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1.
Cien Saude Colet ; 26(suppl 2): 3493-3504, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468645

RESUMO

BACKGROUND: Brazil has shown a considerable decline in fertility rates in recent decades. However, sociodemographic differences still have a direct impact on access to family planning in the country. OBJECTIVE: To estimate the prevalence of contraceptive use according to sociodemographic variables among Brazilian women in reproductive age. METHODS: A cross-sectional study conducted with 17,809 women who have responded to the National Health Survey. We estimated the prevalence as well as the 95% confidence intervals and we used Pearson's chi-square test at a significance level of 5% to analyze differences between groups. RESULTS: More than 80% of the women reported to use some contraception method, the most used method was oral contraceptive (34.2%), followed by surgical (25.9%) and condoms (14.5%). Black/Brown, northerly, and low-educated women are more frequently sterilized, while white women, with higher schooling and those living in the south and southeast are the ones who use oral contraception and double protection the most. CONCLUSION: Despite the observed improvements, there was no decrease in the prevalence for not using any CM and there are inequalities in access to contraception in the country.


Assuntos
Comportamento Contraceptivo , Serviços de Planejamento Familiar , Brasil/epidemiologia , Anticoncepção , Estudos Transversais , Feminino , Humanos
2.
Ethiop J Health Sci ; 31(3): 457-466, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483602

RESUMO

Background: Ethiopia is the second most populous nations in Africa. Family planning is a viable solution to control such fast-growing population. This study aimed to assess the prevalence of contraceptive use and its predictors in Ethiopia. Methods: About 4,563 women were drawn randomly by Central Statistics Agency from its master sampling frame. The survey was conducted from January, 2014 to March, 2016 within six months' interval for the study period. The study was conducted using secondary data collected by PMA2020/Ethiopia project. Negative Binomial regression model was employed for data analysis. The model was selected using information criterion. Results: Predictors like easy access of health service, residence area, level of health institutions, regions, availability of community health volunteers, experience sharing, support from husbands, level of education and employment status of women as well as residence area significantly affected the performance of contraceptive use in Ethiopia. From the interaction effects of health centers with region and health post with number of opening days per a week were significant predictors of the contraceptive use. Conclusion: The performance of contraceptive use was different from one individual to another because of their experience sharing, support from their husbands, employment status and education level. A woman who got encouragement to use birth control from her husband had good performance to be effective for her contraceptive use. There should be an experience sharing/orientation, about use of birth control to protect women from unwanted pregnancy. Hence, rural women should get experience from urban women.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Anticoncepção , Estudos Transversais , Etiópia , Serviços de Planejamento Familiar , Feminino , Humanos , Gravidez
3.
East Mediterr Health J ; 27(8): 818-825, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34486718

RESUMO

Background: Family planning helps to avoid unwanted pregnancy and reduce maternal mortality and morbidity. Contraceptive prevalence is still relatively low (58%) in Iraq compared with other countries in the Eastern Mediterranean Region, and the unmet need (12%) and total fertility (4.2 children per woman) rates are still high. Services are available free of charge or heavily subsidized in many public and private health facilities, yet many women may still not use them due to social, cultural, financial or health care services constraints. Aims: This scoping review explores barriers to family planning services utilization and uptake among women in Iraq. Methods: The review uses an adapted conceptual framework from quality of care and human rights-based frameworks to analyse published scientific studies. Results: At policy level, the government has supported family planning but not enough resources were allocated. At the service level, low family planning promotion from health care providers (especially during antenatal care visits) along with provider bias for certain types of contraception, have contributed to inaccurate information and misconceptions. At the community and individual level, women's choice is still largely influenced by the husband's position on contraception as men are still considered the key decision-makers in regard to fertility. Valuing a large family is still a barrier to family planning services utilization and uptake whereas religion was found to support the use of family planning. Conclusion: There is a need to provide promotional messages and encouraging mutual fertility decisions.


