Associations of the implementation of the three-child policy with changes in contraceptive methods among women who underwent induced abortion: a cross-sectional study of Wuhan, a megacity in central China.

BACKGROUND: Induced abortion, as a legal medical practice in China, has an enormous negative impact on women's sexual and reproductive health. After the implementation of the three-child policy, guiding women to choose appropriate contraceptive measures to protect their fertility is the focus of China's family planning. But little is known about the impact of the family planning policy on women's contraceptive behaviour. METHODS: We collected 7022 cases who underwent abortion between July 2020 and June 2022 in Wuhan. Based on the time of implementation of the policy, the study population was divided into two groups, namely, the pre-policy group (before July 2021, Group 1) and the post-policy group (after July 2021, Group 2). Logistic regression was used to analyse the effect of the policy on women's choice of different contraceptive methods for abortion. RESULTS: There were a total of 3487 cases in Group 1, accounting for 49.65%, and 3535 cases in Group 2, accounting for 50.34%. The proportion of women choosing efficient contraceptive methods after the Three-Child Policy decreased compared with before. A correlation was observed between the implementation of the Three-Child Policy and whether to choose efficient contraceptive methods after abortion (p < 0.001). CONCLUSION: The study has found that after the Three-Child Policy, women opting for induced abortion tend to prefer less effective contraceptive methods, particularly condoms. There is a marked shift towards more effective contraception methods both before and after the implementation of the Three-Child Policy.

The implementation of the three-child policy in China has changed the preferences of women who choose contraception methods after induced abortion. Family planning work should raise awareness and help women choose appropriate contraceptive methods to reduce induced abortion and protect women fertility.

Unmet Need for Modern Contraceptive Methods Among Displaced Married Women in Their Reproductive Years in Bishan Guracha Town, West Arsi Zone, Oromia Region, Ethiopia.

Background: Refugees and conflict-affected areas are often unreached by national strategies and programs. As a result, high unmet needs are more likely because of their social interruption with their traditional information sources, support, protection, and lack of income which limits refugees' ability to make a free choice that would allow them to plan and space the number of children they desire. Information on the unmet needs of internally displaced persons (IDPs) women is scarce. This study is aimed at assessing the magnitude of the unmet need for modern contraceptive methods and associated factors among IDPs currently married reproductive-age women. Methods: A community-based cross-sectional study was conducted among 393 internally displaced women currently married reproductive-age women using a simple random sampling method using a structured, pretested, and interview-administered questionnaire. A logistic regression model was used to identify associated factors. Statistically significant variables at p value < 0.25 in the bivariate analysis were entered into multivariable analysis, and statistical significance was declared at p value ≤ 0.05. Results: About 160 (40.7%) (95% CI: 35.94%-45.67%) of women had an unmet need for modern contraceptive methods, 139 (35.4%) for spacing, and 21 (5.3%) for limiting. Less than 18 years of age at first marriage, lack of access to modern contraception, lack of discussion with healthcare providers, and travel time of 30 min or more to obtain family planning were found to be risk factors for unmet contraceptive needs. The risk of unmet need for modern contraceptives was high among women who were married at age of less than 18 years of age in comparison with women who were married at 18 and above (AOR = 1.559; 95%CI = 1.019-2.385). Unmet needs were higher among participants who had no adequate availability of modern contraceptive methods than those who had adequate availability of modern contraceptive methods (AOR = 1.738; 95%CI = 1.125-2.684). Similarly, the odds of unmet needs were 1.673 times higher among participants who did not discuss FP with healthcare providers than those who discussed FP with healthcare providers (AOR = 1.673; 95%CI = 1.085-2.581). Moreover, the odds of unmet needs were 1.551 times higher among participants who traveled 30 min and above to access family planning services as compared to those respondents who traveled below 30 min (AOR = 1.551; 95%CI = 1.002-2.401). Conclusion and Recommendations: The magnitude of the unmet need for modern contraceptive methods was higher than both the Ethiopian national and Oromia regional state total unmet need for the general population. Governmental and nongovernmental organizations should increase their efforts to reduce this high magnitude of unmet needs by emphasizing those factors that have a great contribution to unmet needs.

