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1.
Pan Afr Med J ; 38: 22, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777290

RESUMO

Introduction: all women, including those living with HIV, have the right to choose the timing, spacing, and number of their births and need access to family planning services. This study aimed at assessing the prevalence and factors associated with an unmet need for family planning among women receiving Antiretroviral Therapy (ART) services. Methods: a facility-based cross-sectional study was conducted from March to April 2018 in Gondar city, Ethiopia. A systematic random sampling technique was used to recruit 441 reproductive-age women on ART. The data were collected using a pretested structured questionnaire. The bivariate and backward multivariable logistic regression model was fitted to identify factors associated with the unmet need for family planning. Results: the prevalence of the unmet need for family planning among women living with HIV was 24.5%. Increase in women´s age (AOR: 0.90, 95% CI (0.85, 0.95)), having more than three children (AOR: 0.13, 95% CI (0.04, 0.38)), intention to have more children (AOR: 0.09, 95% CI (0.03, 0.23)), not disclosing sero-status to partner (AOR: 0.40, 95% CI (0.20, 0.82)) and having no experience of contraception use (AOR: 0.43, 95% CI (0.21, 0.90)) were protective factors against unmet need for family planning. Rural residence (AOR: 2.17, 95% CI (1.05, 4.46)) was associated with increased odds of unmet need for family planning. Conclusion: one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Etiópia , Feminino , Humanos , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
3.
Reprod Health ; 18(1): 48, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622358

RESUMO

BACKGROUND: Contraceptive use among adolescent girls is low in many sub-Saharan African countries including Kenya. Attitude and perspectives about contraception of community members including adolescent girls themselves may be likely to limit contraceptive use among adolescent girls. This study was conducted to explore and compare adults'/parents' and adolescent girls' narratives and perspectives about contraception in Narok and Homa Bay counties, Kenya. METHODS: Qualitative data from 45 in-depth-interviews conducted with purposively selected consenting adolescent girls aged 15-19 was used. Additionally, twelve focus group discussions were held with 86 consenting adults conveniently recruited from the two counties. All discussions were conducted in the local language and audio recorded following consent of the study participants. Female moderators were engaged throughout the study making it appropriate for the study to solicit feedback from the targeted respondents. RESULTS: Findings highlighted adults' perceptions on adolescents' sexuality and the presence of stringent conceptions about the side-effects of contraception in the study communities. Some participants underscored the need for open contraceptive talk between parents and their adolescent girls. Four main themes emerged from the discussions; (i) Perceptions about adolescents' sexuality and risk prevention, (ii) Conceptions about contraception among nulligravida adolescents: fear of infertility, malformation and sexual libertinism, (iii) Post-pregnancy contraceptive considerations and (iv) Thinking differently: divergent views regarding contraceptives and parent/adolescent discussion. CONCLUSIONS: Our findings suggest the need for increased attention towards adolescents and their caregivers particularly in demystifying contraceptive misconceptions. Programmatic responses and models which include the provision of comprehensive sexuality education and increased access to and utilization of SRH information, products and services through a well-informed approach need to be well executed. Programmatic efforts like SRH community education should further seek to enhance the capacity of parents to discuss sexuality with their adolescents.


Assuntos
Comportamento Contraceptivo , Casamento , Relações Pais-Filho , Percepção , Psicologia do Adolescente , Adolescente , Comportamento do Adolescente/fisiologia , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Quênia/epidemiologia , Casamento/psicologia , Casamento/estatística & dados numéricos , Relações Pais-Filho/etnologia , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/psicologia , Gravidez na Adolescência/estatística & dados numéricos , Pesquisa Qualitativa , Educação Sexual/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
4.
N Z Med J ; 134(1528): 88-95, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33444309

RESUMO

AIM: This paper offers a grassroots view of the impact of a recent government initiative designed to increase access to contraception and improve health and social outcomes for women in New Zealand. METHOD: District health board and primary health organisation project leads were contacted to request information on how each region had chosen to configure contraception services under the new contract in August 2019, a month after the rollout of the initiative, and again in August 2020. In addition, feedback from individual general practitioners was sought via social media groups. RESULTS: There is significant variation in regional funding and provision of contraception services. Further, complex eligibility criteria can create unnecessary barriers to access for women. CONCLUSION: Variation in funding and access to contraception continues to be a feature of service provision in New Zealand and may have been exacerbated by the recent Ministry of Health funding initiative. This perpetuates inequity, particularly for vulnerable women. Urgent consideration should be given to a whole-of-system approach with contraception being free at the point of access for all women in New Zealand.


