Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study.

BACKGROUND: Today's young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today's young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. OBJECTIVE: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). METHODS: This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. RESULTS: Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5% (n=1200) reported that they visit pornographic websites. CONCLUSIONS: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3390/ijerph192416586.

[Characteristics of the migrant women attended by the Reproductive Health Care Services of the Catalan Health Institute.] / Características de las mujeres migradas atendidas por los Servicios de Salud Reproductiva del Institut Català de la Salut.

OBJECTIVE: The feminization of migration, the need to provide health care to an increasingly diverse population, seeking optimal health data led to considering this research. The objective was to determine the characteristics (socio-demographic profile, obstetric and gynecological record, and monitoring) of migrated pregnant women with a pregnancy process completed in 2019 in Catalonia compared to native women, in public centers (ASSIR-ICS). METHODS: This descriptive study was based on computerized clinical records of women in the 28 centers dependent on the ICS. A descriptive analysis of the variables was carried out to compare the origin of the pregnant women. The Pearson Chi-Square test at 5% and the corrected standardized residual was used to compare the groups and an analysis of variance for the comparison of means also at 5%. RESULTS: 36.315 women were analyzed and the resulting mean age was 31.1 years. The BMI at the beginning of pregnancy was 25.4 on average. Smoking habit was 18.1% among Spanish 17.3% among European. Sexist violence was 4% in Latin American women, being statistically higher than the rest. The risk of preeclampsia was 23.4% in sub-Saharan women. Gestational diabetes was diagnosed mainly among Pakistanis (18.5%). The prevalence of Sexually Transmitted Infections (STIs) was detected in Latin Americans (8.6%), Spanish (5.8%) and Europeans (4.5%). Sub-Saharan women performed insufficient ultrasound control (58.2%) and had the lowest percentage of visits with 49.5%. Pregnancy monitoring was insufficient in 79.9% of all rural pregnant women. CONCLUSIONS: There are differences derived from the geographical origins of pregnant women that condition access to health services.

OBJETIVO: La feminización de la migración y la necesidad de dar asistencia sanitaria a una población cada vez más diversa, buscando unos datos óptimos de salud, llevó a plantearse esta investigación. El objetivo fue determinar las características (perfil socio-demográfico, antecedentes obstétricos-ginecológicos y el seguimiento) de gestantes migradas con un proceso de embarazo finalizado en 2019 en Cataluña frente a las autóctonas, en centros públicos (ASSIR-ICS). METODOS: Este estudio descriptivo se basó en los registros de historia clínica informatizada de mujeres en veintiocho centros dependientes del ICS. Se analizaron las variables según la procedencia de las gestantes y se utilizó la prueba de Ji Cuadrado de Pearson al 5% acompañada del residuo estandarizado corregido para compararlas, así como el análisis de la varianza para la comparación de medias también al 5%. RESULTADOS: Se analizaron 36.315 registros con edad media de 31,1 años. El IMC al inicio de gestación fue de 25,4. El consumo de tabaco fue del 18,1% entre españolas y del 17,3% en el resto de las europeas. El cribado de violencia machista llegó al 4% en latinoamericanas, siendo estadísticamente superior al resto. El riesgo de preeclampsia fue del 23,4% en subsaharianas. La diabetes gestacional fue diagnosticada principalmente entre paquistaníes (18,5%). La prevalencia de Infecciones de Transmisión Sexual (ITS) fue del 8,6% en latinoamericanas, del 5,8% en españolas y del 4,5% en europeas. Las subsaharianas (58,2%) realizaron un control insuficiente de ecografías y un menor porcentaje de visitas con un 49,5%. El seguimiento del embarazo fue insuficiente en el 79,9% del total de las gestantes rurales. CONCLUSIONES: Existen diferencias derivadas del origen geográfico de las gestantes que condicionan el acceso a los servicios sanitarios.

