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2.
Niger Postgrad Med J ; 26(3): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441457

RESUMO

Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.


Assuntos
Comportamento Contraceptivo , Anticoncepção/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Comportamento de Escolha , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Governo Local , Estado Civil , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Inquéritos e Questionários , Adulto Jovem
3.
Pan Afr Med J ; 32: 172, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303941

RESUMO

Introduction: Postpartum family planning is still little known and little practised by most couples in Cameroon. However, just after childbirth, many couples wish to postpone their second birth. This study aims to determine the level of competence and the education need of couples in immediate postpartum family planning in the Biyem-Assi health district, Cameroon. Methods: We performed a KAP survey (knowledge, attitudes and practices) in the Biyem-Assi health district. Data were collected using two questionnaires with 40 questions, written in french, one addressed to women in couples and during the post-partum period and the other addressed to men in couples and having at least one child. Collected data were entered in the software CSPro version 6.2 and then analyzed using the software SPSS version 20.0. Results: A total of 300 subjects with a sex ratio of 1 were surveyed. More than half (56.7%) had an approximate knowledge of family planning in the immediate postpartum period. Thirty six percent of the respondents believed that the immediate postpartum period was not an appropriate time to use a modern method of contraception. The interaction between contraceptives and breast milk (65.4%) and female infertility (26.3%) were the main reasons reported. Immediate postpartum contraception of 60.5% of couples living in the Biyem-Assi health district was inadequate. Therefore, the level of competence in the immediate postpartum family planning was insufficient (32.6%) and low (23.3%) in most of the respondents. Conclusion: Some prejudices and misconceptions about modern contraceptive methods persist in the Biyem-Assi health district population and these are an obstacle to contraceptive practice in general and during the immediate postpartum period in particular. Awareness and education efforts of couples to improve their competence in contraception during the immediate postpartum period are necessary.


Assuntos
Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Serviços de Planejamento Familiar , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Camarões , Feminino , Humanos , Masculino , Período Pós-Parto , Gravidez , Educação Sexual/métodos , Inquéritos e Questionários
4.
Drugs Today (Barc) ; 55(7): 449-457, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31347613

RESUMO

The Food and Drug Administration (FDA) approved on August 10, 2018, a soft, reusable, flexible silicone ring (56 mm diameter) containing segesterone acetate and ethinyl estradiol as the first contraceptive vaginal ring (CVR) that can be used for a year and that is totally under the control of the woman using it. The vaginal ring releases segesterone and ethinyl estradiol at estimated rates of 150 mcg/day and 13 mcg/day, respectively. The CVR is inserted into the upper two-thirds of the vagina and left in place for 21 days, then removed for 7 days. The same ring can be used for 13 cycles for a total of a year's contraception. The CVR was found to be 97.5% effective in preventing pregnancy with a Pearl Index of 2.98. The adverse effects in women using the ring were similar in nature and frequency to those reported during the use of other hormonal contraceptives. The one exception was the occurrence of venous thromboembolism, which was reported more often than expected. Because of this, the FDA has required a postmarketing study to determine the true incidence of this adverse effect. The CVR was developed by the Population Council, is known as Annovera, and will be marketed by TherapeuticsMD in the U.S.


Assuntos
Anticoncepcionais/administração & dosagem , Dispositivos Anticoncepcionais Femininos , Etinilestradiol/administração & dosagem , Anticoncepção , Feminino , Humanos , Gravidez , Estados Unidos , Vagina
5.
Pan Afr Med J ; 33: 15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312331

