Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso: A mixed-methods study.

Provider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care. First, we surveyed providers in Tanzania and Burkina Faso (N = 295) to assess provider attitudes about young, unmarried, and nulliparous clients. Second, mystery clients anonymously visited providers for contraceptive care and we randomly assigned the reported age, marital status, and parity of each visit (N = 306). We used data from these visits to investigate contraceptive care disparities across 3 domains: information provision and counseling quality, contraceptive method provision, and perceived treatment. Third, we complemented mystery client data with client exit surveys (N = 31,023) and client in-depth interviews (N = 36). In surveys, providers reported biased attitudes against young, unmarried, and nulliparous clients seeking contraceptives. Similarly, we found disparities according to these characteristics in the reporting of contraceptive care quality; however, we found that each characteristic affected a different quality of care domain. Among mystery clients we found age-related disparities in the provision of methods; 16/17-year-old clients were 18 and 11 percentage points less likely to perceive they could take a contraceptive method relative to 24-year-old clients in Tanzania and Burkina Faso, respectively. Unmarried mystery clients perceived worse treatment from providers compared to married clients. Nulliparous mystery clients reported lower quality contraceptive counseling than their parous counterparts. These results suggest that clients of different characteristics likely experience bias across different elements of care. Improving care quality and reducing disparities will require attention to which elements of care are deficient for different types of clients.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China.

OBJECTIVE: There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population. DESIGN: A cross-sectional study. SETTING: 8 cities (regions, autonomous prefectures) in China. PARTICIPANTS: 13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis. OUTCOME MEASURES: Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations. METHODS: A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations. RESULTS: The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01). CONCLUSIONS: Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.

Geographic and socioeconomic inequalities in the coverage of contraception in Uttar Pradesh, India.

BACKGROUND: Uttar Pradesh (UP) is the most populous state in India, with a historically lower level of family planning coverage than the national average. In recent decades, family planning coverage in UP has significantly increased, yet there are considerable geographic and socio-economic inequalities. METHODS: The data used for the study is derived from a cross-sectional quantitative survey of 12,200 currently married women conducted during December 2020-February 2021 in UP by the Technical Support Unit. Univariate and bivariate analyses were performed and equiplots were used to make visualizing inequalities easy. RESULTS: The findings of the study reveal significant variation in family planning coverage indicators amongst currently married women in reproductive ages by administrative divisions in UP. For instance, in the Jhansi division, it was 72.4%, while in Faizabad, it was 39.3%. Jhansi division experienced the highest modern contraceptive coverage with the lowest inequity compared to other divisions. However, the range of coverage within the division by Accredited Social Health Activist (ASHA) areas is 25% to 75%. In fact, for some ASHA areas in the Jhansi division, the family planning demand satisfied for modern contraception ranged from more than 85% to less than 22%. On the other hand, the Gonda division with the lowest coverage and lowest inequity for demand satisfied for modern contraception has some ASHA areas with less than 5% and some with more than 36%. The study also revealed intersectionality of education, wealth, place of residence and geographic divisions in identifying inequity patterns. For instance, in case of Mirzapur and Varanasi, the demand satisfied among the illiterates was 69% and the corresponding percentage for literates was 49%. With respect to place of residence, Basti division, where the coverage for modern contraception is extremely low, demand satisfied for modern contraceptive methods is 16.3% among rural residents compared to 57.9% in the case of urban residents. CONCLUSIONS: The findings showed inequality in the modern family planning methods coverage in UP in both best and worst performing divisions. The inequalities exist even in extremely small geographies such as ASHA areas. Within the geographies as well, the socio-economic inequalities persisted. These inequalities at multiple levels are important to consider for effective resource allocation and utilization.

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative.

Importance: Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective: To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants: In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure: The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures: Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results: A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance: In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

Access to family planning services and associated factors among young people in Lira city northern Uganda.

BACKGROUND: Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. METHODS AND MATERIALS: A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15-24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. RESULTS: Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09-0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01-0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01-0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24-0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60-7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05-0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02-5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. CONCLUSION: The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda.

National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010-2021.

