The role of advocacy in sustaining male contraceptive research and development.

Novel male contraceptives have been in development for well over half a century, and despite a robust predicted global market for new methods, funding for research and development has been extremely limited. While the pharmaceutical industry previously supported male contraceptive research and development, industry partners are only spectators in the current space, awaiting a product that has been de-risked by the public sector before re-entering the field. Current male contraceptive development efforts are thus primarily funded by nonprofit, non-governmental, and government agencies who also act as the primary advocates for the field. Specific organizations include the International Consortium on Male Contraception, the Population Council, the Male Contraceptive Initiative, the World Health Organization, and the US National Institutes of Health. The funding provided by these public agencies, alongside their social and policy-based advocacy efforts such as market research, public education, and calls to action have kept the male contraceptive product development space afloat, resulting in a pipeline of potential products advancing towards market approval. However, as these products mature into more expensive clinical stages of development, they continue to face significant funding challenges, which many programs may not overcome. To fully realize the benefits of novel male contraceptive options, it is incumbent on philanthropic entities, impact investors, venture capital, and/or the pharmaceutical sector to provide significant and timely support for male contraceptive research and development.

Adolescent girls' perceptions regarding the use of contraceptives in Ekurhuleni District, Gauteng.

Background: Unintended pregnancies pose various challenges for adolescent girls and can be prevented through contraceptive use. However, contraceptive use among adolescents is lower compared to among older women. Aim: To describe adolescent girls' perceptions of the use of contraceptives. Setting: Two high schools in Tembisa were selected as the study setting. Methods: Purposive sampling was used to select adolescent girls who had reached menarche and were willing to participate. Data collection involved narrative writing for girls under 16 and interviews for older adolescents. Braun and Clark's six-step method was used for data analysis. Results: A total of 35 adolescent girls were identified, and the final sample size was N = 33 adolescent girls whose ages ranged from 13 to 18 years. Two main themes emerged. Theme 1 was positive perceptions of contraceptives. Theme 1 was supported by two subthemes: the first was the influence of the male partner; the second was financial constraints in families. The second theme was negative perceptions of contraceptives. Four subthemes supported the second main theme, which were: myths and misconceptions, influence of parents, healthcare worker attitudes and negative attitudes of community members. Conclusion: Addressing the low contraceptive uptake among adolescent girls requires understanding their perceptions to tailor interventions accordingly. Contribution: The study contributes by highlighting the negative perceptions of contraceptive use, including family financial constraints and the influence of male partners. These findings can inform reproductive health initiatives aimed at increasing contraceptive use among adolescents.

Comparing English- and Spanish-Reading Patients' Comprehension of the Drug Facts Label for a New Over-The-Counter Oral Contraceptive.

BACKGROUND: Health literacy is known to impact health outcomes in a multitude of ways and is impacted by language barriers. Lower health literacy is also associated with higher rates of unintended pregnancies. A progestin-only oral hormonal contraception product, norgestrel (Opill-Perrigo), was approved for over-the-counter (OTC) use in the United States in July 2023. OBJECTIVE: (s): The objective was to utilize a knowledge assessment survey to determine participants' comprehension of norgestrel from its drug facts label and compare the comprehension between primarily English- and Spanish-reading participants. METHODS: A 7-item knowledge assessment was developed and distributed to English and Spanish readers at one site within a network of federally qualified health centers. English-reading participants completed the English survey alongside use of an English copy of norgestrel's drug facts label. Spanish-reading participants completed the Spanish survey and were randomized in a 1:1 fashion to either receive an English or Spanish copy of norgestrel's drug facts label. RESULTS: The English-reading/English label (E/E) group had a higher level of comprehension of norgestrel's drug facts label compared to the Spanish-reading/English label (S/E) or Spanish-reading/Spanish label (S/S) groups. CONCLUSION: Differences exist in OTC label comprehension for norgestrel based on primary language able to be read. Advocacy for OTC labels to be readily available in languages other than English is imperative to mitigate unintended pregnancies associated with lower levels of health literacy.

Are self-reported fertility preferences biased? Evidence from indirect elicitation methods.

Desired fertility measures are routinely collected and used by researchers and policy makers, but their self-reported nature raises the possibility of reporting bias. In this paper, we test for the presence of such bias by comparing responses to direct survey questions with indirect questions offering a varying, randomized, degree of confidentiality to respondents in a socioeconomically diverse sample of Nigerian women ([Formula: see text]). We find that women report higher fertility preferences when asked indirectly, but only when their responses afford them complete confidentiality, not when their responses are simply blind to the enumerator. Our results suggest that there may be fewer unintended pregnancies than currently thought and that the effectiveness of family planning policy targeting may be weakened by the bias we uncover. We conclude with suggestions for future work on how to mitigate reporting bias.

