Efectividad de la intervención educativa para prevenir el embarazo y enfermedades de transmisión sexual / Effectiveness of educational intervention to prevent pregnancy and sexually transmitted diseases / Eficácia da intervenção educacional para prevenir a gravidez e as doenças sexualmente transmissíveis

La salud sexual y reproductiva, el embarazo en la adolescencia y las infecciones de trasmisión sexual, son temas tratados en salud pública, adicionalmente cuentan con disímiles estrategias que buscan la reducción del embarazo en adolescentes e infecciones de transmisión sexual. Objetivo. Determinar la efectividad de la intervención educativa en la disminución del embarazo y las enfermedades de trasmisión sexual en adolescentes perteneciente a la Unidad Educativa Guillermo Ordóñez Gómez, de la Provincia de Santa Elena, en Ecuador en el periodo de2021-2022. Materiales y Métodos. Se realizó un estudio cuasi- experimental, con una población de 148 estudiantes, de la cual se consideró la muestra de forma aleatoria simple quedando establecida en 74 estudiantes de 1ro de Bachillerato General Unificado y 48 estudiantes de 2do. Primero se realizó un análisis preliminar (Etapa inicial) que permitió determinar cuál fue la situación inicial y el grado de información de las adolescentes. Resultados. El 51% tenían 15 años. Según la localidad la zona urbana con un 52% y la zona rural con un 48%. el 89% refirieron tener conocimientos y el 3% tal vez, en relación al preservativo masculino el 63% mencionaron que sí conocen, el 32% respondieron no conocerlo, y la satisfacción de los estudiantes con la información recibida, fue del 50% de los beneficiarios se sintieron muy satisfecho con la información recibidas, el 30% de los estudiantes satisfechos, mientras que el 20% de forma neutral. Conclusiones. La intervención educativa resultó adecuada, ya que incrementó el nivel de conocimiento de los adolescentes con respecto a los temas de Salud Sexual y Salud Reproductiva para la prevención de embarazo y enfermedades de transmisión sexual y existió un nivel satisfacción con la información recibida.

Sexual and reproductive health, adolescent pregnancy and sexually transmitted infections are topics addressed in public health, and there are also different strategies aimed at reducing adolescent pregnancy and sexually transmitted infections. Objective. To determine the effectiveness of the educational intervention in the reduction of pregnancy and sexually transmitted diseases in adolescents belonging to the Guillermo Ordóñez Gómez Educational Unit, in the Province of Santa Elena, Ecuador, during the period of 21-21-2022. Materials and Methods. A quasi-experimental study was carried out with a population of 148 students, from which the sample was considered in a simple random way, being established in 74 students of 1st grade of General Unified High School and 48 students of 2nd grade. First, a preliminary analysis (initial stage) was carried out to determine the initial situation and the degree of information of the adolescents. Results. Fifty-one percent were 15 years old. According to the locality of the urban area with 52% and the rural area with 48%, 89% reported having knowledge and 3% maybe, in relation to the male condom 63% mentioned that they do know, 32% responded that they did not know, and the satisfaction of the students with the information received was 50% of the beneficiaries were very satisfied with the information received, 30% of the students were satisfied, while 20% were neutral. Conclusions. The educational intervention was adequate, since it increased the level of knowledge of adolescents regarding the topics of Sexual and Reproductive Health for the prevention of pregnancy and sexually transmitted diseases and there was a level of satisfaction with the information received.

A saúde sexual e reprodutiva, a gravidez na adolescência e as infecções sexualmente transmissíveis (ISTs) são tópicos abordados na saúde pública, com uma variedade de estratégias destinadas a reduzir a gravidez na adolescência e as ISTs. Objetivo. Determinar a eficácia da intervenção educativa na redução da gravidez na adolescência e das infecções sexualmente transmissíveis em adolescentes pertencentes à Unidade Educacional Guillermo Ordóñez Gómez, na Província de Santa Elena, Equador, durante o período de 21-21-2022. Materiais e métodos. Foi realizado um estudo quase experimental com uma população de 148 alunos, dos quais a amostra foi considerada uma amostra aleatória simples de 74 alunos do 1º ano do Ensino Médio Geral Unificado e 48 alunos do 2º ano. Primeiramente, foi realizada uma análise preliminar (etapa inicial) para determinar a situação inicial e o grau de informação dos adolescentes. Resultados. Cinquenta e um por cento tinham 15 anos de idade. De acordo com a localidade da área urbana com 52% e a área rural com 48%. 89% relataram ter conhecimento e 3% talvez, em relação ao preservativo masculino 63% mencionaram que sabiam, 32% responderam que não sabiam, e a satisfação dos alunos com as informações recebidas foi de 50% dos beneficiários estavam muito satisfeitos com as informações recebidas, 30% dos alunos estavam satisfeitos, enquanto 20% eram neutros. Conclusões. A intervenção educativa foi adequada, pois aumentou o nível de conhecimento dos adolescentes em relação aos temas de Saúde Sexual e Reprodutiva para a prevenção de gravidez e doenças sexualmente transmissíveis, e houve um nível de satisfação com as informações recebidas.

