Contraception during Coronavirus-Covid 19 pandemia. Recommendations of the Board of the Italian Society of Contraception.

Purpose: The Italian Society of Contraception identified as one of its priorities the need to give recommendations on management of contraception during Coronavirus-Covid 19 pandemiaMaterials and methods: A concise communication was produced which summarises in an easy-to-read format suitable for clinicians the management of the different contraceptives mostly used. Information how to manage contraception in different conditions is presented.Results: Women may, in general, continue to use either intrauterine and or hormonal contraceptives. The use of condom should be added to any hormonal contraceptive, when the contraceptive efficacy is reduced or when women stop the contraceptive method.Conclusion: At the present time, during the Coronavirus-Covid 19 pandemia, no data contraindicate the use of intrauterine or hormonal contraceptives. Conversely the use of an appropriate contraception is advocate to prevent unintended pregnancies.

Uso seguro de anticoncepcionais hormonais injetáveis segundo critérios médicos de elegibilidade / El uso seguro de anticonceptivos inyectables hormonales segundo criterio de elegibilidad médica / Safe use of injectable hormonal contraceptives according to medical eligibility criteria

Objetivo: classificar usuárias de anticoncepcionais hormonais injetáveis (AHI) quanto ao uso seguro segundo critérios médicos de elegibilidade da Organização Mundial da Saúde (OMS) e verificar associação entre tipo de injetável e tempo de uso com o uso seguro. Métodos: Estudo transversal, descritivo e exploratório. A população foi composta pelas 52 usuárias de AHI. Os dados foram coletados por meio de entrevista, que seguiu formulário elaborado pelas autoras, sendo identificado fatores que contraindicassem ou indicassem o uso do método, classificando-as em categorias de 1 a 4. O Projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Ceará, CAAE: 36668314.3.0000.5054. Resultados: Foram identificadas 44 (84,7%) mulheres em uso seguro e 8 (15,3%) inseguro. Usuárias há mais de um ano tiveram uma frequência maior de uso inseguro (p=0,001). Conclusão: Seguir as recomendações da OMS deve ser rotina nas consultas de enfermagem visando à proteção e segurança da mulher.

Objective: to classify users of injectable hormonal contraceptives (AHI) in accordance with the safe use according to medical eligibility criteria of the World Health Organization (WHO) and assess the association between type of injection and use of time with safe use. Methods: Cross-sectional, descriptive and exploratory study. The population was composed by 52 users of AHI. Data were collected through interviews, which followed form developed by the authors, and identified factors that contraindicate or indicate the use of the method, classifying them into categories from 1 to 4. The project was approved by the Ethics Committee of the University Federal do Ceará, CAAE: 36668314.3.0000.5054. Results: Were identified 44 (84.7%) women in safe use and 8 (15.3%) in unsafe use. Users with over a year of use had a higher frequency of unsafe use (p=0.001). Conclusion: Following WHO recommendations should be routine in nursing consultation to the protection and safety of women.

Objetivo: clasificar las usuarias de anticonceptivos hormonales inyectables (AHI) segundo criterio de elegibilidad médica de la Organización Mundial de la Salud (OMS) y evaluar la asociación entre el tipo de inyección y el uso del tiempo con uso seguro. Métodos: Estudio transversal, descriptivo y exploratorio. La población fue compuesta por 52 usuarias de AHI. Los datos fueron colectados a través de entrevistas desarrollada por las autoras, e identificó los factores que contraindican o indiquen el uso del método, clasificándolos en categorías 1 a 4. El proyecto fue aprobado por el Comité de Ética de Investigación de la Universidad Federal do Ceará, CAAE: 36668314.3.0000.5054. Resultados: Se identificaron 44 (84,7%) mujeres en el uso seguro y 8 (15,3%) no seguro. Las usuarias más de un año habían una mayor frecuencia de uso inseguro (p=0,001). Conclusión: El uso de las recomendaciones de la OMS debe ser rutinario en la consulta de enfermería.

Postabortion contraception.

The European Society of Contraception Expert Group on Abortion identified as one of its priorities to disseminate up-to-date evidence-based information on postabortion contraception to healthcare providers. A concise communication was produced which summarises the latest research in an easy-to-read format suitable for busy clinicians. Information about individual methods is presented in boxes for ease of reference.

Contraception for women with multiple sclerosis: Guidance for healthcare providers.

