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2.
Reprod Health ; 16(1): 55, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088518

RESUMO

INTRODUCTION: Postabortion contraceptive use differs across countries, suggesting the need for country-level research to identify barriers and suggest appropriate interventions. This study aimed to identify the prevalence and correlates of postabortion long-acting reversible contraceptive (LARC) use among women aged 24 or younger in Nepal. METHODS: This is a cohort study using Health Management Information System (HMIS) data where individual case records of women seeking induced abortion or postabortion care were documented using structured HMIS 3.7 records. Analysis was performed on the individual case records of 20,307 women 24 years or younger who received induced abortion or postabortion care services in the three-year period from July 2014 to June 2017 at 433 public and private health facilities. FINDINGS: Overall, LARC uptake during the study period was 11% (IUD: 3% and implant: 8%). The odds of LARC acceptance was higher for young women (24 and below) who belonged to Brahmin/Chhetri (AOR = 1.23; 95% CI: 1.02-1.47) and Janajatis (AOR = 1.20; 95% CI: 1.01-1.43) as compared to Dalits; young women who had an induced abortion (AOR = 3.75; 95% CI: 1.75-8.06) compared with postabortion care; and those receiving service from public sector health facilities (AOR = 4.00; 95% CI: 2.06-7.75) compared with private sector health facilities. CONCLUSION: The findings from this study indicate the need to focus on barriers to acceptance of LARC among several groups of young women (24 and below) receiving abortion care in Nepal: Dalits, Madhesis and Muslims; nulliparous women; and those receiving services at private sector health facilities.


Assuntos
Comportamento Contraceptivo/tendências , Contracepção Reversível de Longo Prazo , Aborto Induzido/estatística & dados numéricos , Assistência ao Convalescente , Estudos de Coortes , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Humanos , Nepal , Gravidez , Gravidez não Planejada , Adulto Jovem
3.
Malawi Med J ; 31(1): 56-64, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143398

RESUMO

Background: Most existing studies on unintended pregnancies tend to examine the influence of individual socio-demographic and health characteristics without sufficient attention to community characteristics. This study examines community characteristics influencing unintended pregnancies in Kenya. Methods: Data were extracted from the 2014 Kenya Demographic and Health Survey (KDHS). The outcome variable was unintended pregnancy. The explanatory variables were selected individual and community level variables. The Multilevel mixed-effects logistic regression was applied. Results: Findings show 41.9% prevalence of unintended pregnancies. Community characteristics such as community education, community timing for initiation of childbearing, community fertility norms, and community media exposure significantly influence the likelihood of unintended pregnancies. The Intra-Cluster Correlation (ICC) provided evidence that community characteristics had effects on unintended pregnancies. Conclusion: There is evidence that community characteristics influence the prevalence of unintended pregnancies in Kenya. Community sensitisation and mobilisation should be central to all efforts aiming to reduce prevalence of unintended pregnancies.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Gravidez não Planejada/etnologia , Características de Residência , Adolescente , Adulto , Comportamento Contraceptivo , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Quênia/epidemiologia , Análise Multinível , Gravidez , Gravidez não Planejada/psicologia , Prevalência , Meio Social , Fatores Socioeconômicos , Adulto Jovem
4.
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
5.
BMC Public Health ; 19(Suppl 1): 605, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138154

RESUMO

BACKGROUND: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa. METHODS: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT. RESULTS: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV. CONCLUSION: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , HIV , Infecções por HIV/transmissão , Humanos , Gravidez , Gravidez não Planejada/psicologia , África do Sul/epidemiologia , Adulto Jovem
6.
Int J Public Health ; 64(5): 743-754, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041453

RESUMO

OBJECTIVES: To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries. METHODS: A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics. RESULTS: A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25-39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted). CONCLUSIONS: Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Gravidez não Planejada/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pobreza/psicologia , Gravidez , Cuidado Pré-Natal/psicologia , Estudos Prospectivos , Estudos Retrospectivos
7.
BMC Health Serv Res ; 19(1): 207, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935394

RESUMO

BACKGROUND: In 2016, Oregon became the first of eight states to allow pharmacists to directly prescribe hormonal contraception (HC), including the pill, patch, or ring, without a clinic visit. In the two years following this policy change, the majority of ZIP codes across the state of Oregon had a pharmacist certified to prescribe HC. METHODS: We will utilize complementary methodologies to evaluate the effect of this policy change on convenient access to contraception (cost, supply dispensed), safety, contraceptive continuation and unintended pregnancy rates. We will conduct a prospective clinical cohort study to directly measure the impact of provider type on contraceptive continuation and to understand who is accessing hormonal contraception directly from pharmacists. We will concurrently conduct a retrospective analysis using medical claims data to evaluate the state-level effect of the policy. We will examine contraceptive continuation rates, incident pregnancy, and safety measures. The combination of these methodologies allows us to examine key woman-level factors, such as pregnancy intention and usual place of care, while also estimating the impact of the pharmacist prescription policy at the state level. DISCUSSION: Pharmacist prescription of HC is emerging nationally as a strategy to reduce unintended pregnancy. This study will provide data on the effect of this practice on convenient access to care, contraceptive safety and continuation rates.


