Sexuality and contraceptive knowledge in university students: instrument development and psychometric analysis using item response theory.

BACKGROUND: As a consequence of biological, psychological and social changes during puberty, youth is a period characterized by impulsiveness and risk-taking. Members of this population often feel invulnerable and have a strong motivation to explore their identity. A good level of knowledge is necessary to allow young people to experience their sexuality in a healthy way, without associated risks. In our environment there is currently no valid Spanish-language tool to measure the level of knowledge about sexuality and contraception. This study sought to develop and test the psychometric properties of a new sexuality and contraception knowledge instrument. METHODS: This is a cross-sectional study to validate the sexuality and contraception knowledge instrument. The validation process followed four phases: (1) development of the instrument, (2) content validation by an expert panel, (3) pilot test and (4) psychometric analysis of the instrument using item response theory according to the Rasch model. The validation process took place from September 2017 to February 2018. RESULTS: The sample included 387 students enrolled at the Nursing and Law degrees from the University of Jaen. The final instrument was made up of 15 items. All of the items presented good adaptation values with respect to the model. The scale showed good fit and reliability: 0.99 for items and 0.74 for people. The temporal stability of the scale was calculated using test-retest, obtaining a value of 0.81 (CI 0.692-0.888). The construct validity showed the one-dimensionality of the construct, while the discriminant validity obtained good results, so the scale appears to be able to differentiate between participants with low or high levels of knowledge. CONCLUSION: The results suggest the Sexuality and Contraception Knowledge Instrument is psychometrically valid and reliable for measuring the knowledge level concerning sexuality and contraceptive methods in young university students.

U.S. Selected Practice Recommendations for Contraceptive Use, 2016.

The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.

Unmet need for contraception and its association with unintended pregnancy in Bangladesh.

BACKGROUND: Unmet need for contraception and unintended pregnancy are important public health concerns both in developing and developed countries. Previous researches have attempted to study the factors that influence unintended pregnancy. However, the association between unmet need for contraception and unwanted pregnancy is not studied adequately. The aim of the present study was to measure the prevalence of unmet need for contraception and unwanted pregnancy, and to explore the association between these two in a nationally representative sample in Bangladesh. METHODS: Data for the present study were collected from Bangladesh demographic and health survey conducted in 2011. Participants were 7338 mothers ageing between 13 and 49 years selected from both rural and urban residencies. Planning status of last pregnancy was the main outcome variable and unmet need for contraception was the explanatory variable of primary interest. Cross tabulation, chi-square tests and logistic regression (Generalised estimating equations) methods were used for data analysis. RESULTS: Mean age of the sample population was 25.6 years (SD 6.4). Prevalence of unmet need for contraception was 13.5%, and about 30% of the women described their last pregnancy as unintended. In the adjusted model, the odds of unintended pregnancy were about 16 fold among women who reported facing unmet need for contraception compared to those who did not (95% CI = 11.63-23.79). CONCLUSION: National rates of unintended pregnancy and of unmet need for contraception remain considerably high and warrant increased policy attention. Findings suggests that programs targeting to reduce unmet need for contraception could contribute to a lower rate of unintended pregnancy in Bangladesh. More in-depth and qualitative studies on the underlying sociocultural causes of unmet need can help develop context specific solutions to unintended pregnancies.

Subjective meanings of 'unintended' pregnancy: interviews from understanding fertility management in contemporary Australia.

Unintended pregnancy can be difficult to identify and conceptualise. We aimed to understand how unintended pregnancies are constructed, explained and situated in a reproductive life. A total of 41 women and 7 men aged 20-50 years were interviewed in depth. Transcripts were analysed using iterative hermeneutic techniques informed by narrative theory. Of 34 participants who had been pregnant or had a partner in pregnancy, 12 women and 1 man described 23 'unintended' pregnancies, about half of which ended in abortion. Their accounts reveal that an unintended pregnancy is identified subjectively, that the same pregnancy may be identified by one partner in the pregnancy as unintended and by the other as intended, and that a researcher's supposedly objective assessment of an unintended pregnancy may be inconsistent with the assessment of the woman who experienced it. A pejorative discourse was evident, predominantly among participants who did not report having an unintended pregnancy: women use an 'unintended' pregnancy to entrap men. Accounts from five participants reporting an unintended pregnancy were selected for illustration. An appreciation of the role such a pregnancy might play in an individual life requires a nuanced understanding of the complexity of human experience and a resistance to simple binary categorisation.

Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria.

BACKGROUND: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications. OBJECTIVE: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos. METHODOLOGY: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. RESULTS: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10-19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities. CONCLUSIONS: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.

Sexuality and sexual reproductive health of disabled young people in Ethiopia.

OBJECTIVES: In Ethiopia, young people with disabilities (YPWD) are often marginalized and not recognized as being sexual, and only little is known about their sexual reproductive health (SRH) status. We therefore aimed to assess the SRH status and associated factors among 426 YPWD in Addis Ababa, Ethiopia. METHODS: A cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire. RESULTS: Fifty-two percent of YPWD ever had sexual intercourse. Seventy-five percent started sex between 15 and 19 years. Only 35% had used contraceptive during their first sexual encounter. Fifty-nine percent of the sexually experienced YPWD had multiple lifetime sexual partners; 19%, a casual sexual partner; and 21%, a commercial sexual partner. Only 48% consistently used condoms with their casual or commercial sexual partners. Twenty-four percent of the sexually experienced YPWD had a history of sexually transmitted infections. CONCLUSIONS: Our findings indicate that YPWD in Ethiopia are sexually active, but also highly involved in risky sexual practices. There is a need for in-depth research to better understand the determinants of risky sexual behavior and to propose preventive approaches.

Providing family planning services to remote communities in areas of high biodiversity through a Population-Health-Environment programme in Madagascar.

Population-Health-Environment (PHE) is an interdisciplinary model of programme design which recognises the complex interconnections between people, their health and their environment. PHE responds holistically to the challenges faced by ecosystems and the communities dependent on them, with thematically distinct but interconnected work strands sharing the same infrastructure, resources and goals. This has been shown to achieve better outcomes than tackling health and environmental issues in isolation. This paper shows how PHE programme design has been used by Blue Ventures for providing family planning services in a remote, biodiverse coastal region in southwest Madagascar. The PHE programme has integrated family planning services into a pre-existing, community-based conservation programme, aided by the established infrastructure and good community relations developed by the conservation workers. Implementation of the programme has led to a strong uptake of family planning services, and couples in the region are now able to make their own family planning choices. Successes and challenges of the programme are discussed.

Determinants of modern contraceptive utilization among married women of reproductive age group in North Shoa Zone, Amhara Region, Ethiopia.

BACKGROUND: Ethiopia is the second most populous country in Africa with high fertility and fast population growth rate. It is also one of the countries with high maternal and child mortality rate in sub-Saharan Africa Family planning is a crucial strategy to halt the fast population growth, to reduce child mortality and improve maternal health (Millennium Development Goal 4 and 5). Therefore, this study aimed to assess the prevalence and determinants of modern contraceptive utilization among married women of reproductive age group. METHODS: A community based cross-sectional study was conducted from August 15 to September 1, 2010 among married women aged 15-49 years in Debre Birhan District. Multistage sampling technique was used to select a total of 851 study participants. A pre-tested structured questionnaire was used for gathering data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 16.0 statistical package. RESULTS: Modern contraceptive prevalence rate among currently married women was 46.9%. Injectable contraceptives were the most frequently used methods (62.9%), followed by intrauterine device (16.8%), pills (14%), norplant (4.3%), male condom (1.2%) and female sterilization (0.8%). Multiple logistic regression model revealed that the need for more children (AOR 9.27, 95% CI 5.43-15.84), husband approve (AOR 2.82, 95% CI 1.67-4.80), couple's discussion about family planning issues (AOR 7.32, 95% CI 3.60-14.86). Similarly, monthly family income and number of living children were significantly associated with the use of modern contraceptives. CONCLUSION: Modern contraceptive use was high in the district. Couple's discussion and husband approval of contraceptives use were significantly associated with the use of modern contraceptives. Therefore, district health office and concerned stakeholders should focus on couples to encourage communication and male involvement for family planning.

Factors associated with screening for sexually transmitted infections.

