Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.061
Filtrar
1.
PLoS One ; 15(7): e0235329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702035

RESUMO

INTRODUCTION: Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS: We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS: The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION: We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.


Assuntos
Aborto Induzido/psicologia , Saúde Reprodutiva/tendências , Saúde da Mulher/tendências , Adolescente , Adulto , África ao Sul do Saara , Benin/epidemiologia , Tomada de Decisão Clínica , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Feminino , Gabão/epidemiologia , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
4.
Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527659

RESUMO

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Gravidez na Adolescência/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais , Feminino , Direitos Humanos , Humanos , Gravidez
5.
Womens Health Issues ; 30(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507617

RESUMO

BACKGROUND: Research on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider-patient relationship. METHODS: We conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD. RESULTS: Although providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider. CONCLUSIONS: There were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient-provider relationship and autonomous contraceptive decision making.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Comportamento Contraceptivo/psicologia , Anticoncepção Pós-Coito/estatística & dados numéricos , Anticoncepção/psicologia , Anticoncepcionais Pós-Coito/provisão & distribução , Serviços de Planejamento Familiar/organização & administração , Relações Profissional-Paciente , Adolescente , Adulto , Serviços de Saúde Comunitária , Anticoncepção/métodos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Revelação , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Entrevistas como Assunto
6.
PLoS Comput Biol ; 16(6): e1007848, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32598357

RESUMO

Contraceptive drugs intended for family planning are used by the majority of married or in-union women in almost all regions of the world. The two most prevalent types of hormones associated with contraception are synthetic estrogens and progestins. Hormonal based contraceptives contain a dose of a synthetic progesterone (progestin) or a combination of a progestin and a synthetic estrogen. In this study we use mathematical modeling to understand better how these contraceptive paradigms prevent ovulation, special focus is on understanding how changes in dose impact hormonal cycling. To explain this phenomenon, we added two autocrine mechanisms essential to achieve contraception within our previous menstrual cycle models. This new model predicts mean daily blood concentrations of key hormones during a contraceptive state achieved by administering progestins, synthetic estrogens, or a combined treatment. Model outputs are compared with data from two clinical trials: one for a progestin only treatment and one for a combined hormonal treatment. Results show that contraception can be achieved with synthetic estrogen, with progestin, and by combining the two hormones. An advantage of the combined treatment is that a contraceptive state can be obtained at a lower dose of each hormone. The model studied here is qualitative in nature, but can be coupled with a pharmacokinetic/pharamacodynamic (PKPD) model providing the ability to fit exogenous inputs to specific bioavailability and affinity. A model of this type may allow insight into a specific drug's effects, which has potential to be useful in the pre-clinical trial stage identifying the lowest dose required to achieve contraception.


Assuntos
Anticoncepcionais/uso terapêutico , Contracepção Hormonal , Ciclo Menstrual/efeitos dos fármacos , Progestinas/uso terapêutico , Adulto , Estrogênios/uso terapêutico , Feminino , Hormônio Foliculoestimulante/fisiologia , Humanos , Hipotálamo/efeitos dos fármacos , Hormônio Luteinizante/fisiologia , Modelos Biológicos , Ovário/efeitos dos fármacos , Hipófise/efeitos dos fármacos
7.
Obesity (Silver Spring) ; 28(6): 1040-1049, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32441474

RESUMO

OBJECTIVE: This study aimed to perform a preliminary investigation of the impact of combined hormonal contraceptive (CHC) use on weight loss during an 18-month behavioral weight-loss trial. METHODS: Adults (n = 170; 18-55 years; BMI 27-42 kg/m2 ) received a weight-loss intervention that included a reduced-calorie diet, a progressive exercise prescription, and group-based behavioral support. Premenopausal women (n = 110) were classified as CHC users (CHC, n = 17) or non-CHC users (non-CHC, n = 93). Changes in weight were examined within groups using a linear mixed model, adjusted for age and randomized group assignment. RESULTS: At 6 M, weight was reduced from baseline in both CHC (mean, -6.7 kg; 95% CI: -9.8 to -3.7 kg) and non-CHC (-9.1 kg; -9.1 to -6.4 kg). Between 6 and 18 M, CHC regained weight (4.9 kg; 0.9 to 8.9 kg), while weight remained relatively unchanged in non-CHC (-0.1 kg; -1.8 to 1.6 kg). At 18 M, weight was relatively unchanged from baseline in CHC (-1.8 kg; -7.3 to 3.6 kg) and was reduced from baseline in non-CHC (-7.9 kg; -10.2 to -5.5 kg). CONCLUSIONS: In this secondary data analysis, CHC use was associated with weight regain after initial weight loss. Prospective studies are needed to further understand the extent to which CHC use influences weight loss and maintenance.