Assuntos
Anticoncepção , Serviços de Planejamento Familiar , Criança , Comportamento Contraceptivo , Países em Desenvolvimento , Feminino , Fertilidade , Humanos , Iraque , Masculino , Gravidez
4.
Am Fam Physician ; 104(2): 164-170, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34383437

RESUMO

Dysmenorrhea is common and usually independent of, rather than secondary to, pelvic pathology. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of reproductive age and is a leading cause of absenteeism. Secondary dysmenorrhea as a result of endometriosis, pelvic anatomic abnormalities, or infection may present with progressive worsening of pain, abnormal uterine bleeding, vaginal discharge, or dyspareunia. Initial workup should include a menstrual history and pregnancy test for patients who are sexually active. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives are first-line medical options that may be used independently or in combination. Because most progestin or estrogen-progestin combinations are effective, secondary indications, such as contraception, should be considered. Good evidence supports the effectiveness of some nonpharmacologic options, including exercise, transcutaneous electrical nerve stimulation, heat therapy, and self-acupressure. If secondary dysmenorrhea is suspected, nonsteroidal anti-inflammatory drugs or hormonal therapies may be effective, but further workup should include pelvic examination and ultrasonography. Referral to an obstetrician-gynecologist may be warranted for further evaluation and treatment.


Assuntos
Anticoncepção/métodos , Anticoncepcionais Orais Hormonais/uso terapêutico , Dismenorreia/terapia , Dismenorreia/diagnóstico , Feminino , Humanos , Ultrassonografia
5.
BMC Womens Health ; 21(1): 320, 2021 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454488

RESUMO

BACKGROUND: This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. CASE PRESENTATION: This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. CONCLUSION: An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.


Assuntos
COVID-19 , Adulto , Anticoncepção , Anticoncepcionais Orais Combinados/efeitos adversos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , SARS-CoV-2
6.
Reprod Health ; 18(1): 177, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454510

RESUMO

BACKGROUND: Women in sub-Saharan Africa (SSA) have a higher risk of unintended pregnancies that are more likely to be terminated, most of which are unsafe with associated complications. Unmet need for contraception is highest in SSA and exceeds the global average. This study investigates the association between unmet/met need for contraception and pregnancy termination SSA. METHODS: We used pooled data from Demographic and Health Surveys conducted from January 2010 to December 2018 in 32 countries in SSA. Our study involved 265,505 women with diverse contraception needs and with complete data on all variables of interest. Multilevel logistic regression at 95% CI was used to investigate the association between individual and community level factors and pregnancy termination. RESULTS: We found an overall pregnancy termination rate of 16.27% ranging from 9.13% in Namibia to 38.68% in Gabon. Intriguingly, women with a met need for contraception were more likely to terminate a pregnancy [aOR = 1.11; 95% CI 1.07-1.96] than women with unmet needs. Women with secondary education were more likely to terminate a pregnancy as compared to those without education [aOR = 1.23; 95% CI 1.19-1.27]. With regards to age, we observed that every additional age increases the likelihood of terminating a pregnancy. At the contextual level, the women with female household heads were less likely to terminate a pregnancy [aOR = 0.95; 95% CI 0.92-0.97]. The least socio-economically disadvantaged women were less likely to terminate a pregnancy compared to the moderately and most socio-economically disadvantaged women. CONCLUSIONS: Our study contributes towards the discussion on unmet/met need for contraception and pregnancy termination across SSA. Women with met need for contraception have higher odds of terminating a pregnancy. The underlying cause of this we argued could be poor adherence to the protocols of contraceptives or the reluctance of women to utilise contraceptives after experiencing a failure. Governments of SSA and non-governmental organisations need to take pragmatic steps to increase met needs for contraception and also utilise mass media to encourage women to adhere to the prescription of contraceptives in order to reduce the incidence of unplanned pregnancies and unsafe abortions.


