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1.
Lancet ; 391(10123): 870-882, 2018 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-29217374

RESUMO

BACKGROUND: The London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress. METHODS: An updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations. FINDINGS: In 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4-49·1), unmet need for modern methods was 21·6% (19·7-23·9), and the demand satisfied with modern methods was 67·9% (64·4-71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8-52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5-53·4) to 51·8% (47·3-56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9-25·0) to 28·5% (26·8-30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012. INTERPRETATION: Whereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor. FUNDING: The Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Inquéritos sobre o Uso de Métodos Contraceptivos/métodos , Países em Desenvolvimento/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Adolescente , Adulto , Anticoncepção/economia , Comportamento Contraceptivo/tendências , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Adulto Jovem
2.
Hum Reprod ; 32(6): 1325-1333, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28398523

RESUMO

STUDY QUESTION: Do the rates at which women transition among different intensities of pregnancy planning vary with age, marital status and race/ethnicity? SUMMARY ANSWER: Rates of transition from low or moderate pregnancy probability groups (PPGs) to higher PPGs vary by age, marital status and race/ethnicity. WHAT IS KNOWN ALREADY: The design of prospective studies of the effects of pre- and peri-conception exposures on fecundity, pregnancy and children's health is challenging because at any specific time only a small percentage of reproductive age women is attempting to conceive. To our knowledge, there has been no population-based, prospective study that repeatedly assessed pregnancy planning, which included women who were not already planning pregnancy at enrollment and whose ages spanned the female reproductive age range. STUDY DESIGN, SIZE, DURATION: A longitudinal study was carried out that repeatedly assessed pregnancy probability in 12 916 women for up to 21 months from January 2009 to September 2010. PARTICIPANTS/MATERIALS, SETTING, METHOD: We analyzed data from the National Children's Study Vanguard Study, a pilot study for a large-scale epidemiological birth cohort study of children and their parents. During the Vanguard Study, investigators followed population-based samples of reproductive age women in each of seven geographically dispersed and diverse study locations over time to identify when they sought to become pregnant, providing a unique opportunity to prospectively assess changes in pregnancy planning in a large sample of US women. At study entry and each follow-up contact, which occurred at 1, 3 or 6 month intervals depending on PPG, a questionnaire was used to assess behavior dimensions of pregnancy planning to assign women to low, moderate, high non-tryer and high tryer PPGs. MAIN RESULTS AND THE ROLE OF CHANCE: Crude rates of pregnancy increased with higher assigned PPG, validating the utility of the instrument. The initial PPG and probabilities of transitioning from low or moderate PPG to higher PPG or pregnancy varied with age, marital status and race/ethnicity. Women aged 25 to <35 years had shorter times to transition to higher PPGs or to pregnant compared with women <25 years. Women who were not currently married had longer times to transition from any initial PPG to pregnant, high tryer or high non-tryer status than currently married women. Non-Hispanic Black (NHB) and Hispanic women had shorter time to transition from low or moderate to high non-tryer than non-Hispanic White (NHW) women. NHB women also had shorter time to transition from low to high tryer than NHW women. High tryers are more likely to be aged 25 to <30 years, to be married, and to be Hispanic, NHB or other race/ethnicity than women in the low PPG. LIMITATIONS, REASONS FOR CAUTION: Loss to follow-up varied by age, marital status and race/ethnicity. Although weights were not developed for the Vanguard study, the self-weighting design minimizes the bias of unweighted analysis. Nonetheless, the SEs for some estimates may be under-estimated. WIDER IMPLICATIONS OF THE FINDINGS: Our results show that demographic characteristics are strong predictors of women's behaviors toward pregnancy. The results further show that frequent follow-up assessments of pregnancy planning behavior in large numbers of women are required to recruit an unbiased sample of preconception women. These findings will be useful to investigators designing prospective studies of fecundability, pregnancy outcomes and children's health. STUDY FUNDING/COMPETING INTERESTS: National Institutes of Health (contracts N01-HD53414, N01-HD63416, N01-HD53410, N01-HD53415, N01-HD53396, N01-HD53413 and N01-HD-53411; grant R21 ES016846) and by the University of California Irvine Center for Occupational and Environmental Health. No competing interests. TRIAL REGISTRATION NUMBER: None.


Assuntos
Inquéritos sobre o Uso de Métodos Contraceptivos , Serviços de Planejamento Familiar , Comportamento Reprodutivo , Adulto , Negro ou Afro-Americano , Asiático , Estudos de Coortes , Serviços de Planejamento Familiar/economia , Feminino , Hispânico ou Latino , Humanos , Modelos Logísticos , Estudos Longitudinais , Estado Civil/etnologia , Projetos Piloto , Gravidez , Taxa de Gravidez/etnologia , Estudos Prospectivos , Comportamento Reprodutivo/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Branca
3.
Health Care Women Int ; 38(10): 1075-1094, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28644720

RESUMO

We investigated the relation of internal migration to contraceptive use and adjusted for individual and contextual (community) characteristics. Multilevel logistic regression models were fitted to nationally representative data of 28,876 women from 884 communities in Nigeria. Only about one out of every 10 women (10.4%) currently used a contraceptive method. Contraceptive prevalence according to the migration status were rural-urban (12.5%), urban-rural (13.8%), rural nonmigrants (6.2%) and urban nonmigrants (17.1%). The relationship between internal migration and contraceptive use was fully explained by individual and community characteristics. Programs aimed at increasing contraceptive prevalence should address contextual challenges alongside socioeconomic factors.