Assuntos
Anticoncepcionais Femininos , Prescrições de Medicamentos , Legislação de Medicamentos , Farmacêuticos/legislação & jurisprudência , Feminino , Acesso aos Serviços de Saúde , Humanos , Oregon , Assistência Farmacêutica/legislação & jurisprudência , Gravidez , Taxa de Gravidez , Gravidez não Planejada , Estudos Prospectivos , Projetos de Pesquisa , Estudos Retrospectivos
8.
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
9.
Afr J Reprod Health ; 23(1): 65-72, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31034173

RESUMO

Adolescent's sexual and reproductive health is a challenge in many low and middle-income countries. We assessed the knowledge and attitude towards sexual and reproductive health among adolescents in West Shoa zone, Oromia region, Ethiopia. The study was cross-sectional using simple multi-stage random sampling and a structured questionnaire was used to collect data among adolescents aged 15 - 19 years. Frequency distribution of dependent and independent variables were computed and Odds ratios were calculated to determine association between variables. Most participants were from poor and illiterate families. Slightly over half of them had heard about sexual and reproductive health and the knowledge of emergency contraceptive was limited. About 80% of the girls who had become pregnant ended the pregnancy with an abortion and discussion between parents and adolescents on sexuality issues were poor. Effort to empower adolescents and communities with correct sexual and reproductive health is required; academic curricula should be reviewed and health facilities should be engaged to provide sexuality education.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva , Saúde Sexual , Adolescente , Criança , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Gravidez , Gravidez não Planejada , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudantes , Adulto Jovem
10.
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
11.
BMC Pregnancy Childbirth ; 19(1): 121, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961542

RESUMO

BACKGROUND: Unintended pregnancies are associated with negative consequences to both mother and baby. Female Sex Workers (FSWs) are at high risk of unintended/unplanned pregnancies. However, prevalence of pregnancy planning and its predictors among FSWs has not been comprehensively investigated. This study was designed to determine contraceptive use, the prevalence, and predictors of pregnancy planning among FSWs in Uganda. METHODS: In this cross-sectional study, 819 FSWs attending most at risk populations initiative (MARPI) clinics were recruited using systematic sampling and interviewed with a pretested questionnaire that included collection of data on pregnancy intention using the London Measure of Unplanned Pregnancy (LMUP). Data were analysed using STATA version 14.0. Multinomial logistic regression model was used to identify predictors of pregnancy planning, RESULTS: Of the 819 study participants, only 90 (11.0%) had planned pregnancies. Overall, 462 (56.4%) were hazardous alcohol users and 335 (40.9%) abused drugs; 172 (21.0%) had been raped in the last 2 years and 70 (40.7%) of these accessed emergency contraception post-rape. Dual contraception use (condom and other modern method) was 58.0%. Having a non-emotional partner as a man who impregnated the FSW compared to emotional partner was significantly associated with less planned relative to unplanned pregnancy, (aRR = 0.15 95%Cl =0.08, 0.30), so was lack of reported social support compared to support from friends, (aRR = 0.44; 95% CI = 0.22-0.87), keeping all factors constant in the model. Being raped (aRR = 0.51; 95% CI = 0.31-0.84) or abuse of substances (aRR = 0.65; 95% CI = 0.45-0.93) were significantly associated with lower ambivalence relative to unplanned pregnancy but not with planned relative to unplanned pregnancy. CONCLUSION: Compared to women in the general population, pregnancy planning was low among FSWs amidst modest use of dual contraceptive. There is an urgent need to promote dual contraception among FSWs to prevent unplanned pregnancies especially with non-emotional partners, drug users, and post-rape.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo/psicologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Gravidez , Gravidez não Planejada/psicologia , Prevalência , Fatores de Risco , Profissionais do Sexo/psicologia , Parceiros Sexuais/psicologia , Uganda/epidemiologia , Adulto Jovem
12.
Reprod Health ; 16(1): 36, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894174