OBJECTIVE: The purpose of this study was to determine predictors of the completion of free annual sexually transmitted infection screening among sexually active young women of ≤ 25 years old. STUDY DESIGN: We analyzed survey data from 2607 sexually active women who were enrolled in the Contraceptive CHOICE Project, a prospective cohort study. We evaluated demographic characteristics, sexual risk behaviors, relationship characteristics, and contraceptive methods. Receipt of a home- or clinic-based test kit within 56 days of the 12-month survey constituted a completed screen. A multivariable model to predict screening completion was created with the use of Poisson regression with robust error variance. RESULTS: Fifty-seven percent of the women completed the screening. Screening completion was associated most strongly with a college education or higher (adjusted relative risk, 1.2; 95% confidence interval, 1.1-1.3) and home-based testing (adjusted relative risk, 1.3; 95% confidence interval, 1.2-1.5). CONCLUSION: Free and home-based testing increased screening rates among young women. To meet annual testing guidelines, the availability and use of home-based testing kits should increase.

Reproductive healthcare needs and desires in a cohort of HIV-positive women.

BACKGROUND: The aim of this study was to determine current contraceptive use, contraceptive desires and knowledge, future fertility desires, and sterilization regret in a cohort of HIV-positive women. STUDY DESIGN: 127 HIV-positive women receiving care at an urban infectious disease clinic completed a survey addressing their contraceptive and reproductive histories as well as their future contraceptive and fertility desires. RESULTS: The most common forms of contraception used were sterilization (44.4%) and condoms (41.3%). Less than 1% used a long-term reversible method of contraception (LARC) despite these being the methods that best fit their desired attributes of a contraceptive method. Overall, 29.4% desired future fertility. Only 50.6% of those sexually active had spoken with a provider within the last year regarding their contraceptive plans. There was a high degree of sterilization regret (36.4%), and 18.2% of sterilized women desired future fertility. Multivariate analysis found women in a monogamous relationship had a statistically increased rate of regret compared to women who were not sexually active (OR 13.8, 95% CI 1.6-119, P = 0.17). CONCLUSION: Given the diversity in contraceptive and fertility desires, coupled with a higher rate of sterilization regret than is seen in the general population, integration of comprehensive family planning services into HIV care via increased contraceptive education and access is imperative.

Knowledge-attitude-practice survey among Portuguese gynaecologists regarding combined hormonal contraceptives methods.

ABSTRACT Objectives To evaluate knowledge, attitude and practices of Portuguese gynaecologists regarding combined hormonal contraceptives. Methods A cross-sectional survey was conducted among 303 gynaecologists. Results Ninety percent of the gynaecologists considered that deciding on contraceptive methods is a process wherein the woman has her say. Efficacy, safety and the woman's preference were the major factors influencing gynaecologists, while efficacy, tolerability and ease of use were the major factors perceived by the specialists to influence the women's choice. Gynaecologists believed that only 2% of women taking the pill were 100% compliant compared to 48% of those using the patch and 75% of those using the ring. The lower risk of omission was the strong point for the latter methods. Side effects were the main reason to change to another method. Vaginal manipulation was the most difficult topic to discuss. Conclusions Most gynaecologists decided with the woman on the contraceptive method. The main reasons for the gynaecologist's recommendation of a given contraceptive method and the women's choice were different. Counselling implies an open discussion and topics related to sexuality were considered difficult to discuss. Improving communication skills and understanding women's requirements are critical for contraceptive counselling.

The relationship between repeated unintended pregnancies and current contraceptive use: National Survey of Family Growth (NSFG) 2006-2008 data.

The purpose of this study is to examine the relationship between the number of unintended pregnancies and current contraceptive use. This is a secondary analysis of a cross-sectional survey, the 2006-2008 National Survey of Family Growth, which included 4,052 women between the ages of 15 and 44 years. A statistically significant association was found between the nonuse of contraceptives and repeated unintended pregnancies, as well as among those who used an effective contraceptive method and repeated unintended pregnancies. Nurses are encouraged to ask questions about intendedness of pregnancies during women's visits and help women choose appropriate contraceptive methods.

Contraception - common issues and practical suggestions.

BACKGROUND: General practitioners are usually the first point-of-contact for young people seeking sexual health and contraceptive advice. Although the combined oral contraceptive pill is still the most common choice for contraception by Australian women, there is an increasing drive to encourage the consideration and use of long acting reversible contraception. OBJECTIVE: This article focuses on common issues that may complicate contraceptive management and provides some practical suggestions for effectively managing the use of different contraceptive methods, particularly in young women. DISCUSSION: If presented with information about the range of contraceptive choices, including long acting reversible contraception, young women will commonly choose a longer acting method. Good counselling is important before advocating either implant or depot injections as irregular bleeding can occur and is likely to be of particular concern to younger women. Clinicians are increasingly considering intrauterine devices in nulliparous women and in women aged less than 25 years. It is uncommon for women to have complications with intrauterine device insertion, the most significant potential problem being pelvic infection. The key to minimising problems in contraceptive practice is the consideration of sustainability (cost, efficiency, duration of action and suitability), making a careful choice and then counselling the patient well.