Assuntos
Anticoncepção/economia , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Orais/provisão & distribução , Anticoncepcionais Orais/economia , Acesso aos Serviços de Saúde/economia , Humanos , Nova Zelândia
5.
Esc. Anna Nery Rev. Enferm ; 25(3): e20200066, 2021. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1149303

RESUMO

Resumo Objetivos Identificar a prevalência do início da atividade sexual em adolescentes e a prática de sexo seguro entre os mesmos. Método Estudo transversal realizado com 499 adolescentes, em Pouso Alegre, Minas Gerais, de fevereiro a abril de 2017, por meio de um questionário autoaplicado e semiestruturado, contemplando iniciação, práticas sexuais, conhecimento sobre contracepção, prevenção de infecções sexualmente transmissíveis e participação em atividades educativas sobre o tema. Os dados foram analisados por estatística descritiva, as diferenças estatísticas avaliadas pelo teste X2 de Pearson. Resultados A prevalência da atividade sexual foi 47,3%, com idade média da sexarca de 14,1 anos, e tendência de iniciação sexual precoce no sexo masculino. Um terço das primeiras relações sexuais foram desprotegidas (33,9%). As participantes do sexo feminino apresentavam maior conhecimento a respeito de contracepção e prevenção de doenças, menor adesão ao uso de preservativos e maior utilização de contraceptivos orais e de emergência. Conclusão e implicações para a prática O estudo mostrou início precoce de vida sexual entre adolescentes, e um terço das relações sexuais sem proteção. Há necessidade de ações de saúde e educação que garantam a aquisição de conhecimento e acesso a métodos contraceptivos.


Resumen Objetivos Identificar la prevalencia de la actividad sexual en adolescentes y la práctica de sexo seguro entre ellos. Método Estudio transversal realizado con 499 adolescentes, de febrero a abril de 2017, por medio de un cuestionario autoadministrado y semiestructurado, que abarca la iniciación sexual y las prácticas, conocimiento sobre métodos anticonceptivos, prevención de infecciones de transmisión sexual y participación en actividades educativas sobre el tema. Los datos se analizaron mediante estadística descriptiva y las diferencias estadísticas se evaluaron mediante la prueba X2 de Pearson. Resultados La prevalencia de la actividad sexual fue del 47,3%, con una edad promedio de la primera relación sexual de 14,1 años y una tendencia a la iniciación sexual temprana entre los participantes masculinos. Un tercio de las primeras relaciones sexuales fueron desprotegidas (33,9%). Las mujeres participantes tenían mayor conocimiento sobre los métodos anticonceptivos y prevención de enfermedades, menos adherencia al uso del condón y mayor uso de anticonceptivos orales y de emergencia. Conclusión e implicaciones para la práctica El estudio mostró un inicio temprano de la vida sexual entre un grupo de adolescentes y un tercio de las relaciones sexuales sin protección. Se advierte la necesidad de llevar a cabo acciones en materia de salud y educación que garanticen la adquisición de conocimiento y el acceso a métodos anticonceptivos.


Abstract Objective Identify the prevalence of sexual activity initiation in adolescents and the practice of safe sex among them. Method A cross-sectional study carried out with 499 adolescents in Porto Alegre, Minas Gerais, from February to April 2017, using a self-administered and semi-structured questionnaire, covering sexual initiation and practices, knowledge about contraceptive methods, prevention of sexually transmitted infections and participation in educational activities on the theme. The data were analyzed using descriptive statistics and the statistical differences were assessed using Pearson's X2 test. Results The prevalence of sexual activity was 47.3%, with a mean age of 14.1 years old at first sexual intercourse, and a tendency for early sexual initiation in the male gender. One third of the first sexual intercourses were unprotected (33.9%). Female participants had greater knowledge about contraceptive methods and disease prevention, lower adherence to condom use and greater use of oral and emergency contraceptives. Conclusion and implications for the practice The study showed an early initiation of sexual life among adolescents, and one third of unprotected sexual intercourses. There is a need for health and education actions that guarantee the acquisition of knowledge and access to contraceptive methods.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Comportamento Sexual , Sexo Seguro/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudos Transversais , Anticoncepção/estatística & dados numéricos
6.
Esc. Anna Nery Rev. Enferm ; 25(3): e20200180, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1149306