RESUMO

Introduction: the use of modern contraception helps couples and individuals realize their basic right to decide freely and responsibly if, when and how many children to have. The current study assessed the factors influencing the use of modern contraception among married women in Ho West District, Ghana. Methods: the study adopted a descriptive cross-sectional design, using a standardized validated pretested interviewer-administered questionnaire adapted from previous studies to collect data from a systematic sample of 225 married women and analyzing them using Stata version 14 software program at the level 0.05. Results: the majority, 202 (89.8%) had used modern contraception before, and the proportion currently using some form of family planning (FP) was 130 (64.4%), majority (46.2%) of whom were currently using injectable. Majority (66.1%) used modern contraception in order to ensure proper care of children. Most (64.2%) of the women who were not using modern contraception were not doing so because of their partner's disapproval. Private employees were 0.20 times less likely to use modern contraception (AOR=0.20 (95% CI: 0.04-0.91); p=0.038) compared to housewives, while women who did not have problems with decision-making were 4 times more likely to use modern contraception (AOR=4.40 (95% CI: 1.25-14.44); p=0.021) compared to their counterparts who had problems with decision-making at home. Conclusion: the use of modern contraception is low. Health promotion interventions to increase modern contraception use among married women in Ho West District of Ghana should focus on the privately employed and those with problems in decision-making at home.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Tomada de Decisões , Serviços de Planejamento Familiar/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/métodos , Estudos Transversais , Feminino , Gana , Humanos , Casamento , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
6.
Pan Afr Med J ; 33: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312333

RESUMO

Introduction: family planning programmes have helped in increasing the prevalence of contraceptive use and reducing total fertility rate in developing countries from six to three births per woman. However, its uptake is lower in the rural areas compared to urban areas. This study seeks to elucidate the effect of community mobilisation on awareness, approval and use of family planning among women of reproductive age in the rural areas of Ebonyi state, Nigeria. Methods: we conducted a quasi-experimental study among women aged 15 to 49 years in two rural communities in Ebonyi state. Using simple random method, we recruited 484 women for the study. We used pre-tested interviewer-administered questionnaire to collect information from the participants. Community awareness and distribution of information, education and communication materials were carried out within one month. We estimated the effect of the intervention on the level of awareness, approval and uptake of family planning methods. Results: level of awareness increased by 19% (p<0.001) while uptake of family planning increased by 16.7% (p<0.001) in the intervention group. The approval rate was higher in the intervention group compared to the control group (p=0.008). The most commonly used method of family planning was the natural method in intervention and control arms. Conclusion: although uptake of family planning increased significantly in the study population, the rate is generally low. Given the critical role of the community in family planning programmes, community mobilisation may be deployed to increase uptake of family planning in similar rural communities.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , População Rural/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria , Educação Sexual/métodos , Inquéritos e Questionários , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 421, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238935

RESUMO

BACKGROUND: Client-centric quality of care (QoC) in family planning (FP) services are imperative for contraceptive method adoption and continuation. Less is known about the choice of contraceptive method in India beyond responses to the three common questions regarding method information, asked in demographic and health surveys. This study argues for appropriate measurement of method choice and assesses its levels and correlates in rural India. METHODS: A cross-sectional study was conducted with new acceptors of family planning method (N = 454) recruited from public and private health facilities in rural Bihar and Uttar Pradesh, the two most populous states in India. The key quality of care indicator 'method choice' was assessed using four key questions from client-provider interactions that help in making a choice about a particular method: (1) whether the provider asked the client about their preferred method, (2) whether the provider told the client about at least one additional method, (3) whether the client received information without any single method being promoted by the provider, and (4) client's perception about receipt of method choice. The definition of method choice in this study included women who responded "yes" to all four questions in the survey. The relationship between contraceptive communication and receipt of method choice was assessed using logistic regression analyses, after adjusting for socio-demographic characteristics of the respondents. RESULTS: Although 62% of clients responded to a global question and reported that they received the method of their choice, only 28% received it based on responses about client-provider interactions. Receipt of the information on side-effects of the selected method (Adjusted Odds Ratio [AOR]: 7.4, 95% Confidence Interval [CI]: 3.96-13.86) and facility readiness to provide a range of contraceptive choice (AOR: 2.67, 95% CI: 1.48-4.83) were significantly associated with receipt of method choice. CONCLUSIONS: Findings demonstrated that women's choice of contraceptive could be improved in rural India if providers give full information prior to and during the acceptance of a method and if facilities are equipped to provide a range of choice of contraceptive methods.


