Unveiling Barriers to the Modern Contraceptive Uptake in the Urban Slums of Karachi: Perceptions, Attitude, and Accessibility.

Background Modern contraception plays a vital role in family planning and preventing unintended pregnancies. However, its uptake remains limited in many developing countries, including Pakistan. This study aimed to evaluate the barriers to modern contraception and identify strategies to enhance its adoption in the urban slums of Karachi. Methods A multi-site, cross-sectional study was conducted in 38 slum areas of Karachi, Pakistan. Women aged 15-49 years were interviewed using a comprehensive questionnaire. The questionnaire covered socio-ethnic and economic demographics, knowledge and perceptions of modern contraception, accessibility, affordability, attitudes, and usage. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24 (IBM SPSS Statistics, Armonk, NY). Results The majority of the respondents identified as Pathan ethnicity (49%), and the age range was predominantly from 23 to 34 years (45.5%). A high proportion of participants demonstrated satisfactory knowledge of contraceptives (87.6%). However, a significant portion perceived contraception or family planning to be in conflict with religious beliefs (84%). Many women expressed a desire for more children (56%) and had concerns about contraceptive side effects (78%). A notable proportion of women reported that their spouses forbade the use of contraceptives (12%). Among the surveyed population, the most widely used contraceptives were injections among women (15.5%) and condoms among their male partners (12%). Conclusion Despite sufficient knowledge and accessibility, considerable barriers exist in the uptake of modern contraception in the urban slums of Karachi, Pakistan. These barriers include religious conflicts, cultural norms, concerns about side effects, spousal disapproval, and desires for larger families.

The impact of accredited social health activists in India on uptake of modern contraception: A nationally representative multilevel modelling study.

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019-21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030.

Factors influencing the utilisation of Youth Friendly Health Services in Blantyre, Malawi.

Background: Usage of Youth Friendly Health Services (YFHSs) remains unsatisfactory in sub-Saharan Africa despite global agreements on the utilisation of these services among the youths. Aim: The aim of the study was to identify factors that influence the utilisation of YFHSs in Blantyre, Malawi. Setting: Four health centres in Blantyre, Malawi. Methods: A descriptive quantitative research design using multistage sampling was used to randomly sample (N = 293) unmarried youths and collect data using a structured questionnaire. Data were analysed using a computerised statistical package for social sciences (SPSS) version 26. Chi-square (χ²) was used to test the significance of the association between variables, and the p-value (p < 0.05) was considered significant. Regression analysis was used to examine the influence of independent variables on the utilisation of the services. Results: Less than half of the respondents have ever accessed YFHSs (43%). The Chi-square test showed that the following variables had a significant association with utilisation of the services (p < 0.05): gender, age, knowledge, signage, printed health education materials, provider attitudes and being shy or fear of being seen at the services. Conclusion: Age, knowledge, signpost, printed health education materials, provider attitudes and being shy or fear of being seen at the YFHSs are factors that influenced the utilisation of the services. Working on these factors would help to increase utilisation. Contribution: The study findings will help to fill the gap in the provision of YFHSs and thus increase utilisation of the services.

Roe v. Wade Overturned: The Association of Acculturation with Interest in and Awareness of Hospital Services for Family Planning Among Hispanic Women.

Introduction: The overturning of Roe v. Wade impacted family planning services in many areas of the United States (US). Our study investigates the association of acculturation with interest in and awareness of family planning hospital services of contraception and elective termination of pregnancy among Hispanic women. Methods: We surveyed 306 Hispanic women at a public hospital in a Long Island suburb of New York City. Predictor variables were acculturation (language, media, ethnic social relations) measured by the Short Acculturation Scale for Hispanics and years lived in the US. Outcome variables were interest in and awareness of hospital services of family planning for elective abortion and non-elective non-abortion family planning methods. Results: For interest in hospital services, both language and ethnic social relations acculturation were significantly positively associated with almost all family planning methods whether abortion or non-abortion. However, media acculturation and years lived in the US were significantly positively associated with abortion but not the non-abortion methods. For awareness of hospital services, only language acculturation was significantly positively associated with abortion and some nonelective non-abortion family planning methods. Conclusion: We recommend that healthcare providers and hospitals should be aware of acculturation levels when providing counseling and information about family planning methods to Hispanic women.

"We wish we had the option": a qualitative study of women's perspectives and experiences with contraception in a provincial prison in Ontario, Canada.

