Initiating Hormonal Contraception.

Most patients can safely begin using hormonal contraception at any point in their menstrual cycle. An evidence-based, flexible, patient-centered approach to initiating contraception promotes health and enhances patients' reproductive autonomy. A recent Papanicolaou test is not necessary before prescribing hormonal contraception. Most patients can begin using progestin-only contraceptives immediately after childbirth. Patients can begin any appropriate contraceptive method immediately after an abortion or early pregnancy loss, except for an intrauterine device following septic abortion. Delaying contraception to wait for the next menses or for an appointment creates unnecessary barriers for patients. Clinicians can facilitate the use of hormonal contraception by providing anticipatory guidance about common side effects (e.g., spotting, other menstrual cycle changes), giving comprehensive information about available contraceptive choices, honoring patients' preferences, and eliminating office-related barriers. Prescribing or dispensing a one-year supply of contraceptives lowers costs and improves adherence. Counseling via telemedicine or a patient portal eliminates unnecessary office visits.

An unwanted pregnancy and language proficiency level are associated with first antenatal visit after the first trimester: Results from a prospective cohort study.

OBJECTIVE: To study the association between the reasons for a 'late' first antenatal visit and the influence of several maternal determinants and practical limitations on the timing of the first antenatal visit. DESIGN: A prospective cohort study. SETTING: Southwest region of The Netherlands, mainly characterised by large urban and suburban areas. PARTICIPANTS: Women receiving information and counselling about prenatal screening between April 2010 and December 2010 were included (n = 9,268). MEASUREMENTS AND FINDINGS: Timing of first antenatal visit, categorised as: 'in time' (<12+0 weeks of gestation), 'late' (≥12-23+6 weeks of gestation) and 'very late' (≥24 weeks of gestation). An unplanned or unwanted pregnancy was the most frequently reported reason for delay of the first antenatal visit (30.7%) especially in Surinamese women (79%), and women younger than 20 years (63%) or older than 40 years (50.0%). Compared to women who timed their first antenatal visit 'in time', women with a delay in their first visit were more often younger than 20 or older than 40 years of age, high order multiparous (P ≥3), with a previous miscarriage, and had an absent Dutch language proficiency level. The latter showed the strongest association with a 'very late' first antenatal visit (OR 4.96, 95%CI 2.45-10.05). KEY CONCLUSIONS: Language proficiency level was highly associated with a delay in the timing of the first antenatal visit. When women timed their first antenatal visit late, having an unplanned or unwanted pregnancy was the most frequently reported reason for this delay. IMPLICATIONS FOR PRACTICE: Findings from this study can be used to inform and develop interventions to improve timely antenatal care use.

Intimate partner violence and its associated factors among pregnant women in Bale Zone, Southeast Ethiopia: A cross-sectional study.

BACKGROUND: Intimate partner violence (IPV) against women is a major public health concern in low income countries. Violence against pregnant women has adverse effects on maternal and newborn outcomes. This study aimed to assess the prevalence and associated factors of intimate partner violence in Southeast Ethiopia pregnant women. METHODS: Institutional based cross-sectional study was conducted on pregnant women who were attending antenatal care (ANC) in Bale Zone health institution during study period. Face to face interviews were conducted using a pre-tested structured questionnaire. Data related to socio-demographic characteristic, pregnancy and reproductive history, intimate partner behavior and IPV encountered during recent pregnancy was gathered for this study. Descriptive analysis and logistic regression were used for the data analysis. Odds ratio with 95% CI was computed to determine the presence and strength of associated factors with IPV. RESULTS: A total of 612 pregnant women participated in the study. Of these, 361 (59.0%) pregnant women faced at least one type of IPV during the recent pregnancy. Physical violence (20.3%), sexual violence (36.3%), psychological/emotional violence (33.0), controlling behavior violence (30.4%) and economic violence (27.0) were the type of IPV encountered by participants. An intimate partners who were drank alcohol [AOR = 2.9; 95% CI: (1.5-5.4)], partners who were chewed Khat [AOR = 1.7; 95% CI: (1.1-2.6)], partners who were smoked cigarette [AOR = 2.6; 95% CI: (1.4-4.9)], partners who had aggressive behavior [AOR = 2.8; 95% CI: (1.7-4.6)], having partner age ≥30 year old [AOR = 1.8; 95% CI: (1.2-2.9)], unwanted pregnancy [AOR = 3.3; 95% CI: (1.9-5.5)] and history of adverse pregnancy outcome [AOR = 2.1; 95% CI: (1.2-3.6)] that were the factors that significantly associated with IPV of the pregnant women. CONCLUSION: The prevalence of IPV during pregnancy was high among the study participants. Intimate partners' use of substance, intimate partners' aggressive behavior, older intimate partners, unwanted pregnancy and history of adverse birth outcome were identified as associated factors for IPV. IPV needs to be considered during ANC service and integrated into the sexual and reproductive health education. Community-based interventions should be advocated as a way of health promotion. Counseling, awareness creation, service provision and program design on IPV is mandatory to minimize the victim.