Assuntos
Comportamento de Escolha , Anticoncepção/psicologia , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Serviços de Saúde Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Índia , Gravidez , Adulto Jovem
8.
BMC Public Health ; 19(1): 689, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159803

RESUMO

BACKGROUND: Reproductive health is a part of a comprehensive definition of complete physical, mental and social well-being. Sex education is an important aspect of public health. Ignorance, due to the lack of sex education leads to risky sexual behaviors. METHODS: Our cross-sectional study was aimed at investigating a representative group of Polish women's knowledge about the physiology of the menstrual cycle, contraceptive methods, infertility and cervical cancer prevention. The data were collected by face-to-face interviews and an anonymous electronic questionnaire. RESULTS: The study group involved 20,002 respondents. Most of the women were of reproductive age (mean 27.7), parous (60.8%), of higher education (71%) and living in large cities (> 500 k citizens, 36.8%). 62.2% of the women gave correct answers to at least 5 of 7 questions concerning the physiology of the menstrual cycle. Three factors had a significant influence on the number of correct answers: higher education (p = 0.0001), more frequent gynecological appointments (p = 0.0001) and living in a larger city (p = 0.002). Women of higher education level had more often used some form of contraceptive method previously (87% vs. 78.4%, p = 0.001), recommended natural family planning methods to their peers (18.4% vs. 15%, p = 0.001) and regularly attended gynecological appointments (85.7% vs. 78.8%, p = 0.001) when compared with those women with lower educational levels. The three most effective contraceptive methods identified by respondents were: oral contraceptives (71.1% answers), intrauterine devices (50.2%) and parenteral hormonal contraceptives (30.4%). The effectiveness of natural family planning was more often emphasized by women who had never used any contraceptives before (20.1% vs 6.7%). Most of the participants (80.8%) believed that in-vitro fertilization is an effective infertility treatment and should be reimbursed in Poland. Also, 95.2% of the respondents reported that they had undergone a Papanicolaou test within the past 3 years, but only 3% of these women were aware of all the risk factors for cervical cancer mentioned in our survey. CONCLUSIONS: It is very important to improve comprehensive reproductive health education in Poland, especially among women of lower educational levels and living in small centers. In future, educational programs and gynecologists should focus on implementing and improving these aforementioned issues.


Assuntos
Anticoncepção , Conhecimentos, Atitudes e Prática em Saúde , Saúde Reprodutiva , Assunção de Riscos , Educação Sexual , Comportamento Sexual , Adulto , Cidades , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Orais , Estudos Transversais , Escolaridade , Serviços de Planejamento Familiar , Feminino , Humanos , Infertilidade , Dispositivos Intrauterinos , Aceitação pelo Paciente de Cuidados de Saúde , Polônia , História Reprodutiva , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
10.
Health Qual Life Outcomes ; 17(1): 90, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126343

RESUMO

OBJECTIVE: The aim of this research was to assess university students' health-related quality of life whether they use some contraceptive method or not. METHODS: This research is a cross-sectional study. Female participants who studied a degree in health at the University of Seville (Spain) were recruited. Respondents completed a demographic questionnaire and health-related quality of life was measured with validated instrument SEC-QoL (Sociedad Española de Contracepción- Quality of Life) in Spanish that measured five dimensions: sexual, social, breast, menstrual and psychosocial. RESULTS: A total of 992 women aged 21.37 (3.6) years old participated in this study. Women who used a contraceptive method reached higher scores at the SEC-QoL questionnaire 47.09 (17.04) and 46.91 (18.73) than those that didn't. Likewise, women who chose a hormonal method showed a better overall health-related quality of life, compared to those who used a non-hormonal method. Participants who used hormonal contraceptives obtained higher scores in all health-related quality of life domains (social, menstrual, breast and sexual), except psychological domain when compared to those who used a non hormonal method or none. Furthermore, a moderated mediation model showed that the effect of the current contraceptive method on health-related quality of life was partially explained by the moderated mediation of the time using this method, the reason for using it and the existence of a partner. CONCLUSION: The usage of hormonal contraceptives increases health-related quality of life in young women. Several variables regarding the experience with contraceptive methods should be considered in order to examine the effect on health-related quality of life in undergraduate women.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Comportamento Sexual/estatística & dados numéricos , Espanha , Inquéritos e Questionários , Adulto Jovem
11.
BMC Public Health ; 19(1): 532, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072352