Assuntos
Comportamento Contraceptivo/etnologia , Anticoncepção/estatística & dados numéricos , Dinâmica Populacional , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Inquéritos sobre o Uso de Métodos Contraceptivos , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Pessoa de Meia-Idade , Prevalência , População Rural , Fatores Socioeconômicos , População Urbana , Adulto Jovem
4.
Reprod Health ; 13: 12, 2016 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-26873678

RESUMO

BACKGROUND: Fertility desires and contraceptive behavior often change over time. This study examined the influence of change in fertility desires on change in modern contraceptive use over time in three peri-urban communities in sub-Saharan Africa. METHODS: This multi-site study includes baseline and follow up data from 3 sites in the Family Health and Wealth Study. Following a census in each site, a probability sample of at least 500 households was obtained. Generalized linear models were employed. RESULTS: Modern contraceptive use increased in Ipetumodu, Nigeria (29.4% to 36.7%), but declined slightly in Sebeta, Ethiopia (66.9% to 61.3%) and Asawase, Ghana (12.6% to 10.8%). Across sites, at baseline and follow up, women who wanted no more children reported more contraceptive use, compared with those who wanted more children, and were more likely to shift to being contraceptive users in Ipetumodu [aOR(95% CI):1.55 (1.07,2.26)]. CONCLUSIONS: Women's fertility desires influenced their contraceptive behavior, although there were cross-site differences. Changing contraceptive demand and program factors will be important to enable peri-urban women to frame and act on their fertility desires.


Assuntos
Comportamento Contraceptivo , Serviços de Planejamento Familiar , Conhecimentos, Atitudes e Prática em Saúde , Comportamento Reprodutivo , Saúde Suburbana , Adolescente , Adulto , África Subsaariana , Estudos de Coortes , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/tendências , Inquéritos sobre o Uso de Métodos Contraceptivos , Escolaridade , Características da Família , Serviços de Planejamento Familiar/tendências , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Modelos Lineares , Estudos Longitudinais , Paridade , Comportamento Reprodutivo/etnologia , Fatores Socioeconômicos , Análise Espaço-Temporal , Saúde Suburbana/etnologia , Saúde Suburbana/tendências , Adulto Jovem
5.
Reprod Health ; 13: 25, 2016 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-26987368

RESUMO

BACKGROUND: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. METHODS: We conducted a quasi-experimental (pre- and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, (1) Suraj model (meaning 'Sun' in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and (2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. RESULTS: The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14% percentage points, current contraceptive use by 5% percentage points and long term modern method--intrauterine device (IUD) use by 6% percentage points. The CMW model significantly increased contraceptive awareness by 28% percentage points, ever use of contraceptives by 7% percentage points and, IUD use by 3% percentage points. Additionally the Suraj intervention led to a 35% greater prevalence (prevalence ratio: 1.35, 95% CI: 1.22-1.50) of contraceptive use among MWRA. CONCLUSION: Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.


Assuntos
Intervalo entre Nascimentos , Redes Comunitárias , Comportamento Contraceptivo , Anticoncepção , Assistência à Saúde Culturalmente Competente , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Adulto , Intervalo entre Nascimentos/etnologia , Agentes Comunitários de Saúde , Anticoncepção/efeitos adversos , Anticoncepção/economia , Anticoncepção/tendências , Comportamento Contraceptivo/etnologia , Inquéritos sobre o Uso de Métodos Contraceptivos , Estudos Transversais , Assistência à Saúde Culturalmente Competente/etnologia , Política de Planejamento Familiar/tendências , Serviços de Planejamento Familiar/educação , Feminino , Gastos em Saúde , Humanos , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/economia , Tocologia , Paquistão , Educação de Pacientes como Assunto , Setor Privado , Setor Público , Saúde da População Rural/etnologia , Cônjuges/etnologia
6.
Reprod Health ; 13: 8, 2016 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-26842976

RESUMO

BACKGROUND: Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. METHODS: From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services. RESULTS: A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7%) had a steady partner, and 737 (53.1%) were male. Among those with a steady partner, 862 (96.0%) did not intend to become pregnant; 709 (82.3%) had sex during the previous 3 months, 683 (96.3%) used at least one contraceptive method, and 202 (29.6%) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8%) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03). CONCLUSION: Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.


Assuntos
Atitude Frente a Saúde , Comportamento Contraceptivo , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente , Comportamento Reprodutivo , Adulto , Atitude Frente a Saúde/etnologia , Estudos de Coortes , Comportamento Contraceptivo/etnologia , Inquéritos sobre o Uso de Métodos Contraceptivos , Serviços de Planejamento Familiar/educação , Feminino , Seguimentos , Infecções por HIV/etnologia , Soropositividade para HIV/etnologia , Humanos , Perda de Seguimento , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Cooperação do Paciente/etnologia , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Comportamento Reprodutivo/etnologia , Parceiros Sexuais , Centros de Atenção Terciária , Tailândia
7.
Reprod Health ; 13(1): 67, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27246329