RESUMO

BACKGROUND: Estimates of pregnancies, abortions and pregnancy intentions can help assess how effectively women and couples are able to fulfil their childbearing aspirations. Abortion incidence estimates are also a necessary foundation for research on the safety of abortions performed and the consequences of unsafe abortion. Furthermore, periodic estimates of these indicators are needed to help inform policy and programmes. METHODS: We will develop a Bayesian hierarchical times series model which estimates levels and trends in pregnancy rates, abortion rates, and percentages of pregnancies and births unintended for each five-year period between 1990 and 2019. The model will be informed by data on abortion incidence and the percentage of births or pregnancies that were unintended. We will develop a data classification process to be applied to all available data. Model-based estimates and associated uncertainty will take account of data sparsity and quality. Our proposed approach will advance previous work in two key ways. First, we will estimate pregnancy and abortion rates simultaneously, and model the propensity to abort an unintended pregnancy, as opposed to modeling abortion rates directly as in prior work. Secondly, we will produce estimates that are reproducible at the country level by publishing the data inputs, data classification processes and source code. DISCUSSION: This protocol will form the basis for updated global, regional and national estimates of intended and unintended pregnancy rates, abortion rates, and the percent of unintended pregnancies ending in abortion, from 1990 to 2019.


Assuntos
Aborto Induzido/estatística & dados numéricos , Intenção , Taxa de Gravidez , Teorema de Bayes , Feminino , Humanos , Incidência , Gravidez , Gravidez não Planejada
13.
J Pregnancy ; 2019: 2920491, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30834145

RESUMO

Background: Unintended pregnancy is seen as the key concept for better understanding the fertility and the unmet need for family planning of populations. It is seen as a major challenge among women in many developing countries including Ghana. However, there is scarcely nationally representative information on its prevalence and predictors in Ghana. Methods: In a cross-sectional study design, data for this study were extracted from the 2014 Ghana Demographic and Health Survey. The prevalence of unintended pregnancies was computed, and logit regression models were fitted to predict the factors influencing unintended pregnancies in the country. Results: The total prevalence of unintended pregnancies among pregnant women in Ghana was found to be 40%. Background characteristics such as age (OR=4.85, CI=1.48-15.84), level of education (OR=0.50, CI=0.26-1.01), marital status (OR=3.83, CI=1.67-8.75), parity (OR=0.13, CI=0.05-0.32), and region of residence (OR=0.11, CI=0.03-0.31) were the significant predictors of unintended pregnancy, net of unmet need for contraception. However, unmet need for contraception (OR=7.13, CI=1.57-8.91) serves as an independently significant predictor of unintended pregnancy regardless of the background characteristics of respondents. Conclusions: The study findings strongly underscore the need for significant improvement in the access to contraception methods and family planning information in the quest to considerably reduce unintended pregnancies in the entire country.


Assuntos
Gravidez não Planejada , Gravidez/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Previsões , Gana/epidemiologia , Humanos , Modelos Logísticos , Estado Civil , Pessoa de Meia-Idade , Prevalência , Educação Sexual , Adulto Jovem
14.
BMC Res Notes ; 12(1): 161, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30902066

RESUMO

OBJECTIVE: The purpose of this study was to assess prevalence and associated factors of unintended pregnancy among pregnant women in Gondar town, North western Ethiopia, 2014. A community based cross-sectional study was conducted among pregnant women to select 325 participants for face to face interview by using simple random sampling technique from April 1-May 30, 2014. Bivariate and multivariate data analysis was performed using SPSS for Windows version 20 and level of significance of association was determined at P value < 0.05. RESULT: This study identified that 20.6% of pregnant women were unintended of which 6.8 were mistimed and 13.8 were unwanted. Unintended pregnancy was associated with family size (≥ 4) (AOR = 2.92; 95% CI 1.605, 5.31), marital status (single) (AOR = 12.59; 95% CI 5.18, 30.6) and age at first pregnancy < 18 years AOR (95% CI) 3.02 (1.522, 6.245). Therefore it is important to adequately counsel women concerning positive mind-sets about its prevention mechanism and its consequences of unintended pregnancies.