Assuntos
Aborto Induzido , Anticoncepção , Estudos Transversais , Demografia , Feminino , Humanos , Análise Multinível , Gravidez
7.
BMJ Open ; 11(8): e046536, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408034

RESUMO

OBJECTIVE: To examine the effects of a positive deviance intervention on dual-method contraceptive use among married or in-union women. DESIGN: Open-label cluster randomised controlled trial. SETTING: 20 health facilities in Mbarara District, Uganda. PARTICIPANTS: 960 married or in-union women aged 18-49 years using a non-barrier modern contraceptive method. INTERVENTIONS: A combination of clinic-based and telephone-based counselling and a 1-day participatory workshop, which were developed based on a preliminary qualitative study of women practising dual-method contraception. PRIMARY OUTCOME MEASURE: Dual-method contraceptive use at the last sexual intercourse and its consistent use in the 2 months prior to each follow-up. These outcomes were measured based on participants' self-reports, and the effect of intervention was assessed using a mixed-effects logistic regression model. RESULTS: More women in the intervention group used dual-method contraception at the last sexual intercourse at 2 months (adjusted OR (AOR)=4.12; 95% CI 2.02 to 8.39) and 8 months (AOR=2.16; 95% CI 1.06 to 4.41) than in the control group. At 4 and 6 months, however, the proportion of dual-method contraceptive users was not significantly different between the two groups. Its consistent use was more prevalent in the intervention group than in the control group at 2 months (AOR=14.53; 95% CI 3.63 to 58.13), and this intervention effect lasted throughout the follow-up period. CONCLUSIONS: The positive deviance intervention increased dual-method contraceptive use among women, and could be effective at reducing the dual risk of unintended pregnancies and HIV infections. This study demonstrated that the intervention targeting only women can change behaviours of couples to practise dual-method contraception. Because women using non-barrier modern contraceptives may be more reachable than men, interventions targeting such women should be recommended. TRIAL REGISTRATION NUMBER: UMIN000037065.


Assuntos
Anticoncepcionais , Infecções por HIV , Anticoncepção , Comportamento Contraceptivo , Feminino , Humanos , Masculino , Gravidez , Uganda
8.
Pan Afr Med J ; 39: 39, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422162

RESUMO

Introduction: contraceptives in family planning are used to control the timings between pregnancies. Although the number of those using family planning has increased, determinants of contraceptive use among women in Indonesia remain insufficient. This research aimed to identify the factors associated with contraceptive use among reproductive aged women in Bangka Belitung Province. Methods: this study employed data from the Indonesian demographic and health survey (IDHS) 2017. The selected respondents were 768 women aged 15-49 years. Then, the determinants of contraceptive use among women were examined by multinomial logistic regression. Results: women's aged 15-49 years (adjusted Odds Ratio (aOR) =8.955; 95% CI=3.573-22.439), level of education (aOR=2.017; 95% CI=1.053-3.862), the number of children (aOR=1.207; 95% CI=0.498-2.926), residential location (aOR=0.877; 95% CI=0.601-1.282), wealth index (aOR=2.23; 95% CI=0.953-5.218), visited health facilities (aOR=1.683; 95% CI=1.174-2.412), knowledge of contraceptive method (aOR=2.043; 95% CI=2.043-2.043) were significantly associated with contraceptive use among reproductive age women. Conclusion: factors such as women's age, education, number of living children, area of residence, wealth index, knowledge, and visits to health facilities were still considered significant issues in determining contraceptive use among reproductive-age women in Bangka Belitung Province.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Fatores Etários , Anticoncepção/estatística & dados numéricos , Escolaridade , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Indonésia , Pessoa de Meia-Idade , Adulto Jovem
9.
Reprod Health ; 18(1): 170, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372864