RESUMO

BACKGROUND: Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual's economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant. METHODS: Using data from the 2008-09 Kenya Demographic and Health Survey (DHS), we analyze data from 5,905 women aged 15-49 years who reported being sexually active in the last 12 months prior to the survey. Bivariate and multivariate logistic regressions are fitted to predict correlates of contraceptive use in the presence of migration streams among other explanatory variables. RESULTS: Modern contraceptive use was significantly higher among women in all migration streams (non-migrant urban (OR = 2.8, p < 0.001), urban-urban (OR = 2.0, p < 0.001), urban-rural (OR = 2.0, p < 0.001), rural-urban (OR = 2.6, p < 0.001), rural-rural (OR = 1.7, p < 0.001), than non-migrant rural women. CONCLUSION: Women who internally migrate within Kenya, whether from rural to urban or between urban centres, were more likely to use modern contraception than non-migrant rural women. This phenomenon appears to be due to selection, adaption and disruption effects which are likely to promote use of modern contraceptives. Programmatically, the differentials in modern contraceptive use by the different migration streams should be considered when designing family planning programmes among migrant and non-migrant women.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais Femininos/administração & dosagem , Dispositivos Anticoncepcionais Femininos , Modelos Econômicos , Saúde da População Rural , Migrantes , Saúde da População Urbana , Adolescente , Adulto , Comportamento Contraceptivo/etnologia , Anticoncepcionais Femininos/economia , Dispositivos Anticoncepcionais Femininos/economia , Inquéritos sobre o Uso de Métodos Contraceptivos , Países em Desenvolvimento , Feminino , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Quênia , Pessoa de Meia-Idade , Pobreza/etnologia , Pobreza/prevenção & controle , Saúde da População Rural/etnologia , Fatores Socioeconômicos , Saúde da População Urbana/etnologia , Adulto Jovem
8.
Contraception ; 101(5): 333-337, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32014521

RESUMO

OBJECTIVES: To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder. STUDY DESIGN: Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont. RESULTS: A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method. CONCLUSIONS: Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method. IMPLICATIONS: Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Contracepção Reversível de Longo Prazo/efeitos adversos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adolescente , Adulto , Comportamento Contraceptivo , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Eficácia de Contraceptivos , Inquéritos sobre o Uso de Métodos Contraceptivos , Estudos Transversais , Implantes de Medicamento/efeitos adversos , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Percepção , Gravidez , Gravidez não Planejada , Vermont , Adulto Jovem
9.
Psicol. ciênc. prof ; 44: e258946, 2024.
Artigo em Português | LILACS, INDEXPSI | ID: biblio-1558745

RESUMO

Este trabalho tem o objetivo de analisar as concepções de maternidade para mulheres inférteis de diferentes níveis socioeconômicos que estão em tratamento de reprodução assistida. Trata-se de um estudo qualitativo, descritivo, que utilizou como instrumento uma entrevista semiestruturada e contemplou temas como o significado de família, desejo/expectativas sobre filho e gestação e expectativas sobre a maternidade. Participaram da pesquisa 48 mulheres inférteis acima de 35 anos que usam tecnologias de reprodução assistida de alta complexidade em instituições privada e pública. Os dados foram tratados pela análise de conteúdo em que emergiram os temas: representações sociais da família; representações sociais da maternidade; expectativas com a gestação e os modelos maternos; e o filho imaginado. As participantes representaram a família de forma positiva, como um sistema de suporte, de fundação e origem de amor, configurando-a como um laço social. Por outro lado, as concepções de família com base na consanguinidade também estiveram presentes, representando a família pela perpetuação da espécie e pela importância do laço biológico. A maternidade foi marcada por significativa idealização, sendo vista como um papel gratificante e de realização da feminilidade. O peso da cobrança social para procriar também foi sentido como um dever a cumprir e que, na impossibilidade de se realizar, gera sentimentos de inferioridade, menos-valia, impotência e inadequação perante a sociedade, o que reforça o estigma da infertilidade. Tais resultados apontam a importância de reflexões sobre o papel da mulher na nossa cultura, visto que a maternidade é ainda utilizada como medida para o sucesso ou fracasso feminino. Faz-se necessário também refletir sobre a possibilidade da maior inserção do trabalho psicológico na reprodução assistida, visto a carga emocional e social envolvidas nesse processo.(AU)


This study aimed to analyze the conceptions of motherhood for infertile women from different socioeconomic levels who are undergoing assisted reproduction treatment. This is a qualitative and descriptive study that used a semi-structured interview as an instrument and included topics such as the meaning of family and desires/expectations about the child, pregnancy, and motherhood. A total of 48 infertile women over 35 years of ages using high-complexity assisted reproductive technologies in private and public institutions participated in this research. The data were treated by content analysis in which the following themes emerged: family social representations; social representations of motherhood; expectations with pregnancy and maternal models; and the imagined son. Participants represented the family in a positive way as a support system and the foundation and origin of love, embracing the family as a social bond. On the other hand, the family concepts based on inbreeding were also present, representing the family by perpetuation of the species and the importance of biological bonds. Motherhood was marked by significant idealization, being seen as a gratifying role and the fulfillment of femininity. The weight of the social demand to procreate was also felt as a duty to be fulfilled that, in the impossibility of carrying it out, generates feelings of inferiority, worthlessness, impotence, and inadequacy toward society, which reinforce the stigma of infertility. Results point to the necessary reflections on the role of women and our culture since Motherhood is still used as a measure of female success or failure. They also point to a reflection on the possibility of greater inclusion of psychological work in assisted reproduction given the emotional and social burden involved in this process.(AU)