Assuntos
Anticoncepcionais/uso terapêutico , Perda de Peso/efeitos dos fármacos , Adulto , Anticoncepcionais/farmacologia , Feminino , Humanos , Masculino , Estudos Prospectivos
9.
J Contemp Dent Pract ; 21(1): 2-10, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32381793

RESUMO

AIM: The photobiomodulation (PBM) effect of 660 nm diode laser in reducing pain, edema, trismus and promote healing subsequently to the transalveolar extraction of mandibular third molars in female patients taking contraceptive pills were evaluated. MATERIALS AND METHODS: Fifty female patients participated in our study. The 660 nm diode laser was applied immediately on randomly selected patients of the study group (n = 25) over the surgical site for 1 minute with continuous laser beam application. For the control group (n = 25), the same extraction procedure was performed without the application of 660 nm diode laser. Pain intensity, swelling, trismus, and healing was evaluated before extraction and during recall visits 24 hours, 48 hours, and 7 days postoperatively. RESULTS: The values of pain, swelling, and trismus were significantly inferior in the study group compared to the control group (p < 0.05) at T2 and T3; while the values of the healing index were significantly superior in the study group compared to the control group (p < 0.001) at T1, T2, and T3. CONCLUSION: Using 660 nm diode laser reduced the postsurgical discomforts (pain, edema, and trismus) and promote healing associated following transalveolar extraction of the lower third molar. CLINICAL SIGNIFICANCE: To develop a framework based on the results regarding the PBM effect of 660 nm diode laser following transalveolar extraction of lower third molar in a female patient taking oral contraceptive pills, which may help to improve the treatment services provided to the community.


Assuntos
Terapia com Luz de Baixa Intensidade , Dente Impactado , Anticoncepcionais , Feminino , Humanos , Lasers Semicondutores , Dor Pós-Operatória
10.
South Med J ; 113(5): 213-218, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358615

RESUMO

OBJECTIVES: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. METHODS: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT. RESULTS: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03-36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34-18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08-0.94). CONCLUSIONS: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.


Assuntos
Anticoncepção/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde , Estereotipagem , Adolescente , Adulto , Agendamento de Consultas , Coerção , Anticoncepcionais Orais/uso terapêutico , Implantes de Medicamento , Feminino , Humanos , Violência por Parceiro Íntimo , Dispositivos Intrauterinos , Modelos Logísticos , Contracepção Reversível de Longo Prazo , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Gravidez não Desejada , Esterilização Reprodutiva , Inquéritos e Questionários , Adulto Jovem
11.
Womens Health Issues ; 30(4): 268-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32376188

RESUMO

BACKGROUND: The Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective. METHODS: An online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception. RESULTS: Of 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received. CONCLUSIONS: A contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.


Assuntos
Anticoncepcionais/provisão & distribução , Aconselhamento/métodos , Acesso aos Serviços de Saúde/organização & administração , Satisfação do Paciente , Assistência Centrada no Paciente , Infecção por Zika virus/prevenção & controle , Zika virus , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo , Surtos de Doenças/prevenção & controle , Serviços de Planejamento Familiar/organização & administração , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Gravidez , Porto Rico/epidemiologia , Infecção por Zika virus/epidemiologia
12.
Obstet Gynecol ; 135(5): 1242-1243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332410

RESUMO

Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/terapia , Doenças dos Genitais Femininos/terapia , Ginecologia/métodos , Adolescente , Criança , Anticoncepcionais/uso terapêutico , Aconselhamento/métodos , Gerenciamento Clínico , Epilepsia/complicações , Feminino , Doenças dos Genitais Femininos/etiologia , Humanos , Menarca , Gravidez , Adulto Jovem
13.
Obstet Gynecol ; 135(5): e213-e220, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332416

RESUMO

Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/terapia , Doenças dos Genitais Femininos/terapia , Ginecologia/métodos , Adolescente , Criança , Anticoncepcionais/uso terapêutico , Aconselhamento/métodos , Gerenciamento Clínico , Epilepsia/complicações , Feminino , Doenças dos Genitais Femininos/etiologia , Humanos , Menarca , Gravidez , Adulto Jovem
14.
J Prev Med Public Health ; 53(2): 117-125, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32268466

