providing counselling for those undergoing ovarian reserve assessments, and can be taken any time in the menstrual cycle, including in women on hormonal contraceptives or who have undergone previous ovarian cystectomy.

Exploring Primary Care Physician Biases in Adolescent Contraceptive Counseling.

OBJECTIVE(S): While previous literature has shown clinician bias in adult contraceptive counseling, less is known on the biases clinicians may exhibit when counseling adolescents about contraception. Our study aimed to describe long-acting reversible contraception (LARC) counseling and prescribing practices of adolescent-serving clinicians. STUDY DESIGN: This study used a cross-sectional discrete choice experiment mixed methods design. We sent a survey containing vignettes and items pertaining to demographics and beliefs to a convenience sample of adolescent-serving clinicians across the United States. RESULTS: Of 296 clinicians, 80% were in pediatrics, and had geographic, practice setting, gender, and racial diversity. Most clinicians reported being up-to-date with current literature regarding contraception. Sixty-eight percent of respondent's practices administer contraceptive injections, but only 17% place IUDs. Of those who do insert IUDs, nearly half inserted five or fewer within the last year. Patients' younger age and Hispanic ethnicity were associated with lower odds, and history of pregnancy was associated with higher odds, of clinicians' recommending LARC. Across all vignettes, the top five reasons clinicians chose their first-choice method for the patient were adherence or compliance, efficacy, side effects, patient age, and reversibility. CONCLUSION(S): Clinicians often recommend contraceptives based on adherence, efficacy, and age, and we found younger age, minoritized race or ethnicity, and history of pregnancy were all associated with LARC recommendations, indicating potential biases against teen parents and assumptions about adolescents' priorities. This may impede the provision of patient-centered contraceptive counseling for adolescents, and highlights the need for improved education and practice changes post-Dobbs.

The Association between Socio-Economic Deprivation and Receipt of Long-Acting Reversible Contraception at a Single Clinic Visit.

OBJECTIVES: To determine the relationship between residing in areas of high deprivation and obtaining single-visit long-acting reversible contraception (LARC). STUDY DESIGN: We utilized Poisson regression to determine the association between area deprivation and single-visit LARC insertion within a state-wide healthcare system between 2019-2021. RESULTS: Among our cohort (N=4,417), 68.60% of patients desiring LARC obtained single-visit LARC and 23.70% lived in high deprivation areas. Participants living in high deprivation areas were less likely to receive single-visit LARC (aRR 0.72, 95% CI 0.65-0.80). CONCLUSIONS: Reducing barriers to desired care among patients living in areas with socioeconomic deprivation is needed to reduce inequities in reproductive healthcare. IMPLICATIONS: While improving access to single-visit LARC should be universally improved, attention is needed to reduce barriers among clinical sites caring for patients with a higher ADI and ultimately help limit further inequities in reproductive healthcare.

A randomised double-blind trial to determine the bleeding profile of the prolonged-release contraceptive dienogest 2 mg/ethinylestradiol 0.02 mg versus an immediate-release formulation of drospirenone 3 mg/ethinylestradiol 0.02 mg.

BACKGROUND: Dienogest (DNG) 2 mg/ethinylestradiol (EE) 0.02 mg is the first low-dose combined oral contraceptive (COC) with a prolonged-release formulation that allows stable plasma concentrations and has high contraceptive efficacy (Pearl index: 0.2). The aim of this trial was to determine the bleeding profile of this contraceptive compared to an immediate release formulation. METHODS: This prospective double-blind randomised controlled trial evaluated the bleeding patterns of DNG 2 mg/EE 0.02 mg compared with immediate-release drospirenone (DRSP) 3 mg/EE 0.02 mg in a 24/4-day regimen over nine cycles (randomisation ratio, 5:2). Participants recorded scheduled and unscheduled bleeding/spotting data using an electronic diary. A non-inferiority analysis for the proportion of participants with unscheduled bleeding/spotting was prespecified for Cycles 2-6. Safety, including adverse events, were monitored throughout the trial. RESULTS: Seven-hundred six and 288 participants received DNG/EE and DRSP/EE, respectively. Scheduled bleeding patterns per each 28-day cycle were similar in both groups. During Cycles 2-6, the proportion of participants with unscheduled bleeding/spotting was significantly lower in the DNG/EE group (50.5% [280/574] than in the DRSP/EE group (72.8% [171/235]]; treatment difference 22.3% [95% CI 15.9, 28.6%]; p < 0.0001). A low proportion of participants discontinued the trial due to bleeding disorders (1.7% and 0.7%, respectively). The safety profiles were similar for both treatments. CONCLUSIONS: The prolonged-release DNG 2 mg/EE 0.02 mg offers a significant decrease in unscheduled bleeding/spotting compared with an immediate-release COC, DRSP/EE, combined with high contraceptive efficacy and a very low adverse event profile.

The prolonged-release DNG 2 mg/EE 0.02 mg offers a significant decrease in unscheduled bleeding compared with an immediate-release COC while maintaining contraceptive efficacy and with no new safety signals.

Mother-Daughter Dyads' Perceptions of Contraception.

STUDY OBJECTIVE: In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception. METHODS: Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semi-structured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach. RESULTS: There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted. CONCLUSION: These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.