Características de las mujeres migradas atendidas por los Servicios de Salud Reproductiva del Institut Català de la Salut / Characteristics of the migrant women attended by the Reproductive Health Care Services of the Catalan Health Institute

Fundamentos: La feminización de la migración y la necesidad de dar asistencia sanitaria a una población cada vez más diversa, buscandounos datos óptimos de salud, llevó a plantearse esta investigación. El objetivo fue determinar las características (perfil socio-demográfico,antecedentes obstétricos-ginecológicos y el seguimiento) de gestantes migradas con un proceso de embarazo finalizado en 2019 en Cataluñafrente a las autóctonas, en centros públicos (ASSIR-ICS). Métodos: Este estudio descriptivo se basó en los registros de historia clínica informatizada de mujeres en veintiocho centros dependientesdel ICS. Se analizaron las variables según la procedencia de las gestantes y se utilizó la prueba de Ji Cuadrado de Pearson al 5% acompañadadel residuo estandarizado corregido para compararlas, así como el análisis de la varianza para la comparación de medias también al 5%. Resultados: Se analizaron 36.315 registros con edad media de 31,1 años. El IMC al inicio de gestación fue de 25,4. El consumo de tabacofue del 18,1% entre españolas y del 17,3% en el resto de las europeas. El cribado de violencia machista llegó al 4% en latinoamericanas, siendoestadísticamente superior al resto. El riesgo de preeclampsia fue del 23,4% en subsaharianas. La diabetes gestacional fue diagnosticada principalmente entre paquistaníes (18,5%). La prevalencia de Infecciones de Transmisión Sexual (ITS) fue del 8,6% en latinoamericanas, del 5,8% enespañolas y del 4,5% en europeas. Las subsaharianas (58,2%) realizaron un control insuficiente de ecografías y un menor porcentaje de visitascon un 49,5%. El seguimiento del embarazo fue insuficiente en el 79,9% del total de las gestantes rurales. Conclusiones: Existen diferencias derivadas del origen geográfico de las gestantes que condicionan el acceso a los servicios sanitarios.(AU)

Background: The feminization of migration, the need to provide health care to an increasingly diverse population, seeking optimal healthdata led to considering this research. The objective was to determine the characteristics (socio-demographic profile, obstetric and gynecological record, and monitoring) of migrated pregnant women with a pregnancy process completed in 2019 in Catalonia compared to native women,in public centers (ASSIR-ICS). Methods: This descriptive study was based on computerized clinical records of women in the 28 centers dependent on the ICS. A descriptiveanalysis of the variables was carried out to compare the origin of the pregnant women. The Pearson Chi-Square test at 5% and the correctedstandardized residual was used to compare the groups and an analysis of variance for the comparison of means also at 5%. Results: 36.315 women were analyzed and the resulting mean age was 31.1 years. The BMI at the beginning of pregnancy was 25.4 onaverage. Smoking habit was 18.1% among Spanish 17.3% among European. Sexist violence was 4% in Latin American women, being statisticallyhigher than the rest. The risk of preeclampsia was 23.4% in sub-Saharan women. Gestational diabetes was diagnosed mainly among Pakistanis(18.5%). The prevalence of Sexually Transmitted Infections (STIs) was detected in Latin Americans (8.6%), Spanish (5.8%) and Europeans (4.5%).Sub-Saharan women performed insufficient ultrasound control (58.2%) and had the lowest percentage of visits with 49.5%. Pregnancy monitoring was insufficient in 79.9% of all rural pregnant women. Conclusions: There are differences derived from the geographical origins of pregnant women that condition access to health services.(AU)

Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: A Mixed-Methods Study Protocol.

The website Sexe Joves is a website on sexuality of the Department of Health of the Government of Catalonia (Spain). This study aims to understand the experiences and opinions of people aged 14 to 25 regarding this website, taking into account sex, gender identity, sexual orientation, socioeconomic status and location within Catalonia (urban, semiurban and rural areas). With the objective of improving the website and adpating the resources allocated to it, this study evaluates whether this population is familiar with it and uses it, as well as the website's usability and accessibility (digital equity), usefulness and the relevance of its content. A parallel convergent triangulation design is used: a qualitative study using a social constructivist perspective, and an observational, descriptive and cross-sectional quantitative study. We conduct a discourse analysis of participants and use an "ad hoc" questionnaire to collect quantitative data. A descriptive analysis of all variables is carried out. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. This analysis will contribute to the design of new strategies for the wesbite Sexe Joves, a public health resource, in order to improve affective-sexual education for young people.