Este estudio tuvo como objetivo analizar las concepciones de maternidad de mujeres infértiles, de diferentes niveles socioeconómicos, que se encuentran en tratamiento de reproducción asistida. Se trata de un estudio cualitativo, descriptivo, que utilizó como instrumento una entrevista semiestructurada e incluyó temas como el sentido de la familia, deseos/expectativas sobre el hijo y el embarazo y expectativas sobre la maternidad. Participaron en la investigación un total de 48 mujeres infértiles, mayores de 35 años, usuarias de tecnologías de reproducción asistida de alta complejidad en instituciones públicas y privadas. Los datos se sometieron a análisis de contenido del cual surgieron los temas: representaciones sociales familiares; representaciones sociales de la maternidad; expectativas con el embarazo y modelos maternos; hijo imaginado. Las participantes representaron a la familia de manera positiva, como sistema de apoyo, fundamento y origen del amor, configurándola como vínculo social. Por otro lado, también estuvieron presentes las concepciones familiares basadas en la consanguinidad, representando a la familia para la perpetuación de la especie y la importancia del vínculo biológico. La maternidad estuvo marcada por una importante idealización, vista como un rol gratificante y de realización de la feminidad. También se sintió el peso de la demanda social de procrear como un deber que cumplir y que, ante la imposibilidad de realizarlo, genera sentimientos de inferioridad, desvalorización, impotencia e inadecuación en la sociedad, lo que refuerza el estigma de la infertilidad. Por tanto, son necesarias reflexiones sobre el papel de la mujer en nuestra cultura, ya que la maternidad se sigue utilizando como medida del éxito o fracaso femenino. También se reflexiona sobre la posibilidad de una mayor inclusión del trabajo psicológico en la reproducción asistida dada la carga emocional y social que implica este proceso.(AU)


Assuntos
Humanos , Feminino , Gravidez , Reprodução , Família , Poder Familiar , Representação Social , Infertilidade Feminina , Ansiedade , Detecção da Ovulação , Indução da Ovulação , Óvulo , Transporte do Óvulo , Relações Pais-Filho , Equipe de Assistência ao Paciente , Pacientes , Manutenção da Gravidez , Gravidez Múltipla , Preconceito , Psicologia , Qualidade de Vida , Autoimagem , Sexo , Abstinência Sexual , Vergonha , Logro , Identificação Social , Transporte Espermático , Espermatozoides , Tabu , Tempo , Tabagismo , Sistema Urogenital , Útero , Características da População , Estratégias de Saúde Nacionais , Trabalho de Parto , Gravidez , Resultado da Gravidez , Preparações Farmacêuticas , Adoção , Divórcio , Casamento , Fertilização in vitro , Infecções Sexualmente Transmissíveis , Educação Infantil , Características da Família , Fatores de Risco , Doença Inflamatória Pélvica , Técnicas Reprodutivas , Idade Gestacional , Coito , Gravidez de Alto Risco , Doação de Oócitos , Consanguinidade , Anticoncepção , Sexualidade , Terapia de Casal , Afeto , Ameaça de Aborto , Infecção Pélvica , Hereditariedade , Padrões de Herança , Previsão da Ovulação , Depressão , Direitos Sexuais e Reprodutivos , Diagnóstico , Sonhos , Alcoolismo , Transferência Embrionária , Endometriose , Estado Conjugal , Mercado de Trabalho , Testes de Obstrução das Tubas Uterinas , Conflito Familiar , Relações Familiares , Fantasia , Medo , Doenças Urogenitais Femininas e Complicações na Gravidez , Masculinidade , Comportamento Sedentário , Consumo Excessivo de Bebidas Alcoólicas , Esperança , Normas Sociais , Desvalorização pelo Atraso , Inquéritos sobre o Uso de Métodos Contraceptivos , Trauma Psicológico , Concepção por Doadores , Estilo de Vida Saudável , Eficácia de Contraceptivos , Contracepção Reversível de Longo Prazo , Construção Social do Gênero , Expressão de Gênero , Necessidades Específicas do Gênero , Frustração , Constrangimento , Tristeza , Regulação Emocional , Angústia Psicológica , Empoderamento , Varicocele , Pertencimento , Apoio Familiar , Exaustão Emocional , Culpa , Felicidade , Imaginação , Infertilidade Masculina , Inseminação Artificial Homóloga , Laboratórios , Estilo de Vida , Solidão , Troca Materno-Fetal , Medicina , Obesidade
10.
Vive (El Alto) ; 6(18): 870-879, dic. 2023.
Artigo em Espanhol | LILACS | ID: biblio-1530591

RESUMO

La salud sexual y reproductiva, el embarazo en la adolescencia y las infecciones de trasmisión sexual, son temas tratados en salud pública, adicionalmente cuentan con disímiles estrategias que buscan la reducción del embarazo en adolescentes e infecciones de transmisión sexual. Objetivo. Determinar la efectividad de la intervención educativa en la disminución del embarazo y las enfermedades de trasmisión sexual en adolescentes perteneciente a la Unidad Educativa Guillermo Ordóñez Gómez, de la Provincia de Santa Elena, en Ecuador en el periodo de2021-2022. Materiales y Métodos. Se realizó un estudio cuasi- experimental, con una población de 148 estudiantes, de la cual se consideró la muestra de forma aleatoria simple quedando establecida en 74 estudiantes de 1ro de Bachillerato General Unificado y 48 estudiantes de 2do. Primero se realizó un análisis preliminar (Etapa inicial) que permitió determinar cuál fue la situación inicial y el grado de información de las adolescentes. Resultados. El 51% tenían 15 años. Según la localidad la zona urbana con un 52% y la zona rural con un 48%. el 89% refirieron tener conocimientos y el 3% tal vez, en relación al preservativo masculino el 63% mencionaron que sí conocen, el 32% respondieron no conocerlo, y la satisfacción de los estudiantes con la información recibida, fue del 50% de los beneficiarios se sintieron muy satisfecho con la información recibidas, el 30% de los estudiantes satisfechos, mientras que el 20% de forma neutral. Conclusiones. La intervención educativa resultó adecuada, ya que incrementó el nivel de conocimiento de los adolescentes con respecto a los temas de Salud Sexual y Salud Reproductiva para la prevención de embarazo y enfermedades de transmisión sexual y existió un nivel satisfacción con la información recibida.