Family planning is essential for any comprehensive treatment plan for women of reproductive age with multiple sclerosis (MS), including counseling on using effective contraception to optimally time desired and prevent unintended pregnancies. This topical review summarizes the first evidence-based recommendations on contraception safety for women with MS. In 2016, evidence-based recommendations for contraceptive use by women with MS were included in US Medical Eligibility Criteria for Contraceptive Use. They were developed after review of published scientific evidence on contraception safety and consultation with experts. We summarize and expand on the main conclusions of the Centers for Disease Control and Prevention guidance. Most contraceptive methods appear based on current evidence to be safe for women with MS. The only restriction is use of combined hormonal contraceptives among women with MS with prolonged immobility because of concerns about possible venous thromboembolism. Disease-modifying therapies (DMTs) do not appear to decrease the effectiveness of hormonal contraception although formal drug-drug interaction studies are limited. Neurologists can help women with MS make contraceptive choices that factor their level of disability, immobility, and medication use. For women with MS taking potentially teratogenic medications, highly effective methods that are long-acting (e.g. intrauterine devices, implants) might be the best option.

Expanding Method Choice in Africa with Long-Acting Methods: IUDs, Implants or Both?

The objective of this article is to review key components of LARC uptake in Sub-Saharan Africa with the aim of guiding policies and programs. We assess trends in access to the IUD and implant, including method knowledge and availability at facilities; examine trends in use, source of supply, discontinuation and characteristics of users; and discuss the prospects for expanding method choice by increasing the availability of LARCs in national programs and the policy implications of our results.

Comparing Effectiveness of Active and Passive Client Follow-Up Approaches in Sustaining the Continued Use of Long Acting Reversible Contraceptives (LARC) in Rural Punjab: A Multicentre, Non-Inferiority Trial.

BACKGROUND: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan. METHODS: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November 2013 and December 2014. The study comprised of three groups of LARC clients: a) home-based follow-up, b) telephone-based follow-up, and c) passive or needs-based follow-up. Participants in the first two study groups received counselling on scheduled follow-up from the field workers at 1, 3, 6, 9, and 12 month post-insertion whereas participants in the third group were asked to contact the health facility if in need of medical assistance relating to LARC method use. Study participants were recruited with equal allocation to each study group, but participants were not randomized. The analyses are based on 1,246 LARC (intra-uterine contraceptive device and implant) users that completed approximately 12-months of follow-up. The non-inferiority margin was kept at five percentage points for the comparison of active and passive follow-up and six percentage points for telephone and home-based approach. The primary outcome was cumulative probability of method continuation at 12-month among LARC users. RESULTS: Women recruited in home-based, telephone-based, and passive groups were 400, 419 and 427, respectively. The cumulative probability of LARC continuation at 12 month was 87.6% (95% CI 83.8 to 90.6) among women who received home-based follow-up; 89.1% (95% CI 85.7, 91.8) who received telephone-based follow-up; and 83.8% (95% CI 79.8 to 87.1) who were in the passive or needs-based follow-up group. The probability of continuation among women who were actively followed-up by field health educators-either through home-based visit or telephone-based follow-up was, 88.3% (95% CI 85.9 to 90.0). An adjusted risk difference of -4.1 (95% CI -7.8 to -0.28; p-value = 0.035) was estimated between active and passive follow-up. Whereas, within the active client follow-up, the telephone-based follow-up was found to be as effective as the home-based follow-up with an adjusted risk difference of 1.8 (95% CI -2.7 to 6.4; p-value = 0.431). CONCLUSION: A passive follow-up approach was 5% inferior to an active follow-up approach; whereas telephone-based follow-up was as effective as the home-based visits in sustaining the use of LARC, and was far more resource efficient. Therefore, active follow-up could improve method continuation especially in the critical post-insertion period.

Emergency Contraception for Adolescents: A Political Battle.

The political debate for adolescents to have access to emergency contraception that is available over the counter has been going on for years. Since 1999, Levonorgestrel, Plan B One Step®, has been used in the United States as an emergency contraception but with a prescription at the time. The FDA has done years of research and testing with Barr Laboratories, the manufacture of Plan B One Step®, to make it safe for females of all ages. In 2003, the FDA recommended the over the counter use of Plan B One Step® for all ages, yet this did not occur. In pharmacies across our nation young women find it impossible to purchase this product whether they be of age or not. Politics is making the choices for our young females, not medical evidence. How long are we going to let this continue?

Top 10 Things Primary Care Physicians Should Know About Maintenance Immunosuppression for Transplant Recipients.

The success of organ transplantation allows many transplant recipients to return to life similar to nontransplant patients. Their need for regular health care, including preventive medicine, has switched the majority of responsibilities for their health care from transplant specialists to primary care physicians. To take care of transplant recipients, it is critical for primary care physicians to be familiar with immunosuppressive medications, their side effects, and common complications in transplant recipients. Ten subjects are reviewed here in order to assist primary care physicians in providing optimal care for transplant recipients.