Social capital mediates knowledge gaps in informing sexual and reproductive health behaviours across Africa.

Advancing sexual and reproductive health is essential for promoting human rights and women's empowerment, and combating the HIV/AIDS epidemic. A large body of literature across the social sciences emphasizes the importance of social capital, generated through the strength of social networks, for shaping health behaviours. However, large-scale measurement of social capital and social networks remains elusive, especially in the context of low-income countries. Here we delve into the role of social capital dynamics, and in particular social connectedness across communities as measured through Facebook friendship links, in shaping knowledge diffusion and behaviour related to sexual and reproductive health in 495 regions across 33 countries in Africa. Our findings demonstrate that regions with higher levels of social connectedness are more similar in their knowledge about contraception and HIV testing, as well as their adoption of these behaviours. We further observe that the influence of social connectedness becomes stronger when the knowledge gaps between regions are larger. In other words, regions are more similar in behaviours, despite knowledge gaps, when they are socially connected. These insights carry significant policy implications, especially for the design and targeting of public health campaigns. We highlight that social connectedness can serve both as a driver and an obstacle in behaviour formation, underscoring the importance of understanding its influence on health-related outcomes.

Provider perspectives on adolescent access to contraception in South Africa.

BACKGROUND:  Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM:  This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING:  This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS:  Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS:  Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION:  Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.

"I will find the best method that will work for me": navigating contraceptive journeys amongst South African adolescent girls and young women.

BACKGROUND: Given that South Africa has one of the highest rates of pregnancy amongst adolescent girls and young women (AGYW) globally, the provision of contraceptives to this group has been a key focus in recent years. Pregnancy prevention involves an on-going continuum of decision-making around contraceptive method choice, uptake, use, experience, continuation, and discontinuation. METHODS: This paper presents analysis of data from a cross-sectional survey with 2376 AGYW, as well as qualitative in-depth interviews (IDIs) with 54 AGYW, inclusive of contraceptive journey narratives. We examine the preferences, valued characteristics, choices, beliefs, understandings and experiences of choosing and using contraceptives amongst AGYW in two South African communities characterised by high rates of pregnancy. RESULTS: These findings shed light on the preferences towards, beliefs about, and experiences of choosing, using and discontinuing contraceptive methods amongst this population, with survey data suggesting that the most popular methods were the injection, followed by the implant, and then the oral pill. Findings illustrate the complexity and dynamic nature of contraceptive decision-making and the varied embodied and lived experiences of contraceptive use, and how these are impacted by contraception service provision. CONCLUSIONS: Our findings show that contraception experiences of each individual are cumulative, and comprise a continuum of method initiation, use, discontinuation, method switching and on-going circular decision-making influenced by multiple social, structural, contextual and interpersonal factors, combined with shifting preferences, values and needs. To maximise the use of contraceptives amongst South African AGYW, it is necessary to provide responsive contraception service provision to reflect the changing contexts and preferences of users, in order to ensure that pregnancy prevention needs are catered for throughout their reproductive life course.

Why it is timely to bring a new hormonal male contraceptive to the public - A 35-year perspective of the authors.

This perspective provides an overview of issues needed to bring a testosterone-progestogen combined transdermal male hormonal contraceptive to the market. Large-scale phase 2b trials are near completion and a pivotal trial to confirm efficacy and safety has been designed. We believe we are close to accomplishing the steps necessary to bring the first male-directed effective, safe, and reversible pharmaceutical contraceptive approach to the public. If successful, we believe it will provide a new option for couples to consider in their family planning.

Fertility patterns in Pakistan: a comparative analysis of family planning trends across different geographic regions.