Assuntos
Gravidez não Planejada , Comportamento Reprodutivo/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores Socioeconômicos , Adulto Jovem
15.
Exp Clin Transplant ; 17(Suppl 1): 159-163, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777545

RESUMO

To avoid graft rejection during pregnancy, frequent monitoring of serum drug levels is recommended. Pregnancy induces hyperfiltration in transplanted kidneys, as in native kidneys; therefore, detection of rejection can be difficult when monitoring by serum creatinine. If rejection is suspected, ultrasonographguided graft biopsy can be done; once proven, it can be treated with pulse steroids, but data are scarce regarding other agents. Here, we present a 28-year-old pregnant female patient with resistant acute rejection but with successful pregnancy outcome. Our patient had end-stage kidney disease secondary to lupus nephropathy and underwent living-donor renal transplant in May 2013 after hemodialysis support for 1 year. She received thymoglobulin as induction therapy and was maintained on prednisolone, mycophenolate mofetil, and tacrolimus. She had normal renal graft function without proteinuria. After she received counseling, she became pregnant in February 2015. In June 2015, she presented with acute graft dysfunction with serum creatinine level of 365 µmol/L. Her abdominal ultrasonography showed mild hydronephrosis and viable fetus. She received empirical pulse steroids with partial response, and her graft biopsy showed acute T-cell-mediated rejection and negative C4d. Intravenous immunoglobulins and minipulse steroids were administered but without response. After gynecologic counseling and informed consent, she received 5 doses of thymoglobulin. She was dialysis dependent until premature vaginal labor, which resulted in birth of a viable 2-kg boy. We suggest that successful pregnancy outcomes could occur with close monitoring and daily dialysis in female kidney transplant patients with resistant rejection.


Assuntos
Soro Antilinfocitário/uso terapêutico , Resistência a Medicamentos , Rejeição de Enxerto/imunologia , Imunidade Celular , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Gravidez não Planejada , Linfócitos T/imunologia , Doença Aguda , Adulto , Soro Antilinfocitário/efeitos adversos , Substituição de Medicamentos , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/terapia , Humanos , Imunidade Celular/efeitos dos fármacos , Imunossupressores/efeitos adversos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Transplante de Rim/métodos , Nascimento Vivo , Doadores Vivos , Nefrite Lúpica/complicações , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Gravidez , Diálise Renal , Fatores de Risco , Linfócitos T/efeitos dos fármacos , Tacrolimo/uso terapêutico , Resultado do Tratamento
16.
J Affect Disord ; 248: 139-146, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30731281

RESUMO

BACKGROUND: Up to 10-15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories. METHODS: Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P)DS). Growth mixture modeling was used to identify trajectories of depressive symptoms during pregnancy. RESULTS: Three trajectories of depressive symptoms (E(P)DS scores) were identified: low stable (class 1, reference group, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly higher mean E(P)DS scores (7-13 throughout pregnancy) compared to the reference group (stable; E(P)DS <4). Factors associated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, and unplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partner involvement experienced by women during their pregnancies. Class 2 (with decreasing E(P)DS scores) reported high partner involvement, while class 3 (with increasing E(P)DS scores) reported poor partner involvement throughout pregnancy. LIMITATIONS: Depressive symptoms were assessed by self-report rather than a diagnostic interview. The participants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch population. CONCLUSIONS: Poor partner involvement was associated with increasing depressive symptoms during pregnancy. Health professionals should focus on partner involvement during pregnancy in order to identify women who are potentially vulnerable for perinatal depression.


Assuntos
Depressão/psicologia , Complicações na Gravidez/psicologia , Trimestres da Gravidez/psicologia , Adulto , Feminino , Humanos , Acontecimentos que Mudam a Vida , Gravidez , Gravidez não Planejada , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Autorrelato , Parceiros Sexuais/psicologia , Adulto Jovem
17.
Womens Health Issues ; 29(2): 153-160, 2019 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30723058

RESUMO

INTRODUCTION: Low-income and young women experience disproportionately high rates of unintended pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators of financial status, particularly during emerging adulthood. This study investigates the relationship between financial strain and contraceptive use, focusing on the differential effects by age group. METHODS: Multinomial logistic regression analyses assessed the relationship between financial strain and contraceptive use in a national sample of U.S. women ages 18-39 years (N = 932). Models were adjusted for income, employment status, and other sociodemographic characteristics and tested the interaction of financial strain and age group. RESULTS: Women with high financial strain were less likely to use short-acting methods (compared with using no method) in the adjusted model; when the age and financial strain interaction was included, associations held only for women ages 18-24 and 25-29 years of age. Relative to contraceptive nonuse, women ages 18-24 years with high financial strain were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95% confidence interval [CI], 0.01-0.99) and short-acting hormonal (RRR, 0.03; 95% CI, 0.00-0.18) methods. Women ages 25-29 with high financial strain were less likely to use short-acting hormonal (RRR, 0.20; 95% CI, 0.05-0.87) and coital-specific (RRR, 0.11; 95% CI, 0.02-0.51) methods. IMPLICATIONS FOR PRACTICE AND/OR POLICY: Young women may be vulnerable to the effect of high financial strain on contraceptive nonuse. Providers working with this group should consider incorporating financial strain into screening tools to identify patients who may need extra attention in contraceptive decision-making conversations. Antipoverty programs could also have a positive effect on effective contraceptive use.