RESUMO

BACKGROUND: In 2012, South Africa adopted the Contraception and Fertility Planning guidelines to incorporate safer conception services into care for HIV-affected couples trying to conceive. These guidelines lacked clear implementation and training recommendations. The objective of this study was to investigate factors influencing integration of safer conception services in a clinical setting. METHODS: Twenty in-depth interviews were conducted between October-November 2017 with providers and staff at Witkoppen Clinic in Johannesburg, where the Sakh'umndeni safer conception demonstration project had enrolled patients from July 2013-July 2017. Semi-structured interview guides engaged providers on their perspectives following the Sakh'umndeni project and possible integration plans to inform the translation of the stand-alone Sakh'umndeni services into a routine service. A grounded theory approach was used to code interviews and an adaptation of the Atun et al. (2010) 'Integration of Targeted Interventions into Health Systems' conceptual framework was applied as an analysis tool. RESULTS: Five themes emerged: (1) The need for safer conception training; (2) The importance of messaging and demand generation; (3) A spectrum of views around the extent of integration of safer conception services; (4) Limitations of family planning services as an integration focal point; and (5) Benefits and challenges of a "couples-based" intervention. In-depth interviews suggested that counselors, as the first point of contact, should inform patients about safer conceptions services, followed by targeted reinforcement of safer conception messaging by all clinicians, and referral to more intensively trained safer conception providers. CONCLUSION: A safer conception counseling guide would facilitate consultations. While many providers felt that the services belonged in family planning, lack of HIV management skills, men and women trying to conceive within family planning may pose barriers.


Assuntos
Anticoncepção/estatística & dados numéricos , Aconselhamento/organização & administração , Serviços de Planejamento Familiar/organização & administração , Infecções por HIV/prevenção & controle , Atitude do Pessoal de Saúde , Fertilização , Teoria Fundamentada , Humanos , Segurança do Paciente , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , África do Sul
12.
BMC Public Health ; 19(1): 568, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088427

RESUMO

BACKGROUND: Unintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements. METHODS: Semi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18-49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation. RESULTS: Most (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community. CONCLUSION: Consultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.


Assuntos
Comportamento Contraceptivo/psicologia , Características da Família , Grupo com Ancestrais Oceânicos/psicologia , Gravidez não Planejada/psicologia , População Rural , Adolescente , Adulto , Austrália , Coerção , Anticoncepção/métodos , Anticoncepção/psicologia , Serviços de Planejamento Familiar , Feminino , Humanos , Intenção , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Adulto Jovem
14.
Rev Infirm ; 68(248): 45-46, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30955543

RESUMO

Catherine is an advanced nurse practitioner (ANP) in the UK. She works in general practice and is trained to manage patients autonomously. Today she is running a family planning clinic.


Assuntos
Anticoncepção , Medicina Geral , Profissionais de Enfermagem , Encaminhamento e Consulta , Adolescente , Serviços de Saúde do Adolescente , Feminino , Humanos
15.
Rev Saude Publica ; 53: 28, 2019 Apr 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942270