An Estimate of Abortion Incidence and Unintended Pregnancies.

BACKGROUND: After the legalization of abortion in Nepal, there has been remarkable changes in policies and service delivery. However, even after two decades of legalization, access to and use of safe abortion services remains limited. The objective of this study is to estimate the incidence of abortion and unintended pregnancies in Nepal. METHODS: A cross sectional study was conducted in 767 health facilities using structured questionnaires to assess the availability of abortion services, and 231 key informant interviews were conducted. Information on medical abortion drugs was collected from distributors and pharmacies. Abortion estimations were segmented into categories: those performed within healthcare facilities, those conducted outside healthcare facilities, and those using other traditional methods. To estimate pregnancy outcomes, we utilized secondary data from national censuses and health surveys. RESULTS: The total incidence of induced abortion cases in Nepal was estimated to be 333,343 for the year 2021. Only 48 percent of abortion services were provided from the listed (legal) sites and providers. The estimates showed that total facility based induced abortion in Nepal was 176,216 in 2021, more than half were medical abortions. The highest and lowest abortion cases were in Bagmati and Karnali province respectively. The result showed that more than half of the pregnancies were unintended (53.3%). CONCLUSIONS: Despite a relatively liberal legal environment, more than half of all abortions are extra-legal in Nepal. Unintended pregnancies are also common, resulting in induced abortion. This demands for increasing access to information and services on contraception and safe abortion among women and girls.

Carrying a Pregnancy to Term With an Intrauterine Device in Place: A Case of an Intraabdominal Intrauterine Device Migration.

Long-acting intrauterine contraceptives such as intrauterine devices (IUD) are popular due to their high rates of long-term efficacy, ease of use, and reversibility. Though rare, these devices can incur complications such as uterine perforation. Signs and symptoms are often vague abdominal and pelvic pain, and patients rarely present with a surgical emergency. This uterine perforation can happen immediately upon IUD placement or in a delayed manner. This case details an example of an IUD uterine perforation with abdominal migration two years after placement. The patient's history is complicated by the unique fact that she became pregnant and carried her pregnancy to a term vaginal delivery after the IUD had been placed. Her pregnancy led healthcare providers from previous encounters to believe that the IUD had been spontaneously expelled. The IUD was identified in the patient's left lower abdominal cavity via computed tomography (CT) and was surgically removed uneventfully.

The prevalence and correlates of unintended pregnancy among female sex workers in South China: a cross-sectional study.

BACKGROUND: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. METHODS: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. RESULTS: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71-4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74-7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14-0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10-0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. CONCLUSIONS: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW.

Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited.To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy.Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week.The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW.

Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg versus other long-acting reversible contraceptives for contraception in Spain.

INTRODUCTION: Condoms and combined oral contraceptive pills are widely used in Spain with high failure rates. Long-Acting Reversible Contraceptive (LARC) methods offer better efficacy and adherence and reduce unintended pregnancies (UP) compared with short-acting reversible contraceptive (SARC) methods. OBJECTIVE: To assess the cost-effectiveness of LNG-IUS 52 mg (Mirena®) versus other LARC for contraception in Spain. MATERIALS AND METHODS: A Markov model with annual cycles and an eight-year time horizon was developed from the Spanish national healthcare system (NHS) perspective, considering costs for contraceptive method acquisition, health care resources (HCR) and UP. Effectiveness was based on failure and discontinuation rates. Sensitivity analyses were performed to test the model's robustness. RESULTS: LNG-IUS 52 mg (Mirena®) resulted in lower costs and fewer UP versus LNG-IUS 13.5 mg (Jaydess®), Implant (Implanon®) and Copper IUD. LNG-IUS 52 mg (Levosert®) prevented the same UP events at a higher cost. LNG-IUS 19.5 mg (Kyleena®) was the most effective option, due to a lower discontinuation rate. CONCLUSIONS: LNG-IUS 52 mg (Mirena®) is the least costly LARC, driven by lower acquisition costs and reduced HCR utilisation. Increasing LNG-IUS 52 mg (Mirena®) uptake in contraception could generate further cost savings for the Spanish NHS and reduce economic burden of UP.

Levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena^®) is an effective and cost-saving long-acting reversible contraceptive (LARC) method compared with other similar methods in Spain over an eight-year time horizon, and Kyleena^® was the most effective option.