Com Ciência e Com Respeito: episódio 18

Neste quinto especial sobre a Cartilha dos Direitos dos Participantes de Pesquisa, vamos falar sobre os direitos ao ressarcimento e ao método contraceptivo escolhido.

Satisfação com o uso do implante contraceptivo e do dispositivo intrauterino com cobre entre usuárias de um hospital público da cidade de São Paulo / Satisfaction with the use of contraceptive implant and copper intrauterine device among users of a public hospital in the city of São Paulo

Introdução: Apesar de serem altamente eficazes, os métodos contraceptivos de longa duração são usados por apenas 2% das mulheres brasileiras. A cidade de São Paulo tem realizado esforços para aumentar o uso desses métodos por meio da ampliação da oferta do dispositivo intrauterino (DIU) com cobre, especialmente no período pós-parto e pós-abortamento, e do implante contraceptivo para mulheres em situação de vulnerabilidade social. No entanto, pouco se sabe sobre a experiência das usuárias desses métodos, principalmente no que concerne à satisfação. Objetivo: Analisar a satisfação das mulheres com o uso do implante contraceptivo e do DIU com cobre. Método: Estudo quantitativo transversal, conduzido com 331 mulheres entre 15 e 49 anos que passaram por inserção de implante ou DIU com cobre em um hospital púbico da cidade de São Paulo/SP, entre 2016 e 2019. Os dados foram obtidos por meio de entrevista telefônica conduzida em 2020 por meio de um instrumento estruturado. A mensuração da satisfação com o método contraceptivo ocorreu de duas formas: por meio da resposta direta satisfação autorreferida e por meio da análise conjunta de quatro atributos (expectativa, experiência, efetividade e continuidade) nomeada como satisfação completa. A análise das duas formas de mensuração e dos aspectos associados a elas ocorreu por meio de teste de diferença entre duas proporções pelo Qui-quadrado. Resultados: A satisfação com o uso do implante foi superior a 90% e alcançou 85% entre as usuárias de DIU com cobre, pela forma de mensuração autorreferida. Pela análise por atributos (satisfação completa), a satisfação foi relacionada à expectativa de que o método fosse seguro para a prevenção da gravidez; à experiência ter sido melhor que o esperado, proporcionando a sensação de tranquilidade em razão da segurança; à efetividade do método em prevenir a gravidez; e à continuidade no uso indicando adesão ao método. O principal motivo para a alta satisfação foi a segurança de que o método seria eficaz para evitar a gravidez (94,6% das entrevistadas). As duas formas de mensuração não foram equivalentes. A melhora dos efeitos colaterais ao longo do tempo foi a única variável associada à satisfação autorreferida, para ambos os métodos (p=0,012 para usuárias de implante e p<0,001 para usuárias de DIU). Nenhuma variável foi associada à satisfação completa. Conclusão: A alta satisfação com o uso do implante e do DIU com cobre foi motivada pela segurança quanto à eficácia em prevenir a gravidez e mostrou estar associada à melhora dos efeitos colaterais ao longo do tempo de uso.