Fertility regulation among women of reproductive age in Ibadan, south-west Nigeria: contraception, abortion or both.

OBJECTIVES: To assess the role of contraception and abortion in fertility regulation amongst Southwestern Nigerian women. SUBJECTS AND METHODS: A survey was conducted through a self- administered questionnaire to women of reproductive age group attending gynecology clinic. Multinominal logistic regression was done to analyze the independent effects of social and demographic variables on the odds that women would adopt any fertility regulation methods instead of doing nothing. RESULTS: Only 13% of surveyed women were using modern contraception. About 42.2% of women had had induced abortion, 15% of them neither use contraception nor abortion. Fifteen per cent of women surveyed used both contraception and abortion for fertility control. Muslims women had lower odds than Christians to use any of three fertility regulation methods instead of doing nothing. Unmarried and high levels of educational attainment were associated with significant odds of adopting each of three fertility regulation methods (Odd ratios; 1.38 - 35.5). CONCLUSIONS: There is a need for better fertility regulation. High dependency on abortion especially among the young, unmarried and high level educational status should be discouraged. Government and non-governmental agencies should assist in making modern contraceptives widely available with adequate rural coverage.

Baseline correlates of inconsistent and incorrect condom use among sexually active women in the contraceptive CHOICE Project.

BACKGROUND: : To provide protection against sexually transmitted infections and pregnancy, condoms must be used consistently and correctly. However, a significant proportion of couples in the United States fail to do so. Our objective was to determine the demographic and behavioral correlates of inconsistent and incorrect condom use among sexually active, condom-using women. METHODS: : Analysis of baseline data from a prospective cohort of sexually active, condom-using women in the Contraceptive CHOICE Project (n = 2087) using self-reported demographic and behavioral characteristics. Poisson regression was used to determine the relative risk of inconsistent and incorrect condom use after adjusting for variables significant in the univariate analysis. RESULTS: : Inconsistent and incorrect condom use was reported by 41% (n = 847) and 36% (n = 757) of women, respectively. A greater number of unprotected acts was most strongly associated with reporting 10 or more sex acts in the past 30 days, younger age at first intercourse, less perceived partner willingness to use condoms, and lower condom use self-efficacy. Incorrect condom use was associated with reporting 10 or more sex acts in the past 30 days, greater perceived risk for future STIs, and inconsistent condom use. CONCLUSIONS: : Inconsistent and incorrect condom use is common among sexually active women. Targeted educational efforts and prevention strategies should be implemented among women at highest risk for STIs and unintended pregnancies to increase consistent and correct condom use.

To use or not to use a condom: a prospective cohort study comparing contraceptive practices among HIV-infected and HIV-negative youth in Uganda.

BACKGROUND: Unwanted pregnancy and HIV infection are issues of significant concern to young people. Limited data exists on contraceptive decision-making and practices among HIV-infected and HIV-negative young people in low resource settings with generalized HIV epidemics. METHODS: From July 2007 until April 2009, we recruited, and followed up over a one year period, a cohort of 501 HIV-negative and 276 HIV-infected young women and men aged 15-24 years residing in Kampala and Wakiso districts. We compared contraceptive use among HIV-infected and HIV-negative young people and assessed factors associated with contraceptive decision-making and use, using multivariate logistic regression modelling to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Contraceptive use among sexually active HIV-infected young people was 34% while it was 59% among the HIV-negative group. The condom was the most frequently used method of contraception. Only 24% of the HIV-infected used condoms consistently compared to 38% among the negative group OR 0.56 (95% CI 0.38, 0.82). HIV-infected young people were more likely to discuss safe sex behaviour with health workers OR 1.70 (95% CI 1.13, 2.57), though its effect on fertility decision-making was not significant. Throughout the year's follow-up, only 24% among the HIV-negative and 18% among the HIV-infected continued to use contraception while 12% and 28% among the HIV-negative and infected respectively did not use contraception at all. At multivariate analysis, the HIV-infected young people were less likely to maintain contraceptive use. Other factors independently associated with sustained contraceptive use were age of the respondent, marital status and being a male. Conversely, HIV-infected young people were less likely to initiate use of contraception. Being married or in a relationship was associated with higher odds of initiating contraceptive use. CONCLUSION: Compared to the HIV-negative group, sexually active HIV-infected young people are less likely to use contraception and condoms. Initiating or sustaining contraceptive use was also significantly less among the HIV-infected group. Strengthening family planning services and developing new innovative ideas to re-market condom use are needed. Policy and guidelines that empower health workers to help young people (especially the HIV infected) express their sexuality and reproduction should urgently be developed.