INTRODUCTION: Family planning includes a wide range of services, such as counseling, contraception, and support to couples. Evidence shows that developing countries have a high degree of inequality in contraception use and prevalence. Reasons for these inequalities include cultural barriers such as traditional preferences and a desire for larger families and lineage, especially in rural areas. The primary objective of this research was to examine the updated contraceptive method preferences of couples in rural and urban regions of Pakistan and how these translate to family planning practices among the different provinces. METHODS: A secondary survey analysis using the Pakistan Demographic and Health Survey 2019 survey data was conducted. The dataset included 15 143 women sampled proportionally from the provinces, including Gilgit Baltistan and Azad Jammu and Kashmir. The unit of analysis was 'women' from the individual survey dataset. Age, type of residence (rural, urban), division, education level, and language were used to evaluate access to family planning and contraception services. The c2 test assessed the relationship between dependent and independent variables. Multivariate logistic regression analysis was then performed to see the likelihood of contraceptive use among women. RESULTS: Of the women in the sample, 55% were from rural areas and 50% were without formal education; 51.7% of these women were using or practicing any form of contraception method. The most common method used was condoms (9.2%), followed by injectables (6.2%). Regression analysis showed that women aged 15-19 years were less likely (odds ratio (OR)=0.71, 95% confidence interval (CI)=0.51-1.01) to use contraception when compared to the reference group. The likelihood of contraceptive use was higher in urban areas (OR=1.53, 95%Cl=1.39-1.69). Noticeably, contraceptive use was less likely in uneducated women (OR=0.62, 95%Cl=0.56-070). Punjab province had the highest contraceptive prevalence (34.3%), whereas Baluchistan had the lowest (6.9%). The use of contraception in urban and rural populations was similar in all provinces except Sindh and Gilgit Baltistan. In urban and rural areas, women in the age group 30-35 years who use contraception show a prevalence of 21% and 22% respectively. CONCLUSION: The study highlights suboptimal use of contraceptives and the existence of high levels of inequalities among the regions. There is a need for the implementation of focused educational initiatives and counseling interventions along with prioritization of accessibility and affordability of contraceptive methods among women in lower socioeconomic regions.

Knowledge, Use, and Perception of Brazilian Women about Contraceptive Methods: An Observational Study.

Background: In Brazil, where approximately 48.7 million women are of reproductive age, understanding contraceptive practices is essential for addressing public health challenges. This study evaluated into the knowledge, usage, and perceptions of contraceptive methods among Brazilian women, highlighting the influence of socioeconomic and demographic factors on their choices. Methods: We conducted a cross-sectional survey with a representative sample of 2000 Brazilian women aged 18-49 years. The questionnaire collected detailed information on their awareness, preferences, and utilization of various contraceptive methods, alongside demographic and socioeconomic data. Results: Oral contraceptives, condoms, injectables, and intrauterine devices (IUDs) were the most recognized methods. Younger women demonstrated greater awareness of modern methods. Socioeconomic disparities were evident, with lower-income women displaying limited knowledge about condoms and IUDs but a higher usage for injectable contraceptives. Oral contraceptives were the most used method, with higher use in the South, and lower in the Central-West and Northeast regions. Satisfaction with current contraceptive methods was high (87.5%), closely associated with personal responsibility in method choice. Although the majority self-financed their contraceptives (63.1%), a significant portion of lower-income women (27.7%) relied on public health care. Physicians' recommendations predominantly influenced contraceptive choice (53.9%), with younger women also guided by other influences. Conclusions: Persistent disparities in contraceptive awareness and access highlight the need for educational initiatives and policy interventions. Health care providers play a vital role in facilitating informed contraceptive choices, enhancing the chances of satisfaction with the method.

Leveraging web search data in Germany to identify unmet needs of contraceptives on a population-based level: A longitudinal retrospective study.