Estupro e gravidez: Relatos das vivências de mulheres antes e após o desfecho da gestação / Rape and pregnancy: Reports of the experiences of women before and after the end of pregnancy / Estupro e gravidez: Relatos de vivencias de mujeres antes y después del desfecho de la gestación

Resumo Investigou-se a experiência de três mulheres que engravidaram resultado de estupro, usuárias de um hospital-maternidade de Fortaleza, Ceará, destacando as vivências anteriores e após o desfecho da gestação (a continuidade ou a interrupção legal). Em dois casos houve a interrupção legal da gestação e em um caso a continuidade, após ter sido negada a concessão para a realização do aborto. Os motivos relacionados à interrupção da gravidez foram: pensamentos e sentimentos negativos em torno da violência, da criança e da perspectiva de vida futura. Após o desfecho, as participantes que interromperam a gestação expressaram o desejo de retomar ou iniciar projetos de vida e no caso da participante que precisou dar continuidade à gestação, sinais de uma possível vinculação afetiva com a criança. Conclui-se que tais experiências necessitam ser conhecidas em seus aspectos de interrupção ou de continuidade da gestação para a melhoria das políticas públicas voltadas para essas mulheres.

Abstract We investigated the experience of three women who became pregnant by rape, using a maternity hospital in Fortaleza, Ceará, highlighting previous experiences and after gestation (continuity or legal interruption). In two cases there was a legal interruption of gestation and in one case continuity, after being denied the concession to perform the abortion. The reasons related to the interruption of pregnancy were: negative thoughts and feelings about violence, the child and the perspective of future life. After the outcome, participants who interrupted gestation expressed a desire to resume or initiate life projects, and in the case of the participant who had to continue gestation, signs of a possible affective attachment to the child. It is concluded that such experiences need to be known in their aspects of interruption or continuity of gestation for the improvement of the public policies directed towards these women.

Resumen Investigue una experiencia de tres mujeres que graven el resultado de estupro, las usuarias de un hospital-maternidad de Fortaleza, Ceará, destacando como vivencias anteriores y después del desfecho de la gestación (una continuidad o una interrupción legal). En los casos en que se produjo una interrupción legal de la gestión y en el caso de una continuidad, después de haber sido negada una concesión para un acto de aborto. Los motivos relacionados con la interrupción de la gravedad son: pensamientos y sentimientos negativos en la violencia, de la infancia y la perspectiva de la vida futura. Tras el desfecho, como participantes que se interrumpen en una gestación expresada en el deseo de retomar o en iniciar los proyectos de vida y en el caso de la participación que precisan en la continuidad de la gestación, los signos de una posible vinculación afetiva con un niño. Conclui-se que tales experiencias necesitan ser conocidas en sus senos de interrupción o de continuidad de la gestación para un mejoramiento de las políticas públicas voltadas para estas mujeres.

Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions.

BACKGROUND: In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis. METHODS: In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care. RESULTS: The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies. CONCLUSIONS: The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic.