Understanding the impact of family planning policy and actions is essential for building effective strategies to increase contraceptive use. This study identifies policies that correlate with modern contraceptive prevalence rate (mCPR) and private-sector contraceptive method mix strategies (the number of contraceptive methods offered in the private sector) in low-income and middle-income countries. While education, contraceptive choices, and economic growth are known determinants of contraceptive prevalence, many national policies intended to increase contraceptive prevalence in the short term to medium term have ambiguous evidence that they indeed do so. By developing beta and Poisson regression models using 12 years of reported Contraceptive Security Indicators Survey data (2010-2021) from 59 countries, this study investigated the effect of 20 independent variables on mCPR or method mix strategies. Furthermore, to help interpret the potential consequences of economic status, separate models segmented by gross national income (low, low-middle, and upper-middle) were assessed. Of 20 independent variables, 10 are implicated with mCPR and 6 with a method mix strategy. Of these, increasing the share of domestic financing (versus donor funding) for contraceptives had the broadest and strongest contribution. mCPR is also predicted by the existence of national insurance systems that cover contraceptive costs, contraceptive security committees, family planning logistics management information systems, and, inversely, by client fees. A comprehensive private-sector method mix strategy-which itself influences mCPR-is also driven by these, as well as the inclusion of more contraceptives on the national essential medicines list. These findings have implications for countries seeking to expand access to and use of contraceptives through policy initiatives.

Equity in family planning policies and programs in Uganda: conceptualization, dimensions and implementation constraints.

BACKGROUND: Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper aims to document the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda. METHODS: A review of Ugandan literature and key informant interviews with 25 key stakeholders on equity in FP was undertaken between April and July 2020. We searched Google, Google Scholar and PubMed for published and grey literature from Uganda on equity in FP. A total of 112 documents were identified, 25 met the inclusion criteria and were reviewed. Data from the selected documents were extracted into a Google master matrix in MS Excel. Data analysis was done across the thematic areas by collating similar information. Data were analyzed using thematic content analysis approach. RESULTS: A limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services. There was a limited focus on equity in FP programs in Uganda. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation constraints (e.g. lack of quality comprehensive FP services, duplicated FP programs and a generic design of FP programs with limited targeting of the underserved populations) continue to hinder effective implementation of equitable FP programs in Uganda. Clients' constraints (e.g. limited contraceptive information) and policy constraints (inadequate focus on equity in policy documents) also remain key challenges. CONCLUSIONS: There is lack of a common understanding and definition of equity in FP programs in Uganda. There is need to build consensus on the definitions and measurements of equity with a multidimensional lens to inform clear policy and programming focus on equity in FP programs and outcomes. To improve equitable access to and use of FP services, attention must be paid to addressing implementation, client and policy constraints.

Exploring the association between unintended pregnancies and unmet contraceptive needs among Ugandan women of reproductive age: an analysis of the 2016 Uganda demographic and health survey.

BACKGROUND: Unintended pregnancy and unmet contraceptive needs pose significant public health challenges, particularly in developing nations, where they contribute to maternal health risks. While previous research has explored determinants of unintended pregnancies, there remains a gap in understanding the association between unplanned pregnancies and unmet contraceptive needs among Ugandan women of reproductive age. This study aimed to assess unmet contraceptive needs and their correlation with unintended pregnancies and other factors in Uganda, utilizing a nationally representative sample. METHODS: Data was extracted from the 2016 Uganda Demographic Health Survey (UDHS), a cross-sectional survey conducted in the latter half of 2016. The study encompassed 18,506 women aged 15-49 with a history of at least one prior pregnancy. The primary outcome variable was the planning status of the most recent pregnancy, while the principal independent variable was unmet contraceptive need. Additional variables were controlled in the analysis. Data analysis was performed using STATA version 17, involving descriptive analysis, cross-tabulation, chi-square testing, and logistic regression. Statistical significance was set at p < 0.05. RESULTS: A substantial proportion of women reported unintended pregnancies (44.5%), with approximately 21.09% experiencing an unmet need for contraception. In the adjusted model, women with unmet contraceptive needs had 3.97 times higher odds of unintended pregnancy (95% CI = 3.61-4.37) compared to those with met contraceptive needs. Significant factors linked to unintended pregnancies included women's age, place of residence, household wealth status, decision-making authority regarding contraceptive use, educational attainment, husband's occupation, and educational level. CONCLUSION: This study revealed that both the rate of unintended pregnancies and unmet contraceptive needs in Uganda exceeded the global average, warranting urgent policy attention. Addressing unmet contraceptive needs emerges as a potential strategy to curtail unintended pregnancies. Further qualitative research may be necessary to elucidate the sociocultural and behavioral determinants of unwanted pregnancies, facilitating context-specific interventions.