Knowledge, Perceptions, Attitudes and Practices of Midwives Regarding Maternal Influenza and Pertussis Vaccination: A Qualitative Study.

The coverage of maternal vaccination against pertussis and, particularly, influenza is lower than expected. The lack of recommendation from healthcare providers conditions non-vaccination in pregnant women. The purpose was to determine the knowledge, perceptions, attitudes and practices of midwives regarding maternal influenza and pertussis vaccination. A qualitative descriptive study based on semi-structured, face-to-face interviews with seventeen midwives was conducted, including purposive sampling and thematic analyses. Midwives had disparate knowledge and perceptions about the severity of influenza and pertussis in pregnant women, and influenza was not considered very serious. The vaccines were generally considered safe. However, because midwives did not have enough information about the safety of the influenza vaccine, there was a tendency not to recommend it. While most midwives had a positive attitude toward vaccination, their advocation for vaccination against influenza was not as clear as it was for pertussis. Not wanting to influence the decision and assuming an informative-facilitating role also led providers to recommend the influenza vaccine less frequently. Midwives are among the main sources of professional advice for pregnant women. Addressing their understanding and professional practices regarding maternal vaccination is key to change the attitude of pregnant women and thus increase vaccine uptake among them, particularly for influenza.

Validation of a Spanish-language scale for evaluating perceived quality of care of medical abortions before 9 weeks gestation.

BACKGROUND: Spanish Organic Law 2/2010 legalizes abortion within 14 weeks of gestation. Medical abortion with mifepristone and misoprostol is around 97% effective and is offered at primary care centers during the first 9 weeks of gestation. It consists of the administration of 200 mg of mifepristone by a healthcare professional and of the self-administration 800 mg of misoprostol by the patient at home, along with prescribed analgesics. However, the quality of this process as perceived by patients has never been assessed. This study aims to validate a scale designed to assess the perceived quality of the entire process, structure and results of at-home medical abortion. METHODS: Validation study of a Spanish adaptation of the SERVPERF scale. In total, 289 patients completed a self-administered questionnaire consisting of 26 items previously evaluated by a group of experts. A re-test was performed on 53 of these patients 15 days later to assess interobserver consistency. RESULTS: The highest non-response rate for any single item was 2.1%. The floor effect was 26% and the ceiling effect did not surpass 83%. The linearly weighted Kappa coefficient was good to excellent, in general. An exploratory factor analysis was performed with Varimax rotation, obtaining a total of 7 dimensions that explain 65.9% of the variability. The internal consistency (Cronbach's alpha) for all items was 0.862. CONCLUSION: This psychometric instrument is valid and reliable for assessing the quality of care of medical abortion. Medical abortion is efficient, effective and eliminates the need for hospital care, anesthesia and surgical risk. However, user satisfaction has yet to be determined. This study offers a validated scale to assess perceived quality of care, their quality experience and person-centered care for abortion as a fundamental part of overall service quality as a fundamental part of overall service quality.

Prevalence and Characterization of Undiagnosed Youths at Risk of Chlamydia trachomatis Infection: A Cross-sectional Study.