Gaps in Migrants' Access to Contraceptive Services: A Survey of Nepalese Women and Men in Japan.

While all modern contraceptive methods are available for free or at minimal cost in Nepal, contraceptive devices in Japan are mainly limited to condoms, requiring Nepalese migrant women to rely on their male partners for their use. Therefore, Nepalese migrants often seek contraceptive devices from Nepal or request friends or relatives to send them from their home country. This study aimed to identify the gaps and challenges associated with Nepalese migrants' needs for sexual and reproductive health services (SRHSs), particularly contraceptives, before and after their migration to Japan. A mixed-methods study was adopted, an explanatory sequential design (ESD) combining quantitative and qualitative approaches, and data were collected from 186 Nepalese migrants (80 females and 106 males) through an online survey and from two focus-group discussions (FGDs) conducted among 24 participants (14 females and 10 males). This study highlighted the obstacles faced by Nepalese migrants in accessing contraceptive services, such as limited options, language barriers, and high costs. The study also revealed the importance of pre-departure training in Nepal and organizing post-arrival training in Japan to increase Nepalese migrants' awareness of the SRHSs available in Japan, thereby helping to prevent SRH-related health problems, including unintended pregnancies and abortions, in Japan.

Maximizing the effectiveness of 1.5 mg levonorgestrel for emergency contraception: The case for precoital use.

Objectives: U.S. and World Health Organization Selected Practice Recommendations for Contraceptive Use state people may have an advanced supply of emergency contraception (EC) to minimize treatment delays. We sought to characterize the potential improvement in effectiveness of 1.5 mg levonorgestrel (LNG-EC) if it were taken up to a few hours before unprotected sex. Study design: We expanded on an existing mathematical model for the maximum attainable effectiveness of LNG-EC, assuming it exclusively works to disrupt ovulation, and compared results with point estimates from nine studies when it was taken up to 72 hours after sex. We then modelled how effectiveness might have improved if subjects had taken LNG-EC up to 3 hours before sex. Results: Taking LNG-EC immediately after sex could potentially reduce the risk of unintended pregnancy by 91%. However, population-average maximum attainable effectiveness levels ranged from just 49% to 67% when accounting for the distributions of postcoital treatment delays in the example studies. If half the subjects had taken it 3 hours before sex, then maximum effectiveness levels would have ranged from 70% to 81%. Conclusions: At the individual level, taking LNG-EC a few hours before sex is a logical extension of Selected Practice Recommendations regarding an advanced supply of EC and, based on our modeling, should be advocated for people who can reasonably anticipate an unprotected sex act. In the absence of more clinical data, however, people should not routinely rely on precoital use of LNG-EC to prevent pregnancy unless modern, effective contraceptives are inaccessible to them. Implications: Based on mathematical modeling, individuals who anticipate needing to take LNG-EC for an impending unprotected act of sex could further reduce their chance of an undesired pregnancy by taking it a few hours in advance.

Factors influencing unintended pregnancy and abortion among unmarried young people in Nigeria: a scoping review.

BACKGROUND: Unintended pregnancies and abortions among unmarried adolescents in Nigeria are outcomes of the interplay of multifaceted factors. Abortion, a global public health and social issue, impacts both developed and developing countries. This scoping review explored the literature and mapped the risk factors for unintended pregnancies and abortions among unmarried female adolescents in Nigeria. METHODS: A scoping literature search was conducted across databases, including PubMed, Science Direct, Web of Science, EBSCOhost, JSTOR, African Index Medicus, and Scopus. Inclusion criteria encompassed peer-reviewed articles and reports in English, focusing on unmarried female adolescents. The range of interest included the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among this demographic. Studies categorized as grey literature were excluded to ensure the reliability and validity of the synthesized information. RESULTS: A total of 560 articles, 553 identified through databases and 7 through hand search, were subjected to a comprehensive full-text review, resulting in the inclusion of 22 studies that met the criteria for the final review. The scoping review shed light on the past incidents of having sex, unintended pregnancies, contraceptive use, and abortions among unmarried adolescents in Nigeria. The range of incidence for having sex varied from 57.2% to 82.7%, with the prevalence of unintended pregnancies ranging from 23.4% to 92.7%. Contraceptive use was notably low, with 21.5% reporting low usage, contributing to the high incidence of abortions, ranging from 20.2% to 51.0%. Factors influencing unintended pregnancies included a lack of awareness of modern contraceptives and limited access to sexual and reproductive health information. For induced abortions, factors such as the impact on educational career, childbearing outside wedlock and fear of expulsion from school were identified. CONCLUSION: This scoping review, through a systematic examination of existing literature, contributes to a more robust understanding of the factors influencing unintended pregnancies and abortions among unmarried adolescents in Nigeria. The findings inform future research directions and guide the development of targeted interventions to improve reproductive health outcomes for this vulnerable population.