Percepción cultural respecto al embarazo no planeado de mujeres gestantes viviendo con VIH / Cultural perception about unplanned pregnancy of pregnant women living with HIV

Objetivo: En el presente trabajo se exploraron percepciones culturales de mujeres gestantes viviendo con VIH que cursaron un embarazo no planeado, con la finalidad de comprender su toma de decisiones en lo relativo a la vida reproductiva. Material y métodos: Todas las mujeres fueron atendidas en el Instituto Nacional de Perinatología, México. El estudio tuvo un enfoque sociocultural con una base metodológica cualitativa, y se realizó análisis del discurso. Previo consentimiento informado, a cada mujer se le aplicó una entrevista semiestructurada. Se estudiaron 15 gestantes con VIH que no planearon su embarazo. Los temas principales que se exploraron en la entrevista fueron: 1) significado del embarazo; 2) percepción de la infección por el VIH; 3) motivos para continuar el embarazo no planeado; y 4) preocupaciones de la tríada mujer-maternidad-VIH. Resultados: La razón más frecuente para continuar el embarazo no planeado fue la percepción sociocultural del aborto como crimen. Los familiares y el personal de salud fueron las personas que con mayor frecuencia sugirieron continuar el embarazo. Conclusiones: El contexto social y cultural que determina las creencias y significados sobre la infección por el VIH y la reproducción, tiene un papel fundamental para comprender el comportamiento de las embarazadas gestantes viviendo con VIH. A estas mujeres se les debe proporcionar la atención sin prejuicios y sugerirles las opciones de manejo solicitándoles su opinión.

Objective: The objective of this study was to explore the sociocultural view of unplanned pregnancy of women living with the human immunodeficiency virus (HIV), who were patients of the National Institute of Perinatology, México City, intending to understand the decisions concerning their reproductive lives. The study had a sociocultural qualitative approach. Material and Methods: Each woman included in the investigation underwent a semi-structured interview; all provided informed consent. We studied 15 pregnant women living with HIV. The main topics explored in the interview were: 1) meaning of pregnancy; 2) perception of the HIV infection concept; 3) cultural reasons for continuing with unplanned pregnancy, and 4)concerns about maternity and living with HIV. Results: The most frequent responses to the question: why continue the unplanned pregnancy? were, firstly, the perception in their social sphere that abortion is a crime, and secondly, the suggestion of relatives and health workers to continue the pregnancy. Conclusions: We conclude that the social and cultural context that determines the beliefs and meanings of HIV infection, and of reproduction have an important role in understanding the behavior of HIV-infected pregnant women. These women must be given unprejudiced medical attention, discussing with them different management options.

Negação da gravidez: um estudo psicanalítico / Denial of pregnancy: a psychonalytical study / Negación del embarazo: un estudio psicoanalítico

A situação de mulheres desconhecerem o próprio estado gravídico durante boa parte da gravidez ou até o momento do parto é denominada na literatura científica como negação da gravidez. Tal fenômeno ocorre com mulheres que não apresentam sintomatologia psicótica. A partir da análise de três casos de mulheres que negaram a gestação, investiga-se a dinâmica psíquica inerente a esse complexo fenômeno pelo método qualitativo. O principal instrumento para coletar os dados foi uma série de três entrevistas semidirigidas. Os dados foram analisados por meio da análise interpretativa e com base nas proposições sobre o trauma do psicanalista Sándor Ferenczi. Foram identificadas três asserções que permitiram concluir que, mulheres que passaram por essa situação, sofreram em tenra idade um trauma marcado por um duplo abandono, tanto da figura materna quanto paterna. Desenvolve- se, assim, a hipótese de que a negação da gravidez seja uma situação de abandono uterino, na qual a experiência de abandono parental é repetida na gestação.

The situation in which women ignore their own pregnancy for a long period or even until labor is known in the scientific literature as denial of pregnancy. Such phenomenon occurs with women who do not present psychotic symptoms. From the analysis of three cases of women who denied their pregnancy, the psychic dynamics inherent to this complex phenomenon is investigated through a qualitative method. The main instrument for data collection was a set of three semi-structured interviews. Data was analyzed by means of Interpretative Analysis, and based on the ideas of the psychoanalyst Sándor Ferenczi about trauma. Three assertions were identified, which allowed observing that women who went through this situation have suffered at early age a trauma marked by a double abandonment by maternal and paternal figures. Thus, the hypothesis is that denial of pregnancy is a situation of uterine abandonment in which the experience of parental abandonment repeats in pregnancy.