Introduction: Despite being highly effective, long-term contraceptives are used by only 2% of Brazilian women. The city of São Paulo has made efforts to increase the use of these methods by expanding the supply of the Copper intrauterine device (IUD), especially in the postpartum and post-abortion period, and contraceptive implant for women in social vulnerability situations. However, little is known about the experience of the users of these methods, especially with regard to satisfaction. Objective: To analyze women's satisfaction with the use of contraceptive implants and Copper IUDs. Method: Cross-sectional quantitative study, conducted with 331 women between 15 and 49 years who underwent implant or Copper IUD insertion in a public hospital in the city of São Paulo/SP, between 2016 and 2019. Data were obtained through a telephone interview conducted in 2020 through a structured instrument. The measurement of satisfaction with the contraceptive method occurred in two ways: through direct response - self-reported satisfaction - and through the joint analysis of four attributes (expectation, experience, effectiveness and continuity) - named as complete satisfaction. The analysis of the two forms of measurement and the aspects associated with them occurred through a test of difference between two proportions by Chi-square. Results: Satisfaction with the use of the implant was higher than 90% and reached 85% among the users of Copper IUD, by the self-reported measurement form. By the analysis by attributes (complete satisfaction), satisfaction was related to the expectation that the method was safe for pregnancy prevention; to experience to have been better than expected, providing the feeling of tranquility due to safety; to the effectiveness of the method in preventing pregnancy; and to the continuity in use indicating adhering to the method. The main reason for the high satisfaction was the safety that the method would be effective to avoid the pregnancy (94.6% of the interviewees). The two forms of measurement were not equivalent. The improvement of side effects over time was the only variable associated with self-reported satisfaction for both methods (p=0.012 for implant users and p<0.001 for IUD users). No variable was associated with complete satisfaction. Conclusion: The high satisfaction with the use of the implant and the Copper IUD was motivated by the safety regarding the efficacy in preventing pregnancy and was shown to be associated with the improvement of side effects over the time of use.

Perceptions of long-acting reversible contraception among women receiving medication for opioid use disorder in Vermont.

OBJECTIVES: To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder. STUDY DESIGN: Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont. RESULTS: A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method. CONCLUSIONS: Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method. IMPLICATIONS: Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.

Antimicrobial prescription pattern in a tertiary hospital

Background: Antimicrobials are nonreplaceable in the treatment of bacterial infections and thus should be used judiciously. In Nigeria, there is currently no restriction on the prescription and sale of antimicrobials. This study was conducted to assess the antimicrobial prescription pattern of physicians at a tertiary hospital in Northwestern Nigeria. Materials and Methods: A point prevalence survey was carried out among all inpatients at Ahmadu Bello University Teaching Hospital in June 2015. Those receiving an antimicrobial agent during the survey period were included in the study while patients admitted on the day of the survey were excluded from the study. Data were obtained using a structured interviewer­administered questionnaire and abstraction from patient records. Information obtained included demographic data, antimicrobial agents prescribed, indication for treatment, laboratory data, and stop/review dates of prescriptions. Data were analyzed using SPSS version 20.0. Results: Twenty­three wards with a total number of 318 inpatients were enlisted. Of these, 210 (66%) patients were on treatment with antimicrobials. Male: female ratio of patients on antimicrobials was 1.2:1, and age of respondents ranged from 1 day (0.0027 years) to 75 years. The overall antimicrobial prevalence rate was 210 (66%) with surgical prophylaxis 100 (47.6%) as the most common indication. Overall, 332 antimicrobials were prescribed with cephalosporins as the most common class prescribed 96 (28.9%). Majority of the prescriptions (328, 98.8%) were based on empirical treatment, 288 (86.7%) were open prescriptions, and only 4 (1.2%) were according to treatment guidelines. Conclusion: The high prevalence of antimicrobial use highlights the need for an antimicrobial stewardship program in this facility

Efeitos adversos associados a uso de contraceptivos orais em discentes / Adverse effects associated with students' use of oral contraceptives

Objetivos: Investigar o número de mulheres, as causas que levam a fazer o uso e descrever os efeitos adversos mais comuns associados ao uso de contraceptivos orais de forma contínua. Métodos: Trata-se de estudo observacional, transversal ou de prevalência e quantitativo. A pesquisa teve população de 832 alunas do curso de Direito dos turnos matutino, vespertino e noturno, no período de agosto a setembro, tendo como amostra 248 participantes para esse estudo. O questionário versou sobre o uso de anticoncepcionais, o perfil das usuárias e os possíveis efeitos adversos observados ao longo do uso. Resultados: A prevalência de uso dos contraceptivos orais foi de 42,3%, justificada principalmente pelo desejo de evitar a concepção (42,9%), regular os níveis hormonais (25,7%) e tratar acne (15,2%). Cerca de 63,8% relataram que já sentiram algum desconforto associado ao uso destes medicamentos, sendo os mais frequentes aumento de peso corporal (32,4%), alterações de humor (24,3%), dor nas mamas (13,5%), cefaleia (4,1%), dor abdominal (2,7%). Conclusão: A prevalência de efeitos adversos decorrentes do uso contínuo de contraceptivos orais é alta, evidenciando-se a necessidade de conscientizar as usuárias a buscarem profissionais habilitados, para que elas façam uso do anticoncepcional mais adequado, minimizando o desconforto advindo dos efeitos adversos.