RESUMO

BACKGROUND: The use of a decision aid in clinical settings has been beneficial. It informs and educates patients about the available treatment options that can help them reduce decision-making conflicts related to feeling uninformed compared with routine care. There is a scarcity of published data about using a decision aid during family planning counseling with postpartum women focusing on long-acting reversible contraception in Tanzania. Therefore, we developed a "postpartum Green Star family planning decision aid" and assessed its feasibility. The study outcomes were practicality, usefulness, and acceptability perceived by pregnant adolescents and nurses/midwives. METHODS: We used an exploratory qualitative in-depth interview involving six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15-19 years. Purposive sampling was used to select the participants, and selection relied on the saturation principle of data collection. We used a semi-structured interview guide translated into the Kiswahili language. Data were transcribed and analyzed following inductive content analysis. RESULTS: The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. The study participants perceived the flow of information to be good, with small significant changes suggested. Kiswahili language was used and reported to be appropriate and well elaborated. However, a few words were told to be rephrased to reduce ambiguity. The nurses/midwives said that the decision aid included most of the vital information the participants wanted to know during their family planning counseling. Pregnant adolescents stated that the decision aid improved their knowledge and provided new details on the long-acting reversible contraception methods (intrauterine copper devices and implants) offered immediately after childbirth. The participants stated that the decision aid addressed long-acting reversible contraception methods' benefits and side effects and dispelled myths and misconceptions. The study participants considered the decision aid helpful in complementing the family planning counseling offered and improving pregnant adolescents' knowledge. CONCLUSION: The postpartum Green Star family planning decision aid was practical, useful, and acceptable in enhancing the objectivity of counseling about long-acting reversible contraception methods. It improved the knowledge of pregnant adolescents in Tanzania about the available contraception methods (i.e., the use of intrauterine copper devices and implants), which can be immediately used postpartum. Further research is needed to assess the effects of the decision aid on long-acting reversible contraception postpartum uptake among pregnant adolescents in Tanzania.


Assuntos
Serviços de Planejamento Familiar , Período Pós-Parto , Adolescente , Anticoncepção , Técnicas de Apoio para a Decisão , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Tanzânia
10.
Soc Sci Med ; 284: 114247, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34339927

RESUMO

Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading "hormonophobia", i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.


Assuntos
Contracepção Hormonal , Sexismo , Anticoncepção , Feminino , Fertilidade , Humanos , Masculino , Comportamento Sexual
11.
Int J Equity Health ; 20(1): 186, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412647

RESUMO

BACKGROUND: Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. METHODS: We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. RESULTS: The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls' club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. CONCLUSIONS: This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.


Assuntos
Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Áreas de Pobreza , Saúde Reprodutiva , Adolescente , Adulto , Criança , Anticoncepção , Anticoncepcionais , Atenção à Saúde , Feminino , Humanos , Masculino , Gravidez , Adulto Jovem
12.
Reprod Health ; 18(1): 178, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461925

RESUMO

BACKGROUND: South Africa faces a high burden of unmet contraceptive need, particularly among adolescent girls and young women. Providing contraception in community-based venues may overcome barriers to contraceptive access. Our objective was to explore the potential impact of the social environment and stylist-client interactions on perceived accessibility of contraceptives within hair salons. METHODS: We conducted 42 semi-structured, in-depth interviews with salon clients (100% identified as female, 100% identified as Black, median age 27.1 years) and 6 focus groups with 43 stylists (95% identified as female, 98% identified as Black, median age 29.6 years) in and around Umlazi Township, Durban, KwaZulu-Natal to explore perspectives on offering contraceptive services in hair salons. We used an inductive and deductive approach to generate the codebook, identified themes in the data, and then organized findings according to Rogers' Individual Adoption Model as applied to community-based health prevention programs. Twenty-five percent of transcripts were coded by two independent coders to ensure reliability. RESULTS: We identified elements of the salon environment and stylist-client relationships as facilitators of and barriers to acceptability of salon-based contraceptive care. Factors that may facilitate perceived contraceptive accessibility in salons include: the anonymous, young, female-centered nature of salons; high trust and kinship within stylist-client interactions; and mutual investment of time. Stylists may further help clients build comprehension about contraceptives through training. Stylists and clients believe salon-based contraceptive delivery may be more accessible due to contraceptive need facilitating client buy-in for the program, as well as a salon environment in which clients may encourage other clients by voluntarily sharing their own contraceptive decisions. The non-judgmental nature of stylist-client relationships can empower clients to make contraceptive decisions, and stylists seek to support clients' continued use of contraceptives through various adherence and support strategies. Some stylists and clients identified existing social barriers (e.g. confidentiality concerns) and made recommendations to strengthen potential contraceptive delivery in salons. CONCLUSION: Stylists and clients were highly receptive to contraceptive delivery in salons and identified several social facilitators as well as barriers within this setting. Hair salons are community venues with a social environment that may uniquely mitigate barriers to contraceptive access in South Africa.