La situación de mujeres que desconocen su propio embarazo durante buena parte del embarazo o hasta el momento del parto es denominada en la literatura científica como negación del embarazo. Tal fenómeno ocurre con mujeres que no presentan sintomatología psicótica. A partir del análisis de tres casos de mujeres que negaran el embarazo, se investiga la dinámica psíquica inherente a ese complejo fenómeno a través del método cualitativo. El principal instrumento para la coleta de los datos fue una serie de tres entrevistas semiestructurada. Se analizaron los datos a través del Análisis Interpretativa y con base en las ideas sobre trauma planteadas por el psicoanalista Sándor Ferenczi. Se identificaron tres aserciones que permitirán concluir que, mujeres que pasaron por esa situación, sufrieron en edad temprana un trauma marcad por un doble abandono, tanto por la figura materna cuanto por la paterna. Se desarrolla la hipótesis de que la negación del embarazo sea una situación de abandono uterino en la cual la experiencia de abandono parental es repetida en el embarazo.

Predictors of pregnant quitters' intention to return to smoking postpartum.

INTRODUCTION: Although many pregnant women quit smoking, most return to smoking postpartum. Returning to smoking is strongly related to women's stated intention about smoking during pregnancy. We examined factors related to women's intention to return to smoking to improve intervention trials. METHODS: We report cross-sectional baseline data from a randomized controlled trial to prevent postpartum return to smoking. Women (n = 382; 98% consent rate) were English-speaking women who smoked at least 100 cigarettes in their lifetimes and at least 5 cigarettes a day prior to becoming pregnant. We fit logistic regression models to test whether women's intention to return to smoking was associated with demographic and smoking factors such as race, parity, and smoker self-identity. RESULTS: Forty-three percent of women had a strong intention of returning to smoking. Factors independently associated with intending to return to smoking were: stating they did not want to be currently pregnant (OR = 2.1, CI = 1.1-3.9), reporting being abstinent for fewer days (OR = 0.8, CI = 0.7-0.9), being less concerned about the harmful effects of smoking to themselves (OR = 1.6, CI = 0.9-2.8), viewing quit as temporary (OR = 2.1, CI = 1.2-3.6), and self-identifying selves as smokers (OR = 8.7, CI = 5.0-15.2). CONCLUSIONS: Although some factors related to intention to return to smoking were unchangeable, it might be possible to attempt to change women's attribution of why they quit to be more permanent and to have them change their self-identity to be a "nonsmoker" from a "smoker who is not currently smoking." Helping women have stronger intentions to stay quit could promote less return to smoking postpartum.

Pregnancy intentions and maternal and child health: an analysis of longitudinal data in Oklahoma.

Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System survey and The Oklahoma Toddler Survey 2006-2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed <2 years, mistimed ≥2 years, unwanted) and maternal behaviors and child health outcomes up to age two. Propensity score methods were used to control for confounding. Births mistimed by two or more years (OR .58) and unwanted births (OR .33) had significantly lower odds than intended births of having a mother who recognized the pregnancy within the first 8 weeks; they were also about half as likely as intended births to receive early prenatal care, and had significantly higher likelihoods of exposure to cigarette smoke during pregnancy. Breastfeeding was significantly less likely among unwanted births (OR .68); breastfeeding for at least 6 months was significantly less likely among seriously mistimed births (OR .70). We find little association between intention status and early childhood measures. Measured associations of intention status on health behaviors and outcomes were most evident in the prenatal period, limited in the immediate prenatal period, and mostly insignificant by age two. In addition, most of the negative associations between intention status and health outcomes were concentrated among women with births mistimed by two or more years or unwanted births. Surveys should incorporate questions on the extent of mistiming when measuring pregnancy intentions.

Receiving versus being denied an abortion and subsequent tobacco use.