RESUMO

RESUMO Objetivo identificar fatores que potencializam ou interferem no planejamento familiar em região de fronteira. Método pesquisa descritiva, de coorte, transversal e quantitativa, realizada com 280 puérperas, Paraná, Brasil. Para a coleta de dados, aplicou-se um instrumento estruturado com variáveis socioeconômicas, antecedentes obstétricos e planejamento familiar. Para análise, utilizou-se o teste de associação Qui-Quadrado ou o teste G complementado pela análise de resíduos ajustados, com nível de significância de 5% (p<0,05). Resultados idade inferior a 19 anos (66%), baixa renda (65,3%), escolaridade (62,6%), ausência de companheiro (95,6%) e multiparidade (74,4%) foram as características que interferiram no planejamento familiar. Maior escolaridade e acesso a métodos contraceptivos apresentaram-se favoráveis ao planejamento familiar. Mulheres que não planejaram a gravidez aderiram mais aos métodos contraceptivos após seis meses do nascimento do filho. Conclusão e implicações para a prática as baixas condições sociodemográficas interferem na adesão ao planejamento familiar em região de fronteira, o que remete para ajustes no serviço de atenção primária.


RESUMEN Objetivo identificar factores que mejoran o interfieren con la planificación familiar en una región fronteriza. Método investigación descriptiva, de cohorte, transversal y cuantitativa, realizada con 280 puérperas, Paraná, Brasil. Para la recolección de datos se aplicó un instrumento estructurado con variables socioeconómicas, antecedentes obstétricos y planificación familiar. Para el análisis se utilizó la Prueba de Chi-Cuadrado o la Prueba G, complementada con el análisis de residuos ajustados, con un nivel de significancia del 5% (p<0,05). Resultados edad menor de 19 años (66%), bajos ingresos (65,3%), educación (62,6%), ausencia de pareja (95,6%) y multiparidad (74,4%) fueron las características que interfirieron en la planificación familiar. La mayor escolarización y el acceso a métodos anticonceptivos favorecieron la planificación familiar. Las mujeres que no planificaron el embarazo se adhirieron más a los métodos anticonceptivos después de seis meses de parto. Conclusiones e implicaciones prácticas las bajas condiciones sociodemográficas interfieren con la adherencia a la planificación familiar en una región fronteriza, lo que se refiere a ajustes en el servicio de atención primaria.


ABSTRACT Objective to identify factors that enhance or interfere with family planning in border region. Method this descriptive, cohort, cross-sectional, quantitative study was performed with 280 puerperal women in Paraná State, Brazil. For data collection, a structured instrument with socioeconomic variables, obstetric antecedents and family planning was applied. For analysis, the chi-square test or the G test complemented by adjusted residual analysis was used, with a significance level of 5% (p <0.05). Results age below 19 years (66%), low income (65.3%) and education (62.6%), absence of a partner (95.6%) and multiparity (74.4%) were the characteristics that interfered with family planning. Greater education level and access to contraceptive methods were favorable to family planning. Women who did not plan for pregnancy more adhered to contraceptive methods six months after the birth of their child. Conclusion and implications for practice low sociodemographic conditions interfere with adherence to family planning in a border region, which refers to adjustments in the primary care service.


Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Áreas de Fronteira , Planejamento Familiar , Fatores Socioeconômicos , Estudos Transversais , Anticoncepção/estatística & dados numéricos
7.
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495

RESUMO

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
8.
PLoS One ; 15(10): e0239903, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052975

RESUMO

INTRODUCTION: Modern contraceptive use during the first year postpartum potentially prevents unplanned pregnancies and help to improve maternal and child health. Therefore, identifying factors associated with contraceptive utilization among women of reproductive age during extended postpartum period is essential. OBJECTIVE: This study aimed to assess factors associated with modern contraceptives use among postpartum women in Bukombe District, Geita region. METHOD: A community-based cross-sectional study was conducted among women who were in their first year after child birth in Bukombe district. A total of 511 women were included using multistage sampling techniques. Data were collected using a structured questionnaire. Data analysis was performed using Stata 15 (College Station, Texas, USA). RESULTS: The prevalence of postpartum modern contraceptive was 11.9%. The most frequently used method was implant (6.5%). Most women started to use the contraceptive during the first three months after delivery. Living in urban (AOR = 1.85, 95% CI: 1.20-3.79), having business (AOR = 2.35, 95% CI: 1.31-2.28), last born aged 3-4 months (AOR = 3.31, 95% CI: 1.11-9.85) and menses resumption (AOR = 9.24, 95% CI: 3.60-23.72) were predictors for postpartum contraceptive use. However, fear of side effects, poor knowledge about contraceptives, husband restrictions, distance to health facility and contraceptive availability were reported as barriers for postpartum modern contraceptive use. CONCLUSION: Prevalence of postpartum modern contraceptive use in the study area is still low. Numerous factors were reported as barriers for postpartum contraceptive use. A strategy such as health education on befits of post-partum modern contraceptive use and counseling women about side effects may help to improve its uptake.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Uso de Medicamentos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Fatores Socioeconômicos , Tanzânia
10.
BMC Med Inform Decis Mak ; 20(1): 218, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912201

RESUMO

BACKGROUND: The objectives of this study were to 1) measure the percentage of women who received SMS-based family planning communication, and 2) its association with modern contraception and maternal healthcare services among mothers. In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning and reproductive health. However, little is known regarding the role of SMS-based family planning communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. METHODS: Cross-sectional data on 94,675 mothers (15-49 years) were collected from the latest Demographic and Health Surveys in 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic maternal healthcare services (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. RESULTS: The coverage of SMS-based family planning communication for the pooled sample was 5.4% (95%CI = 3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI = 3.38, 8.70) compared with Asia (5.23, 95%CI = 1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI = 11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI = 1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI = 1.95, 2.83). The strength of the association was highest for Senegal (OR = 4.70, 95%CI = 1.14, 7.33) and lowest for Burundi (OR = 1.5; 95%CI = 1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. CONCLUSION: Although positively associated with using facility delivery services, receiving SMS on family planning does not appear to affect modern contraceptive use and other components of maternal healthcare services such as timely and adequate utilisation of antenatal care.


Assuntos
Telefone Celular , Comunicação , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Serviços de Saúde Materna/estatística & dados numéricos , Envio de Mensagens de Texto , Adolescente , Adulto , África ao Sul do Saara , Estudos Transversais , Assistência à Saúde/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
11.
PLoS One ; 15(9): e0239376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966322

RESUMO

BACKGROUND AND OBJECTIVE: India contributes a major share of global unintended births. It is established that contraception plays a significant role in preventing unintended pregnancies, maternal mortality and induced abortion. In this study, to analyze the effectiveness of our family welfare program, we tried to give district-level estimates of number of births averted due to contraception. DATA AND METHODS: Data for this study came from the cross-sectional, population-based data from the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Here, we discussed two methods based on robust regression for computing number of births averted at district level. Further, we analyzed the percentage increase in births (PIB) that would be experienced by each district in the absence of contraception. RESULTS: Findings of this study clearly showed that there was a huge variation in the estimates of number of births averted among different districts as well as states of India. Out of 640 districts, 315 districts achieved below-replacement fertility and 365 districts have contraceptive prevalence rate (CPR) more than 50 percent. Method 1 found around 22 percent districts showed less than 15 percent reduction in births while Method 2 suggested nearly 14 percent districts predominantly located in Uttar Pradesh, Bihar, Jharkhand, Arunachal Pradesh, Meghalaya and Manipur exhibited less than 30 percent reduction of births due to use of all forms of contraception. At all India level, an average estimate obtained by two methods, nearly 63 million births would have been averted by the use of contraception or 40 percent more than the number of births occurred during that period. CONCLUSION: The study successfully identified the districts that were not performing well at the front of utilization of various family planning methods for birth control. To achieve objectives of National Population Policy (2000), poor-performing districts must be monitored like the government keeps monitoring of Aspirational districts.


Assuntos
Anticoncepção/estatística & dados numéricos , Parto , Adulto , Feminino , Humanos , Índia , Gravidez , Educação Sexual , Inquéritos e Questionários
12.
Cochrane Database Syst Rev ; 8: CD013680, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32779730

RESUMO

BACKGROUND: The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES: To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS: We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS: TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Comunicação , Saúde Reprodutiva/normas , Saúde Sexual/normas , Aborto Legal/estatística & dados numéricos , Adolescente , Anticoncepção/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Sexualmente Transmissíveis , Envio de Mensagens de Texto , Incerteza , Adulto Jovem
14.
PLoS One ; 15(8): e0236352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760153

RESUMO

INTRODUCTION: Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS: Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS: The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION: This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , África ao Sul do Saara , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Civil/estatística & dados numéricos , Análise Multinível/métodos , Fatores Socioeconômicos , Adulto Jovem
15.
BMC Public Health ; 20(1): 1025, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600290

RESUMO

BACKGROUND: Many unmarried young people in low- and middle-income countries (LMIC) want to avoid pregnancy but do not use modern methods of contraception-as a result, half of teen births in these countries are unintended. Researchers have identified numerous barriers that prevent youth from using contraception. However, much of the research in West Africa is narrowly focused on married women, and relatively little research has been done to understand the needs, preferences, barriers, and solution set for sexually active unmarried young people who would like to avoid pregnancy. The purpose of this study was to gain insight into the behavioral barriers that prevent unmarried young people in eastern Senegal from using modern methods of contraception. METHODS: This qualitative study conducted in 2017 in the Tambacounda and Kedougou regions in Senegal explores attitudes and beliefs relating to sex and contraception among unmarried young women and men through 48 in-depth individual interviews with young people aged 15-24 and parents of youth and 5 sex-segregated focus groups with 6-9 young people per group. The research team conducted a thematic content analysis and synthesized the findings by major theme following the behavioral diagnosis methodology. RESULTS: Drawing insights from behavioral science, the analysis yields five key findings: (1) unmarried young people avoid making a decision about contraception because thinking about contraceptive use provokes uncomfortable associations with a negative identity (i.e., being sexually active before marriage); (2) unmarried young people see modern methods as inappropriate for people like them; (3) unmarried young people are overconfident in their ability to prevent pregnancy through traditional and folk methods; (4) unmarried young people overestimate the social and health risks of modern contraceptive methods; and (5) unmarried young people fail to plan ahead and are not prepared to use modern contraceptive methods before every sexual encounter. CONCLUSIONS: Interventions aimed at increasing uptake of contraceptives among unmarried young people in eastern Senegal must address several significant behavioral barriers in addition to structural, informational, and socio-cultural barriers in order to be successful.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Gravidez na Adolescência/psicologia , Comportamento Sexual/psicologia , Pessoa Solteira/psicologia , Adolescente , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Masculino , Gravidez , Gravidez na Adolescência/prevenção & controle , Pesquisa Qualitativa , Senegal , Adulto Jovem
16.
Am J Public Health ; 110(8): 1214-1220, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552027

RESUMO

Objectives. To measure changes in the contraceptive methods used by Title X clients after implementation of Delaware Contraceptive Access Now, a public-private initiative that aims to increase access to contraceptives, particularly long-acting reversible contraceptives (LARCs).Methods. Using administrative data from the 2008-2017 Family Planning Annual Reports and a difference-in-differences design, we compared changes in contraceptive method use among adult female Title X family planning clients in Delaware with changes in a set of comparison states. We considered permanent methods, LARCs, moderately effective methods, less effective methods, and no method use.Results. Results suggest a 3.2-percentage-point increase in LARC use relative to changes in other states (a 40% increase from baseline). We were unable to make definitive conclusions about other contraceptive method types.Conclusions. Delaware Contraceptive Access Now increased LARC use among Title X clients. Our results have implications for states considering comprehensive family planning initiatives.