Promoting Healthy Adolescent Romantic Relationships: Results of a Multisite, Two-group Parallel Randomized Clinical Trial.

PURPOSE: To examine the impact of About Us, an innovative healthy relationships intervention that promotes positive adolescent romantic relationships and the use of effective contraceptives, on improving behavior, attitudes, and intentions related to sexual intercourse, relationship communication, and conflict resolution at 3- and 9-month follow-up, compared to services as usual. METHODS: This was a multi-site, two-group, parallel, randomized-controlled trial with an intervention/comparison allocation ratio of 3:2 conducted at seven high schools in California between February 2018 and May 2021. RESULTS: Overall, our study did not find statistically significant evidence of improved behavior, attitudes, and intentions related to sexual intercourse, relationship communication, and conflict resolution among participants (14-18 years old) randomized to the intervention group (n = 316) compared to services as usual (n = 217) during follow-up (group x time; p > .05). Exploratory within group analyses showed that, compared to baseline, at the 3-month follow-up, the prevalence of reporting having had sex increased in the control group relative to intervention group (+19% vs. +9%, p < .01). Our sub-group analyses showed that changes in condom use intentions scores differed across school sites (group x time x school; p < .01); mixed (positive and negative) trends were observed for intervention effect, and schools with positive intervention effect trends tended to have greater program participation. DISCUSSION: About Us did not show statistically significant positive impacts on primary or secondary outcomes as anticipated. Our exploratory findings show evidence of some promising trends of intervention effects at the school-level, suggesting a need for better tailored intervention components and/or delivery to address the unique environmental contexts of participants. Overall, the context of study implementation was negatively affected by the COVID-19 pandemic and challenges related to using a non-classroom delivery intervention approach. Combined, these factors may have contributed to the study null findings. Moreover, it is difficult to know (or determine) the intervention's impact under more ideal conditions (i.e., no COVID pandemic).

Contraceptive use following gestational trophoblastic disease: A systematic review.

OBJECTIVE: To systematically review the effect of contraceptive methods following gestational trophoblastic disease (GTD) on timing of beta-human chorionic gonadotropin (hCG) remission, risk of post-molar gestational trophoblastic neoplasia (GTN), risk of unintended incident pregnancy, and interactions between contraceptive methods and disease treatment. STUDY DESIGN: We conducted a search of primary literature with search terms related to GTD and contraception through April 2023 in PubMed and extrapolated our search to other platforms. Randomized controlled trials, observational studies and case reports were eligible for inclusion if they reported on patients with known GTD who received a contraceptive method for pregnancy prevention. Data was abstracted on our main outcomes of interest: timing of beta-hCG remission, risk of post-molar GTN, risk of unintended incident pregnancy, and interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy). At least two authors reviewed manuscripts at each screening stage with consensus reached before data extraction. Quality assessment checklists were used to assess risk of bias for the different study types. RESULTS: Five thousand one hundred and five studies were identified in the database search, of which 42 were included for analysis. Eight thousand two hundred and ninety four participants were evaluated. Over half of the studies were case reports and only two were randomized controlled trials. While there was sparse data on all outcomes, no differences were noted in beta-hCG monitoring, risk of post-molar GTN or incident pregnancies between different contraceptive types. Interactions between contraceptive methods and cancer-directed systemic disease treatment (e.g., chemotherapy) or specific adverse events of contraceptive methods were not identified. CONCLUSIONS: Data on contraceptive use following GTD is limited, but use of both hormonal and non-hormonal modern contraceptive methods appears safe. Counseling patients on the full range of contraceptive methods is important to help patients achieve their reproductive health goals and minimize the risk of disease progression through incomplete beta-hCG monitoring prior to future pregnancy. IMPLICATIONS: Hormonal and non-hormonal contraceptive options may be used by patients following gestational trophoblastic disease without apparent changes in beta-hCG regression or risk of post-molar gestational trophoblastic neoplasia.

Hormonal contraception and medical readiness for female service members.