La anticoncepción de larga duración tras el parto: una oportunidad infrautilizada / Long-acting contraception after delivery: an underused opportunity

Cada año, muchas mujeres sufren embarazos no deseados. Subyace tras este problema la falta de uso de algún método anticonceptivo y las incidencias/uso inadecuado de los métodos más populares: el preservativo y la anticoncepción oral. Cerca de la mitad de las mujeres que se sometieron a una interrupción voluntaria del embarazo en nuestro país tenía 1 o 2 hijos: existe un colectivo de mujeres que ha sido madre, que se plantea no serlo de nuevo a corto-medio plazo, y que no ha satisfecho sus necesidades anticonceptivas. El periodo posparto ofrece una oportunidad, infrautilizada, para abordar estas necesidades. Tras la maternidad, la mujer valora especialmente la facilidad de uso del método anticonceptivo, la protección a largo plazo y no tener que preocuparse continuamente por él, y le preocupa que afecte a la lactancia. La anticoncepción de larga duración y reversible o LARC permitiría a la mujer que ha sido madre reducir la posibilidad de un embarazo no deseado durante el tiempo que quisiera. Los más populares son los dispositivos intrauterinos de cobre (DIU-Cu) y los liberadores de levonorgestrel (DIU-LNG), ambos con índices de Pearl muy bajos. Pueden insertarse inmediatamente tras el parto en mujeres no lactantes, con tasas de expulsión bajas. En mujeres lactantes no existe consenso acerca del uso de DIU-LNG antes de las 4 semanas. Pese a sus ventajas, el uso de LARC en nuestro país es muy bajo, sobre todo debido a la falta de información

Every year, many women suffer unwanted pregnancies. Behind this problem, it is found the lack of use of contraception and the incidents / misuse of the most popular methods: condoms and oral contraception. About half of the women who underwent abortion in our country had one or two children: there is a group of women who have been mother, who not contemplate to be again in short-medium term, and who has not fulfilled their contraceptive needs. The postpartum period provides an underused opportunity to address these needs. After maternity, women particularly appreciate the ease of use of the contraceptive method, the long-term protection and not have to constantly worry about it, and are concerned about affect breastfeeding. Long-acting reversible contraception, or LARC allow the woman who has been mother reduce the possibility of an unwanted pregnancy for as long as wanted. The most popular are the copper intrauterine devices (Cu-IUD) and the releasing levonorgestrel systems (LNG-IUS), both with very low Pearl Index. They can be inserted immediately after delivery in non-lactating women, with low rates of expulsion. In lactating women there is no consensus on the use of LNG-IUD before 4 weeks. Despite its advantages, the use of LARC in our country is very low, mainly due to lack of information

Injectable contraceptive sales at licensed chemical seller shops in ghana: access and reported use in rural and periurban communities.

CONTEXT: Most women in Ghana obtain oral contraceptives and condoms from shops run by licensed chemical sellers, but such shops are not legally permitted to sell the country's most widely used method, the injectable. Allowing shops to sell the injectable could increase access to and use of the method. METHODS: In 2012-2013, semistructured telephone interviews were conducted among convenience samples of 94 licensed chemical seller shop operators in two districts who were trained to sell the injectable and of 298 women who purchased the method from these shops. Follow-up interviews were conducted with 92 clients approximately three months after their initial injectable purchase. RESULTS: Ninety-seven percent of shop operators reported selling the injectable, and 94% felt sufficiently trained to provide family planning methods and services. Virtually all sellers (99%) referred clients to a hospital or health facility for injection; none provided injections themselves. Fifty-six percent of injectable clients were new family planning users. Of those who completed a follow-up interview, 79% had purchased the injectable again from a shop. Virtually all clients (97%) reported getting their injection at the health facility to which they were referred by the seller. Women cited trust, convenience and commodities being in stock as key reasons for purchasing from a shop. CONCLUSION: Licensed chemical seller shop operators can safely sell the injectable and refer clients to health facilities for screening, counseling and injection.

New york city physicians' views of providing long-acting reversible contraception to adolescents.

PURPOSE: Although the US adolescent pregnancy rate is high, use of the most effective reversible contraceptives-intrauterine devices (IUDs) and implantable contraception-is low. Increasing use of long-acting reversible contraception (LARC) could decrease adolescent pregnancy rates. We explored New York City primary care physicians' experiences, attitudes, and beliefs about counseling and provision of LARC to adolescents. METHODS: We conducted in-depth telephone interviews with 28 family physicians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, findings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (attitudes and beliefs) conceptual model of behavior change. RESULTS: Enablers to IUD counseling and provision include knowledge that nulliparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly influenced by a physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity). CONCLUSION: Knowledge, skills, clinical environment, and physician attitudes, all influence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents' access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.

Development and implementation of a quality assurance program for a hormonal contraceptive implant.

