Women's experiences of postpartum contraceptive services when elective caesarean section is the method of birth: a qualitative study.

BACKGROUND: The unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but is not routinely practised in Sweden. To improve contraceptive services and facilitate the informed choice of IUD placement at the time of a caesarean section (CS), we performed this study to identify and describe women's experiences of contraceptive services before, during and after an elective CS. METHODS: A qualitative design and methodology was used. We interviewed 20 women aged 28-42 years who underwent elective CS in Sweden. Interviews were analysed using reflexive thematic analysis. RESULTS: The three main themes found were (1) receptivity to contraceptive counselling in the context of CS, (2) communication and decision-making about postpartum contraception before CS and (3) lack of support and guidance to receive contraceptive services before and after CS. The participants described readiness and interest regarding postpartum contraception. They prefered counselling from around 25 weeks of gestation. Despite this finding, antenatal communication and contraceptive decision-making seemed rare. Participants reported a lack of support and guidance which necessitated a need by women to navigate the contraceptive services themselves in order to receive information about contraception before CS and to receive postpartum support. CONCLUSIONS: Antenatal contraceptive counselling including information about IUD placement during CS was appreciated and welcomed by women with elective CS as their birth method. Most of the women whom we interviewed would prefer to receive contraception counselling on postpartum use during the second half of their pregnancy.

Why Pakistani Women Do Not Use Intrauterine Contraceptive Devices: A Systematic Review of Barriers and Misconceptions.

This review explores barriers limiting the adoption of Intrauterine Contraceptive Devices (IUCDs) in Pakistan, focusing exclusively on local articles. As Pakistan's high population calls for widespread contraception, we aim to pinpoint obstacles hindering IUCD utilization, irrespective of parity. We conducted a comprehensive search of PubMed, Google Scholar, PakMedinet, and Wiley Online Library for English-language primary studies published between 2000 and 2022, reporting on IUCD utilization in Pakistan. Our analysis reveals multiple barriers impeding IUCD use in Pakistan. These encompass patriarchal social norms, male dominance, low education, socioeconomic status, and unemployment. Post-insertion health concerns, inadequate counseling, government commitment, and awareness were also identified barriers. Provider confidence, client trust, women's autonomy, social constraints, and limited male partner involvement hindered IUCD adoption. A desire for larger families and male offspring, vague religious beliefs, fear, and misconceptions further restricted usage. Accessibility and high service costs also posed challenges. This review highlights prevailing impediments to IUCD adoption in Pakistan, encompassing knowledge gaps, motivation deficits, resistance from husbands and in-laws, cultural and religious beliefs, limited access, and communication barriers. To promote IUCDs as a modern contraceptive method, it is essential to raise awareness among both men and women. Active involvement of religious leaders and community stakeholders is crucial in addressing these social factors hindering IUCD utilization.

Multiple Adverse Outcomes of Intrauterine Devices in One Patient: A Case Report.

Intrauterine devices (IUDs) are commonly used, effective forms of long-acting removable contraceptives that may be inserted by primary care providers. Adverse outcomes with copper IUDs specifically have been extensively documented; however, there is little guidance on whether to offer an IUD to a patient who has already experienced adverse outcomes related to IUDs. In this case report, our patient experienced three complications with three different copper IUDs, including a spontaneous expulsion, a fragmented device, and a retained device in addition to two unintended pregnancies. In our view, a different form of contraception should be offered for a patient that has already experienced multiple adverse outcomes related to IUDs.

[Acceptability of innovative male contraceptive methods among major of age heterosexual adult men in France in 2021]. / Acceptabilité des méthodes de contraception masculine innovantes chez les hommes majeurs hétérosexuels en France en 2021.

INTRODUCTION: New methods of male contraception are being studied: male hormonal contraception, reversible occlusion of the vas deferens and thermal contraception. This study aimed to evaluate the acceptability of these methods among men. MATERIAL AND METHODS: We carried out an opinion survey from July to November 2021, through an anonymous questionnaire distributed in France on the internet. The subjects were adult, heterosexual men. RESULTS: Of the 1545 connections to the questionnaire, we analyzed the 905 complete questionnaires. Seventy three percent of men say they are in favor of adopting an innovative male contraceptive method as their primary contraception: 64% in favor of reversible occlusion of the vas deferens, 22% in favor of male hormonal contraception and 13% in favor of thermal contraception. CONCLUSION: Despite its limitations, this study shows that a significant part of the male population is interested in innovative methods of contraception that concern them. This should encourage continued research in this area.

One-year follow up of contraceptive use and pregnancy rates after early medical abortion: Secondary outcomes from a randomized controlled trial of immediate post-abortion placement of intrauterine devices.