RESUMO

OBJECTIVES: This study investigated the role of information and communication technology and women's empowerment in contraceptive discontinuation in Indonesia. METHODS: The study used data from the 2017 Indonesia Demographic and Health Survey and monthly contraceptive calendar data. A Gompertz proportional hazards model was used for analysis. RESULTS: The 12-month contraceptive discontinuation rate was higher among women who had used the Internet in the past year, women who were mobile phone owners, and women who reported having fully participated in household decision-making than among their counterparts. These factors significantly impacted the risk of contraceptive discontinuation in Indonesia, even after controlling for contraceptive method, age, parity, contraceptive intent, education, work status, place of residence, and wealth status. CONCLUSIONS: After adjustment for the control variables, a higher risk of contraceptive discontinuation was associated with having used the Internet in the past year, owning a mobile phone, and not participating in household decision-making. Higher contraceptive discontinuation risk was also associated with using contraceptive pills, older age, lower parity, intent of spacing births, more education, current unemployment, and rural residence, and the risk was also significantly higher for those in the lowest household wealth quintile than for those in the fourth household wealth quintile. The association of contraceptive discontinuation with the use of modern information and communication technology and relatively disempowerment in household decision-making may imply that information regarding family planning and contraception should be conveyed via social media as part of setting up an eHealth system. This must include a strong communication strategy to empower and educate women in contraceptive decision-making.


Assuntos
Comunicação , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Tomada de Decisões , Empoderamento , Tecnologia da Informação , Adolescente , Adulto , Anticoncepção/psicologia , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Serviços de Planejamento Familiar , Feminino , Acesso aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Indonésia , Pacientes Desistentes do Tratamento/psicologia , Gravidez , Fatores Socioeconômicos
15.
Cent Eur J Public Health ; 28(1): 3-12, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32228810

RESUMO

OBJECTIVE: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. METHODS: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. RESULTS: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. CONCLUSION: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.


Assuntos
Anticoncepcionais/administração & dosagem , Assunção de Riscos , Comportamento Sexual/psicologia , Adolescente , República Tcheca/epidemiologia , Feminino , Humanos , Gravidez , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
16.
J Glob Health ; 10(1): 010705, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257163

RESUMO

Background: There is ample evidence that gender norms affect contraceptive practice; however, data are mostly qualitative with limited geographical scope. We investigated that association quantitatively using collective community-level attitudes towards premarital sex and wife-beating as proxies for gender norms. Methods: Data came from nationally representative Demographic and Health Surveys (2005-2009) for women of reproductive age (15-49 years) in nine sub-Saharan African countries. Using multilevel logistic models, controlling for individual covariates and community-level indicators of women's empowerment, we assessed the community-level association of gender norms regarding premarital sex and wife-beating with individual contraception uptake and demand satisfied among fecund sexually active women. Norms were approximated as 'collective attitudinal norms' from female/male residents (aged 15-49 years) from the same community. We assessed the magnitude and significance of the community-level effects and attributed variance across communities. The same analysis was replicated for each country. Results: In a fully-adjusted model with a pooled sample of 24 404 adolescent women, the odds of contraception use increased with a 1 standard deviation (SD) increase in the variation of collective permissive attitudes towards premarital sex of female (odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.02-1.15) and male (OR = 1.11, 95% CI = 1.05-1.17) peers (15-24 years), while odds of contraceptive use declined by 10% (OR = 0.90, 95% CI = 0.85-0.96) with collective accepting attitudes towards wife-beating of women aged 15-49 years. Similar results were found in separate models that controlled for adults' permissive attitudes towards premarital sex. The community-level attributed variance (V2 = 1.62, 95% CI = 1.45-1.80) represented 33% (intra-class correlation (ICC) = 33.0, 95% CI = 30.0-35.4) of the total variation of contraception use, and attitudes towards premarital sex and violence jointly explained nearly 26% of that V2 variance. The community-level shared of attributed variation of contraceptive use varied significantly across countries, from 3.5% in Swaziland (ICC = 3.5, 95% CI = 0.8-13.7) to 60.2% in Nigeria (OR = 60.2, 95% CI = 56.0-64.2). Conclusions: Overall, significant positive associations of collective permissive attitudes of both adolescent and adult women towards premarital sex were found for use of, and demand for, contraception, whereas collective accepting attitudes towards wife-beating were negatively associated with the use and demand for contraception. Ours is the first study to define quantitatively the influence of proxies for gender norms at the community level on women's family planning decisions. These findings offer new insights for understanding the role of sex-related attitudes and norms as important factors in shaping contraceptive practices and improving the effectiveness of family planning policies by targeting individuals as well as their groups of influence.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais , Serviços de Planejamento Familiar/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Maus-Tratos Conjugais/psicologia , Adolescente , Adulto , África ao Sul do Saara , Atitude , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Adulto Jovem
18.
PLoS Med ; 17(3): e1003086, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32231356