The negative health consequences of tobacco use are well documented. Some research finds women receiving abortions are at increased risk of subsequent tobacco use. This literature has methodological problems, most importantly, inappropriate comparison groups. This study uses data from the Turnaway Study, a longitudinal study of women who all sought, but did not all receive, abortions at 30 facilities across the United States. Participants included women presenting just before an abortion facility's gestational age limit who received abortions (Near Limit Abortion Group, n = 452), just after the gestational limit who were denied abortions (Turnaways, n = 231), and who received first trimester abortions (First Trimester Abortion Group, n = 273). This study examined the association between receiving versus being denied an abortion and subsequent tobacco use over 2-years. Trajectories of tobacco use over 2 years were compared using multivariate mixed effects regression. Women receiving abortion maintained their level of tobacco use over 2 years. Women denied abortion initially had lower levels of tobacco use than women receiving abortion, but increased their tobacco use from 1 week through 12-18 months post-abortion seeking and then decreased their use by 2 years post-abortion seeking. Baseline parity modified these associations. Receiving an abortion was not associated with an increase in tobacco use over time. Overall, women who carry unwanted pregnancies to term appear to demonstrate similar cessation and resumption patterns to other pregnant women.

Prenatal psychological distress and access to mental health care in the ELFE cohort.

BACKGROUND: Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care. METHODS: We used data from the French cohort Étude Longitudinale Française depuis l'Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses. RESULTS: Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad. LIMITATIONS: Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics. CONCLUSIONS: Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.

Alcohol use before and during unwanted pregnancy.

BACKGROUND: There is little information about pregnancy-related changes in alcohol use and factors contributing to changes among women with unwanted pregnancies. This study describes changes in alcohol use from before pregnancy recognition to during pregnancy and identifies important predictors of alcohol use severity among women with unwanted pregnancies. METHODS: Data are from the Turnaway Study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom were denied care because they were past the gestational limit of the facility where they were recruited and were still pregnant at the baseline interview, 1 week after termination seeking. Predictors of alcohol use severity (a latent variable) were identified. RESULTS: About 56% of the total sample reported any alcohol use the month before pregnancy recognition, with 23% reporting 6 or more drinks on an occasion. Among the total sample, 35% of those drinking before pregnancy recognition had quit and 20% had reduced 1 week after termination seeking. Among those denied terminations and still pregnant, 71% had quit and 14% had reduced. In a multivariate model predicting alcohol severity, younger age, still pregnant, 1 or more previous births, later gestation, childhood physical abuse, and marijuana and other drug use were associated with lower severity; having completed college, tobacco use, and recent physical violence were associated with higher severity. CONCLUSIONS: The proportion of the total sample drinking before pregnancy recognition is similar to national samples of women of childbearing age, while the proportion binge drinking appears higher. Of women denied terminations, who were still pregnant, the proportion having quit is similar to other populations of pregnant women. More research is needed to examine whether pregnant women may be substituting alcohol for marijuana and other drugs. Interventions focusing on alcohol use severity during pregnancy may need to also focus on tobacco.

Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study.

Prenatal depression (PD) as a risk factor for adverse birth outcomes is well documented. Less is known about maternal risks for PD, which could inform preventive strategies for perinatal and interconceptional care. This exploratory study investigates associations between prenatal depression symptoms and unintended and mistimed pregnancies and other maternal risk factors for PD. A subset of birth records from the New York Statewide Perinatal Data System (n = 19,219) was used in this secondary analysis of cross-sectional data. Univariate and multivariate multinomial regression was used to identify factors that are independently associated with four self-reported levels of prenatal depression symptoms. Women with unintended pregnancies were more likely (AOR, 95 % CI) to report severe (3.6, 2.6-5.1) or moderate (2.0, 1.6-2.5) prenatal depression symptoms and less likely to report no symptoms, compared to women with intended pregnancies. Likewise, women with mistimed pregnancies were more likely to report severe (2.7, 2.2-3.5) or moderate (1.7, 1.5-2.1) prenatal depression symptoms than no symptoms, compared to women with intended pregnancies. Low education, drug use, smoking, minority race, being unmarried and having Medicaid insurance were also significant, independent predictors of PD symptoms. Results suggest that routine screening for depression, intendedness of pregnancy and other associated risk factors such as smoking and drug use during prenatal and interconceptional care visits may enable coordinated interventions that can reduce prenatal depression and unintended and mistimed pregnancies and improve pregnancy outcomes.