Acces to abortion in the Grand Est region in 2023 / L'accès à l'interruption volontaire de grossesse dans la région Grand Est en 2023

Objectives: Although access to abortion is a national priority in France, there is little documented evidence that it is actually respected. In the Grand Est region, the 2021­2023 plan for access to abortion includes a review of family planning practices and health care provision, to update the 2019 report. It raises the question of access to abortion in all its dimensions, and aims to implement improvement actions best suited to the region's problems. Method: An online questionnaire was sent to hospitals, local perinatal centers, sexual health centers, and independent professionals with presumed family planning activity. Of those who responded, only those with actual family planning activity were included. Results: The five-day deadline for the first appointment recommended by the HAS can be met by 73% of those surveyed. During pre- or post-abortion consultations, a psychosocial interview is offered to 92% of patients, and the detection of violence to 97%. Although 14 hospitals (38%) have extended their abortion access time to 16 weeks of amenorrhea, the number of facilities handling abortions beyond 13 weeks of amenorrhea has fallen since 2019. In primary care, 70% of private practitioners and 61% of sexual health centers offer abortions up to 9 weeks of amenorrhea. Conclusions: Access to abortion has weakened in the Grand Est region between 2019 and 2023. New laws and regulations could be a lever for improvement, provided that the professionals involved are given the means.

Objectifs: Si l'accès à l'IVG est une priorité nationale en France, son respect effectif n'est que peu documenté. Dans le Grand Est, le plan d'accès à l'IVG 2021-2023 inclut la réalisation d'un état des lieux des pratiques et de l'offre de soins en orthogénie, pour actualiser celui de 2019. Il pose la question de l'accès à l'IVG dans toutes ses dimensions et vise la mise en place des actions d'amélioration les plus adaptées aux problématiques de la région. Méthodes: Un questionnaire en ligne a été envoyé aux centres hospitaliers, aux centres périnataux de proximité, aux centres de santé sexuelle et aux professionnels libéraux ayant une activité d'orthogénie supposée. Parmi ceux qui y ont répondu, seuls ceux qui avaient une activité d'orthogénie effective ont été inclus. Résultats: Le délai de premier rendez-vous de cinq jours recommandés par l'HAS peut être respecté par 73 % des enquêtés. Lors des consultations pré- ou post-IVG, un entretien psychosocial est proposé à 92 % et un repérage des violences à 97 %. Bien que 14 centres hospitaliers (38 %) aient allongé leur délai d'accès à l'IVG jusqu'à 16 SA, le nombre d'établissements prenant en charge les IVG au-delà de 13 semaines d'aménorrhée a baissé depuis 2019. En médecine de ville, 70 % des professionnels libéraux et 61 % des CSS ont une offre IVG allant jusqu'à 9 SA. Conclusions: L'accès à l'IVG s'est fragilisé dans le Grand Est entre 2019 et 2023. Les nouvelles lois et réglementations pourraient être un levier d'amélioration à condition que des moyens soient donnés aux professionnels impliqués.

Assessment of unintended pregnancies, contraception, and abortion in Botswana.

Botswana has a policy of contraception for all that is delivered through a rights-based family planning program. The program combines a "rights-based family planning approach" with "supportive policies for contraception," and "a commitment to promote equitable access to modern contraception, and expand availability, method mix and uptake of modern contraceptive methods for all women and girls." However, abortion is legally restricted up to 16 weeks of pregnancy provided that provisions of Section 160-162 of the Botswana Penal Code Amendment Act 1991 are met, and that the termination of pregnancy is carried out by a registered medical practitioner in a health facility approved for the purpose. In 2020, the Ministry of Health and Wellness, Botswana, in collaboration with United Nations Population Fund and World Health Organization, conducted a strategic assessment of unintended pregnancies, contraception, unsafe abortion, and abortion services in Botswana. A consensus operational plan to address these issues was developed during a national stakeholder meeting in Gaborone, Botswana. The consensus reached was to avert unintended pregnancies, improve access to modern contraception, and open nationwide discussions around abortion in the community to enable positive change and decrease maternal morbidity and mortality from unsafe abortion. This article describes the findings of the assessment and outlines the foundation for new or modified services or practices to be developed and pilot tested.