BACKGROUND: Evidence suggests that women who are incarcerated desire access to contraception while incarcerated, and that this need is not currently being met. Our objective in this study was to explore the perspectives and experiences of women in prisons regarding contraception and contraception access using data from focus groups with women in a provincial prison. We analyzed focus group data collected in a provincial prison in Ontario, Canada using content analysis and a constructivist epistemology. RESULTS: We conducted three focus groups, each approximately one hour in length. Discussions revolved around (1) knowledge and decision making about contraception, (2) accessing contraception, and (3) ideas for increasing access to contraception in the prison setting. Decision making about contraception was mainly related to concerns about side effects, consistent access to care, impacts on future fertility, and autonomy around decision-making. Participants discussed a wide range of experiences with contraception. Ideas for increasing access to contraception included information sessions, inclusion of discussions about contraception as a component of admission and release planning, and time spent in prison as a crucial juncture for decision-making about contraception. CONCLUSIONS: More qualitative research is needed to better understand the needs of women in prisons related to contraception. The findings of this study suggest that programs should focus on consistency and continuity of access to care, education opportunities, and integration of discussions about contraception into official admission and release procedures.

Pregnancy Planning, Prevention and Risk Evaluation Clinics: Rethinking the Traditional Preconception Consult.

The preconception consultation has traditionally centered pregnancy as desired and preordained. Separating preconception and contraceptive visits burdens patients and further fragments reproductive healthcare. We argue that the creation of a combined preconception and complex contraception clinic for individuals with significant medical and obstetric comorbidities is one approach to promoting reproductive autonomy. Pregnancy planning, prevention, and risk evaluation (PrePPARE) clinics are designed to review pregnancy related risks in the setting of patients' medical and obstetric comorbidities, recommend strategies to reduce risks, and, if desired, provide contraceptive methods. Consultations for pregnancy risk evaluation and pregnancy prevention should not be considered mutually exclusive. Combining these visits is critical for obstetrically and/or medically complex patients. Rethinking the traditional preconception consultation is a change in healthcare delivery that centers comprehensive reproductive healthcare.

Continuity of Health Insurance Coverage and Choice of Contraception Method.

Objective: To evaluate whether part-year or year-round uninsurance is associated with reduced likelihood of using prescription contraception methods rather than using nonprescription methods or using no contraceptive methods. Methods: We identified nonpregnant and sexually active female respondents participating in the National Longitudinal Survey of Youth, 1997 cohort between 2007 and 2019. At each interview, we classified the contraceptive method used most frequently as prescription, nonprescription, or none, and used mixed-effects multinomial logistic regression to predict contraceptive method based on health insurance coverage over the past year (classified as continuous private, continuous public, part-year uninsured, or year-round uninsured). Results: Our sample included 3,738 respondents and 18,678 observations (person-years). In the most recent interview, 35% of respondents used prescription contraception, 16% used nonprescription methods only, and 49% used no method. On multivariable analysis using all available years of data, respondents with part-year uninsurance were 20% less likely to use prescription rather than nonprescription methods, as compared to respondents with continuous private insurance (95% confidence interval: -31%, -6%; p = 0.007), but did not differ on the likelihood of using prescription methods rather than no method. Conclusions: Part-year uninsurance was associated with lower use of prescription contraceptive methods rather than nonprescription methods when compared with continuous private insurance coverage. Use of prescription contraceptives was lowest among people with year-round uninsurance. Policy efforts ensuring continuous insurance coverage with greater flexibility of eligibility and enrollment periods may promote greater access to prescription contraceptives.

Psychosocial Stressors and Postpartum Depressive Symptoms Are Linked to Postpartum Contraceptive Use.

