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1.
Contraception ; 103(6): 377-379, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33781763

RESUMO

The COVID-19 pandemic has exposed the vulnerability of global contraception provision, exacerbating the barriers to access reproductive health services, leading to suspension of clinical services and disruption of supply chains. Critical to combatting this crisis is the expansion of healthcare to include self-care approaches to de-medicalize contraception and increase an individual's agency in determining what method they use, when they use it, and where they obtain it. Expanding the mix of self-administered contraceptives is essential for ensuring choice, access, and availability. We highlight advances in the self-care movement and actions needed to strengthen self-management approaches to maximize our chances of preventing a reproductive health crisis.


Assuntos
COVID-19 , Anticoncepção/métodos , Dispositivos Anticoncepcionais/provisão & distribuição , Serviços de Planejamento Familiar/provisão & distribuição , Acesso aos Serviços de Saúde , Autogestão/métodos , Serviços de Planejamento Familiar/métodos , Saúde Global , Humanos , Autoadministração
2.
South Med J ; 114(3): 150-155, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655308

RESUMO

OBJECTIVES: Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS: We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS: Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS: Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.


Assuntos
Documentação/métodos , Serviços de Planejamento Familiar/educação , Capacitação em Serviço/métodos , Programas de Rastreamento/métodos , Inquéritos e Questionários/normas , Veteranos/psicologia , Adulto , Documentação/normas , Características da Família , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/normas , Feminino , Implementação de Plano de Saúde , Humanos , Programas de Rastreamento/normas , Projetos Piloto , Gravidez , Atenção Primária à Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estatística & dados numéricos , Adulto Jovem
3.
Nurs Womens Health ; 25(1): 54-62, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33450243

RESUMO

OBJECTIVE: To improve adolescent and young adult clients' knowledge of long-acting reversible contraception (LARC) methods by standardizing the education they received at an outpatient clinic. DESIGN: The Plan-Do-Study-Act was used as a framework to implement and evaluate a practice change aimed at improving the contraceptive education provided to adolescent and young women. SETTING/LOCAL PROBLEM: This single-center quality improvement project took place at a community-based clinic in the Northeastern United States where clinicians' practice for contraceptive counseling lacked use of a standardized educational tool. PARTICIPANTS: Thirty female participants between the ages of 14 and 25. INTERVENTION/MEASUREMENTS: A pre- and postintervention survey was used to assess participants' knowledge of LARC methods after viewing an online video. A focus group of clinicians was held to assess their thoughts on the use of the video education. RESULTS: Survey results indicated improved knowledge of participants on all six knowledge points assessed in the survey. Focus group feedback indicated the video education was considered sustainable and desired by clinicians for an additional year and Plan-Do-Study-Act cycle. CONCLUSION: Online, video-based education may be an effective and sustainable way to provide adolescent and young adult clinic clients with evidence-based information on LARC methods to help them make informed decisions about contraception.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Contracepção Reversível de Longo Prazo/psicologia , Melhoria de Qualidade , Adolescente , Adulto , Serviços de Planejamento Familiar/métodos , Feminino , Grupos Focais , Humanos , New England , Educação de Pacientes como Assunto/métodos , Adulto Jovem
4.
PLoS One ; 16(1): e0243854, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33439888

RESUMO

BACKGROUND: Family planning is a key means to achieving many of the Sustainable Development Goals. Around the world, governments and partners have prioritized investments to increase access to and uptake of family planning methods. In Uttar Pradesh, India, the government and its partners have made significant efforts to increase awareness, supply, and access to modern contraceptives. Despite progress, uptake remains stubbornly low. This calls for systematic research into understanding the 'why'-why people are or aren't using modern methods, what drives their decisions, and who influences them. METHODS: We use a mixed-methods approach, analyzing three existing quantitative data sets to identify trends and geographic variation, gaps and contextual factors associated with family planning uptake and collecting new qualitative data through in-depth immersion interviews, journey mapping, and decision games to understand systemic and individual-level barriers to family planning use, household decision making patterns and community level barriers. RESULTS: We find that reasons for adoption of family planning are complex-while access and awareness are critical, they are not sufficient for increasing uptake of modern methods. Although awareness is necessary for uptake, we found a steep drop-off (59%) between high awareness of modern contraceptive methods and its intention to use, and an additional but smaller drop-off from intention to actual use (9%). While perceived access, age, education and other demographic variables partially predict modern contraceptive intention to use, the qualitative data shows that other behavioral drivers including household decision making dynamics, shame to obtain modern contraceptives, and high-risk perception around side-effects also contribute to low intention to use modern contraceptives. The data also reveals that strong norms and financial considerations by couples are the driving force behind the decision to use and when to use family planning methods. CONCLUSION: The finding stresses the need to shift focus towards building intention, in addition to ensuring access of trained staff, and commodities drugs and equipment, and building capacities of health care providers.


Assuntos
Comportamento Contraceptivo , Serviços de Planejamento Familiar , Educação Sexual/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/tendências , Feminino , Humanos , Índia , Intenção , Masculino , Pessoa de Meia-Idade , População Rural , Comportamento Sexual , Adulto Jovem
5.
Adv Ther ; 38(2): 1011-1023, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33459975

RESUMO

The rapid spread of novel coronavirus (COVID-19) has posed complex challenges to global public health. During this pandemic period, access to essential services including post-abortion care (PAC) has been disrupted. Along with the clinical management of the disease in women, protection of the healthcare workers and medical staff from nosocomial infection is important to ensure infection control. Thus, in order to implement the proper contraceptive measures and to reduce the rate of repeated abortion, the family planning group of minimally invasive gynecological branch of the Liaoning Medical Association organized a committee of experts to formulate guidance and suggestions to ensure the timely treatment and surgery of women opting for abortion, the implementation of PAC, implementation of safe contraceptive measures after surgery, and the protection of healthcare professionals and medical staff from infection. We believe these guidelines might be helpful for obstetrics and gynecology departments in China and globally, as well for women who wish to undergo abortion during these unprecedented times.


Assuntos
Aborto Induzido , Assistência ao Convalescente/métodos , COVID-19 , Anticoncepção/métodos , Serviços de Planejamento Familiar/métodos , Controle de Infecções , Guias de Prática Clínica como Assunto , Telemedicina , Abortivos/uso terapêutico , China , Consenso , Anticoncepcionais , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Equipamento de Proteção Individual , Gravidez , SARS-CoV-2 , Autogestão , Triagem
6.
Taiwan J Obstet Gynecol ; 59(6): 808-811, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33218393

RESUMO

Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.


Assuntos
Aborto Induzido/métodos , Infecções por Coronavirus/prevenção & controle , Serviços de Planejamento Familiar/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Telemedicina/métodos , Betacoronavirus , Anticoncepção/métodos , Feminino , Humanos , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Infecciosas na Gravidez/virologia
8.
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 , Atenção à Saúde/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
9.
BMC Public Health ; 20(1): 1228, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787807

RESUMO

BACKGROUND: Vasectomy is one of the highly effective and non-reversible types of long-term family planning methods for men. Ethiopia has a limited number of studies on the use of vasectomy, and they are focused on men rather than married men. The current study was aimed to identify the intention to use vasectomy as a method of contraception among married men in the study setting. METHODS: A community-based cross-sectional study was conducted from February 1 - April 30, 2018. A sample of 422 married men was recruited using a systematic random sampling method. We conducted face to face interviews with a structured questionnaire (i.e. closed-ended questions). Data were entered into Epi data version 3.1 and SPSS version 23 used for data analysis. The statistical association between the outcome variable (Intention to use vasectomy) and the explanatory variables were first tested with binary logistic regression. Multivariable logistic regression was used to control for confounding effect of each predictor. RESULTS: The study findings showed that the intention to use vasectomy as a method of family planning was reported as high (24%). About 34.8% of the respondents had good knowledge and nearly a quarter (23.2%) of them had a positive attitude toward the acceptance of vasectomy use. In multivariate analysis, age range between 30 and 39 years [AOR = 2.4, 95% CI = (1.16-4.82)], having good knowledge about vasectomy use [AOR = 6.22, 95% CI = (3.17-12.21)], and having a positive attitude toward vasectomy use [AOR = 7.81, 95% CI = (4.25-14.38)] were factors significantly associated to use vasectomy as compared to their counterparts. CONCLUSION: The level of acceptance of vasectomy (24%) was high compared to the level of its use in developing countries (i.e. if acceptability translates to use). The study revealed that age, good knowledge, and a positive attitude towards the use of vasectomy were important predictors of the intention to accept vasectomy. To further promote the use of vasectomy effective communication strategies in family planning programs are needed.


Assuntos
Intenção , Estado Civil/estatística & dados numéricos , Vasectomia/psicologia , Adulto , Estudos Transversais , Etiópia , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Inquéritos e Questionários
10.
Womens Health Issues ; 30(4): 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507617

RESUMO

BACKGROUND: Research on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider-patient relationship. METHODS: We conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD. RESULTS: Although providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider. CONCLUSIONS: There were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient-provider relationship and autonomous contraceptive decision making.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Comportamento Contraceptivo/psicologia , Anticoncepção Pós-Coito/estatística & dados numéricos , Anticoncepção/psicologia , Anticoncepcionais Pós-Coito/provisão & distribuição , Serviços de Planejamento Familiar/organização & administração , Relações Profissional-Paciente , Adolescente , Adulto , Serviços de Saúde Comunitária , Anticoncepção/métodos , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Revelação , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Entrevistas como Assunto
11.
Arq Bras Cardiol ; 114(5): 849-942, 2020 06 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491078
12.
Ideggyogy Sz ; 73(05-06): 161-169, 2020 05 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32579305

RESUMO

Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients - and often even doctors - are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients' individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice.


Assuntos
Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Fatores Imunológicos/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla/tratamento farmacológico , Adulto , Aleitamento Materno , Anticoncepção , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Gravidez
13.
Enferm. clín. (Ed. impr.) ; 30(supl.5): 73-76, jun. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-196478

RESUMO

Preconception Care is an intervention starting from adolescence until near conception. Preconception Care refers to biomedical interventions and social preventive behaviors which can improve healthy babies and healthy mothers. Interventions carried out during adolescence are more effective in reducing the occurrence of pregnancies untimely, unplanned pregnancies. Preconception Care program has not run optimally so far. The purpose of this literature study is to present the research findings on how Preconception Care interventions in adolescents. The method used is the study of the research findings on Preconception Care published in the last ten years (2009-2019) in national and international reputable literature sources indexed by Scopus, Elsiver, Proquest, Plos One, and Google Scholar database. The keywords of Preconception Care, Adolescent, AKI, and AKB are used to facilitate the search for literature. The results of the study show that Preconception Care has a powerful impact on women's health and is part of Continuum Care, including Preconception Care, Antenatal Care, Intranatal, and Post Natal. Preconception Care in adolescents has a good impact on the preconception period and can reduce maternal mortality (AKI) and infant mortality (AKB), thus, it is necessary to optimize Preconception Care on adolescents


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Cuidado Pré-Concepcional/organização & administração , Cuidado Pré-Concepcional/normas , Serviços de Saúde do Adolescente/normas , Cuidado Pré-Natal , Comportamento do Adolescente , Padrões de Prática em Enfermagem , Serviços de Planejamento Familiar/métodos
14.
Obstet Gynecol ; 135(5): 1095-1103, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282596

RESUMO

OBJECTIVE: To describe characteristics of the full population of women who participated in the Zika Contraception Access Network program in Puerto Rico during the virus outbreak and to examine factors associated with removal of a long-acting reversible contraception (LARC) method by a Zika Contraception Access Network provider during the program's duration (May 2016-September 2017). METHODS: We conducted an observational cohort study. The Zika Contraception Access Network program was designed to increase access to contraception services in Puerto Rico for women who chose to prevent pregnancy during the Zika virus outbreak as a primary strategy to reduce adverse Zika virus-related pregnancy and birth outcomes. Among program participants, an observational cohort of women served by the Zika Contraception Access Network Program, we describe their demographic and program-specific characteristics, including contraceptive method mix before and after the program. We also report on LARC removals by Zika Contraception Access Network providers during the program. We examined factors associated with LARC removal using multivariable logistic regression. RESULTS: A total of 29,221 women received an initial Zika Contraception Access Network visit during the program. Ninety-six percent (27,985) of women received same-day provision of a contraceptive method and 70% (20,381) chose a LARC method. While the program was active, 719 (4%) women who chose a LARC at the initial visit had it removed. Women with a college degree or higher were more likely to have their LARC removed (adjusted prevalence ratio [aPR] 1.24); breastfeeding women (aPR 0.67) and those using a LARC method before Zika Contraception Access Network (aPR 0.55) were less likely to have their LARC removed. CONCLUSION: The Zika Contraception Access Network program was designed as a short-term response for rapid implementation of contraceptive services in a complex emergency setting in Puerto Rico and served more than 29,000 women. The Zika Contraception Access Network program had high LARC uptake and a low proportion of removals by a Zika Contraception Access Network provider during the program. A removal-inclusive design, with access to removals well beyond the program period, maximizes women's reproductive autonomy to access LARC removal when desired. This model could be replicated in other settings where the goal is to increase contraception access.


Assuntos
Remoção de Dispositivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção por Zika virus/prevenção & controle , Adolescente , Adulto , Surtos de Doenças , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Contracepção Reversível de Longo Prazo/métodos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Avaliação de Programas e Projetos de Saúde , Porto Rico/epidemiologia , Adulto Jovem , Zika virus , Infecção por Zika virus/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32169418

RESUMO

Fertility awareness-based methods (FABMs) of family planning involve monitoring various signs and symptoms of fertility during the menstrual cycle to identify the "fertile window," or the days of the cycle when unprotected intercourse is most likely to result in pregnancy. Signs and symptoms include menstrual cycle length, basal body temperature, urinary hormone measurements, and/or cervical fluid and may be used alone or in combination. Fertility signs reflect both physiological changes during the menstrual cycle and the life cycle of the ovum and sperm. Women learn to observe or measure and interpret these signs according to the instructions of their chosen FABM and avoid unprotected intercourse on fertile days. FABMs are appropriate for those who choose to use them, are able and willing to observe one or more fertility signs, and are in relationships that support the use of a coitus-related method such as a condom or abstaining from intercourse on fertile days.


Assuntos
Serviços de Planejamento Familiar/métodos , Fertilidade/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Feminino , Humanos , Masculino , Ciclo Menstrual/fisiologia , Métodos Naturais de Planejamento Familiar , Gravidez , Educação Sexual , Espermatozoides
16.
PLoS One ; 15(3): e0230421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187224

RESUMO

BACKGROUND: A novel indicator, 'percentage of women of reproductive age who are sexually active and who have their demands for FP satisfied with modern contraceptive methods (mDFPS)', was developed in 2012 to accelerate the reduction of unmet needs of family planning (FP). In Jordan, unmet needs for modern contraception remain high. To address this situation, this study measured the mDFPS and identified its associated factors in rural Jordan. METHODS: This cross-sectional study included married women of reproductive age (15-49 years) from ten villages in Irbid Governorate, Jordan, where advanced health facilities are difficult to reach. A two-stage stratified sampling with random sampling at the household stage was used for this field survey which was conducted between September and October 2016. Univariate analysis was used to assess the differences between mDFPS and unmet mDFPS groups. Logistic regression analysis was performed to identify the correlates of mDFPS. RESULTS: Of 1019 participants, 762 were identified as needing modern contraception. mDFPS coverage accounted for 54.7%. The most significant factors associated with mDFPS were the husband's agreement on FP (adjusted odds ratio [AOR]: 15.43, 95% confidence interval [CI]: 5.26-45.25), knowledge of modern contraceptives (AOR: 8.76, 95% CI: 5.72-13.40), and lack of awareness of the high risk of conception in the postpartum period (AOR: 2.21, 95% CI: 1.41-3.47). Duration of current residence, receipt of FP counselling at health centres and number of living children were also correlated. In addition, 95.3% of local women were aware of the presence of health centres that were mostly located in a 10-minute walking distance. CONCLUSION: To increase mDFPS, this study suggested that accelerating male involvement in FP decision-making is necessary through community-based health education. Furthermore, expanding FP services in village health centres and improving the quality of FP counselling in public health facilities are required to correct misconceptions about modern methods among rural women.


Assuntos
Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Jordânia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Período Pós-Parto , População Rural , Adulto Jovem
17.
Midwifery ; 83: 102631, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036192

RESUMO

OBJECTIVE: To assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. DESIGN: Community-randomized trial. SETTING: "Reproductive and Sexual Health Care" units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain). PARTICIPANTS: 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. INTERVENTIONS: At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. MEASUREMENTS AND FINDINGS: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. KEY CONCLUSIONS: Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. IMPLICATIONS FOR PRACTICE: Despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.


Assuntos
Comportamento Contraceptivo/psicologia , Aconselhamento/normas , Assistência Perinatal/métodos , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Aconselhamento/métodos , Aconselhamento/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Educação de Pacientes como Assunto/métodos , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , Gravidez , Espanha , Inquéritos e Questionários
18.
PLoS One ; 15(2): e0228678, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017797