Identifying Profiles of Support for Legal Abortion Services in Zambia: A Latent Class Analysis.

Relative to neighboring countries, Zambia has among the most progressive abortion policies, but numerous sociopolitical constraints inhibit knowledge of pregnancy termination rights and access to safe abortion services. Multistage cluster sampling was used to randomly select 1,486 women aged 15-44 years from households in three provinces. We used latent class analysis (LCA) to partition women into discrete groups based on patterns of endorsed support for legalized abortion on six socioeconomic and health conditions. Predictors of probabilistic membership in latent profiles of support for legal abortion services were identified through mixture modeling. A three-class solution of support patterns for legal abortion services emerged from LCA: (1) legal abortion opponents (∼58 percent) opposed legal abortion across scenarios; (2) legal abortion advocates (∼23 percent) universally endorsed legal protections for abortion care; and (3) conditional supporters of legal abortion (∼19 percent) only supported legal abortion in circumstances where the pregnancy threatened the fetus or mother. Advocates and Conditional supporters reported higher exposure to family planning messages compared to opponents. Relative to opponents, advocates were more educated, and Conditional supporters were wealthier. Findings reveal that attitudes towards abortion in Zambia are not monolithic, but women with access to financial/social assets exhibited more receptive attitudes towards legal abortion.

Achieving Reproductive Justice Within Family Planning.

There is a long-standing history of reproductive oppression in the United States which impacts how patients, particularly those from marginalized communities, receive reproductive health services today. The reproductive justice (RJ) framework is a tool to support people to become pregnant, to not become pregnant, and to parent in safe communities. In this review, the authors provide essential background about this history and how those in reproductive health care can use the RJ framework through an intersectional lens to achieve inclusive reproductive goals and advocate for comprehensive access to family planning care, including contraceptive and abortion care.

Assessing the inequalities in demand for family planning satisfied in Ghana: evidence from the 1993-2014 Demographic and Health Surveys.

BACKGROUND: Family planning is essential in promoting the well-being of women and their families and communities and ensuring quality of care in contraceptive use. This study sought to assess the trend and inequalities in the demand for family planning satisfied (DFPS) in Ghana from 1993 to 2014. METHODS: The World Health Organization's Health Equity Assessment Toolkit was employed to analyse the data. We disaggregated DFPS by five equity stratifiers: age, economic status, education, residence and region. Inequality was measured using difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF). RESULTS: The study showed an increment in DFPS from 17.8% to 38.7% between 1993 and 2014. With respect to age, we noted substantial inequality in 2003 (D=21.9 [95% confidence interval {CI} 15.2 to 28.7]), 1993 (D=4.8 [95% CI -1.8 to 11.4]) and 2014 (D=15 [95% CI 3 to 26.9]). The greatest economic inequality occurred in 1993 (PAF=69.7 [95% CI 50.8 to 88.6]; D=20.1 [95% CI 14.8 to 25.4]). Regarding education, significant inequality existed in 1993 (PAF=112 [95% CI 100.8 to 123.2]; D=29.7 [95% CI 21.9 to 37.4]). Ashanti and the Upper West regions reported significant inequalities (PAF=55.6 [95% CI 33.1 to 78.2]; D=16.1 [95% CI 8.9 to 23.3]). CONCLUSIONS: There are age-, education-, wealth-, residence- and region-related inequalities with respect to DFPS. Policymakers will have to prioritize the needs of women with no formal or low educational attainment in order to improve DFPS coverage. Special attention needs to be given to adolescent girls since they suffer greater inequalities than adult women.

Getting ready for reduced donor dependency: the co-financing of family planning commodities.