BACKGROUND: There are a variety of possible contraceptives available. While medical advice is an important resource for selecting the individual contraceptive, previous research has shown that the Internet has become an increasingly important source of health care information. OBJECTIVES: This study aims to identify key trends in contraception-related web searches in Germany and thus allows conclusions about preferences and unmet needs with regard to pregnancy prevention. DESIGN: Longitudinal retrospective study. METHODS: Google Ads Keyword Planner was used to identify contraception-related keywords and their search volume in Germany and all federal states between 2018 and 2021. The keywords were categorized based on gender, hormonal/non-hormonal, and different contraceptive methods. Search volume and categories were analyzed for temporal trends, regional differences, and underlying socioeconomic variables. RESULTS: The 1481 contraception-related keywords corresponded to 15,081,760 searches. In total, a 56% increase in searches/100,000 inhabitants was observed. Highest mean search volume was observed in categories "woman," "woman/non-hormonal" and "woman/non-hormonal/barrier," respectively, and in the federal state Hamburg, while the lowest was seen in North Rhine-Westphalia. CONCLUSION: The increase in search volume reflects a high interest in contraception, particularly in non-hormonal female methods. This stands in contrast to the limited number of effective non-hormonal contraceptives available and points to an unmet need. In addition, the low search volume for male contraceptives demonstrates gender-specific responsibilities regarding family planning in German society.

Analyzing Google search volume to identify preferences and unmet needs in contraception in German societyContraception is a topic that occupies many people in their daily lives. There is a wide range of different contraceptives available. The decision for a particular contraceptive can be made with the help of a consultation with a gynecologist or through other sources, such as the Internet. Research has shown that the Internet has become an important source for obtaining health information. This study aims to identify key trends in contraception-related web searches in Germany and thus allows conclusions about preferences and unmet needs with regard to pregnancy prevention. Google Ads Keyword Planner was used to identify contraception-related keywords and their search volume in Germany and all federal states between 2018 and 2021. The keywords were assigned to different categories based on whether the woman or the man uses the contraceptive, whether the contraceptive methods contain hormones or no hormones, and which exact contraceptive methods are associated with the search term. The search volume was analyzed in terms of trends over time, regional differences in Germany and socioeconomic variables. A 56% increase in searches per 100,000 inhabitants was observed. The highest mean search volume was observed in the category woman, followed by female non-hormonal contraceptives and within that category, the contraceptive method "barrier." The study shows that there is a high interest in contraception, especially in non-hormonal female contraceptives. These results contrast with the limited number of non-hormonal and effective contraceptive methods available. In addition, the low search volume in the category man shows that women are the main responsible party in terms of contraception in German society.

Provider Perspectives on Analgesic Use in Intrauterine Device Insertion Procedures: A Mixed Methods Analysis.

CONTEXT: The intrauterine device (IUD) is one type of long-acting reversible contraceptive that is becoming increasingly popular among patients and healthcare providers alike, though many are deterred from using this option due to pain or fear of pain with IUD insertion. While the IUD insertion process itself is standardized, the use of pain medication is not. There is a lack of research regarding provider preference in analgesic use for IUD insertion procedures, which analgesics are being provided to patients, and under which circumstances. This study aims to explore which analgesics are being used routinely in clinical settings, which patient populations are more likely to receive or benefit from these treatments, and why. Secondarily, this study aims to evaluate the impacts of provider characteristics such as location of training and practice, length of practice, and type of training in analgesic administration. METHODS: Various national organizations were contacted via email and asked to distribute the "IUD Pain Management" survey via discussion board or email newsletter. This survey was developed to gather demographic information on providers of IUD placement procedures and evaluate trends in analgesic methods used based on provider and patient characteristics. Additionally, the survey included an opportunity for participants to agree to participate in a brief interview to further elaborate on their responses via phone. Survey responses were collected and evaluated on the secure QuestionPro platform. Results from the interview were qualitatively assessed by coding recurrent themes between participant interviews. RESULTS: Survey respondents represented physicians from family medicine and OB-GYN specialties, as well as nurse practitioners, registered nurses, physician assistants, and OB-GYN resident physicians. The average length of clinical practice is 6.7 years. The majority of respondents reported offering some sort of analgesic for IUD insertion procedures, with nonsteroidal anti-inflammatory drugs being the most commonly used. Participants also reported an increased likelihood of prescribing analgesics for adolescent and nulliparous patients. Participant interviews included themes such as patient perception of pain, provider training, barriers to access, and alternative analgesic options. CONCLUSIONS: Our study has identified a significant amount of variation in practices regarding analgesic use for IUD insertion procedures and highlighted some underlying causes of these inconsistencies. Future studies should further investigate trends in analgesic administration in IUD insertion procedures with a larger sample size and delve into factors such as provider education and barriers to access.