Assuntos
Anticoncepção , Anticoncepcionais , Adolescente , Adulto , Feminino , Humanos , Relações Interpessoais , Pesquisa Qualitativa , Reprodutibilidade dos Testes , África do Sul
13.
BMC Public Health ; 21(1): 1498, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344339

RESUMO

BACKGROUND: In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. METHODS: We analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach's alpha test to explore and assess specific and consistently relevant components of women's agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women's agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors. RESULTS: Overall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women's agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06-1.51) associated with mDFPS. For community-level variables, women's greater access to assets (aOR 1.72, 95% CI 1.13-2.61) and family planning messages (aOR 2.68, 95% CI 1.64-4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64-0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52-3.99) to have mDFPS. CONCLUSIONS: Empowering women has the potential to reduce gender inequality, raise women's agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women's rights. TRIAL REGISTRATION: No clinical trial has been performed in this study.


Assuntos
Anticoncepção , Casamento , Burkina Faso , Serviços de Planejamento Familiar , Feminino , Humanos , Análise Multinível , Gravidez
14.
Medicina (Kaunas) ; 57(7)2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34356998

RESUMO

Background and Objectives: Uterine fibroids develop in 25-40% of women of childbearing age; however, there are discrepancies resulting from population and socioeconomic differences. The pathogenesis of fibroids is not clear. The aim of the study was to assess the potential connection between the use of oral contraceptives and the occurrence of uterine fibroids in women of childbearing age. Materials and Methods: In this prospective, survey, case-control study, data were collected from Caucasian female patients (mean age = 30) using a questionnaire concerning the onset, duration and form of hormonal contraception, and medical and obstetrical history. The questionnaires were handed personally to hospitalized patients as well as distributed through Google forms on social media. Results: In a study group (n = 140) of patients using hormonal contraception, 37.8% of them were diagnosed with uterine fibroids, whereas among the patients not using hormonal contraception (n = 206), uterine fibroids were diagnosed in 59.6% of the patients. The most common hormonal contraception was two-component hormonal tablets used by 93.3% of the patients. Taking contraceptives was a uterine fibroids protective factor (OR = 0.4, p = 0.007). In the study group, 5.5% of the patients were pregnant and 60.42% were diagnosed with uterine fibroids (OR = 4.4, p < 0.000001). Conclusion: Contraception was found to be a protective factor for uterine fibroids among the women surveyed. The presented data confirm the theory about the hormonal dependence of uterine fibroids.


Assuntos
Leiomioma , Adulto , Estudos de Casos e Controles , Anticoncepção , Anticoncepcionais Orais/efeitos adversos , Feminino , Humanos , Leiomioma/induzido quimicamente , Leiomioma/epidemiologia , Gravidez , Estudos Prospectivos
15.
BMJ Open ; 11(8): e048048, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341048

RESUMO

OBJECTIVE: We tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico. METHODS: This is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge. RESULTS: Our sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group. CONCLUSION: Women with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.