Family planning (FP) programmes in low and lower-middle income countries are confronting the dual impact of reduced external donor commitments and stagnant or reduced domestic financing, worsened by economic consequences of the COVID-19 pandemic. Co-financing-a donor-government agreement to jointly fund aspects of a programme, with transition towards the government assuming increasing responsibility for total cost-can be a powerful tool to help build national ownership, fiscal sustainability and programme visibility. Using Gavi's successful co-financing model as reference, the current paper draws out a set of key considerations for developing policies on co-financing of FP commodities in resource-poor settings. Macroeconomic and contextual sensitivities must be incorporated while classifying countries and determining co-financing obligations-using the actual GNI per capita on a scale or sovereign credit ratings, in conjunction with programmatic indicators, may be preferred. It is also important for policies to allow sufficiently long time for countries to transition-dependent on the country context, may be up to 10 years as allowed under the US Agency for International Development FP graduation policy and flexibility to revisit the terms following externalities that can influence the fiscal space for health. Incentivizing new domestic financing to pay for co-financing dues is critical, so as not to displace government funding from related health or social sector programs. Pragmatic ways to ensure country compliance can include engaging both the ministries of health and finance as co-signatories to identify and address known administrative and fiscal challenges; establishing dedicated co-financing account with the finance ministry; and instituting a mutual monitoring mechanism. Lastly, the overall process of policymaking can benefit from an alignment of goals and interests of the key development partners.

Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth.

BACKGROUND: Hypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. OBJECTIVE: The primary objective of the study is to compare contraception counseling and use between hypertensive and nonhypertensive individuals at risk for unintended pregnancy. Our secondary objectives are the following: (1) to evaluate the effect of race on the probability of counseling and the use of contraception, and (2) to evaluate the methods used by individuals with hypertension. METHODS: Data from the 2015-2017 and 2017-2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the previous 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health. The social determinants of health covariate was based on reported experiences within 5 social determinants of health domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were used to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference-in-difference analyses, we compared the change in counseling and use between hypertensive and nonhypertensive respondents by race, relative to White respondents. RESULTS: Of the 8625 participants analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95% confidence interval, 20.4-31.9) of hypertensive individuals and 20.7% (95% confidence interval, 19.3-22.2) of nonhypertensive individuals. Contraception use was reported by 39.8% (95% confidence interval, 33.2-46.5) of hypertensive and 35.3% (95% confidence interval, 33.3-37.2) of nonhypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes, and social determinants of health indicated that hypertensive individuals were 8 percentage points (95% confidence interval, 3-18 percentage points) more likely to receive counseling and 9 percentage points (95% confidence interval, 3-16 percentage points) more likely to use contraception. Hypertensive Black individuals did not receive more counseling or use more contraceptives compared with nonhypertensive Black individuals. The difference in counseling when hypertension was present was 13 percentage points lower than the difference observed for White respondents when hypertension was present (P=.01). The most frequently used contraceptive method among hypertensive individuals was combined oral contraceptive pills (54.0%; 95% confidence interval, 44.3%-63.5%). CONCLUSION: Despite the higher likelihood of receiving contraception counseling and using contraception among hypertensive individuals at risk for unintended pregnancy, two-thirds of this population did not receive contraception counseling, and <40% used any contraceptive method. Furthermore, unlike White individuals, Black individuals with hypertension did not receive more contraception care than nonhypertensive Black individuals. Of all those who used contraception, half relied on a method classified as Centers for Disease Control and Prevention Medical Eligibility Criteria Category 3. These findings highlight a substantial unmet need for safe and accessible contraception options for hypertensive individuals at risk for unintended pregnancy, emphasizing the importance of targeted interventions to improve contraceptive care and counseling in this population.

Assessment of a Novel Interactive Website to Inform Adolescent and Young Adult Decision-Making about Contraception.

STUDY OBJECTIVE: Adolescents and young adults (AYAs) rely on internet resources for sexual and reproductive health (SRH) information. Interactive tools are promising in health education, yet existing SRH websites do not contain validated resources to support AYAs in contraception decision-making. "Teen Health" is an original, interactive educational website designed for AYAs that includes a novel contraception education tool (CET). METHODS: A convenience sample of pregnancy-capable patients aged 13-25 years were recruited during scheduled appointments at outpatient clinics affiliated with a tertiary children's hospital from January to June 2022. Electronic surveys evaluated participants' contraception preferences before and after website exposure. CET results were reported in the post-website exposure survey. Written feedback was solicited after website exposure. RESULTS: One hundred and twenty-eight participants with a mean age of 15.95 years (SD 1.93) participated in this study. Participant demographic characteristics were notable for diverse representation of gender identities and sexual preferences. Contraception preferences before and after website exposure differed significantly (P < .001). Oral contraceptive pills were the most commonly selected contraception method both before and after website exposure. There was a significant relationship between CET results and post-website contraception preference. Many participants asked for additional topics in adolescent health to be featured on "Teen Health." CONCLUSION: This study demonstrates the feasible implementation and utility of an interactive, teen-friendly SRH educational tool for AYAs. Further study of this website's utility may include broadening the research population to include other languages, clinical institutions, and educational settings; non-contraceptive uses for this resource; and contraception selection outcomes after exposure to this website.