OBJECTIVE: The aim of this study was to determine the prevalence of Chlamydia trachomatis infection in undiagnosed young people aged between 15 and 24 years. MATERIALS AND METHODS: A convenience sample of 623 youths, with a mean (SD) age of 20.1 (2.2) years, was recruited from key spaces in the North Metropolitan area of Barcelona in Catalonia, Spain. Participants completed a 21-item questionnaire and provided a urine sample or vaginal swab for testing. RESULTS: The most common age at the first sexual intercourse was 16 years (24.6%), followed by 15 years (21.3%). Only 32.6% reported always use of condoms, 49.2% sometimes, and 15.6% never. A positive test for chlamydia was found in 34 participants (5.5%; 95% CI, 3.8-7.5), with no difference by sex. A positive test was significantly more common among the participants who were working, who had been diagnosed with a sexually transmitted disease (STD) at some point in their life, and who used web pages/apps to find new sexual partners more than once a month. In the multivariate analysis, working status was an independent factor associated with chlamydial infection (adjusted odds ratio[OR], 8.88; 95% CI, 1.71-46.17), whereas not having been previously diagnosed with an STD (OR, 0.34; 95% CI, 0.07-1.49) and never using the Internet to find sexual partners (OR, 0.16; 95% CI, 0.03-080) were protective factors against chlamydial infection. CONCLUSIONS: The prevalence of C. trachomatis infection was 5.5%. Working status, a previous diagnosis of STD, and use of the Internet to find new sexual partners were associated with chlamydial test positivity.

Influenza and Pertussis Maternal Vaccination Coverage and Influencing Factors in Spain: A Study Based on Primary Care Records Registry.

The purpose was to determine the coverage of maternal vaccination against influenza and pertussis, and the characteristics associated with being vaccinated, in a health area of Catalonia, Spain. Some 36,032 anonymized and computerized clinical records registries of pregnant women from Primary Care Centres (e-CAP database) were analysed, from between 2015 and 2018. Vaccination coverage and the association with sociodemographic variables and clinical conditions were estimated using a Poisson regression model. Maternal vaccination coverage against influenza ranged between 11.9% in 2015 and 6.8% in 2018, following a decreasing trend (p < 0.001). Coverage with the tetanus toxoid, diphtheria toxoid, and acellular pertussis vaccine varied between 49.8% in 2016 and 79.4% in 2018, following an increasing trend (p < 0.001). Having living children and suffering from obesity were factors associated with not being vaccinated against both infections. The predictive variables of vaccination against influenza were diabetes (IRR: 2.17, 95% CI: 1.42−3.30) and asthma (IRR: 2.05, 95% CI: 1.76−2.38); and for pertussis, it was asthma (IRR: 1.10, 95% CI: 1.03−1.17). Different socio-demographic factors and chronic conditions in pregnant women were associated with maternal vaccination, and which will have to be taken into account in clinical practice when implementing strategies to improve the coverage of the programme.

Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: A qualitative study.

AIMS AND OBJECTIVES: To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. BACKGROUND: Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. DESIGN: We conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. METHODS: We carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. RESULTS: We identified an overarching theme, 'factors that influenced participants' decision to be vaccinated or not', which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants' decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. CONCLUSIONS: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. RELEVANCE TO CLINICAL PRACTICE: Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse-midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.

Level of Job Burnout among Midwives Working in Labour Rooms in Barcelona Region: A Cross-Sectional Study.

BACKGROUND: Nowadays, burnout syndrome (BS) symptoms appear to have increased in healthcare workers, specifically midwives, but there are no studies on burnout among midwives in Catalonia. The present study aimed to assess and describe the prevalence of BS in midwives working in labour rooms. METHODS: A cross-sectional descriptive study was conducted on 122 midwives working in 24 maternity hospitals in the Barcelona (region) which were selected using purposive sampling from January to March 2017. Data were collected using two questionnaires (demographic information, job burnout using Spanish Burnout Inventory with 20 items and four subscales). Data analysis was performed using SPSS software version 21 and Chi-Square, U Mann-Whitney, and Kruskall-Wallis. P<0.05 was considered statistically significant. RESULTS: None of the participants obtained a critical level of BS. 37 (30.33%) participants scored medium burnout and 47 (38.52%) recorded low burnout. Statistically, work stress (P=0.01), marital status (P=0.006), attendance of more than three women per shift (P=0.001), the number of children (P=0.01), parity (P=0.005), health status (P=0.04), and being on sick leave over last year (P=0.04) were significantly correlated with medium-high levels of burnout. Burnout scores were higher in midwives having a life partner and those without children. CONCLUSION: Following the results, no participant obtained a critical level of BS; about one-third of them scored medium-high burnout. However, specific interventions are suggested to be conducted to maintain the midwives' motivation and prevent burnout development.

Perinatal contraceptive counselling: Effectiveness of a reinforcement intervention on top of standard clinical practice.

OBJECTIVE: To assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. DESIGN: Community-randomized trial. SETTING: "Reproductive and Sexual Health Care" units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain). PARTICIPANTS: 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. INTERVENTIONS: At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. MEASUREMENTS AND FINDINGS: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. KEY CONCLUSIONS: Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. IMPLICATIONS FOR PRACTICE: Despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.

La anticoncepción durante la cuarentena: situación actual y colectivos más vulnerables a embarazos no planificados durante este periodo / The contraception during the quarantine: current situation and groups more vulnerable to unplanned pregnancies during this period

OBJETIVOS: Conocer la prevalencia de reinicio de relaciones sexuales coitales (RSC) en mujeres puérperas, antes de las 6 semanas posparto, cuántas tienen cobertura anticonceptiva inadecuada y sus características. Sujetos, material y método: Estudio transversal de datos recogidos en mujeres participantes en el grupo control del estudio MAYA, llevado a cabo en 20 centros de Cataluña con el fin de analizar la efectividad a largo plazo de un programa de asesoramiento anticonceptivo posparto de refuerzo (grupo intervención, 10 centros) con respecto a la práctica clínica habitual (grupo control, 10 centros). Los datos analizados provienen de la información recogida a las 30 semanas de embarazo y a las 6 semanas posparto. No usar métodos anticonceptivos y el coito interrumpido se consideraron «cobertura anticonceptiva inadecuada». RESULTADOS: Se analizaron 428 mujeres de 32 ± 5,1 años. El 32,9% (n= 141) había reiniciado las RSC antes de las 6 semanas posparto, y el 20% (n= 28) tenía una cobertura anticonceptiva inadecuada. Las mujeres <30 años o usuarias de lactancia artificial frente a mixta/materna reiniciaron las RSC durante la cuarentena con más frecuencia. Las extranjeras frente a las españolas, con un menor nivel educativo o que daban lactancia mixta frente a artificial/materna presentaron más frecuentemente una cobertura anticonceptiva inadecuada. Las que no eran laboralmente activas o no habían planificado la gestación presentaban ambos comportamientos. CONCLUSIONES: Una de cada 3 mujeres inicia las relaciones sexuales antes de las 6 semanas, y de éstas, 1 de cada 5 no tiene una cobertura anticonceptiva adecuada. Este estudio ha identificado las características de mujeres que podrían ser especialmente vulnerables a embarazos no planificados

OBJECTIVES: To determine the prevalence of resumption of sexual intercourse (SI) among puerperal women before 6 weeks postpartum, how many do not use adequate contraception and their characteristics. Subjects, material and method: Cross-sectional study of data collected from women in the control group of the MAYA study that was conducted at 20 centres in Catalonia (Spain) in order to analyze the long-term effectiveness of an additional postpartum contraceptive counselling program (intervention group, 10 centres) vs. standard clinical practice (control group, 10 centres). The data was collected by midwives at week 30 of pregnancy and at week 6 postpartum. Not using any contraception or using the withdrawal method was considered «inadequate contraception». RESULTS: 428 women aged 32 ± 5.1 years were analyzed. 32.9% (n= 141) had resumed SI before 6 weeks postpartum, with 20% (n= 28) using inadequate contraception. Women aged <30 years and those who formula fed vs. those who mixed- or breastfed were most likely to resume SI during the 6-week postpartum period. Compared to Spanish women, foreigners, those with lower education levels or who mixed fed instead of formula feeding or breastfeeding were more likely to use inadequate contraception. Women who were unemployed or who had not planned pregnancy expressed both behaviours. CONCLUSIONS: One woman in three resumes sexual intercourse before the end of the 6-week postpartum period and of these, one in five uses inadequate contraception. This study identifies the characteristics of women who may be especially vulnerable to unintended pregnancy