Objectives: To investigate the number of women, the causes that lead to making use, and to describe the most common adverse effects associated with oral contraceptive continuous use. Methods: This is an observational, cross-sectional, or prevalence and quantitative study. The research had a population of 832 students of the law course of the morning, afternoon and evening shifts, from August to September, with a sample of 248 participants for this study. The questionnaire was about contraceptive use, users' profile, and possible adverse effects observed during use. Results: The prevalence of oral contraceptive use was 42.3%, mainly explained by the desire to avoid conception (42.9%), regulate hormone levels (25.7%), and to treat acne (15.2%). About 63.8% reported already having some discomfort associated with the use of these medications, with the most frequent being body weight gain (32.4%), mood swings (24.3%), breast pain (13.5%), headache (4.1%), abdominal pain (2.7%). Conclusion: The prevalence of adverse effects resulting from the continued use of oral contraceptives is high, so there is a need to guide users to seek qualified professionals so that they make use of the most appropriate contraceptive, minimizing the discomfort arising from adverse effects.

Trends in contraceptive prevalence in Sub-Saharan Africa: the roles of family planning programs and education

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment,Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially

Uso seguro de anticoncepcionais hormonais injetáveis segundo critérios médicos de elegibilidade / El uso seguro de anticonceptivos inyectables hormonales segundo criterio de elegibilidad médica / Safe use of injectable hormonal contraceptives according to medical eligibility criteria

Objetivo: classificar usuárias de anticoncepcionais hormonais injetáveis (AHI) quanto ao uso seguro segundo critérios médicos de elegibilidade da Organização Mundial da Saúde (OMS) e verificar associação entre tipo de injetável e tempo de uso com o uso seguro. Métodos: Estudo transversal, descritivo e exploratório. A população foi composta pelas 52 usuárias de AHI. Os dados foram coletados por meio de entrevista, que seguiu formulário elaborado pelas autoras, sendo identificado fatores que contraindicassem ou indicassem o uso do método, classificando-as em categorias de 1 a 4. O Projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Ceará, CAAE: 36668314.3.0000.5054. Resultados: Foram identificadas 44 (84,7%) mulheres em uso seguro e 8 (15,3%) inseguro. Usuárias há mais de um ano tiveram uma frequência maior de uso inseguro (p=0,001). Conclusão: Seguir as recomendações da OMS deve ser rotina nas consultas de enfermagem visando à proteção e segurança da mulher.

Objective: to classify users of injectable hormonal contraceptives (AHI) in accordance with the safe use according to medical eligibility criteria of the World Health Organization (WHO) and assess the association between type of injection and use of time with safe use. Methods: Cross-sectional, descriptive and exploratory study. The population was composed by 52 users of AHI. Data were collected through interviews, which followed form developed by the authors, and identified factors that contraindicate or indicate the use of the method, classifying them into categories from 1 to 4. The project was approved by the Ethics Committee of the University Federal do Ceará, CAAE: 36668314.3.0000.5054. Results: Were identified 44 (84.7%) women in safe use and 8 (15.3%) in unsafe use. Users with over a year of use had a higher frequency of unsafe use (p=0.001). Conclusion: Following WHO recommendations should be routine in nursing consultation to the protection and safety of women.

Objetivo: clasificar las usuarias de anticonceptivos hormonales inyectables (AHI) segundo criterio de elegibilidad médica de la Organización Mundial de la Salud (OMS) y evaluar la asociación entre el tipo de inyección y el uso del tiempo con uso seguro. Métodos: Estudio transversal, descriptivo y exploratorio. La población fue compuesta por 52 usuarias de AHI. Los datos fueron colectados a través de entrevistas desarrollada por las autoras, e identificó los factores que contraindican o indiquen el uso del método, clasificándolos en categorías 1 a 4. El proyecto fue aprobado por el Comité de Ética de Investigación de la Universidad Federal do Ceará, CAAE: 36668314.3.0000.5054. Resultados: Se identificaron 44 (84,7%) mujeres en el uso seguro y 8 (15,3%) no seguro. Las usuarias más de un año habían una mayor frecuencia de uso inseguro (p=0,001). Conclusión: El uso de las recomendaciones de la OMS debe ser rutinario en la consulta de enfermería.

Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool.

BACKGROUND: The London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress. METHODS: An updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations. FINDINGS: In 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4-49·1), unmet need for modern methods was 21·6% (19·7-23·9), and the demand satisfied with modern methods was 67·9% (64·4-71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8-52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5-53·4) to 51·8% (47·3-56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9-25·0) to 28·5% (26·8-30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012. INTERPRETATION: Whereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor. FUNDING: The Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health.

"Without bodily autonomy we are not free": exploring women's concerns about future access to contraception following the 2016 US presidential election.

OBJECTIVE: Following the 2016US presidential election, social media posts and news stories amplified concerns about the potential for reduced access to contraception under the incoming administration and urged women to seek long-acting reversible contraception. We aimed to describe women's concerns about future access to contraception, in their own words. STUDY DESIGN: A social-media-based, anonymous online survey assessing thoughts and concerns about future access to contraception was distributed to reproductive-aged US women for 1 week in mid-January 2017. Participants who were concerned about future access to contraception could share their thoughts and feelings in an open-ended comments box. We qualitatively analyzed 449 written responses for content and themes, with the goal of characterizing key concerns. RESULTS: Women who provided written comments had a mean age of 28years; 85% were white, 88% had at least a college degree, and 93% identified as Democratic or Democratic-leaning. Women were highly concerned about future affordability of contraceptive methods due to potential loss of insurance, reduced insurance coverage for contraceptive methods and reduced access to low-cost care at Planned Parenthood. Many also worried about increased restrictions on abortion. Participants' concerns regarding access to contraception and abortion centered around themes of reproductive and bodily autonomy, which women described as fundamental rights. CONCLUSIONS: Women in this study expressed considerable fear and uncertainty regarding their future access to contraception and abortion following the 2016US presidential election. The potential for restricted access to affordable contraception and abortion was viewed as an unacceptable limitation on bodily autonomy. IMPLICATIONS: As the future of US health care policy is debated, many women are concerned about the impact of policy changes on their ability to access affordable contraception and abortion, which many view as essential to the preservation of bodily and reproductive autonomy.

Knowledge of and concerns about long-acting reversible contraception among women in medication-assisted treatment for opioid use disorder.

OBJECTIVES: To assess interest in, concerns about and knowledge of long-acting reversible contraceptives (LARC) among women in medication-assisted treatment (MAT) for opioid use disorder who were at risk for unintended pregnancy. STUDY DESIGN: Women in MAT completed a survey on contraceptive use, attitudes and knowledge, including LARC methods, as part of eligibility screening for an ongoing trial evaluating family planning interventions for this population. RESULTS: Eighty-three women at risk for unintended pregnancy completed the survey, and a subset of 51 completed supplemental questions about implants. All participants had heard of IUDs and 75/83 (90%) had heard of implants, but only 34/83 (41%) and 14/51 (27%) reported being likely to use IUDs and implants, respectively. Thirty-five women reported they were unlikely to use IUDs, with 29/35 (83%) citing unspecified "other reasons" for this position and 24/35 (69%) endorsing concerns about side effects. Seventeen women reported they were unlikely to use implants, with 8/17 (47%) citing "other reasons" and 9/17 (53%) and 10/17 (59%) reporting concerns about insertion and removal, respectively. Participants reported they knew "a little" about LARCs, but only their knowledge of implants was limited. Only 50/83 (60%) participants were aware of the superior effectiveness of IUDs and 26/51 (51%) were aware of the superior effectiveness of implants relative to other reversible methods. CONCLUSIONS: Participants reported relatively low interest in LARCs. Many women had unspecified reasons for not using LARCs. Participants also lacked information about LARC safety and effectiveness, especially with regard to implants. IMPLICATIONS: Women in medication-assisted treatment for opioid use disorder are at high risk of unintended pregnancy, yet contraceptive use is low and use of less effective methods is common. Women in MAT may benefit from efforts to increase knowledge about implants and assuage concerns about their insertion and removal as well as more general efforts to improve knowledge about the relative efficacy of LARCs. Many women in MAT endorsed unspecified "other reasons" for not using LARCs, which should be explored further.

Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation.

OBJECTIVE: This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception. STUDY DESIGN: We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes. RESULTS: Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use. CONCLUSION: Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use. IMPLICATIONS: Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more effectively to prevent STI morbidity.

The effect of internal migration, individual and contextual characteristics on contraceptive use among Nigerian women.

We investigated the relation of internal migration to contraceptive use and adjusted for individual and contextual (community) characteristics. Multilevel logistic regression models were fitted to nationally representative data of 28,876 women from 884 communities in Nigeria. Only about one out of every 10 women (10.4%) currently used a contraceptive method. Contraceptive prevalence according to the migration status were rural-urban (12.5%), urban-rural (13.8%), rural nonmigrants (6.2%) and urban nonmigrants (17.1%). The relationship between internal migration and contraceptive use was fully explained by individual and community characteristics. Programs aimed at increasing contraceptive prevalence should address contextual challenges alongside socioeconomic factors.

Prevalence of rapid repeat pregnancy and associated factors in adolescents in Caruaru, Pernambuco / Prevalência da gravidez de repetição rápida e fatores associados em adolescentes de Caruaru, Pernambuco

Abstract Objectives: to determine the prevalence and factors associated with the rapid repeat pregnancy (RRP) in pregnant adolescents. Methods: a cross-sectional study was carried out with pregnant adolescents assisted at the Family Health Strategies in Caruaru-PE from March to August 2013. A questionnaire with sociodemographic, economic, schooling, gynecological, obstetric and contraceptive characteristics was used. The data were analyzed in the Statistical Package for Social Sciences (SPSS), version 20. Binary logistic regression models were used. Results: among the 204 pregnant adolescents interviewed, the data of 26.5% (n = 54) multiparous were analyzed. The occurrence of RRP was 42.6% (n = 23) [95% CI 29.23-56.79]. The variables associated with RRP were non-use of contraceptive methods [OR 7.40 (CI95% 1.56-3.49)] and no previous pregnancy planning [OR 0.19 (95% CI 0.05-0.78)]. Conclusions: the percentage of RRP in adolescents was high. The non-use of contracep-tive methods increased the chances of RRP, while the no previous pregnancy planning decreased the chances of adolescents getting pregnant again without previous program-ming.

Resumo Objetivos: determinar a prevalência e fatores associados a gravidez de repetição rápida (GRR) em gestantes adolescentes. Métodos: estudo transversal desenvolvido com gestantes adolescentes assistidas nas Estratégias de Saúde da Família de Caruaru-PE no período de março a agosto de 2013. Foi utilizado um questionário com características sociodemográficas, econômicas, escolares, ginecológicas, obstétricas e contraceptivas. Os dados foram analisados no Statistical Package for the Social Sciences (SPSS), versão 20. Empregou-se modelos de regressão logís-tica binária. Resultados: dentre as 204 gestantes adolescentes entrevistadas, foram analisados os dados de 26,5% (n=54) que eram multigestas. A ocorrência de GRR foi de 42,6% (n=23) [IC95% 29,23-56,79]. As variáveis associadas à GRR foram não uso de métodos contracep-tivos [OR 7,40 (IC95% 1,56-3,49)] e não planejamento da gravidez anterior [OR 0,19 (IC95% 0,05-0,78)]. Conclusões: foi elevado o percentual de GRR nas adolescentes. O não uso de métodos contraceptivos aumentou as chances de GRR, enquanto a não realização de planejamento da gestação anterior diminuiu as chances das adolescentes engravidarem novamente sem programação prévia.

Transitions in pregnancy planning in women recruited for a large prospective cohort study.