BACKGROUND: The importance of the distribution of safe, effective and cost-effective pharmaceutical products in resource-constrained countries is the subject of increasing attention. FHI 360 has developed a program aimed at evaluating the quality of a contraceptive implant manufactured in China, while the product is being registered in an increasing number of countries and distributed by international procurement agencies. The program consists of (1) independent product testing; (2) ongoing evaluation of the manufacturing facility through audits and inspections; and (3) post-marketing surveillance. STUDY DESIGN: This article focuses on the laboratory testing of the product. The various test methods were chosen from the following test method compendia, the United States Pharmacopeia (USP), British Pharmacopeia (BP), International Organization for Standardization (ISO), the American Society for Testing and Materials (ASTM), or lot release tests mandated by Chinese regulatory requirements. Each manufactured lot is independently tested prior to its distribution to countries supported by this program. In addition, a more detailed annual testing program includes evaluation of the active ingredient (levonorgestrel), the final product and the packaging material. RESULTS: Over the first 4 years of this 5-year project, all tested lots met the established quality criteria. CONCLUSIONS: The quality assurance program developed for this contraceptive implant has helped ensure that a safe product was being introduced into developing country family planning programs. This program provides a template for establishing quality assurance programs for other cost-effective pharmaceutical products that have not yet received stringent regulatory approval and are being distributed in resource-poor settings.

Contraceptive features preferred by women at high risk of unintended pregnancy.

CONTEXT: Available contraceptives are not meeting many women's needs, as is evident by high levels of typical-use failure, method switching and discontinuation. To improve women's satisfaction with contraceptive methods, determining what features they prefer and how these preferences are satisfied by available methods and methods under development is crucial. METHODS: The importance of 18 contraceptive method features was rated by 574 women seeking abortions--a group at high risk of having unprotected intercourse and unintended pregnancies--at six clinics across the United States in 2010. For each available and potential method, the number of features present was assessed, and the percentage of these that were "extremely important" to women was calculated. RESULTS: The three contraceptive features deemed extremely important by the largest proportions of women were effectiveness (84%), lack of side effects (78%) and affordability (76%). For 91% of women, no method had all of the features they thought were extremely important. The ring and the sponge had the highest percentage of features that women deemed extremely important (67% each). Some streamlined modes of access and new contraceptive technologies have the potential to satisfy women's preferences. For example, an over-the-counter pill would have 71% of extremely important features, and an over-the-counter pericoital pill, 68%; currently available prescription pills have 60%. CONCLUSION: The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women's preferences presumably could help increase satisfaction and thereby encourage consistent and effective use.

Prescribing contraception for young women.

BACKGROUND: Since 2002, specially qualified nursing sisters and midwives have had the right to prescribe contraceptive pills for women aged 16 to 19. This arrangement has since been expanded to cover hormonal contraception, with the exception of the hormonal coil. The purpose of this study is to evaluate the arrangement. MATERIAL AND METHOD: The prescription register uses pseudonyms and contains a number of facts about user, medication and prescriber. A database of women born in 1989, totalling 29,821, has been designed as a unit for analysis. RESULTS: 75 and 79% of the cohort had filled at least one prescription for contraceptive pills or hormonal contraception by the end of the calendar year in which they turned 19. Almost 12% had filled at least one prescription for the mini-pill, while far fewer had filled prescriptions for vaginal hormone ring, contraceptive injection, contraceptive patch or hormonal coil. Doctors issued two third of the prescriptions. Nursing sisters wrote more prescriptions than doctors for the age group 17-18. The period of time during which they had been using the contraceptive pill and the mini-pill did not depend on who prescribed them. INTERPRETATION: The fact that close to 80% of the cohort born in 1989 has filled at least one prescription for hormonal contraception shows that there is a high degree of awareness about preventing unplanned pregnancy. Extending the right to write prescriptions to nurses and midwives has increased the availability of contraception, and young women are taking advantage of this option.

Study design to evaluate the safety and effectiveness of hormonal contraception for women.

A discussion of the issues that affect the study design of hormonal contraception is presented, including ethical issues, measurement of contraceptive efficacy. Observational studies, experimental studies, and meta-analysis in hormonal contraception are also reviewed.

Contraceptive efficacy and side effects of Implanon.

OBJECTIVE: To determine the efficacy and side effects of Implanon used for long-term contraception. MATERIAL AND METHOD: Prospective study of 80 patients who used Implanon for long-term contraception between January 2004 and January 2006. Side effects, efficacy and removals were recorded. RESULTS: Amenorrhoea, infrequent bleeding and frequent bleeding were reported by 33 (41.25%), 19 (23.75%) and 14 patients (17.5%), respectively. Non-menstrual side effects comprised breast tenderness in 15 patients (18.75%), acne in eight (10%), headache and dizziness in three (3.75%); depressive mood disorders, pelvic pain and loss of libido were mentioned each by two of the women (2.5%). During the study period, Implanon was removed from 20 participants. No problem was encountered during its placement or removal. CONCLUSION: Patients considering use of Implanon must be carefully selected and informed about its expected side effects before placement.