Many female military service members choose to use hormonal contraception to prevent pregnancy and/or to control or suppress menses. Hormonal contraception, which comes in many different forms based on dose, estrogen/progestin type, and route of administration (oral, vaginal, transdermal, implant, intrauterine device, injectable), may cause side effects, some of which can influence military medical readiness, or the health status necessary to perform assigned missions. This expert review summarizes the evidence around common military-relevant side effects of hormonal contraception that could impact readiness, including effects on weight and body composition, bone health, psychological health, and physical performance, and serves as a tool for uniformed and civilian clinicians counseling female service members about hormonal contraception. Current evidence suggests some hormonal contraception can lead to weight and fat gain, may modulate susceptibility to mood or mental health disorders, and could impact bone mineral density and stress fracture risk; more research is needed on physical performance effects. Clinicians must be familiar with readiness considerations of each type of hormonal contraception to provide comprehensive patient education and allow for optimal shared decision-making about hormonal contraception use among female Service members. Considering the relative lack of data on the effects of nonoral hormonal contraception routes on readiness outcomes and the growing interest in long-acting reversible contraceptives among female service members, future research should continue to investigate effects of all hormonal contraception methods available to service members.

Unintended and ectopic pregnancy in woman with iud translocation with history of two times previous cesarean section and history of spontaneous abortion: Case report.

Intrauterine device is a widely used contraceptive method. However, it may translocate to other sites within the pelvic cavity, including the intestines and the bladder. This contraceptive method has failure rate between 1 and 3 out of 100 women/year. The use of intrauterine device also slightly increases the risk of ectopic pregnancy upon its failure. The combination of intrauterine device translocation and contraceptive failure is rare. We present such a case. A 29-year-old woman (Gravida 4, Para 2) presented with a complaint of abdominal pain and presence of blood spotting over the last 7 h. She tested positive for pregnancy. Upon arrival, her vital signs were normal, but she was moderately obese with a body mass index (BMI) of 38.8 kg/m2. She displayed tenderness during abdominal examination and cervical motion tenderness. Her blood test results showed no significant abnormalities. Abdominal ultrasound revealed a translocated part of intrauterine device to the cervix and transvaginal ultrasound confirmed the presence of a hypoechoic complex structure in the left adnexa, measuring 53 mm, alongside free fluid in Morrison's pouch. An emergency laparotomy was performed, revealing a normal uterus and a ruptured left fallopian tube with approximately 800 cc of blood in the abdomen.

Reducing behavior problems in children born after an unintended pregnancy: the generation R study.

OBJECTIVES: To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth. METHODS: Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support. RESULTS: Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems. CONCLUSIONS: Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention.

Knowledge about unintended pregnancy shortly after childbirth: An issue of ineffective counseling or adherence?

BACKGROUND: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. OBJECTIVE: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. DESIGN: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. METHODS: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. RESULTS: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03-1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. CONCLUSION: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance.

A study found more women were unaware of pregnancy soon after birth before mensesUnplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity.

Emerging approaches to male contraception.

BACKGROUND: Currently, approximately half of all pregnancies worldwide are unintended. Contraceptive use significantly reduces the risk of unintended pregnancy; however, options for men are particularly limited. Consequently, efforts are underway to develop novel, safe, and effective male contraceptives. RESULTS: This review discusses research into emerging male contraceptive methods that either inhibit sperm production or impair sperm function. It focuses on those in the preclinical or early clinical stages of development.

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.

Expanding comprehensive pregnancy care for Emergency Medicaid recipients: a cost-effectiveness analysis.

BACKGROUND: Emergency Medicaid is a restricted benefits program for individuals who have low-income status and who are immigrants. OBJECTIVE: This study aimed to compare the cost-effectiveness of 2 strategies of pregnancy coverage for Emergency Medicaid recipients: the federal minimum of covering the delivery only vs extended coverage to 60 days after delivery. STUDY DESIGN: A decision analytical Markov model was developed to evaluate the outcomes and costs of these policies, and the results in a theoretical cohort of 100,000 postpartum Emergency Medicaid recipients were considered. The payor perspective was adopted. Health outcomes and cost-effectiveness over a 1- and 3-year time horizon were investigated. All probabilities, utilities, and costs were obtained from the literature. Our primary outcome was the incremental cost-effectiveness ratio of the competing strategies. RESULTS: Extending Emergency Medicaid to 60 days after delivery was determined to be a cost-saving strategy. Providing postpartum and contraceptive care resulted in 33,900 additional people receiving effective contraception in the first year and prevented 7290 additional unintended pregnancies. Over 1 year, it resulted in a gain of 1566 quality-adjusted life year at a cost of $10,903 per quality-adjusted life year. By 3 years of policy change, greater improvements were observed in all outcomes, and the expansion of Emergency Medicaid became cost saving and the dominant strategy. CONCLUSION: The inclusion of postpartum care and contraception for immigrant women who have low-income status resulted in lower costs and improved health outcomes.