Sexual and reproductive health, adolescent pregnancy and sexually transmitted infections are topics addressed in public health, and there are also different strategies aimed at reducing adolescent pregnancy and sexually transmitted infections. Objective. To determine the effectiveness of the educational intervention in the reduction of pregnancy and sexually transmitted diseases in adolescents belonging to the Guillermo Ordóñez Gómez Educational Unit, in the Province of Santa Elena, Ecuador, during the period of 21-21-2022. Materials and Methods. A quasi-experimental study was carried out with a population of 148 students, from which the sample was considered in a simple random way, being established in 74 students of 1st grade of General Unified High School and 48 students of 2nd grade. First, a preliminary analysis (initial stage) was carried out to determine the initial situation and the degree of information of the adolescents. Results. Fifty-one percent were 15 years old. According to the locality of the urban area with 52% and the rural area with 48%, 89% reported having knowledge and 3% maybe, in relation to the male condom 63% mentioned that they do know, 32% responded that they did not know, and the satisfaction of the students with the information received was 50% of the beneficiaries were very satisfied with the information received, 30% of the students were satisfied, while 20% were neutral. Conclusions. The educational intervention was adequate, since it increased the level of knowledge of adolescents regarding the topics of Sexual and Reproductive Health for the prevention of pregnancy and sexually transmitted diseases and there was a level of satisfaction with the information received.


A saúde sexual e reprodutiva, a gravidez na adolescência e as infecções sexualmente transmissíveis (ISTs) são tópicos abordados na saúde pública, com uma variedade de estratégias destinadas a reduzir a gravidez na adolescência e as ISTs. Objetivo. Determinar a eficácia da intervenção educativa na redução da gravidez na adolescência e das infecções sexualmente transmissíveis em adolescentes pertencentes à Unidade Educacional Guillermo Ordóñez Gómez, na Província de Santa Elena, Equador, durante o período de 21-21-2022. Materiais e métodos. Foi realizado um estudo quase experimental com uma população de 148 alunos, dos quais a amostra foi considerada uma amostra aleatória simples de 74 alunos do 1º ano do Ensino Médio Geral Unificado e 48 alunos do 2º ano. Primeiramente, foi realizada uma análise preliminar (etapa inicial) para determinar a situação inicial e o grau de informação dos adolescentes. Resultados. Cinquenta e um por cento tinham 15 anos de idade. De acordo com a localidade da área urbana com 52% e a área rural com 48%. 89% relataram ter conhecimento e 3% talvez, em relação ao preservativo masculino 63% mencionaram que sabiam, 32% responderam que não sabiam, e a satisfação dos alunos com as informações recebidas foi de 50% dos beneficiários estavam muito satisfeitos com as informações recebidas, 30% dos alunos estavam satisfeitos, enquanto 20% eram neutros. Conclusões. A intervenção educativa foi adequada, pois aumentou o nível de conhecimento dos adolescentes em relação aos temas de Saúde Sexual e Reprodutiva para a prevenção de gravidez e doenças sexualmente transmissíveis, e houve um nível de satisfação com as informações recebidas.


Assuntos
Humanos , Adolescente , Saúde Reprodutiva/educação , Inquéritos sobre o Uso de Métodos Contraceptivos/estatística & dados numéricos , Fatores Sociodemográficos , Saúde Pública
11.
Contraception ; 96(5): 365-369, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28778423

RESUMO

OBJECTIVES: To assess interest in, concerns about and knowledge of long-acting reversible contraceptives (LARC) among women in medication-assisted treatment (MAT) for opioid use disorder who were at risk for unintended pregnancy. STUDY DESIGN: Women in MAT completed a survey on contraceptive use, attitudes and knowledge, including LARC methods, as part of eligibility screening for an ongoing trial evaluating family planning interventions for this population. RESULTS: Eighty-three women at risk for unintended pregnancy completed the survey, and a subset of 51 completed supplemental questions about implants. All participants had heard of IUDs and 75/83 (90%) had heard of implants, but only 34/83 (41%) and 14/51 (27%) reported being likely to use IUDs and implants, respectively. Thirty-five women reported they were unlikely to use IUDs, with 29/35 (83%) citing unspecified "other reasons" for this position and 24/35 (69%) endorsing concerns about side effects. Seventeen women reported they were unlikely to use implants, with 8/17 (47%) citing "other reasons" and 9/17 (53%) and 10/17 (59%) reporting concerns about insertion and removal, respectively. Participants reported they knew "a little" about LARCs, but only their knowledge of implants was limited. Only 50/83 (60%) participants were aware of the superior effectiveness of IUDs and 26/51 (51%) were aware of the superior effectiveness of implants relative to other reversible methods. CONCLUSIONS: Participants reported relatively low interest in LARCs. Many women had unspecified reasons for not using LARCs. Participants also lacked information about LARC safety and effectiveness, especially with regard to implants. IMPLICATIONS: Women in medication-assisted treatment for opioid use disorder are at high risk of unintended pregnancy, yet contraceptive use is low and use of less effective methods is common. Women in MAT may benefit from efforts to increase knowledge about implants and assuage concerns about their insertion and removal as well as more general efforts to improve knowledge about the relative efficacy of LARCs. Many women in MAT endorsed unspecified "other reasons" for not using LARCs, which should be explored further.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Contracepção Reversível de Longo Prazo/efeitos adversos , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Dissonância Cognitiva , Comportamento Contraceptivo , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Eficácia de Contraceptivos , Inquéritos sobre o Uso de Métodos Contraceptivos , Implantes de Medicamento/efeitos adversos , Feminino , Humanos , Intenção , Dispositivos Intrauterinos/efeitos adversos , Gravidez , Gravidez não Planejada , Vermont , Adulto Jovem
12.
Sultan Qaboos Univ Med J ; 17(1): e50-e58, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28417029