Experiences of women on the use of Implanon NXT in Gauteng province, South Africa: A qualitative study.

Background: Maternal-related illnesses and pregnancy-related deaths could be averted using contraceptives, particularly long-acting methods because they improve overall access to family planning because of their benefits, such as fewer visits to the healthcare facility, higher effectiveness and value for money. The introduction of Implanon NXT in the South African health system raised great concern about the number of women who returned to healthcare facilities for its early removal within a few months of insertion. Aim: This article focussed on exploring the experiences of women regarding early removal of Implanon NXT insertion. Setting: The study was conducted in four selected clinics in Region E sub-district, city of Johannesburg. Methods: A qualitative exploratory approach was followed using semi-structured individual interviews to collect data. Data were analysed using the content analysis method. Results: The most cited reasons for its discontinuity were that women experienced unpleasant side effects such as amenorrhoea, excessive bleeding and headaches, whilst other women found it to be reliable and convenient. Conclusion: Contraceptive methods empower women to take control of their lives and to decide on the right time for them to have children. It is, therefore, important to equip women with relevant information about the contraceptive methods so that they can make informed decisions and choices. Contribution: The study calls for health promoters to periodically conduct information sessions with women as guided by the National Contraception Policy Guidelines to ensure up-to-date practice.

An exploratory study of the factors associated with use of contraceptive methods in young Chilean women aged 17-29 years.

OBJECTIVE: To explore factors related to the use of contraceptive methods in young Chilean women with higher education. METHODS: Using the 9th Chilean National Youth Survey, multinomial models were conducted to predict contraceptive methods used during the last intercourse among sexually initiated female college students aged 17-29 years who had already completed high school (n = 1828). RESULTS: The results indicate that using contraceptive methods at onset sexual activity was positively associated with the use of all contraceptive methods (relative risk ratio [RRR]immediate = 3.97, RRRdaily = 2.95, RRRlong-term = 1.82, P < 0.05). Having a previous unintended pregnancy increased the odds of using long-term contraceptive methods (RRR = 2.13, P < 0.05). Increased age of sexual initiation was associated with increased odds of using immediate contraception methods (RRRadolescence = 2.57, RRRyoung adulthood = 3.75, P < 0.05). Substance use was not associated with contraception methods used. Medium socioeconomic status, compared with high, decreased the odds of using immediate and daily contraceptive methods (RRR = 0.26, P < 0.05 for both). Low socioeconomic status was associated with decreased odds of using daily contraception (RRR = 0.39, P < 0.05). Finally, incomplete (RRR = 2.21, P < 0.05) or complete (RRR = 2.38, P < 0.05) professional education increased the odds of immediate contraceptive methods. CONCLUSIONS: To generate family planning policies aimed at university students, individual factors related to sexual behavior should be addressed in accordance with the local reality and with a gender focus.

"They call me the 'Great Queen'": implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania.

BACKGROUND: Adolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu ("Queen Club") program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania. METHODS: Forty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process. RESULTS: The Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program's adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW's need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program. CONCLUSIONS: The Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program's future adaptation and scale-up. TRIAL REGISTRATION: clinicaltrials.gov #NCT04045912.

Adolescent girls and young women (AGYW) in sub-Saharan Africa have limited access to family planning and reproductive health products and information even though they are at greater risk of pregnancy and HIV infection. The Malkia Klabu intervention was designed with AGYW and shopkeepers from private drug shops to facilitate access to products and information through a loyalty program that included free products, prizes for purchases, educational videos, and a non-verbal system of requesting products through symbols. Qualitive interviews with AGYW, drug shop staff, and health system counselors suggested that the program helped provide greater privacy and confidence to AGYW while bringing new business to drug shops. These findings can help as the study team charts a pathway for scaling up the intervention.

How do contraception preferences change over time? Eight years of experience in a tertiary hospital.