INTRODUCTION: Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after early medical abortion. MATERIAL AND METHODS: We present secondary outcome data of continuation rates, factors associated with continuation and discontinuation, choice of IUD type, women's satisfaction with IUD, and IUD expulsions, subsequent pregnancies, and abortions within 1 year post-abortion in a randomized, controlled, multicenter trial on IUD placement within 48 hours compared with placement 2-4 weeks after medical abortion up to 63 days' gestation (ClinicalTrials.gov NCT03603145). RESULTS: Of the 240 women studied, 112/120 (93.3%) in the intervention group vs 113/120 (94.2%) in the control group completed the 12-month follow-up. The rate of IUD use at 12 months was 84/112 (75%) in the intervention group vs 75/113 (66.4%) in the control group (P = 0.19). Attendance at the IUD placement visit was the only predictor of long-term IUD use (relative risk [RR] = 5.7, 95% confidence interval [CI] 2.03-16.0; P = 0.001). The main reason for choosing an IUD was high contraceptive effectiveness. The most common reasons for IUD discontinuation were bleeding problems and abdominal pain. IUD expulsion was rare and did not differ between groups. Satisfaction among IUD users at 1 year was high (>94%) and the majority of all participants would recommend IUD to a friend (65.8%). Use of no contraception and experience of unprotected intercourse were less common in the intervention group (11/112 [9.8%] vs 25/113 [22.1%], P = 0.02 and 17/112 [15.2%] vs 32/113 [28.3%], P = 0.02, respectively). There was no difference in the rate of subsequent pregnancies and abortions (pregnancies 14/112, 12.5% in the intervention group vs 8/113, 7.1% in the control group, P = 0.19; abortions 5/112, 4.5% vs 3/113, 2.7%, P = 0.5). CONCLUSIONS: IUD placement after medical abortion led to high continuation and satisfaction rates with no difference between groups. We found no difference in IUD expulsions after immediate compared with later placement. Unprotected intercourse was significantly less common in the immediate group. In clinical practice, immediate placement of IUDs available free of charge at the abortion clinic is likely to increase attendance to the placement visit and continued use of IUDs after abortion.

Epidemiological profile and effectiveness of immediate postpartum contraception in Brazilian women.

Purpose: To determine the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum period and compare the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC. Methods: We analyzed the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum. The data was collected by electronic medical records of postpartum women assisted at the University Hospital of São Bernardo do Campo (HMU-SBC) from January 2016 to December 2020. Also, we compared the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC by identifying women who returned for second delivery during the study period and analyzing the contraceptive method chosen in the first hospitalization. Then the pregnancies interval and the sociodemographic characteristics were analyzed according to contraceptive method type. Results: Data from 20,896 women were collected, of which 8,183 (39%) opted for Cu-IUD, 559 (2.5%) DPMA, and 10,989 (52.5%) chose not to use contraception at the time of hospital discharge. When comparing these groups, women in the DPMA were younger (26.5 ± 7.3, p < 0.05), and NCM showed women with a lower number of pregnancies (2.2 ± 1.3, p < 0.05). Subjects in the TL group (4.6%) had the higher number of pregnancies (3.8 ± 1.2, p < 0.05), and ENG group, the highest number of miscarriages (1.6 ± 1.3, p < 0.05). Of those women who returned pregnant, 5.5% belonged to the DPMA group, 6% to the NCM group, and 2.3% to the Cu-IUD. Conclusions: Women who opted for Cu-IUD insertion were younger, had more pregnancies and vaginal delivery when compared to those who did not choose a method. Of those women who returned, the minority opted for Cu-IUD compared to those that opted for DPMA or no method.

Early discontinuation of long-acting reversible contraceptives and associated factors among women discontinuing long-acting reversible contraceptives at national referral hospital, Kampala-Uganda; a cross-sectional study.

BACKGROUND: High levels of unmet need for contraception and unwanted pregnancies are high in developing countries despite efforts to reduce them. Long-acting reversible contraceptive (LARC) methods are more than 99% effective in preventing pregnancy. Discontinuation of LARC within the first year of initiation contributes to the high levels of unmet need. This study aimed to determine the prevalence and factors associated with the first-year discontinuation of LARC at Kawempe National Referral hospital. METHODS: A facility-based cross-sectional study was conducted from February 2020 to June 2021. We consecutively recruited 354 participants who discontinued a LARC (intrauterine device {IUD} and sub-dermal implant) during the study period after informed written consent. Data on duration of use, reasons for discontinuation, and factors associated were collected using a face-to-face interviewer-administered questionnaire and review of client records. Early LARC discontinuation was defined as the termination of the contraception within the first 12 months of use. Data were entered using SPSS version 14/0 and analyzed in STATA version 15. Prevalence was expressed as a proportion while logistic regression was used to assess factors associated with early LARC discontinuation. Variables with a p-value of < 0.05 were considered statistically significant. RESULTS: The proportion of first-year discontinuation of LARC was 29%. Women Age less than 25 years (OR = 5.07; 95% CI: 1.1-24.8) and those who desired a family size of fewer than four children (OR = 3.19; 95%CI: 1.2-8.7 ) were more likely to discontinue the LARC within 12 months of initiation after multivariate analysis. Method-related reasons for removal were painful menstrual cramps for implants, recurrent infections for IUDs, and a non-side effect reason was the desire to get pregnant. CONCLUSION: A high proportion of women discontinue LARC within 12 months following initiation. Young adults and those who desire small families are more likely to have first-year discontinuation of LARC. We recommend age-specific counseling for patients receiving the LARC and further studies looking at the depth analysis of reasons for the first-year discontinuation.

Endoscopic Removal of Intrauterine Contraceptive Device Perforating Into the Bladder: A Case Report and Review of Literature.

Intrauterine contraceptive device (IUCD) is a commonly used contraceptive method with the advantage of being a long-acting and reversible contraceptive method. However, its insertion can be rarely associated with serious complications such as uterine perforation, which can more rarely result in injury of the nearby viscus. In this report, we document a rare case of IUCD perforation of the uterus and bladder, its diagnosis using transvaginal ultrasonography and hysteroscopy, and management using a minimally invasive approach with a satisfactory patient outcome.

Self-reported contraceptive use and satisfaction among women accessing telemedicine medical abortion at the onset of the COVID-19 pandemic at 3-6-month follow-up.

BACKGROUND: Changes in legislation due to COVID-19 led to the introduction of telemedicine for early medical abortion (EMA) at home in Scotland. The opportunity to provide contraception at presentation may be more limited with this model of care. We compared contraceptive use immediately post-abortion with 3-6 months later to determine if contraceptive needs were being met. METHODS: We contacted 579 women by telephone call or text message who agreed to be involved in a service evaluation of telemedicine EMA in NHS Lothian at 3-6 months post-abortion. A research nurse administered a questionnaire on the women's current contraception use. The research nurses also offered women support in switching or initiating contraception via the abortion service if desired. RESULTS: The response rate to the contact was 57% (331/579). Under a third of the women (30%, 98/331) were using the progestogen-only pill (POP) at 3-6 month follow-up, a significant decrease (p<0.00) compared with 65% (215/331) who were provided with POP at the time of abortion. Thirty-nine women (12%) were provided with contraception through this telephone contact, leading to a significant increase in the proportion using subdermal implants, the progestogen injectable or intrauterine contraception. CONCLUSIONS: This study shows that there was a decrease in the use of the POP 3-6 months after telemedicine EMA during the COVID-19 pandemic. Telephone contact at 3-6 months to facilitate obtaining contraception may be a promising strategy to improve access to effective methods with this model of abortion care.

Improving access to quality contraceptive counselling in community pharmacy: examining the knowledge, attitudes and practices of community pharmacists in Australia.

BACKGROUND: Across most of Australia, the role of community pharmacists in contraceptive care has been unchanged since 2004. To understand their current scope of practice and potential for practice advancements, we examined community pharmacists' contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contraceptive counselling provision. METHODS: A nationwide postal survey was conducted between September and December 2020. We contacted a state/territory-stratified sample of 2149 community pharmacies and limited eligibility to one pharmacist per pharmacy. Summary statistics of respondent characteristics and parametric (χ2, linear regression) and non-parametric (Mann-Whitney, logistic regression) tests were computed for the outcomes: practices, knowledge (reported and tested), confidence, attitudes, barriers and benefits. RESULTS: Eligible responses were received from 366 pharmacies (19%). Pharmacists' median age was 34. Most (85% of) pharmacists agreed that contraceptive counselling fits within their current professional activities and emphasised benefits to their patients, including improved access to contraceptive decision support (80%), as being key motivators of counselling. A lack of payment mechanisms (66%), training opportunities (55%) and technical assistance tools (54%) were the most important barriers. Self-rated knowledge and confidence were highest for combined oral contraceptive pills and lowest for the copper intrauterine device (IUD). When tested, pharmacists were very knowledgeable about method, dosage, frequencies and costs, and relatively less knowledgeable about side-effects and IUD suitability for adolescents. CONCLUSIONS: Community pharmacists provide contraceptive information and counselling but lack the necessary resources and support to be able to consistently provide quality, person-centred care. Remuneration mechanisms, training opportunities and pharmacy-specific professional resources need to be explored.

Uso de métodos anticonceptivos de alta eficacia posterior a la interrupción voluntaria del embarazo en Profamilia, 2015-2020

Objetivo: Describir los métodos anticonceptivos reportados por las usuarias de servicios de interrupción voluntaria del embarazo (IVE), antes y posterior a la consulta, y explorar la asociación entre las características sociodemográficas y los antecedentes ginecológicos con la elección de anticonceptivos de alta eficacia posterior a la IVE, con gestaciones menores de 15 semanas, en el departamento de Antioquia, Colombia, en la institución Profamilia, entre el 2015 y el 2020. Metodología: Estudio de corte transversal. Se analizaron los 13 067 registros de consultas de IVE realizadas en Profamilia de la regional Antioquia, del 2015 al 2020. Las variables cualitativas se midieron con frecuencias y porcentajes, y las cuantitativas, con la media y la desviación estándar. Se implementaron modelos de regresión logística para establecer la asociación de las variables independientes con la variable de interés. Resultados: La consulta de IVE contribuyó al incremento del uso de métodos anticonceptivos de alta eficacia. Antes de la IVE, el 53 % de las mujeres no usaban ningún método. Posterior a la interrupción, el 97 % empezó a utilizar métodos de alta eficacia. Además del uso de métodos poco eficaces o el uso de preservativo, obtuvieron una posibilidad 13 veces más alta de elegir un método de alta eficacia. Conclusiones: La educación en métodos anticonceptivos posterior a una IVE es fundamental para promover el uso de opciones muy efectivas, con el fin de disminuir la aparición de nuevos embarazos no deseados que puedan llevar a una IVE recurrente.

Objective: To describe the contraceptive methods reported by users of voluntary termination of pregnancy (VTP) services, before and after consultation, and to examine the association between sociodemographic characteristics and gynecological history with choosing highly effective contraceptive methods after VTP, in gestations shorter than 15 weeks, in the department of Antioquia, Colombia, at the Profamilia institution, from 2015 to 2020. Methodology: This is a cross-sectional study. We analyzed 13 067 records of VTP consultations performed in Profamilia in Antioquia from 2015 to 2020. Qualitative variables were measured with frequencies and percentages, and quantitative variables with the mean and standard deviation. Logistic regression models were implemented to establish the association of the independent variables with the variable of interest. Results: VTP consultation contributed to increased use of highly effective contraceptive methods. Before VTP, 53% of women were not using any method. After the termination, 97% started using highly effective methods. Likewise, those using low efficacy methods or condoms were 13 times more likely to choose a highly effective method. Conclusions: Post-VTP contraceptive education is essential for promoting the use of highly effective methods to reduce the occurrence of new unwanted pregnancies that may lead to repeated VTP

Objetivo: Descrever os métodos anticoncepcionais referidos pelas usuárias de serviços de interrupção voluntária da gravidez (IVG), antes e depois da consulta, e estudar a associação entre as características sociodemográficas e os antecedentes ginecológicos com a eleição de anticoncepcionais de alta eficiência depois da IVG, com gestações menores de 15 semanas, no departamento de Antioquia, Colômbia, na instituição Profamilia, entre 2015 e 2020. Metodologia: Estudo de corte transversal. Analisaram-se os 13067 registros de consultas de IVG realizadas em Profamilia na sede Antioquia, de 2015 a 2020. As variáveis qualitativas mediram-se com frequências e porcentagens, e as quantitativas com a média e o desvio padrão. Implementaram-se modelos de regressão logística para estabelecer a associação das variáveis independentes com a variável de interesse. Resultados: A consulta de IVG contribuiu ao incremento do uso de métodos anticoncepcionais de alta eficiência. Antes da IVG, o 53% das mulheres não usavam nenhum método. Depois da interrupção, o 97% começou a usar métodos de alta eficiência. Além do uso de métodos pouco eficientes ou o uso da camisinha, obtiveram uma possibilidade 13 vezes maior de escolher um método de alta eficiência. Conclusões: A educação em métodos anticoncepcionais posterior a uma IVG é fundamental para promover o uso de opções muito efetivas, com o fim de diminuir a aparição de novas gravidezes não desejadas que podem levar a uma IVG recorrente.

Building Blocks for the Long-acting and Permanent Contraceptives Coordinated Registry Network.

Objectives: A multistakeholder expert group under the Women's Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies. Design: We applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved. Results: Twenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes. Conclusions: The WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women's health stakeholders.

A rendezvous technique using laparoscopy and cystoscopy to remove transmigrated intrauterine contraceptive device from abdomen and urinary bladder.

Intrauterine contraceptive devices (IUCDs) are the most commonly used reversible contraceptive methods. Uterine perforation followed by transmigration is a rare but potentially life-threatening complication associated with the use of IUCDs. Perforation of the bladder by an IUCD is extremely rare. We present the case of a 36-year-old woman with a 3-year history of IUCD placement presenting with symptoms of lower urinary tract infection. X-ray of the pelvis and hysteroscopy revealed an inverted T-shaped metallic shadow resembling an IUCD in the pelvis and an empty uterine cavity, respectively. Using a cystoscope, the IUCD was visualized embedded in the urinary bladder and its retrieval was attempted unsuccessfully with the cystoscope. Hence a rendezvous technique, in which laparoscopy, assisted with cystoscopy was performed. The vertical limb and half of the horizontal limb of the copper-T were retrieved from the outer wall of the urinary bladder laparoscopically, and the intravesical part of the horizontal limb along with the calculus was retrieved per urethra.

Thermal male contraception: A study of users' motivation, experience, and satisfaction.

PURPOSE: The aim of this study is to evaluate the motivations, experience, and acceptability of thermal male contraception (TMC) in male partners of couples requesting the use of TMC as the only couple contraceptive. MATERIALS AND METHODS: To the 72 men of couples seeking male contraception and using TMC between 2011 and 2019, we suggested an anonymous online survey (93 questions) exploring population characteristics, contraceptive histories, motivations for choosing TMC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with this method. RESULTS: Sixty-seven men agreed to participate (93% response rate); 63 responses were complete and were analyzed (94% participation rate). The main motivations for choosing TMC were "not using hormones" (n = 59/63, 94%) and using a method regarded as "natural" (n = 49/63, 78%). Most of the men surveyed (68%) adopted the method in less than 2 weeks. During the contraception use phase (n = 59 men), they described significantly improved sexual satisfaction, compared to that experienced with their previous contraceptive methods, and they reported high confidence (100% rather/totally confident partner) and support (88% rather/totally supporting partner) from their partner. Most men (n = 35/59, 59%) also reported improved self-esteem. The main negative point was discomfort, reported by 24% of the men. The overall satisfaction score of using this method was 3.78 ± 0.46/4, and 100% of the men reported that they would recommend the method to other men. DISCUSSION AND CONCLUSION: Men using TMC successfully assumed the responsibility for and performed a daily task to provide couple contraception. This positive evaluation, together with the already published contraceptive efficacy and reversibility of TMC, should encourage the development of this method.

High prevalence of sexually transmitted infections among asymptomatic women opting for the intrauterine contraceptive device use in Mwanza, Tanzania: An urgent call for control interventions.

Objective: Placement of intrauterine contraceptive device (IUCD) in asymptomatic woman infected with sexually transmitted infection (STIs) can lead to pelvic inflammatory diseases (PID) and infertility if not well treated. The current study investigated the magnitude of sexually transmitted infections among women opting for IUCD use in the city of Mwanza, Tanzania. Methods: A cross-sectional study involving 150 asymptomatic women was conducted from August to December 2017. Detection of Chlamydia trachomatis antigen from endocervical swabs was done using immunochromatographic rapid tests while sera were used for detection of Treponema pallidum, human immunodeficiency virus (HIV) and herpes simplex virus Type 2 (HSV-2) antibodies. Results: The overall prevalence of STIs was 45/150 (30%, 95% CI: 22-37) while that of individual STIs were 27.3%, 5.3%, and 2.6% for C trachomatis, T pallidum, and HSV-2, respectively. History of dysuria (aOR 6.6; 95% CI 2.3-18.8; p < 0.001) and history of STIs (aOR 4.6; 95%CI 1.0-20.8; p = 0.049) independently predicted presence of STIs. Conclusions: Prevalence of STIs among women opted for IUCD use in the city of Mwanza, Tanzania is alarmingly high and is predicted by past history of dysuria and history of partner's STIs, calling for the need of screening of the STIs among high-risk women in low- and middle-income countries (LMICs) opting for IUCD use.

Retained Copper Intrauterine Device Fragment in Pregnancy: A Case Report.

Copper intrauterine device (IUD) failure and fragmentation are rare, with minimal documentation on their effects in pregnancy. Recommendations from professional organizations highlight the importance of prompt identification and surgical removal, as case reports have noted various acute and chronic intra-abdominal pathologies. However, limited guidance exists around counseling patients who are pregnant with a retained IUD fragment. Here, we present a case of a normal pregnancy with a retained copper IUD fragment, while reviewing existing data on management and counseling.