RESUMO

BACKGROUND: Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15-24 in the health zones served by the partners' programs. METHODS AND FINDINGS: The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July-August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15-49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15-24 who reported ever having sex: 326 adolescents (15-19 years) and 696 young women (20-24 years), 31.7% (95% confidence interval [CI] 29.5-34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method. Despite this high knowledge, unmet need for contraception was also high: 31.7% (95%CI 27.9-35.7) among 15-19-year-olds and 40.1% (95% CI 37.1-43.1, p = 0.001) among 20-24-year-olds. Current modern contraceptive use (16.5%, 95% CI 14.7-18.4) was similar in both age groups, the majority of whom received their method from a supported health facility. Among current users, more than half of 15-19-year-olds were using a long-acting reversible contraceptive (LARC; 51.7%, 95% CI 41.1-61.9) compared to 36.5% of 20-24-year-olds (95% CI 29.6-43.9, p = 0.02). Age, younger age of sexual debut, having some secondary education, being unmarried, and having begun childbearing were associated with modern contraceptive use. The main limitations of our study are related to insecurity in three health zones that prevented access to some villages, reducing the representativeness of our data, and our defining sexually active women as those who have ever had sex. CONCLUSIONS: In this study, to our knowledge one of the first to measure contraceptive prevalence among adolescents in a humanitarian setting, we observed that adolescent and young women will use modern contraception, including long-acting methods. Meaningful engagement of adolescent and young women would likely contribute to even better outcomes. Creating an enabling environment by addressing gender and social norms, however, is key to reducing stigma and meeting the demand for contraception of young women. As we continue to build such supportive environments, we can see that they will use effective contraception when contraceptive services, including short- and long-acting methods, are available, even in protracted crisis settings.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Adolescente , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Adulto Jovem
19.
Womens Health Issues ; 30(3): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303431

RESUMO

OBJECTIVE: To model the impacts of out-of-pocket cost of an over-the-counter (OTC) progestin-only pill on use and associated unintended pregnancy among U.S. women. STUDY DESIGN: Using data from a 2015 nationally representative survey of 2,539 U.S. women aged 15 to 44 assessing interest in using an OTC progestin-only pill, we used discrete survival analysis and a Markov model to analyze women's likelihood of using of an OTC pill at different price points and by sociodemographic characteristics. We modeled the impact of product price on the potential total number of U.S. users and on unintended pregnancies in 1 year among adult women at risk of unintended pregnancy. RESULTS: In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8% decrease in unintended pregnancy in 1 year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5% decrease in unintended pregnancy among adults. CONCLUSIONS: At low and no out-of-pocket cost, a large population of women in the United States might likely use an OTC progestin-only pill. A low retail price and insurance coverage are necessary to provide equitable access to this method for low-income populations across the United States, fill current gaps in contraceptive access, and potentially decrease unintended pregnancy.


Assuntos
Anticoncepcionais/economia , Gastos em Saúde/estatística & dados numéricos , Medicamentos sem Prescrição/economia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Estatísticos , Gravidez , Gravidez não Planejada , Progestinas/economia , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
20.
Womens Health Issues ; 30(4): 283-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32321666

RESUMO

BACKGROUND: Women veterans who use the Veterans Affairs Healthcare System theoretically have access to the full range of contraceptive methods. This study explores match between currently used and self-reported "ideal" methods as a potential marker of contraceptive access and preference matching. METHODS: This mixed methods study uses data from a nationally representative survey of reproductive-aged women veterans who use the Veterans Affairs Healthcare System for primary care, including 979 participants at risk of unintended pregnancy. Women reported all contraceptive methods used in the past month and were asked, "If you could choose any method of contraception or birth control to prevent pregnancy, what would be your ideal choice?" and selected a single "ideal" method. If applicable, participants were additionally asked, "Why aren't you currently using this method of contraception?" We used adjusted logistic regression to identify patient-, provider-, and system-level factors associated with ideal-current method match. We qualitatively analyzed open-ended responses about reasons for ideal method nonuse. RESULTS: Overall, 58% were currently using their ideal method; match was greatest among women selecting an IUD as ideal (73%). Non-White race/ethnicity (adjusted odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and mental illness (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.92) were negatively associated with ideal-current match in adjusted analyses; the presence of a gynecologist at the primary care site was associated with an increased odds of match (adjusted odds ratio, 1.35; 95% confidence interval, 1.03-1.75). Modifiable barriers to ideal method use were cited by 23% of women, including access issues, cost concerns, and provider-level barriers; 79% of responses included nonmodifiable reasons for mismatch including relationship factors and pregnancy plans incongruent with ideal method use, suggesting limitations of our measure based on differential interpretation of the word "ideal." CONCLUSIONS: Many women veterans are not currently using the contraceptive method they consider ideal. Results emphasize the complexity of contraceptive method selection and of measuring contraceptive preference matching.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/métodos , Anticoncepcionais/uso terapêutico , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos , Veteranos/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Assistência à Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada , Autorrelato , Veteranos/estatística & dados numéricos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA