Progestogen only contraception in women with congenital heart disease.

BACKGROUND: There is little information of progestogen-only contraceptives in patients with congenital heart disease (CHD) on the long-term. OBJECTIVE: To evaluate the use of contraception in patients with CHD. We studied both short-acting reversible contraceptives (SARCs), oral progestin-only pills (POPs) and long-acting reversible contraceptives (LARCs): intrauterine devices (IUD-IPs) and subdermal implants both impregnated with progestogens (SI-IPs). STUDY DESIGN: Retrospective study of all women attending the preconception clinic. Contraceptive methods were classified in three TIERs of effectiveness before and after consultation. ESC classification regarding pregnancy risk, WHOMEC classification for combined oral contraceptive safety was collected. RESULTS: Six hundred and fifty-three patients. A significant proportion of them switched from TIER 3 to TIER 2 or 1 (p < .001) after consultation. One hundred and ninety-nine patients used POPs, 53 underwent IUD-IPs implantation and 36 SI-IPs, mean duration was 58 ± 8, 59 ± 8 and 53 ± 38 months, respectively. CONCLUSIONS: Because of their safety and efficacy, IUD-IPs and SI-IPs should be considered as first-line contraception in patients with CHD.

We looked at the use of progestogen-only contraceptives in women with congenital heart disease (CHD) over a long period and determine how safe and effective these contraceptives are for such patients. We considered two types of contraceptives: short-acting ones like progestin-only pills (POPs) and long-acting ones like intrauterine devices and subdermal implants that release progestogens.We gathered information from 653 women and assessed how women's contraceptive choices changed before and after they had a consultation with us.After consulting with our clinic, a significant number of women switched from less effective contraceptives to more effective ones. Among the women who used POPs, most of them followed the prescribed regimen quite well. Additionally, 89 women used long-acting contraceptives, without failure of method.In conclusion, our findings suggest that long-acting progestogen-only contraceptives are safe and effective choices for contraception in women with CHD. Therefore, these options should be considered as the first choice.

Strategies to enhance indigenous men's support for utilisation of long-acting reversible contraceptives among women in Kiboga and Rubanda rural districts in Uganda.

Unintended pregnancies, a global public health concern with an annual incidence of about 74 million, significantly impact Africa, representing 25% of cases. These pregnancies, linked to health risks and mortalities, underscore the critical need for effective family planning especially the Long-acting reversible contraceptives (LARCs). Long-acting reversible contraceptives offer a significant solution, yet their uptake in Uganda faces challenges due to insufficient male support. This qualitative study in Rubanda and Kiboga revealed negative perceptions and belief systems among rural Indigenous Ugandan men regarding the use of LARCs by their wives, which acted as barriers to utilization. Recommendations include enhancing Social and Behavioural Change Communication (SBCC) and improving LARCs service delivery to counter limited knowledge and service concerns, aiming to foster better understanding and correcting the negative perceptions, belief sytems and acceptance of these contraceptive methods for improved maternal and child health outcomes.

Les grossesses non désirées, une préoccupation mondiale en matière de santé publique avec une incidence annuelle d'environ 74 millions, impactent significativement l'Afrique, représentant 25 % des cas. Ces grossesses, liées à des risques sanitaires et à des mortalités, soulignent le besoin critique d'une planification familiale efficace, en particulier des contraceptifs réversibles à longue durée d'action (LARCs). Les contraceptifs réversibles à longue durée d'action offrent une solution significative, mais leur adoption en Ouganda est confrontée à des défis en raison du manque de soutien des hommes. Cette étude qualitative menée à Rubanda et Kiboga a révélé des perceptions négatives et des systèmes de croyances parmi les hommes indigènes ougandais ruraux concernant l'utilisation des LARCs par leurs épouses, ce qui a agi comme des obstacles à leur utilisation. Les recommandations incluent le renforcement de la communication pour le changement social et comportemental (SBCC) et l'amélioration de la prestation de services de LARCs pour contrer le manque de connaissance et les préoccupations concernant les services, visant à favoriser une meilleure compréhension et à corriger les perceptions négatives, les systèmes de croyances et l'acceptation de ces méthodes contraceptives pour des résultats améliorés en matière de santé maternelle et infantile.

Barriers and facilitators influencing utilization of intrauterine contraceptive device (IUCD) in Zimbabwe.