OBJECTIVES: To examine the contraceptive preferences of women based on their age and to track changes in these preferences over time. METHODS: This was an observational, retrospective cross-sectional study. Data from 2742 patients were evaluated for this study. The patient group of the first 4 years was classified as Group I (n=1371) and the last 4 years was classified as Group II (n=1371). The preferred contraception methods between the groups and their changes across the years were examined. RESULTS: Coitus interruptus was found to be the prevailing contraceptive method across all age groups, with 304 (70.9%) in 18-24 age group; 1314 (65.4%) in 25-40 age group; and 148 (48.8%) in 41-53 age group using this method. Breastfeeding rates were also analyzed across age groups, revealing that 11% of patients aged 18-24 years, 5% of patients aged 25-40 years, and 1.7% of patients aged 41-53 years were breastfeeding. Among these patients, 114 (74.5%) were not using any contraception method, while coitus interruptus remained the most popular choice. CONCLUSION: It was determined that there are many couples who do not have sufficient knowledge regarding family planning and birth control in our country. At the same time, the use of birth control methods has increased due to the increase in the education level of women and easier access to sexual health services.

Determinants of Contraceptive Options among Postpartum Women Attending Selected Health Care Facilities in Nigeria: A Cross-Sectional Study.

Introduction: Differences in availability and choices of contraceptive methods among postpartum women have been found to influence their quality of life as the fertility rate is very high, and the contraceptive usage rate persistently remains low in Nigeria. Objectives: This study assessed the determinants of contraceptive options among postpartum women in Nigeria. Methods: Two Local Governments were randomly selected from the four Local Governments. Within these two local governments, five health facilities were selected. A multistage sampling technique was used to select the 240 respondents, while a structured questionnaire was used to collect data. Results: Findings from the study indicated that 81.7% of the respondents have planned to have their current baby, and about 65.4% of the women have resumed sexual activities since delivery. Of those who have resumed sexual activities, the majority, 91.1% did so 6 weeks after delivery. Some form of contraceptive usage was prominent among 59.2% of the respondents, as the most common contraceptive method used was withdrawal (24.8%). Contraceptive prevalence was slightly lower for urban respondents than rural respondents, although the relationship was not significant. Also, there was a statistically significant relationship between the current use of contraceptives and resumption of sexual activities since delivery (p = .001), resumption of menstruation (p = .001), and information received about postpartum family planning (p = 0.013). Conclusion: Findings from this study emphasize the urgent need for enhanced accessibility and availability of contraceptive methods, with a parallel emphasis on targeted interventions and effective communication strategies to promote contraceptive uptake and family planning. Addressing these determinants is vital in improving postpartum women's overall quality of life in the study area.

A retrospective analysis of the trends in modern contraceptive use among adolescents and young women (15-24 years) in the Democratic Republic of the Congo in the last two decades.

Introduction: The increasing rate of unsafe abortion among adolescents and young women (AYW) in Sub-Saharan Africa may be attributed to a high rate of undesirable pregnancies and limited access to contraception services. The study looked at the prevalence of current contraception use among young women (15-24 years old) in the Democratic Republic of the Congo (DRC). Methods: The study analyzed secondary data from the demographic health survey (DHS) and UNICEF concerning AYW aged 15-24 years using IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. (Armonk, NY: IBM Corp.). The study population included 15,319 female adolescents and young adults in DRC. DHS datasets for 2001, 2010, 2017/2018, and UNICEF 2007 and 2013-2014 were downloaded after permission to use the data. Results: The AYW aged 20-24 accounted for 67% of the study population. The use of modern contraceptives has followed a roller coaster course. It dropped significantly from 2.6% in 2001 to 0.1% in 2007; it climbed to 2.7% in 2010 and 3.3% in 2013/14 but dropped to 2% in 2017/18. The most used method was male condoms (1.76%). A higher proportion of unmarried (2.3%) used any methods than married (1.8%). Those who attained secondary/higher education (2.6%) used modern contraceptives more than those with no formal education (1.5%), P < 0.0001. Those residing in the urban areas (4.5%) used modern contraceptives compared to those who lived in rural areas (1.7%) P < 0.0001. Modern contraceptive use among those with birth histories (2.6%) was comparatively higher than those who have not (2.3%), P < 0.0001. Those who lived in urban areas were adjusted odds ratio (AOR) = 2.504 times (95% confidence interval (CI): 1.793-3.497) more likely to use birth control than those in rural areas (P < 0.001). Conclusion: As reported in this study, the proportion of AYW's awareness of modern contraceptives is deficient in DRC, which might be attributed not only due to a lack of knowledge or enlightenment but also due to healthcare facilities' limited capacity to provide reproductive and sexual health services. Educating the AYW about modern contraceptive methods and interventions, including parents, the school system, and youth organizations, and strengthening the capacity of health facilities to provide modern contraception should be considered.