Family Planning Experiences and Challenges of Mohs Fellowship Trainees.

BACKGROUND: There is a paucity of literature describing family planning challenges faced by Mohs fellows. OBJECTIVE: To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows. MATERIALS AND METHODS: A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship. RESULTS: In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female ( n = 81, 69.8%) than male ( n = 35, 30.2%). Most had children before completion of their Mohs training ( n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% ( n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents ( n = 10) who breastfed or pumped did not have a convenient place to do so. CONCLUSION: This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed.

Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes.

INTRODUCTION: Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes. MATERIALS AND METHODS: We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008-2009) and two post-periods (2012-2013; 2017-2019). We identified those likely eligible for P4HB in Georgia (n = 1,967) and 10 comparison states (n = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling. RESULTS: P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (p < .01) and an 11.4 pp decrease in the later post-period (p < .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (p < .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (p < .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (-3.9 pp; p < .05) but not for mothers of other races/ethnicities. DISCUSSION: Medicaid family planning waivers are an important structural policy intervention that can improve reproductive health care, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.

Prevalence, trends, and determinants of contraception use among women in Nigeria: An analysis of Nigeria demographic and health surveys 2008 to 2018.

Within Africa, maternal mortality remains a concern that can be prevented and addressed. Among the various African countries, Nigeria has one of the highest mortality rates, particularly in a context where the population continues to rise. The relationship between contraceptive usage among married Nigerian women and low socioeconomic development contributes to another concerning public health issue- performing unskilled abortions. This cross-sectional study examines how seven (7) key social determinants of health impact the usage of contraceptive methods among Nigerian women ages 15-24. Data were analyzed and acquired from the Nigerian Demographic and Health Survey (NDHS) and the National Population Commission (NPC) in 2008, 2013, and 2018. Bivariate and multivariable logistic regression analyses illustrate social determinants have a deep effect on access and usage of contraceptives in Nigeria. Results yielded that as factors such as age, education, and socioeconomic status increase, the use of contraceptives increases as well. While autonomy has little to no significance, religion and urbanity present challenges to Nigerian women who are interested in using contraceptives. More so, this study suggests a stronger need for education for Nigerian women at an early age and deepening the understanding of the barriers to contraception use with the help of the community and religious leaders.

En Afrique, la mortalité maternelle reste une préoccupation qui peut être évitée et traitée. Parmi les différents pays africains, le Nigeria présente l'un des taux de mortalité les plus élevés, notamment dans un contexte où la population ne cesse d'augmenter. La relation entre l'utilisation de contraceptifs chez les femmes nigérianes mariées et le faible développement socio-économique contribue à un autre problème de santé publique préoccupant : la pratique d'avortements non qualifiés. Cette étude transversale examine l'impact de sept (7) déterminants sociaux clés de la santé sur l'utilisation des méthodes contraceptives chez les femmes nigérianes âgées de 15 à 24 ans. Les données ont été analysées et acquises à partir de l'Enquête démographique et de santé nigériane (NDHS) et de la Commission nationale de la population (NPC) en 2008, 2013 et 2018. Les analyses de régression logistique bivariées et multivariées illustrent que les déterminants sociaux ont un effet profond sur l'accès et l'utilisation des contraceptifs. au Nigéria. Les résultats ont montré qu'à mesure que des facteurs tels que l'âge, l'éducation et le statut socio-économique augmentent, l'utilisation de contraceptifs augmente également. Même si l'autonomie n'a que peu ou pas de signification, la religion et l'urbanité présentent des défis pour les femmes nigérianes qui souhaitent utiliser des contraceptifs. Plus encore, cette étude suggère un besoin plus fort d'éducation des femmes nigérianes dès leur plus jeune âge et d'approfondir la compréhension des obstacles à l'utilisation de la contraception avec l'aide de la communauté et des chefs religieux.