RESUMO

OBJECTIVES: This study aimed to determine contraceptive utilisation among mothers aged 18-49 years old in Ajman, United Arab Emirates (UAE). METHODS: This cross-sectional study was carried out from May to November 2013. A total of 400 participants were recruited from two primary healthcare centres and one private hospital in Ajman. An interviewer-administered validated questionnaire was used for data collection. RESULTS: The frequency of previous and current contraceptive use was 68.0% and 61.8%, respectively. Expatriates more frequently used contraceptives in comparison to Emiratis (77.3% versus 54.3%, respectively). Contraceptive use increased significantly with age (75.5% among >35-year-olds versus 57.3% among ≤25-year-olds; P <0.050) and education level (83.3% among postgraduates versus 60.0% among those with primary education; P <0.050). In addition, contraceptive use was significantly higher among those living in a nuclear family system (P <0.050). A univariate analysis indicated significant associations between contraceptive use and age, nationality, education level, type of family system, employment sector, parity, knowledge of birth control measures and source of birth control information (P <0.050 each). However, no significant associations were found via multivariate analysis. CONCLUSION: Healthcare practitioners can play a pivotal role in providing contraceptive advice which could lead to an improvement in contraceptive utilisation. Efforts are recommended to raise awareness regarding newer forms of contraceptives among mothers of reproductive age in the UAE.


Assuntos
Anticoncepcionais/administração & dosagem , Inquéritos sobre o Uso de Métodos Contraceptivos , Mães/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Análise de Variância , Anticoncepção , Estudos Transversais , Serviços de Planejamento Familiar , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Gravidez , Fatores Socioeconômicos , Emirados Árabes Unidos , Adulto Jovem
13.
Contraception ; 96(5): 352-356, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28669507

RESUMO

OBJECTIVE: This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception. STUDY DESIGN: We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes. RESULTS: Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use. CONCLUSION: Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use. IMPLICATIONS: Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more effectively to prevent STI morbidity.


Assuntos
Preservativos , Comportamento Contraceptivo , Anticoncepcionais Femininos/administração & dosagem , Modelos Psicológicos , Motivação , Gravidez não Desejada , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Comportamento do Adolescente , Adulto , Colorado/epidemiologia , Preservativos/efeitos adversos , Comportamento Contraceptivo/psicologia , Anticoncepcionais Femininos/efeitos adversos , Inquéritos sobre o Uso de Métodos Contraceptivos , Serviços de Planejamento Familiar , Feminino , Teoria Fundamentada , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Gravidez não Desejada/psicologia , Pesquisa Qualitativa , Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/transmissão , Adulto Jovem
14.
Contraception ; 96(5): 370-377, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28801054

RESUMO

OBJECTIVE: Following the 2016US presidential election, social media posts and news stories amplified concerns about the potential for reduced access to contraception under the incoming administration and urged women to seek long-acting reversible contraception. We aimed to describe women's concerns about future access to contraception, in their own words. STUDY DESIGN: A social-media-based, anonymous online survey assessing thoughts and concerns about future access to contraception was distributed to reproductive-aged US women for 1 week in mid-January 2017. Participants who were concerned about future access to contraception could share their thoughts and feelings in an open-ended comments box. We qualitatively analyzed 449 written responses for content and themes, with the goal of characterizing key concerns. RESULTS: Women who provided written comments had a mean age of 28years; 85% were white, 88% had at least a college degree, and 93% identified as Democratic or Democratic-leaning. Women were highly concerned about future affordability of contraceptive methods due to potential loss of insurance, reduced insurance coverage for contraceptive methods and reduced access to low-cost care at Planned Parenthood. Many also worried about increased restrictions on abortion. Participants' concerns regarding access to contraception and abortion centered around themes of reproductive and bodily autonomy, which women described as fundamental rights. CONCLUSIONS: Women in this study expressed considerable fear and uncertainty regarding their future access to contraception and abortion following the 2016US presidential election. The potential for restricted access to affordable contraception and abortion was viewed as an unacceptable limitation on bodily autonomy. IMPLICATIONS: As the future of US health care policy is debated, many women are concerned about the impact of policy changes on their ability to access affordable contraception and abortion, which many view as essential to the preservation of bodily and reproductive autonomy.


Assuntos
Anticoncepção , Democracia , Acessibilidade aos Serviços de Saúde , Autonomia Pessoal , Política , Mudança Social , Estresse Psicológico/etiologia , Aborto Legal/ética , Aborto Legal/psicologia , Adulto , Atitude Frente a Saúde , Anticoncepção/ética , Anticoncepção/psicologia , Inquéritos sobre o Uso de Métodos Contraceptivos , Feminino , Política de Saúde/tendências , Acessibilidade aos Serviços de Saúde/ética , Inquéritos Epidemiológicos , Humanos , Cobertura do Seguro/ética , Seguro Saúde/ética , Internet , Direitos Sexuais e Reprodutivos/ética , Direitos Sexuais e Reprodutivos/psicologia , Estresse Psicológico/psicologia , Estados Unidos , Serviços de Saúde da Mulher/ética , Adulto Jovem
15.
J Fam Plann Reprod Health Care ; 42(1): 12-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25900524