IUCD (Copper-T) is a safe, effective and long-acting reversible contraceptive and its uptake in Zimbabwe is currently less than 1%. Interventions to improve the uptake of IUCD require evidence on key factors contributing to its low uptake. The study was conducted to identify the gaps and offer opportunities for evidence-based family planning aimed at improving demand for IUCD, supply-side conditions, and influencing attitudes towards IUCD. A descriptive qualitative study design was conducted to explore and understand the perceptions of 169 women, 22 men, 16 community leaders and 20 health care providers regarding the use of IUCDs (Copper-T). In-depth interviews, Key informant interviews and focus group discussions with IUCD users, former IUCD users, and users of modern contraceptives (15-49 years) and men were conducted. Rural women showed reluctance to use IUCD because of myths, misconceptions and fears associated with the method which include barrenness, cancers, birth deformities and pregnancy complications. Negative community perceptions, dominant social norms, religious and socio-cultural beliefs, limited awareness of IUCD among men and weak health service delivery platforms were the major barriers to IUCD uptake in Zimbabwe. Evidence-based strategies on demand generation, supply-side interventions, advocacy and communication for development (C4D) are crucial in improving the uptake and provision of IUCD in Zimbabwe.

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use.

OBJECTIVES: Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. METHODS: We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women's Medicaid enrollment. RESULTS: Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046). CONCLUSIONS FOR PRACTICE: The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia.

BACKGROUND: Long Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia. METHODS: A Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching. RESULTS: Of the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children. CONCLUSION: Discontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Ethiopia has a substantially greater percentage of unintended pregnancy than other developing and developed countries. Long-acting reversible contraception (LARC) has a potential to address a huge and growing unmet need in resource limited countries like Ethiopia, such as reducing unwanted births and abortion rates.As part of this global approach to fertility management, Ethiopia has been implementing various strategies like an on-going task shifting and task sharing with the implanon scale up program, and IUD revitalization program starting from the community health services to higher level healthcare systems to increase access and utilization of long acting reversible family planning methods. However, discontinuing LARCs before the recommended duration use and switching to short-acting contraceptives have proven difficulty in Ethiopia. This may have led to low utilization rate of LARCs in Ethiopian contexts including the study area, when compared to the national target. Very low coverage of use of LARC among unmet need has shown by many studies in various corners of the country. Thus, determining the magnitude and factors of LARC discontinuing and switching is still a pressing need to establish additional strategies used to improve consistent use of LARC for the recommended duration and expand access to LARC for better planning of births.In this study we assessed magnitude and factors of LARC discontinuation and switching from a relatively huge number of records extracted from systematically selected health facilities in Southern Ethiopia. Extracted data from registers of long acting reversible family planning methods were analysed using descriptive statistics and logistic regression. Accordingly, we found significant proportion women discontinued long acting reversible family planning methods before the recommended duration of use as well as switched from long acting reversible family planning methods to other modern short-acting methods due to various reasons. Only a number of children women had is associated with discontinuation and no single factor was associated with method switching in Southern Ethiopia. Family planning services should be re-evaluated with a focus on effective counseling on the side effects of LARCs approaches, and training for family planning providers, particularly community healthcare workers, should be provided.

The HER Salt Lake media campaign: comparing characteristics and outcomes of clients who make appointments online versus standard scheduling.

BACKGROUND: Little research has examined how media outreach strategies affect the outcomes of contraceptive initiatives. Thus, this paper assesses the potential impact of an online media campaign introduced during the last six months of a contraceptive initiative study based in Salt Lake City, UT (USA). METHODS: During the last six months of the HER Salt Lake Contraceptive Initiative (September 2016-March 2017), we introduced an online media campaign designed to connect potential clients to information about the initiative and a brief (9-item) appointment request form (via HERsaltlake.org). Using linked data from the online form and electronic medical records, we examine differences in demographics, appointment show rates, and contraceptive choices between "online requester" clients who made clinical appointments through the online form (n = 356) and "standard requester" clients who made appointments using standard scheduling (n = 3,051). We used summary statistics and multivariable regression to compare groups. RESULTS: The campaign logged 1.7 million impressions and 15,765 clicks on advertisements leading to the campaign website (HERSaltLake.org). Compared to standard requesters, online requesters less frequently reported a past pregnancy and were more likely to be younger, white, and to enroll in the survey arm of the study. Relative to standard requesters and holding covariates constant, online requesters were more likely to select copper IUDs (RRR: 8.14), hormonal IUDs (RRR: 12.36), and implants (RRR: 10.75) over combined hormonal contraceptives (the contraceptive pill, patch, and ring). Uptake of the contraceptive injectable, condoms, and emergency contraception did not differ between groups. CONCLUSION: Clients demonstrating engagement with the media campaign had different demographic characteristics and outcomes than those using standard scheduling to arrange care. Online media campaigns can be useful for connecting clients with advertised contraceptive methods and initiatives. However, depending on design strategy, the use of media campaigns might shift the demographics and characteristics of clients who participate in contraceptive initiatives. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02734199, Registered 12 April 2016-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02734199 .