Background: Postpartum contraception plays a critical role in reducing the occurrence of rapid subsequent pregnancy, offering individuals reproductive choice, and promoting overall reproductive planning and well-being. In this study, we investigated the relationship between psychosocial stress during pregnancy, postpartum depressive symptoms (PDS), and postpartum contraceptive use. Materials and Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System (2012-2019), which included comprehensive information about maternal experiences, views, and needs before, during, and after pregnancy from four states and a large city, with a total sample size of N = 36,356. We conducted descriptive analyses as well as adjusted multivariable logistic regression models. Main Findings: Our findings demonstrate significant negative associations between partner-related (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [95% CI]: 0.76-0.89, p ≤ 0.001) and trauma-related (aOR = 0.83, 95% CI: 0.75-0.92, p ≤ 0.001) stressors and postpartum contraceptive use. Additionally, we observed a negative association between PDS and postpartum contraceptive use (OR = 0.88, 95% CI: 0.80-0.97, p ≤ 0.01), indicating that individuals experiencing PDS are less likely to utilize contraception after giving birth. Furthermore, our study highlights racial/ethnic, socioeconomic, and parity postpartum contraceptive use disparities. Conclusions: Our findings emphasize the importance of incorporating psychosocial stressors and mental health into the promotion of effective postpartum contraception practices. These results have valuable implications for health care providers, policymakers, and researchers as they can guide the development of targeted interventions and support systems to contribute to improved reproductive health outcomes.

Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens.

In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.

Pregnancy and the Autoimmune Patient.

PURPOSE OF REVIEW: This article will review the current understanding of the immunologic changes that occur during pregnancy. It will discuss the impact of pregnancy on the disease activity of autoimmune or inflammatory rheumatic diseases (AIRD). Lastly, it will highlight the most recent data on pre-conception and pregnancy management practices that can improve pregnancy outcomes in autoimmune patients. RECENT FINDINGS: Pregnancy is an immunologically complex and dynamic state that may affect the activity of AIRDs, with more patients having active disease during pregnancy than previously thought. Uncontrolled inflammatory diseases are associated with poor pregnancy outcomes such as preeclampsia, small for gestational age infants, and prematurity. Pre-conception counseling and early pregnancy planning discussions can help ensure optimal disease control and medication management prior to attempting conception. Adequate control of AIRDs on pregnancy-compatible medications during the pre-conception, pregnancy, and postpartum periods is required for optimal pregnancy outcomes.

Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City.

CONTEXT: The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities. METHODS: We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach. RESULTS: Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities. CONCLUSION: Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.

Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study.

OBJECTIVE: To examine the uptake of postnatal contraception (PNC) and experiences of PNC care across a geographical region of England. DESIGN: Cross-sectional online survey. SETTING: The North East and North Cumbria Integrated Care System (ICS). POPULATION: Women who had completed a pregnancy in the previous 3 years. METHODS: The uptake of PNC by accessed method(s) and the availability of preferred method(s) is described, and adjusted odds ratios are reported for group differences in uptake by characteristics of interest. MAIN OUTCOME MEASURES: Uptake of medically prescribed/administered contraception and uptake of long-acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods. RESULTS: Although almost half of respondents (47.1%; n = 1178) reinitiated some form of sexual activity during the postnatal period, only 38.7% (n = 969) of respondents accessed a medically prescribed/administered contraceptive method postnatally, and only 15.5% (n = 389) of respondents accessed a LARC. It is a matter of concern that 18.8% (n = 451) of respondents indicated that they were unable to access their preferred PNC. In multivariate analysis, younger age, lower household income, higher multiparity, operative delivery, unplanned pregnancy and not breastfeeding were significant predictors of higher PNC uptake. CONCLUSIONS: The uptake of PNC in this cohort was low, with almost a fifth of women unable to access their preferred method. However, there was some evidence that women belonging to groups perceived to be at risk of rapid repeat pregnancy were more likely to access reliable PNC methods.

Family planning in the Eastern Democratic Republic of the Congo: personal beliefs, intimate partner negotiations and social pressure.

The Democratic Republic of the Congo (DRC) has a low prevalence of family planning use. Recent studies have highlighted the significant role that socio-cultural factors play in the decision to use family planning or not. This qualitative study explored barriers to women's use of family planning methods in an ongoing conflict region, South-Kivu, DRC. Focus group discussions and individual in-depth interviews were conducted to understand perceptions and habits regarding family planning. An inductive approach was used to analyse the data. Precariousness of life, religious beliefs and fear of side effects were limiting factors to the use of family planning. Power relations within the couple also played an important role in decision-making. Sole provider ('breadwinner') women were more likely to use family planning, including hormonal methods. Our findings highlight the continued importance of family planning programmes that respond to socio-cultural factors, personal beliefs, and fear of side effects in parallel with addressing availability and accessibility. This will require including the community in their design and implementation in order to meet unmet family planning needs. Health care providers' capacity building and training to help women manage family planning side effects will also be beneficial.

Can period-related symptoms predict menstrual manipulation among Australian female cyclists?