Suicide attempts and suicides in Bolivia from 2007 to 2012: pesticides are the preferred method - females try but males commit suicide!

BACKGROUND: Suicide attempts and suicides constitute a significant burden on communities and health systems, especially in low income countries. However, many low income countries lack epidemiological information on which to base future preventive strategies. This study reports on gender and age profiles as well as the likely background and means used for suicide attempts and suicides in Bolivia. METHOD: This study presents 1124 cases from four different sources of information: (i) emergency ward data with suicide attempts by poisoning from the year 2007, (ii) psychiatric ward data including suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010-2011. Data on age was stratified into three age groups: adolescents aged 10-19 years, young adults aged 20-29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21. RESULTS: Hospital data showed that more females (403/657, 61%) than males (254/657, 39%) attempted suicide, and females attempted suicide at a younger age than males (p<0.05). In contrast to this, more males (208/293, 70.5%) than females (85/293, 29.5%) committed suicide, and furthermore it was most prevalent among young adults aged 20-29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate (65/77, 85.1%) among those using violent methods such as hanging and jumping compared to non-violent methods (43/84, 50.9%) such as ingesting chemicals and drugs (p<0.05). The reasons were related to interpersonal problems, economic problems, depression, and unwanted pregnancies. Many cases of suicide seemed to be hidden due to cultural and religious reasons. CONCLUSION: More females attempted suicide, whereas more males realized suicide. Suicide attempts were most numerous among adolescents in contrast to suicides being most prevalent in the older age groups. Self-poisoning with pesticides was the most popular method used. Access to potential suicide materials should be restricted and psychosocial interventions initiated to prevent suicides.

El embarazo y sus complicaciones en la madre adolescente / Pregnancy and its complications in adolescent mothers

Introducción: el embarazo en adolescentes puede tener consecuencias adversas para la salud. Objetivo: disminuir la incidencia del embarazo y sus riesgos en adolescentes. Métodos: se realizó un estudio de intervención educativa para modificar los criterios sobre el embarazo y sus riesgos en adolescentes embarazadas atendidas en el Policlínico Arturo Puig Ruiz de Villa...

Introduction: adolescent pregnancy can have adverse health consequences. Objective: to reduce the incidence of pregnancy and its risks in adolescents. Method: a study of educational intervention was carried out to modify the criteria on pregnancy and its risks for pregnant adolescents, who were assisted at the Polyclinic Arturo Ruiz de Villa Puig...

Ante- and perinatal circumstances and risk of attempted suicides and suicides in offspring: the Northern Finland birth cohort 1966 study.

PURPOSE: To investigate those ante- and perinatal circumstances preceding suicide attempts and suicides, which have so far not been studied intensively. METHODS: Examination of the Northern Finland Birth Cohort 1966 (n = 10,742), originally based on antenatal questionnaire data and now followed up from mid-pregnancy to age 39, to ascertain psychiatric disorders in the parents and offspring and suicides or attempted suicides in the offspring using nationwide registers. RESULTS: A total of 121 suicide attempts (57 males) and 69 suicides (56 males) had occurred. Previously unstudied antenatal factors (maternal depressed mood and smoking, unwanted pregnancy) were not related to these after adjustment. Psychiatric disorders in the parents and offspring were the risk factors in both genders. When adjusted for these, the statistically significant risk factors among males were a single-parent family for suicide attempts (OR 3.71, 95% CI 1.62-8.50) and grand multiparity for suicides (OR 2.67, 95% CI 1.15-6.18). When a psychiatric disorder in females was included among possible risk factors for suicide attempts, it alone remained significant (OR 15.55, 8.78-27.53). CONCLUSIONS: A single-parent family was a risk factor for attempted suicides and grand multiparity for suicides in male offspring even after adjusting for other ante- and perinatal circumstances and mental disorders in the parents and offspring. Mothers' antenatal depressed mood and smoking and unwanted pregnancy did not increase the risk of suicide, which is a novel finding.