STUDY QUESTION: Do the rates at which women transition among different intensities of pregnancy planning vary with age, marital status and race/ethnicity? SUMMARY ANSWER: Rates of transition from low or moderate pregnancy probability groups (PPGs) to higher PPGs vary by age, marital status and race/ethnicity. WHAT IS KNOWN ALREADY: The design of prospective studies of the effects of pre- and peri-conception exposures on fecundity, pregnancy and children's health is challenging because at any specific time only a small percentage of reproductive age women is attempting to conceive. To our knowledge, there has been no population-based, prospective study that repeatedly assessed pregnancy planning, which included women who were not already planning pregnancy at enrollment and whose ages spanned the female reproductive age range. STUDY DESIGN, SIZE, DURATION: A longitudinal study was carried out that repeatedly assessed pregnancy probability in 12 916 women for up to 21 months from January 2009 to September 2010. PARTICIPANTS/MATERIALS, SETTING, METHOD: We analyzed data from the National Children's Study Vanguard Study, a pilot study for a large-scale epidemiological birth cohort study of children and their parents. During the Vanguard Study, investigators followed population-based samples of reproductive age women in each of seven geographically dispersed and diverse study locations over time to identify when they sought to become pregnant, providing a unique opportunity to prospectively assess changes in pregnancy planning in a large sample of US women. At study entry and each follow-up contact, which occurred at 1, 3 or 6 month intervals depending on PPG, a questionnaire was used to assess behavior dimensions of pregnancy planning to assign women to low, moderate, high non-tryer and high tryer PPGs. MAIN RESULTS AND THE ROLE OF CHANCE: Crude rates of pregnancy increased with higher assigned PPG, validating the utility of the instrument. The initial PPG and probabilities of transitioning from low or moderate PPG to higher PPG or pregnancy varied with age, marital status and race/ethnicity. Women aged 25 to <35 years had shorter times to transition to higher PPGs or to pregnant compared with women <25 years. Women who were not currently married had longer times to transition from any initial PPG to pregnant, high tryer or high non-tryer status than currently married women. Non-Hispanic Black (NHB) and Hispanic women had shorter time to transition from low or moderate to high non-tryer than non-Hispanic White (NHW) women. NHB women also had shorter time to transition from low to high tryer than NHW women. High tryers are more likely to be aged 25 to <30 years, to be married, and to be Hispanic, NHB or other race/ethnicity than women in the low PPG. LIMITATIONS, REASONS FOR CAUTION: Loss to follow-up varied by age, marital status and race/ethnicity. Although weights were not developed for the Vanguard study, the self-weighting design minimizes the bias of unweighted analysis. Nonetheless, the SEs for some estimates may be under-estimated. WIDER IMPLICATIONS OF THE FINDINGS: Our results show that demographic characteristics are strong predictors of women's behaviors toward pregnancy. The results further show that frequent follow-up assessments of pregnancy planning behavior in large numbers of women are required to recruit an unbiased sample of preconception women. These findings will be useful to investigators designing prospective studies of fecundability, pregnancy outcomes and children's health. STUDY FUNDING/COMPETING INTERESTS: National Institutes of Health (contracts N01-HD53414, N01-HD63416, N01-HD53410, N01-HD53415, N01-HD53396, N01-HD53413 and N01-HD-53411; grant R21 ES016846) and by the University of California Irvine Center for Occupational and Environmental Health. No competing interests. TRIAL REGISTRATION NUMBER: None.

Contraceptive Utilisation Among Mothers of Reproductive Age in Ajman, United Arab Emirates.

OBJECTIVES: This study aimed to determine contraceptive utilisation among mothers aged 18-49 years old in Ajman, United Arab Emirates (UAE). METHODS: This cross-sectional study was carried out from May to November 2013. A total of 400 participants were recruited from two primary healthcare centres and one private hospital in Ajman. An interviewer-administered validated questionnaire was used for data collection. RESULTS: The frequency of previous and current contraceptive use was 68.0% and 61.8%, respectively. Expatriates more frequently used contraceptives in comparison to Emiratis (77.3% versus 54.3%, respectively). Contraceptive use increased significantly with age (75.5% among >35-year-olds versus 57.3% among ≤25-year-olds; P <0.050) and education level (83.3% among postgraduates versus 60.0% among those with primary education; P <0.050). In addition, contraceptive use was significantly higher among those living in a nuclear family system (P <0.050). A univariate analysis indicated significant associations between contraceptive use and age, nationality, education level, type of family system, employment sector, parity, knowledge of birth control measures and source of birth control information (P <0.050 each). However, no significant associations were found via multivariate analysis. CONCLUSION: Healthcare practitioners can play a pivotal role in providing contraceptive advice which could lead to an improvement in contraceptive utilisation. Efforts are recommended to raise awareness regarding newer forms of contraceptives among mothers of reproductive age in the UAE.