Sexual and reproductive health status and related problems of young people with disabilities in selected associations of people with disability, Addis Ababa, Ethiopia.

BACKGROUND: Young people in Ethiopia face many sexual and reproductive health problems. In particular young people with disability are among the most stigmatized, poorest, and least educated. To date, very little is known about the sexuality of disabled youth, in general the reproductive health need and related problems of this group. OBJECTIVE: The aim of this study is to assess the sexual reproductive health status and associated problems of young people with disability at selected associations of people with disability in Addis Ababa. METHOD: A cross-sectional survey was conducted from Feb 11-17, 2008 to assess disabled youth reproductive health status and related problems. Data were collected by trained interviewers using a structured questionnaire and two complementary focus group discussions were also conducted guided by semi-structured questions. A total of 384 young people with disability were selected using systematic sampling technique. The sociodemographic and the sexual reproductive health characteristics of the respondents were described and appropriate statistical methods including chi-square test, crude and adjusted odds ratio were used to make comparisons RESULT: A total 174 (45.3%) of respondents in the study ever had sexual intercourse; out of which 100 (57.5%) and 74 (42.5%) were males and females respectively. Seventy three (42.0%) started sex between the age of 15-19 years and only 9.2% were married Only 45.4% of the sexually experienced respondents had used some kind of contraceptive during their first sexual encounter. The prevalence of unintended pregnancy was 62.5% among young disabled females who had ever been pregnant and 50% of them had history of abortion, 87.5% of this abortion was induced type. In this study, 58.6% of the sexually active respondents had multiple life time sexual partners, 20.7% had a casual sex partner and 18.0% of sexually active males had a commercial sex partner in the past 12 months period prior to the survey. The prevalence of history of ever having STI was 25.3% Only 55.5%, 33.1% and 51.8% of respondents had good knowledge on HIV transmission, STI Sign and symptom, HIV Prevention respectively and only 33.3% of respondents had utilized reproductive health services. Adjusting for socio-demographic variables, respondents' educational status, occupation, sex and forms of disability were found to have a significant association with modern contraceptive use (P < 0.05). CONCLUSION & RECOMMENDATIONS: Young People with Disability (YPWD) are at great risk for sexual and reproductive health associated problems. Female young people with disability and the illiterate are the most disadvantaged Awareness of parents, family members and the community about the needs and the capabilities of YPWD should improve and they should work together with the government to provide a safe environment for YPWDs. Organizing programs focused on acquisition of essential skills (communication and negotiation skills) and provision of appropriate for YPWD sexual and reproductive health services deserve due emphasis.

Contraceptive choices and practices among urban women in southeastern Nigeria.

BACKGROUND: Determining the contraceptive choices among the women is the first step in scaling up family planning methods. OBJECTIVE: To determine the contraceptive choices and practices as well as the underlining factors among market women in Nnewi, southeastern Nigeria. SUBJECTS/METHOD: This is a cross sectional descriptive study of market women, that assessed their contraceptive choices and practices. RESULT: Knowledge about family planning was 96.5%. One hundred and seventy five (44.0%) of the interviewed women were currently using a family planning method while 59.0% had ever used a method. The common methods in use were the natural method (24.1%), withdrawal method (7.5%) and the IUCDs (6.1%). The commonest ever used method was the natural method (26.7%) followed by withdrawal method (10.6%) and condom (7.8%). Fear of family planning commodities interfering with future fertility was the commonest reason for non use of family planning services (14.6), followed by the fear of the side effects (10.6%). Seventy one (17.8%) of the non-users had no reason. The use of family planning services was significantly high among the women aged 35 and above (x2 = 9.98; P = 0.04) and the (x2 = 23.8; P = 0.00). Focus group discussions indicated that husband's refusal, fear of side effects, cancer and delayed fertility were the main barriers to the use of family planning methods. CONCLUSION: The contraceptive prevalence rate among Nnewi market women is high and cuts across all religions and social classes. However, the methods in common use are associated with high failure rates. The use of the more reliable methods should be encouraged.