Assuntos
Comportamento Contraceptivo , Anticoncepção/economia , Anticoncepcionais Femininos/economia , Tomada de Decisões , Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Adolescente , Adulto , Feminino , Humanos , Renda , Modelos Logísticos , Razão de Chances , Gravidez , Gravidez não Planejada , Estados Unidos , Adulto Jovem
18.
Womens Health Issues ; 29(2): 161-169, 2019 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30797632

RESUMO

OBJECTIVES: Given persistent racial/ethnic disparities in unintended pregnancies, this study aims to understand factors associated with emergency contraception (EC) use among non-Hispanic White, non-Hispanic Black, and Hispanic women. METHODS: This study used a nationally representative sample of 1,990 women of reproductive age in the United States who participated in the 2016 Survey of Family Planning and Women's Lives. Logistic regressions were estimated to assess the association of sexual/pregnancy history, attitudes toward pregnancy, attitudes toward contraception, awareness and beliefs about EC, and source of information regarding contraception with ever using EC. RESULTS: After adjusting for demographic characteristics, we found no significant differences in ever using EC by race/ethnicity. Among non-Hispanic White women, those who used barrier methods of contraception, reported a previous unplanned pregnancy, reported having heard some or a lot about EC, and believed that EC is somewhat to very effective had higher odds of EC use. Among non-Hispanic Black women, those who reported a previous unplanned pregnancy and believed that EC was somewhat to very effective had higher odds of EC use. Among Hispanic women, those who reported using long-acting reversible contraceptives, having recent male sexual partners, and believing that EC is both somewhat to very safe and effective had higher odds of EC use. CONCLUSIONS: Awareness and beliefs about safety and effectiveness are modifiable factors that may influence EC use. Population-level interventions can focus on improving awareness and understanding of the safety and effectiveness of EC.


Assuntos
Conscientização , Grupos de Populações Continentais , Comportamento Contraceptivo , Anticoncepção Pós-Coito , Grupos Étnicos , Conhecimentos, Atitudes e Prática em Saúde , Mulheres , Adolescente , Adulto , Afro-Americanos , Anticoncepcionais Femininos , Emergências , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Modelos Logísticos , Masculino , Gravidez , Gravidez não Planejada , Parceiros Sexuais , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
19.
Isr J Health Policy Res ; 8(1): 21, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717783

RESUMO

Israel has compulsory military service, beginning at the age of 18. Women serve about two years and men for about three years. However, de facto only some of the potential service entrants are recruited. Among women, those who enlist are mainly secular Jews who are unmarried; among men, most of the ultra-Orthodox Jews do not enlist. In addition, only a fraction of the recruits chooses to turn the military service into a career and sign up for additional service as professional military personal (officers and non-commissioned officers). Thus, military personnel are not representative of the general Israeli population, even after controlling for age.The rate of pregnancies among female soldiers (obligatory service) in the Israeli army is low, but almost all pregnancies in this group are unplanned and most result in termination of pregnancy. An unplanned pregnancy carries a direct impact on the service of that female soldier and consequently on the military's routine.In a recent article in the Israel Journal of Health Policy Research (IJHPR), Rottenstreich et al. (IJHPR 7:42, 2018) describe a retrospective cohort study designed to evaluate the prevalence and risk factors for repeated unintended pregnancies among this population of female soldiers.This commentary presents the current IDF policy intended to further reduce unplanned pregnancies and repeat unplanned pregnancies rates. We also suggest additional tools to support evidence-based strategy planning in this field.


Assuntos
Militares , Gravidez não Planejada , Feminino , Humanos , Israel , Masculino , Gravidez , Estudos Retrospectivos , Pessoa Solteira
20.
Tex Med ; 115(1): 26-29, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811555

RESUMO

Today LARCs are one of the safest and most-effective types of reversible birth control, but their reputation took a huge hit in the 1970s thanks to the Dalkon Shield intrauterine device (IUD). Memories persist of news reports about the shield's many defects. This mistrust of LARCs - along with other obstacles to their wider use - hamper progress toward a wider goal for Texas medicine: improving maternal health and reducing maternal deaths across the state.


Assuntos
Contracepção Reversível de Longo Prazo , Morte Materna/estatística & dados numéricos , Gravidez não Planejada , Anticoncepcionais Femininos/administração & dosagem , Implantes de Medicamento , Feminino , Humanos , Dispositivos Intrauterinos , Morte Materna/prevenção & controle , Gravidez , Texas
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