Utilisation des méthodes contraceptives modernes en République Démocratique du Congo: prévalence et barrières dans la zone de santé de Dibindi à Mbuji-Mayi

Introduction: l'objectif de cette étude était de déterminer la prévalence contraceptive moderne et les barrières à l'utilisation des méthodes contraceptives modernes chez les couples de la Zone de Santé Dibindi, à Mbuji-Mayi en République Démocratique du Congo.Méthodes: de Mai à Juin 2015, nous avons réalisé une étude descriptive transversale. Nous avons inclus les femmes âgées de 15 à 49 ans, en union maritale, non enceinte au moment de l'enquête, qui habitaient la Zone de santé Dibindi depuis deux ans et ayant consenti librement de participer à l'étude. La collecte des données a été réalisée par interview libre des femmes. La prévalence contraceptive moderne se référait aux femmes en cours d'utilisation, au moment de l'enquête, des contraceptifs modernes. La comparaison des proportions a été réalisée au seuil de signification de 5%. Le test de Bonferroni a été utilisé pour comparer, deux à deux, les proportions des barrières à l'utilisation des contraceptifs modernes.Résultats: la prévalence contraceptive moderne à Dibindi, en 2015, était de 18,4%. Elle était faible eu égard aux services de planification familiale disponibles dans cette Zone de santé. Plusieurs femmes refusaient d'utiliser les méthodes contraceptives modernes malgré l'information dont elles disposaient à cause de leur désir de maternité, l'interdiction religieuse, l'opposition du conjoint et la crainte des effets secondaires.Conclusion: l'information suffisante et centrée sur chaque cliente ou son couple, sur la planification familiale, devrait être renforcée de façon à éliminer les fausses croyances, ce qui accroitrait l'utilisation des méthodes contraceptives modernes

Prevalence of contraceptive use in New Zealand women.

AIMS: To estimate the prevalence of contraceptive use among New Zealand women and to measure changes in contraceptive use since the last population-based prevalence estimates were published in 1988. METHODS: Nine hundred and four women, aged 35-69 years were randomly selected from the electoral roll. A postal questionnaire was used to gather information on contraceptive use, socio-demographic characteristics and risk factors for ovarian cancer. Data were collected in 2013-2015. Estimates of current and ever-use of contraceptives were made and compared with the findings of the 1988 study by Paul et al. In both studies, participants were members of the control arm of case-control studies. RESULTS: The study by Paul et al had a response proportion of 84%, whereas that of the current study was 47%. Oral contraceptives had the highest prevalence of ever-use among women aged 35-69 years (89% [347/389]), followed by condom use (54% [211/389]) and vasectomy (44% [170/389]). Compared to the previous study, there has been an increase in ever-use of condoms (24% [185/767] to 64% [148/231]), vasectomy (26% [202/767] to 40% [92/231]) and oral contraceptives (75% [575/767] to 89% [205/231]) among women aged 35-54 years. In contrast, a lower prevalence of tubal ligation (22% [168/767] to 8% [19/231]) was observed. CONCLUSION: The study demonstrates a change in patterns of contraceptive use among women aged 35-54 years. The prevalence of ever-use of oral contraceptives and vasectomy remains high in New Zealand compared with other countries.

Chronic Diseases and Use of Contraception Among Women at Risk of Unintended Pregnancy.

BACKGROUND: Women with chronic diseases are at increased risk of having unintended pregnancies. Little is known whether chronic diseases are associated with increased likelihood of effective/highly effective contraceptive use. METHODS: We analyzed 2008-2010 Florida Behavioral Risk Factor Surveillance System data for women aged 18-44 years who were at risk of unintended pregnancy. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for contraceptive use in relation to diabetes, cardiovascular disease (CVD), and current asthma. We assessed the association of chronic disease status with use of three different contraception outcomes: (1) any method versus none, (2) less effective methods (methods associated with ≥10 unintended pregnancies/100 women/year) versus none, and (3) effective/highly effective methods (<10 unintended pregnancies/100 women/year) versus none. RESULTS: Among 4473 women at risk for unintended pregnancy, 87% were using any method of contraception (22.5% less effective methods and 64.5% effective/highly effective methods). Women with CVD were more likely than those without CVD to use any contraception (aPR = 1.09, 95% CI: 1.04, 1.15), less effective (aPR = 1.39, 95% CI: 1.13, 1.70), and effective/highly effective (aPR = 1.10, 95% CI: 1.03, 1.19) contraception. Women with diabetes were more likely to use less effective methods than women without diabetes (aPR = 1.34, 95% CI: 1.05, 1.72). No significant associations were observed for asthma, regardless of contraceptive effectiveness. CONCLUSIONS: Self-reported use of effective/highly effective contraception was higher than nonuse or use of less effective methods among all women at risk of unintended pregnancy, but could be improved, especially among women with chronic diseases.