Assuntos
Anticoncepção , Período Pós-Parto , Comportamento Contraceptivo , Feminino , Humanos , México , Gravidez , Estudos Retrospectivos
16.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34344746

RESUMO

BACKGROUND: Unintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%-10% in 3-month period. METHOD: A fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used. INTERVENTIONS: Daily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers. RESULT: The PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%-35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques. CONCLUSION: Sensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.


Assuntos
Anticoncepção , Serviços de Planejamento Familiar , Dispositivos Intrauterinos , Período Pós-Parto , Melhoria de Qualidade , Adulto , COVID-19 , Anticoncepção/estatística & dados numéricos , Aconselhamento , Feminino , Pessoal de Saúde , Humanos , Índia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Alta do Paciente , Gravidez
17.
Sci Transl Med ; 13(606)2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380769

RESUMO

Many women risk unintended pregnancy because of medical contraindications or dissatisfaction with contraceptive methods, including real and perceived side effects associated with the use of exogenous hormones. We pursued direct vaginal delivery of sperm-binding monoclonal antibodies (mAbs) that can limit progressive sperm motility in the female reproductive tract as a strategy for effective nonhormonal contraception. Here, motivated by the greater agglutination potencies of polyvalent immunoglobulins but the bioprocessing ease and stability of immunoglobulin G (IgG), we engineered a panel of sperm-binding IgGs with 6 to 10 antigen-binding fragments (Fabs), isolated from a healthy immune-infertile woman against a unique surface antigen universally present on human sperm. These highly multivalent IgGs (HM-IgGs) were at least 10- to 16-fold more potent and faster at agglutinating sperm than the parent IgG while preserving the crystallizable fragment (Fc) of IgG that mediates trapping of individual spermatozoa in mucus. The increased potencies translated into effective (>99.9%) reduction of progressively motile sperm in the sheep vagina using as little as 33 µg of the 10-Fab HM-IgG. HM-IgGs were produced at comparable yields and had identical thermal stability to the parent IgG, with greater homogeneity. HM-IgGs represent not only promising biologics for nonhormonal contraception but also a promising platform for engineering potent multivalent mAbs for other biomedical applications.


Assuntos
Imunoglobulina G , Motilidade Espermática , Animais , Anticoncepção , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas , Masculino , Gravidez , Ovinos , Espermatozoides
18.
Sci Rep ; 11(1): 16310, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34381115

RESUMO

The coronavirus disease (COVID-19) has already been declared a global pandemic. To our knowledge, there is very little information regarding the effects of COVID-19 on women seeking reproductive health services, specifically abortion. This study was aimed to assess the impact of the COVID-19 pandemic on reproductive and sexual health among women seeking abortion services. We conducted a series of preliminary analyses using data collected from ten maternal and child health hospitals of seven provinces in China before and during the COVID-19 lockdown. The present study showed that a significant decrease was observed in the frequency of sexual intercourse during the COVID-19 pandemic. Moreover, a significant increase in contraceptive use including condom, rhythm method and coitus interruptus whereas a decrease in choosing oral contraceptives were observed during the COVID-19 pandemic. In addition, the pandemic was associated with increased intention of seeking induced abortion due to social factors. Future research should look into the long-term impact of the COVID-19 pandemic on sexual and reproductive health.


Assuntos
Aborto Induzido , COVID-19/fisiopatologia , Reprodução , Saúde Sexual , Adolescente , Adulto , Estudos de Coortes , Anticoncepção/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Comportamento Sexual , Adulto Jovem
19.
Reprod Health ; 18(1): 173, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419083

RESUMO

OBJECTIVE: To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level. METHODS: Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities. RESULTS: The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies. CONCLUSION: Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.


Assuntos
Anticoncepcionais , Serviços de Planejamento Familiar , Adulto , Anticoncepção , Comportamento Contraceptivo , Feminino , Humanos , Índia , Gravidez
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