Assuntos
Comportamento Contraceptivo , Anticoncepção , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Comportamento Contraceptivo/estatística & dados numéricos , Comportamento Contraceptivo/tendências , Delaware , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Pobreza , Parcerias Público-Privadas , Estados Unidos
18.
JAMA Netw Open ; 3(6): e206874, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32496568

RESUMO

Importance: Use of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net. Objective: To evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception). Design, Setting, and Participants: This was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk for pregnancy, with an ambulatory care visit at a participating community health center during the study period (315 clinics in expansion states and 165 clinics in nonexpansion states). Exposures: Medicaid expansion status (by state). Main Outcomes and Measures: Two National Quality Forum-endorsed contraception quality metrics, calculated annually: the proportion of women at risk of pregnancy who received (1) either a moderately effective or most effective method (hormonal and long-acting reversible contraception) methods and (2) the most effective method (long-acting reversible contraception). Results: The sample included 310 132 women from expansion states and 235 408 women from nonexpansion states. The absolute adjusted increase in use of long-acting reversible contraceptive methods was 0.58 (95% CI, 0.13-1.05) percentage points greater among women in expansion states compared with nonexpansion states in 2014 and 1.19 (95% CI, 0.41-1.96) percentage points larger in 2016. Among adolescents, the association was larger, particularly in the longer term (2014 vs 2013: absolute difference-in-difference, 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013: absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states. Conclusions and Relevance: In this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicaid/organização & administração , Patient Protection and Affordable Care Act , Adolescente , Adulto , Estudos Transversais , Registros Eletrônicos de Saúde , Serviços de Planejamento Familiar/estatística & dados numéricos , Serviços de Planejamento Familiar/provisão & distribução , Feminino , Humanos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
19.
PLoS One ; 15(6): e0234463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525965

RESUMO

The affordability of pharmaceuticals has been a major challenge in US health care. Generic substitution has been proposed as an important tool to reduce the costs, yet little is known how the prices of more expensive brand-name drugs would be affected by an increased utilization of generics. We aimed to examine the trend of overall utilization and the total costs of brand-name oral contraceptive pills (OCPs), the most widely used form of contraception, and its association with the pharmaceutical market concentration among the OCPs. Data from the Medical Expenditure Panel Survey (MEPS) 2011-2014, a nationally representative survey of healthcare utilization, were extracted on the utilization of generic and brand-name OCPs. A multiple logit regression analysis was conducted to assess the trend in utilization of brand-name OCPs over time. Total costs, including the costs to the payers and consumers, were synthesized. The Herfindahl-Hirschman Index (HHI), an index describing market concentration, was constructed, and a multiple regression analysis was conducted to evaluate the association between the brand-name OCP prices and the market share of individual brand-name drugs. The odds of utilizing brand-name drugs decreased steadily in 2012, 2013, and 2014 compared to 2012 (AOR 0.87, 0.73, 0.55, respectively, p<0.05) controlling for patient mix. Despite significant decline in total utilization, there was a 90% increase in the price of brand-name OCPs, resulting an 18% increase in revenue from 2011 to 2014 for the industry. During this time, pharmaceutical market concentration for OCPs increased (HHI increased from 1105 in 2011 to 2415 in 2014). Each percentage point increase in the market share by a brand-name OCPs was associated with a $3.12 increase in its price. Market mechanisms matter. Practitioners and policy makers need to take market mechanisms into account in order to realize the benefits of generic substitutions.


Assuntos
Anticoncepcionais Orais Combinados/economia , Custos de Medicamentos/tendências , Indústria Farmacêutica/tendências , Uso de Medicamentos/tendências , Gastos em Saúde/tendências , Adulto , Anticoncepção/economia , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Comportamento Contraceptivo/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Indústria Farmacêutica/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Competição Econômica/estatística & dados numéricos , Competição Econômica/tendências , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/estatística & dados numéricos , Humanos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , Adulto Jovem
20.
Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527659

RESUMO

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Gravidez na Adolescência/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais , Feminino , Direitos Humanos , Humanos , Gravidez
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