RESUMO

OBJECTIVE: To describe the contraceptive methods used by adult women and the associated socioeconomic and demographic factors. METHODS: Population-based cross-sectional study with 20 to 49-year-old women from São Leopoldo, state of Rio Grande do Sul, in 2015. Three outcomes were considered to analyze the association with demographic and socioeconomic characteristics: use of oral contraceptive pills, tubal ligation and male condom. The crude prevalence ratios, stratified by age, and 95% confidence intervals (95%CI) were obtained using Poisson regression, taking the experimental error into account. RESULTS: A total of 736 women, aged from 20 to 49 years old, were evaluated. The prevalence of the use of oral contraceptive pills, tubal ligation and male condom were respectively 31.8% (95%CI 28.4-35.3), 11.1% (95%CI 9.0-13.6) and 10.9% (95%CI 8.7-13.3). In addition, 10.5% (n = 77) of the women reported making combined use of oral contraceptive pills and condom. In the stratified analysis, younger women with lower education level and from lower social classes reported less use of oral contraceptive pills. Tubal ligation was more prevalent among the lower social classes, but only in the age group from 30 to 39 years old. No differences were found in relation to male condom. CONCLUSIONS: The results indicated that differences persist in relation to contraception, which can be associated with both the difficulties of access to these inputs and the frailty of actions in reproductive health to achieve the needs and preferences of women who are more socially vulnerable.


Assuntos
Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Adulto , Fatores Etários , Brasil , Preservativos/estatística & dados numéricos , Anticoncepcionais Orais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Esterilização Tubária/estatística & dados numéricos , Inquéritos e Questionários , População Urbana , Adulto Jovem
16.
Cochrane Database Syst Rev ; 4: CD004317, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31013349

RESUMO

BACKGROUND: Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite high perfect-use effectiveness rates, typical-use effectiveness rates for shorter-term methods such as oral and injectable contraceptives are much lower. In large part, this disparity reflects difficulties in ongoing adherence to the contraceptive regimen and low continuation rates. Correct use of contraceptives to ensure effectiveness is vital to reducing unintended pregnancy. OBJECTIVES: To determine the effectiveness of strategies aiming to improve adherence to, and continuation of, shorter-term hormonal methods of contraception compared with usual family planning care. SEARCH METHODS: We searched to July 2018 in the following databases (without language restrictions): The Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), PubMed via MEDLINE, POPLINE, Web of Science, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparing strategies aimed to facilitate adherence and continuation of shorter-term hormonal methods of contraception (such as oral contraceptives (OCs), injectable depot medroxyprogesterone acetate (DMPA or Depo-Provera), intravaginal ring, or transdermal patch) with usual family planning care in reproductive age women seeking to avoid pregnancy. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. Primary outcomes were continuation or discontinuation of contraceptive method, rates of discontinuation due to adverse events (menstrual disturbances and all other adverse events), and adherence to method use as indicated by missed pills and on-time/late injections. Pregnancy was a secondary outcome. MAIN RESULTS: We included 10 RCTs involving 6242 women. Six trials provided direct in-person counseling using either multiple counseling contacts or multiple components during one visit. Four trials provided intensive reminders of appointments or next dosing, of which two provided additional educational health information as well as reminders. All trials stated 'usual care' as the comparison.The certainty of the evidence ranged from very low to moderate. Main limitations were risk of bias (associated with poor reporting of methodological detail, lack of blinding, and incomplete outcome data), inconsistency, indirectness, and imprecision.Continuation of hormonal contraceptive methodsIt is uncertain whether intensive counseling