Online survey of consumer awareness and perceptions of a Massachusetts law for 12-month supply of contraception.

OBJECTIVES: This study aimed to characterize awareness of a 2017 Massachusetts (MA) law that ensures access to a 12-month supply of short-acting contraceptive methods (e.g., pill, patch, and vaginal ring) among short-acting contraceptive users in MA and to identify perceived benefits and concerns of a 12-month supply. STUDY DESIGN: An online survey was administered to a Qualtrics panel of MA women who were using short-acting contraceptive methods and were insured by an eligible health plan. The survey's primary outcome was general awareness of the law; interest in, receipt of, and perceived benefits and risks of a 12-month supply were also elicited. Analysis included descriptive statistics and bivariate and multivariable analyses examining factors associated with awareness of the law. RESULTS: Among the 207 survey respondents, 76% were aware of the law, and 93% expressed interest in receiving a 12-month supply of a short-acting method; however, only 9% received it. Respondents identified as White (66%), privately insured (59%), and pill users (44%). Concerns about a 12-month supply included privacy, product expiration, and change in personal medical status. Perceived benefits included avoiding multiple trips to pharmacy and increased compliance. Multivariable analyses showed general awareness of the law was only associated with employer-based insurance, with those respondents having 75% lower odds of being aware of the law than respondents with Medicaid coverage. CONCLUSION: Although a high percentage of women surveyed were aware of the law and most were interested in receiving a 12-month supply of their short-acting method, the low percentage who have received a 12-month supply suggests barriers to policy uptake. IMPLICATIONS: This study describes perceptions of the 12-month supply provision of the contraception Act Advancing Contraceptive Coverage and Economic Security in our State law. Addressing consumer concerns may be important to improve the implementation and dissemination of this state policy change.

Factors associated with access to condoms and HIV services among women in high migration communities in six Southern African countries.

Despite the documented importance of sexual and reproductive health in women's life, access to sexual and reproductive health (SRH) services by migrant women remains low leading to negative sexual and reproductive health outcomes. This study investigated the factors associated with access to condoms and Human immunodeficiency virus (HIV) testing services among 2070 women aged 15-49 years residing in high migration communities. Logistic regression models were fitted and migration status was found to be an important factor in women's access to HIV testing services. In addition to migration status, age, educational level, marital status, religion, comprehensive knowledge about SRH, comprehensive knowledge about HIV, partner's age, and partner's educational level were significantly associated with access to condoms and HIV testing services. Programmes aimed at increasing access to condoms and HIV services should collaborate with adult basic education programmes in order to increase women's education and involve all women regardless of migration status, age and marital status. In addition, the involvement of male partners and religious leaders in disseminating and imparting accurate information and knowledge regarding SRH and HIV services to ensure women's access to both condoms and HIV testing services is required.

Subdermal contraceptive implants and repeat teenage motherhood: Evidence from a major maternity hospital-based program in Uruguay.

Teenage fertility is a social problem because of its private and public costs in countries of different development levels. Reductions in adolescent birth rates do not necessarily follow drops in overall fertility due to the demographic transition model. This paper analyses the impact of a subdermal contraceptive program on repeat teenage motherhood. Using a regression discontinuity design, we find that the intervention reduced mothers' likelihood of having another child in the next 48 months by 10 percentage points. This reduction is not random, and we also identify small positive selection in subsequent births.

The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study.

BACKGROUND AND AIM: By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS: Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION: Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.