This study explored the extent of menstrual manipulation and its associated impact on period-related symptoms and training disruptions in Australian Female Cyclists. 205 female cyclists, from recreational to elite level, participated in an online "Female Cyclist Questionnaire (FCQ)". The FCQ utilised a series of validated questionnaires to obtain demographic information and menstrual function of the respondents, and to investigate their menstrual manipulation habits and perceptions on how their period-related symptoms affected their well-being, mood, energy and training tolerance. More than 80% of the cyclists reported that their period-related symptoms impacted upon training and 41% made training adjustments based on these symptoms. Two-thirds of respondents thought their training should be phase-controlled yet only half discussed their hormonal cycles with their coaches. Menstrual manipulation was predicted by reduced "workout tolerance" in these cyclists (odds ratio = 0.632). Half of the respondents reported compromised ability to tolerate high-intensity interval training with period-related symptoms. Period pain, increased irritability, lower energy levels and more sugar cravings were commonly reported but did not predict menstrual manipulation. The data indicated that period-related symptoms are present in Australian female cyclists across all levels of participation. However, the perceived impact to training and subsequent behavioural changes varied among individuals.

Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

BACKGROUND: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. METHODS: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. RESULTS: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. CONCLUSION: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Role of Female Sex Hormones in ADPKD Progression and a Personalized Approach to Contraception and Hormonal Therapy.

This review navigates the intricate relationship between gender, hormonal influences, and the progression of autosomal dominant polycystic kidney disease (ADPKD), highlighting the limited literature on this crucial topic. The study explores the impact of female sex hormones on liver and renal manifestations, uncovering gender-specific differences in disease progression. Actually, hormonal therapy in women with ADPKD remains a challenging issue and is a source of concern regarding its potential impact on disease outcomes, particularly at the hepatic level. Notably, women with ADPKD exhibit a slower renal disease progression compared to men, attributed to hormonal dynamics. This review sheds light on the role of estrogen in regulating pathways of the renin-angiotensin-aldosterone system, revealing its complex interplay and implications for cardiovascular and renal health. Therapeutic considerations for fertile women with ADPKD, including contraception options, are discussed, emphasizing the necessity for personalized approaches. In the postmenopausal phase, the review evaluates the role of hormonal replacement therapy, considering its potential benefits and risks in the context of ADPKD. The review concludes by underscoring the imperative need for tailored treatment approaches for ADPKD patients, considering individual risks and benefits. The scarcity of literature underlines the call for further research to enhance our understanding of optimal hormonal therapies in the context of ADPKD, ultimately paving the way for innovative and personalized therapeutic interventions.

Variables predictoras del uso de los métodos anticonceptivos en jóvenes: una revisión sistemática / Predictor variables of contraceptive method use in young people: A systematic review

Diseño: Revisión sistemática. Fuentes de datos: Se consultaron las bases de datos PubMed, CINAHL, Scopus, Cuiden Plus, LILACS e IME. Selección de estudios: Se realizó una evaluación de la calidad de los estudios que fue revisada por dos investigadores en paralelo. Como resultado, se seleccionaron un total de cinco investigaciones primarias. Extracción de datos: Se extrajo información sobre la población seleccionada en el estudio, método anticonceptivo estudiado y las variables predictoras identificadas. Resultados: Se identificaron siete variables predictoras que explican específicamente el uso del preservativo masculino, píldora anticonceptiva o píldora anticonceptiva de emergencia. Las variables más relevantes fueron el nivel de conocimiento y las actitudes hacia el empleo de los métodos anticonceptivos, de manera que un mayor conocimiento y unas actitudes positivas incrementan la probabilidad de uso de métodos anticonceptivos. Otro resultado destacado fue la presencia de un sesgo formativo con un mayor conocimiento de las mujeres sobre las opciones anticonceptivas hormonales y actitudes más positivas. Conclusión: Los futuros programas formativos deben orientarse hacia la evaluación de cambios en el comportamiento, mediante el desarrollo de actitudes positivas hacia el uso de los métodos anticonceptivos a través de la adquisición de un conocimiento de calidad sobre las opciones contraceptivas.(AU)

Objective: To analyse predictor variables of contraceptive method use in young people. Design: Systematic review. Data sources: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. Study selection: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. Data extraction: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. Results: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with womenhaving higher knowledge of hormonal contraceptive options and more positive attitudes. Conclusion: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.(AU)