RESUMO

OBJECTIVES: Contraceptive use is important for reproductive-aged women living with HIV to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraception and safe sexual activity. This study aimed to determine the frequency and predictors of discussions regarding sexual activity and contraceptive use. METHODS: Retrospective clinical study of all reproductive-aged women (n=128) treated for HIV between 2010 and 2012 at two metropolitan hospitals. Evidence of discussion between treating doctors and patients regarding sexual activity and contraception and variables including patient age, gender of doctor, time since HIV diagnosis, previous pregnancy, country of birth and antiretroviral regimen were obtained from medical records. RESULTS: Sexual activity status was documented for 54% of the women and discussion regarding contraception was recorded for less than one-third of the study participants. Contraceptive use was not recorded in 63% of the medical records. In the study cohort 27% of the women used contraception, 10% did not use contraception, and when a discussion regarding sexual activity was documented, contraception was 3.7 times more likely to also be discussed (p=0.04). Excluding women who were pregnant, women who were documented as using contraception were 1.8 times as likely to have had a discussion about contraception documented (p=0.05). After adjustment for other factors, previous pregnancy, gender of doctor and age of patient were not associated with discussions regarding sexual activity or contraception. CONCLUSIONS: Discussions regarding sexual activity and contraception between HIV-infected women of reproductive age and their clinicians were inconsistent and suboptimal. Mechanisms to facilitate regular discussion about sexual activity and contraception between clinicians and women with HIV warrant further investigation.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Infecções por HIV/epidemiologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto , Antirretrovirais/uso terapêutico , Austrália , Anticoncepcionais Femininos/administração & dosagem , Inquéritos sobre o Uso de Métodos Contraceptivos , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Relações Profissional-Paciente , Estudos Retrospectivos , Parceiros Sexuais , Adulto Jovem
16.
J Womens Health (Larchmt) ; 25(12): 1262-1269, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27295335

RESUMO

BACKGROUND: Women with chronic diseases are at increased risk of having unintended pregnancies. Little is known whether chronic diseases are associated with increased likelihood of effective/highly effective contraceptive use. METHODS: We analyzed 2008-2010 Florida Behavioral Risk Factor Surveillance System data for women aged 18-44 years who were at risk of unintended pregnancy. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for contraceptive use in relation to diabetes, cardiovascular disease (CVD), and current asthma. We assessed the association of chronic disease status with use of three different contraception outcomes: (1) any method versus none, (2) less effective methods (methods associated with ≥10 unintended pregnancies/100 women/year) versus none, and (3) effective/highly effective methods (<10 unintended pregnancies/100 women/year) versus none. RESULTS: Among 4473 women at risk for unintended pregnancy, 87% were using any method of contraception (22.5% less effective methods and 64.5% effective/highly effective methods). Women with CVD were more likely than those without CVD to use any contraception (aPR = 1.09, 95% CI: 1.04, 1.15), less effective (aPR = 1.39, 95% CI: 1.13, 1.70), and effective/highly effective (aPR = 1.10, 95% CI: 1.03, 1.19) contraception. Women with diabetes were more likely to use less effective methods than women without diabetes (aPR = 1.34, 95% CI: 1.05, 1.72). No significant associations were observed for asthma, regardless of contraceptive effectiveness. CONCLUSIONS: Self-reported use of effective/highly effective contraception was higher than nonuse or use of less effective methods among all women at risk of unintended pregnancy, but could be improved, especially among women with chronic diseases.


Assuntos
Doença Crônica , Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Gravidez não Planejada , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Inquéritos sobre o Uso de Métodos Contraceptivos , Estudos Transversais , Feminino , Florida/epidemiologia , Humanos , Modelos Logísticos , Gravidez , Prevalência , Análise de Regressão , Adulto Jovem
17.
N Z Med J ; 129(1444): 58-67, 2016 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-27806029

RESUMO

AIMS: To estimate the prevalence of contraceptive use among New Zealand women and to measure changes in contraceptive use since the last population-based prevalence estimates were published in 1988. METHODS: Nine hundred and four women, aged 35-69 years were randomly selected from the electoral roll. A postal questionnaire was used to gather information on contraceptive use, socio-demographic characteristics and risk factors for ovarian cancer. Data were collected in 2013-2015. Estimates of current and ever-use of contraceptives were made and compared with the findings of the 1988 study by Paul et al. In both studies, participants were members of the control arm of case-control studies. RESULTS: The study by Paul et al had a response proportion of 84%, whereas that of the current study was 47%. Oral contraceptives had the highest prevalence of ever-use among women aged 35-69 years (89% [347/389]), followed by condom use (54% [211/389]) and vasectomy (44% [170/389]). Compared to the previous study, there has been an increase in ever-use of condoms (24% [185/767] to 64% [148/231]), vasectomy (26% [202/767] to 40% [92/231]) and oral contraceptives (75% [575/767] to 89% [205/231]) among women aged 35-54 years. In contrast, a lower prevalence of tubal ligation (22% [168/767] to 8% [19/231]) was observed. CONCLUSION: The study demonstrates a change in patterns of contraceptive use among women aged 35-54 years. The prevalence of ever-use of oral contraceptives and vasectomy remains high in New Zealand compared with other countries.


Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/classificação , Esterilização Tubária/estatística & dados numéricos , Vasectomia/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Inquéritos sobre o Uso de Métodos Contraceptivos , Anticoncepcionais Orais/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia
18.
Perspect Sex Reprod Health ; 48(1): 9-16, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26841331

RESUMO

CONTEXT: Understanding the nature of rural-urban variation in U.S. family planning services would help address disparities in unmet contraceptive need. METHODS: In 2012, some 558 Title X-supported clinics in 16 Great Plains and Midwestern states were surveyed. Rural-urban commuting area (RUCA) codes were used to categorize clinic locations as urban, large rural city, small rural town or isolated small rural town. Bivariate analyses examined key domains of service provision by RUCA category and clinic type. RESULTS: The proportion of clinics offering walk-in appointments was lower in isolated small rural towns (47%) than in the other RUCA categories (67-73%). Results were similar for sites that do not specialize in family planning or reproductive health, but no variation was seen among specialty clinics. Overall, availability of evening or weekend appointments varied in a linear fashion, falling from 73% in urban areas to 29% in isolated small rural towns. On-site provision of most hormonal methods was most common in urban areas and least common in isolated small rural towns, while provision of nonhormonal methods was similar across RUCA categories. Sixty percent of clinics provided IUDs or implants. For clinics that did not, the only barriers that varied geographically were low IUD demand and lack of trained IUD providers; these barriers were most common in isolated rural towns (42% and 70%, respectively). CONCLUSIONS: While important characteristics, such as clinics' specialization (or lack thereof), are linked to the provision of family planning services, geographic disparities exist.


Assuntos
Serviços de Planejamento Familiar , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Inquéritos sobre o Uso de Métodos Contraceptivos/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Masculino , Meio-Oeste dos Estados Unidos/epidemiologia , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos
19.
Contraception ; 92(2): 170-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25998937

RESUMO

OBJECTIVE: This paper seeks to determine factors associated with nonuse of contraception by women at risk of unintended pregnancy in the United States. This nonuse may be associated with about 900,000 unintended births in the US each year. STUDY DESIGN: The 2002 and 2006-2010 National Surveys of Family Growth were combined to yield a nationally representative sample of 9,445 women at risk of unintended pregnancy. Logistic regression analyses identified factors associated with nonuse of contraception. RESULTS: This analysis reveals previously undocumented patterns of nonuse: controlling for confounding variables, cohabiting women [adjusted odds ratio (AOR)=2.3, 95% confidence interval (CI)=1.45-3.52] had higher odds of nonuse than married women; women who reported a difficulty getting pregnant (AOR=2.5, 95% CI=2.01-3.01) had higher odds of nonuse than those who did not. Nonuse was also more common among women with a master's degree or more (AOR=1.5, 95% CI=1.11-2.08) compared with those with some college or bachelor's degree, and it was more common among women in their first year after first intercourse than after the first year (AOR 1.6, 95% CI=1.12-2.22). Among women who had a recent unintended birth, the most common reason for not using contraception prior to conception was that she did not think she could get pregnant. CONCLUSIONS: This study establishes national estimates of reasons for nonuse of contraception and identifies some new subgroups at risk of nonuse. IMPLICATIONS: These results may help better understand factors affecting nonuse of contraception and develop strategies for preventing unintended pregnancy in the United States.


Assuntos
Comportamento Contraceptivo , Gravidez não Planejada , Adolescente , Adulto , Inquéritos sobre o Uso de Métodos Contraceptivos , Autoavaliação Diagnóstica , Escolaridade , Serviços de Planejamento Familiar , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Modelos Logísticos , Gravidez , Análise de Regressão , Risco , Pessoa Solteira , Estados Unidos/epidemiologia , Adulto Jovem
20.
Contraception ; 92(2): 152-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25983013

RESUMO

OBJECTIVE: The objective was to determine individual and dyadic factors associated with effective contraceptive use among human immunodeficiency virus (HIV)-infected women accessing antiretroviral therapy (ART) in rural Uganda. STUDY DESIGN: HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing sociobehavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires) and phlebotomy (October 2011-March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous 6 months among sexually active, nonpregnant women (18-40 years). We assessed covariates of contraceptive use using multivariable logistic regression. RESULTS: A total of 362 women (median values: age 30 years, CD4 count 397 cells/mm(3), 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child, and 51% had a seroconcordant partner. Forty-five percent (n=127) reported effective contraceptive use, of whom 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only "partnership fertility desire" was independently associated with contraceptive use; women who reported that neither partner desired a child had significantly increased odds of contraceptive use (adjusted odds ratio: 2.40, 95% confidence interval: 1.07-5.35) compared with women in partnerships where at least one partner desired a child. CONCLUSIONS: Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer-acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming. IMPLICATIONS STATEMENT: Less than half of sexually active HIV-infected women accessing ART in rural Uganda reported using effective contraception, of whom 44% relied exclusively on the male condom. These findings highlight the need to expand access to a wider range of longer-acting, female-controlled contraceptive methods for women seeking to limit or space pregnancies. Use of contraception was more likely when both the male and female partner expressed concordant desires to limit future fertility, emphasizing the importance of engaging men in reproductive health programming.


Assuntos
Antirretrovirais/uso terapêutico , Comportamento Contraceptivo , Infecções por HIV/tratamento farmacológico , Saúde da População Rural , Adolescente , Adulto , Estudos de Coortes , Preservativos , Comportamento Contraceptivo/etnologia , Anticoncepcionais Femininos/administração & dosagem , Inquéritos sobre o Uso de Métodos Contraceptivos , Estudos Transversais , Implantes de Medicamento/administração & dosagem , Feminino , Seguimentos , Soropositividade para HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Saúde da População Rural/etnologia , Parceiros Sexuais , Uganda , Adulto Jovem
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