RESUMO

INTRODUCTION: The first year after birth is an ideal time to offer contraception services, as many women have many opportunities to be in contact with the health care system. Nevertheless, a large number of postpartum women in developing countries do not use the service owing to the interplay of factors operating at various stages. Therefore, this study aimed to assess predictors of modern contraceptive use in the extended postpartum period. METHODS: A community based retrospective cross-sectional study was done among 1281 women who gave birth within 12 months preceding the survey. Kaplan-Meier plots and log rank tests were used to explore the rate of modern contraceptive use. The Weibull regression survival model with multivariate frailty was employed to identify the predictors of time to contraception. RESULTS: Of the respondents, 59.1% (95% CI: 56.8%-62.2%) had started using modern contraceptive methods within 12 months after birth. By the second month after birth, only 11.1 percent of the women surveyed started to use a contraceptive method, which increased steadily to 25.9%, 37.7%, and 59.5% at 6, 9, and 12 months, respectively. The most preferred contraceptive method was injectable (71.5%), followed by implants (21.5%). Women's education (aHR = 1.29; 95%CI: 1.02, 1.66), four or more antenatal care (aHR = 1.59; 95% CI: 1.22, 2.06), early initiation of antenatal care (aHR = 2.03; 95% CI: 1.28, 3.21), and early postnatal checkup (aHR = 1.39; 95% CI: 1.12, 1.73) were statistically significant predictors of earlier initiation of modern contraceptive methods. CONCLUSIONS: A substantial proportion of women did not use modern contraceptive methods in the first year after birth. Maternal services were found to be the sole predictors in postpartum contraceptive use. Findings suggest the importance of linking postpartum family planning along the continuum of care. The observed heterogeneity at cluster level also urges the need of disaggregating data for decision-making.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Saúde Materna , Período Pós-Parto , Adolescente , Adulto , Anticoncepção , Estudos Transversais , Etiópia , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
19.
J Womens Health (Larchmt) ; 29(5): 622-626, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32074475

RESUMO

Objectives: Contraception use reduces teen pregnancy, and long-acting reversible contraception is recommended as first-line treatment. Since many adolescents use the emergency department (ED) as a primary source of health care, it is a potential site of contraceptive counseling and provision. We surveyed female adolescents to assess desire for contraceptive counseling and initiation/change during an ED visit. Materials and Methods: This was a cross sectional study of a convenience sample of female ED patients aged 16-21 years in an urban pediatric ED. Participants completed an anonymous questionnaire about sexual health, contraceptive use, and interest in contraceptive counseling. The primary outcome was adolescent interest in starting/changing contraception during an ED visit. Results: Three hundred eighty-one patients (mean age 19.1 ± 1.6 years) completed the survey. Most (80.5%) had been sexually active with a male partner, and 110 (28.2%) had previously been pregnant. Two-thirds were interested in discussing contraception and 22.5% were likely to start or change contraception during the ED visit. Those who wanted to start or change contraception were more likely to be sexually active with a male partner (93% vs. 82%, p = 0.02) and to report that they were not satisfied with their current contraception (44% vs. 21%, p = 0.0003). Fifteen (17%) of the adolescents likely to start or change contraception were interested in progestin implant initiation in the ED. Conclusions: Adolescents were interested in initiating or changing contraception during the ED visit, providing an important opportunity to discuss and initiate effective contraception.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviço Hospitalar de Emergência , Serviços de Planejamento Familiar/métodos , Contracepção Reversível de Longo Prazo/métodos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Anticoncepção , Anticoncepcionais , Dispositivos Anticoncepcionais/estatística & dados numéricos , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
20.
Eur J Contracept Reprod Health Care ; 25(1): 20-27, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31914332

RESUMO

Objectives: The aims of the study were to investigate foreign-born women's lifestyle and health before and during early pregnancy and compare them with those of Nordic-born women.Methods: Women recruited at antenatal clinics in Sweden answered a questionnaire in Swedish, English or Arabic or by telephone interview with an interpreter. Questions covered pregnancy planning and periconceptional lifestyle and health. The responses of women born in or outside Europe were compared with those of Nordic-born women. The impact of religiousness and integration on periconceptional lifestyle and health was also investigated.Results: Twelve percent of participants (N = 3389) were foreign-born (n = 414). Compared with Nordic women, European and non-European women consumed less alcohol before conception (respectively, adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.24, 0.58 and aOR 0.14; 95% CI 0.10, 0.19) and during early pregnancy (respectively, aOR 0.61; 95% CI 0.40, 0.91 and aOR 0.20; 95% CI 0.14, 0.29). Non-European women used less tobacco and were less physically active, but body mass index (BMI) did not differ between groups. Self-perceived health, stress and anxiety during early pregnancy did not differ, but non-European women more often had depressive symptoms (aOR 1.67; 95% CI 1.12, 2.51). Non-European women's healthy lifestyle was associated with religiousness but not with the level of integration.Conclusions: Non-European women were overall less likely to engage in harmful lifestyle habits before and during early pregnancy but were more likely to suffer from depressive symptoms in comparison with Nordic women.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Estilo de Vida/etnologia , Cuidado Pré-Concepcional/estatística & dados numéricos , Gestantes/etnologia , Saúde da Mulher/etnologia , Adulto , Comparação Transcultural , Europa (Continente)/etnologia , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Cuidado Pré-Concepcional/métodos , Gravidez , Gestantes/psicologia , Inquéritos e Questionários , Suécia/etnologia
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