improves continuation of hormonal contraceptive methods compared with usual care (OR 1.28, 95% CI 1.07 to 1.54; 2624 participants; 6 studies; I2 = 79%; very low certainty evidence). The evidence suggested: if the chance of continuation with usual care is 39%, the chance of continuation with intensive counseling would be between 41% and 50%. The overall pooled OR suggested continuation of improvement, however, when stratified by contraceptive method type, the positive results were restricted to DMPA.It is uncertain whether reminders (+/- educational information) improve continuation of hormonal contraceptive methods compared with usual care (OR 1.33, 95% CI 1.03 to 1.73; 933 participants; 2 studies; I2 = 69%; very low certainty evidence).The evidence suggested: if the chance of continuation with usual care is 52%, the chance of continuation with reminders would be between 52% and 65%.Discontinuation due to adverse eventsThe evidence suggested that counseling may be associated with a decreased rate of discontinuation due to adverse events compared with usual care, with a lower rate of discontinuation due to menstrual disturbances (OR 0.20, 95% CI 0.11 to 0.37; 350 participants; 1 study; low certainty evidence), but may make little or no difference to all other adverse events (OR 0.73, 95% CI 0.36 to 1.47; 350 participants; 1 study; low certainty evidence). The evidence suggested: if the chance of discontinuation with usual care due to menstrual disturbances is 32%, the chance of discontinuation with intensive counseling would be between 5% and 15%; and that if the chance of discontinuation with usual care due to other adverse events is 55%, the chance of discontinuation with intensive counseling would be between 30% and 64%.Discontinuation was not reported among trials that investigated the use of reminders (+/- educational information).Adherence Adherence was not reported among trials that investigated the use of intensive counseling.Among trials that investigated reminders (+/- educational information), there was no conclusive evidence of a difference in adherence as indicated by missed pills (MD 0.80, 95% CI -1.22 to 2.82; 73 participants; 1 study; moderate certainty evidence) or by on-time injections (OR 0.84, 95% CI 0.54 to 1.29; 350 participants; 2 studies; I2 = 0%; low certainty evidence). The evidence suggested: if the chance of adherence to method use as indicated by on-time injections with usual care is 50%, the chance of adherence with method use as indicated by on-time injections with reminders would be between 35% and 56%.PregnancyThere was no conclusive evidence of a difference in rates of pregnancy between intensive counseling and usual care (OR 1.24, 95% CI 0.98 to 1.57; 1985 participants; 3 studies; I2 = 0%, very low certainty evidence). The evidence suggested: if the chance of pregnancy with usual care is 18%, the chance of pregnancy with counseling would be between 18% and 25%.Pregnancy was not reported among trials that investigated the use of reminders (+/- educational information). AUTHORS' CONCLUSIONS: Despite the importance of this topic, studies have not been published since the last review in 2013 (nine studies) with only one study added in 2019 that neither changed the results nor improved the certainty of evidence.Overall, the certainty of evidence for strategies to improve adherence and continuation of contraceptives is low. Intensive counseling and reminders (with or without educational information) may be associated with improved continuation of shorter-term hormonal contraceptive methods when compared with usual family planning care. However, this should be interpreted with caution due to the low certainty of the evidence. Included trials used a variety of shorter-term hormonal contraceptive methods which may account for the high heterogeneity. It is possible that the effectiveness of strategies for improving adherence and continuation are contingent on the contraceptive method targeted. There was limited reporting of objectively measurable outcomes (e.g. electronic monitoring device) among included studies. Future trials would benefit from standardized definitions and measurements of adherence, and consistent terminology for describing interventions and comparisons. Further research requires larger studies, follow-up of at least one year, and improved reporting of trial methodology.


Assuntos
Anticoncepção/métodos , Anticoncepcionais Femininos/administração & dosagem , Aconselhamento , Serviços de Planejamento Familiar , Anticoncepcionais Orais Hormonais , Feminino , Humanos , Gravidez , Gravidez não Planejada
17.
Afr J Reprod Health ; 23(1): 73-87, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31034174

RESUMO

In the era of HIV/AIDS, repeat pregnancies among adolescents indicate the growing problem of high-risk sexual behavior and the status of reproductive health services. A cross sectional survey was conducted to establish the prevalence and risk factors of repeat pregnancies among South African adolescents. A total of 326 adolescents participated in this study at a district hospital in, KwaZulu-Natal, South Africa from June 2017 to November 2017. Data was analysed using R Software. Out of the 326 adolescents, 19.9% had experienced a repeat pregnancy. The risk factors associated with adolescent repeat pregnancy included a history of spontaneous abortion (p <0.001) and previous contraceptive use (p <0.001). A higher level of education (p <0.001) and emotional support from family (p=0.007) were found to be significant protective factors against adolescent repeat pregnancy. These findings have implications for future interventions aimed at reducing repeat pregnancy among adolescents.


Assuntos
Aborto Espontâneo/epidemiologia , Comportamento do Adolescente , Infecções por HIV/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Anticoncepção , Comportamento Contraceptivo , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Gravidez , Prevalência , Fatores de Risco , África do Sul/epidemiologia , Adulto Jovem
19.
BMJ Sex Reprod Health ; 45(2): 88-94, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000571

RESUMO

OBJECTIVES: Provision of immediate postnatal contraception, including long-acting reversible contraceptive (LARC) methods, is increasingly identified and endorsed as a key strategy for reducing unplanned and rapid repeat pregnancies. This literature review aims to evaluatethe views of women and healthcare professionals regarding the receipt, initiation or delivery of these services. METHODS: Databases (Embase, Medline, CINAHL, HMIC) were searched for relevant English language studies, from January2003 to December 2017. In addition, Evidence Search, Google Scholar and Scopus (citation search) were used to identify further literature. Other relevant websites were accessed for policies, guidance and supplementary grey literature. RESULTS: There is clear guidance on how to deliver good-quality postnatal contraception to women, but the reality of service delivery in the UK does not currently meet these aspirations, and guidance on implementation is lacking. The available evidence on the provision of immediate postnatal contraception focuses more on clinical rather than patient-centred outcomes. Research on postnatal women's views is limited to receptivity to LARC and contraception counselling rather than what influences their decision-making process at this time. Research on views of healthcare professionals highlights a range of key systemic barriers to implementation. CONCLUSIONS: While views of postnatal women and healthcare professionals are largely in support of immediate postnatal contraception provision, important challenges have been raised and present a need for national sharing of service commissioning and delivery models, resources and evaluation data. Provider attitudes and training needs across multidisciplinary groups also need to be assessed and addressed as collaborative working across a motivated, skilled and up-to-date network of healthcare professionals is viewed as key to successful service implementation.


Assuntos
Anticoncepção/métodos , Pessoal de Saúde/psicologia , Mães/psicologia , Percepção , Cuidado Pós-Natal/normas , Feminino , Humanos , Cuidado Pós-Natal/métodos , Gravidez , Gravidez não Planejada
20.
Fertil Steril ; 111(4): 763-771, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30929732

RESUMO

OBJECTIVE: To estimate the association between perceived fertility potential and contraception use and to characterize factors important in contraceptive decision making in reproductive-age, female cancer survivors. DESIGN: Cross-sectional study. SETTING: Participants were from two state cancer registries, physician referrals, and cancer survivor advocacy groups in the United States. PATIENT(S): A total of 483 female survivors aged 18-40 years. INTERVENTION(S): Online questionnaire. MAIN OUTCOME MEASURE(S): Contraception use. RESULT(S): Eighty-four percent of participants used contraception; 49.7% used highly effective, World Health Organization tiers I and II methods (surgical sterilization, intrauterine devices, contraceptive implant, combined hormonal contraceptives, medroxyprogesterone acetate, progestin-only pills, contraceptive diaphragm). Contraception non-use was more common among survivors who perceived themselves to be infertile, compared with survivors who perceived themselves to be as or more fertile than similarly aged peers (prevalence ratio 4.0, 95% confidence interval 2.5-7.4). In mediation analysis that adjusted for clinical infertility, 59% of the association between prior chemotherapy and contraception non-use was explained by perceived infertility. Contraception efficacy (n = 62, 25.8%) and ease of use (n = 50, 20.8%) were the most cited reasons for using tier I/II methods; compared with lack of hormones (n = 81, 49.7%) as the predominant reason for using less-effective, tier III/IV methods. CONCLUSION(S): Although female, reproductive-age cancer survivors had high uptake of contraception, those who perceived themselves to be infertile were less likely to use contraception. Throughout survivorship, clinicians should counsel survivors on fertility potential in the context of their prior cancer treatments and on factors, including contraceptive efficacy and hormone-free contraception, that inform reproductive decision making in this population.


Assuntos
Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Fertilidade , Percepção , Adolescente , Adulto , Fatores Etários , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Anticoncepcionais Femininos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Dispositivos Intrauterinos/estatística & dados numéricos , Esterilização Reprodutiva/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
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