Proactively providing contraception to New Zealand adolescents.

High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider with PCP: the range of contraceptives that should be offered, the age range that should be approached, and finally whether to include adolescents without uteruses. We conclude that PCP is an approach worth considering in the NZ context and should be piloted to assess feasibility and effectiveness.

Perspectives on contraceptive implant use in women living with HIV in Cape Town, South Africa: a qualitative study among primary healthcare providers and stakeholders.

BACKGROUND: This study explored primary healthcare provider and HIV/contraception expert stakeholder perspectives on South Africa's public sector provision of contraceptive implants to women living with HIV. We investigated the contraceptive service-impact of official advice against provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. METHODS: Qualitative data was collected in Cape Town in 2017 from primary healthcare contraceptive providers in four clinics that provide implants, as well as from other expert stakeholders selected for expertise in HIV and/or contraception. In-depth interviews and a group discussion explored South Africa's implant introduction and implant provision to women living with HIV. Data was analysed using an inductive thematic analysis approach. RESULTS: Interviews were conducted with 10 providers and 10 stakeholders. None of the four clinics where the providers worked currently offered the implant to women living with HIV. Stakeholders confirmed that this was consistent with patterns of implant provision at primary healthcare facilities across Cape Town. Factors contributing to providers' decisions to suspend provision of the implant to women living with HIV included: inadequate initial and ongoing provider training; interpretation of NDoH communications about implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures related to provider capacity. CONCLUSIONS: All South African women, including those living with HIV, should have access to the full range of contraceptive options for which they are medically eligible. Changing guidance should be initiated and communicated in consultation with primary-level providers and service beneficiaries. Guidance issued to providers needs to be clear and fully evidence-informed, and its correct interpretation and implementation facilitated and monitored. Guidance should be accompanied by provider training, as well as counselling messages and tools to support providers. Generalized retraining of providers in rights-based, client-centred family planning, and in particular implant provision for women with HIV, is needed. These recommendations accord with the right of women living with HIV to access the highest possible standard of sexual and reproductive healthcare, including informed contraceptive choice and access to the contraceptive implant.

Trends and determinants of IUD use in the USA, 2002-2012.

STUDY QUESTION: What factors and subgroups have propelled the recent increase in intrauterine device (IUD) use in the USA? SUMMARY ANSWER: The increase in IUD use, from 1.8 to 9.5% in the USA between 2002 and 2012, was driven primarily by a marked uptake among parous women who intended to have more children. WHAT IS KNOWN ALREADY: Recent data suggest an unprecedented increase in IUD use among women in the USA, yet less is known about how this increase has affected the overall proportion of women, at risk of unintended pregnancy, who are using contraception and which social and economic groups are involved. STUDY DESIGN, SIZE, DURATION: Data are drawn from the 2002 and 2011-2013 National Surveys of Family Growth. The surveys were based on cross-sectional, national samples of women of 15-44 years of age in the USA. Women responded to in-person interviews, which lasted an average of 80 min. The response rate was 80% in 2002 and 73% in 2011-2013. The sample included 7643 completed interviews in 2002 and 5601 interviews in 2011-2013. PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was limited to women at risk of unintended pregnancy, i.e. women who were sexually active in the previous 3 months (using contraception or not); it excludes women who were sterile, currently pregnant or trying to conceive. Altogether, 5181 women were at risk in the 2002 sample and 3681 were at risk in the 2012 sample. We used descriptive statistics to investigate trends in contraceptive use patterns by women's sociodemographic characteristics between 2002 and 2012 and used logistic regression to identify current predictors of IUD use in 2012. MAIN RESULTS AND THE ROLE OF CHANCE: IUD use increased from 1.8% in 2002 to 9.5% in 2012 (P < 0.001). The surge was especially marked among parous women who intended to have more children (4.2% in 2002 to 19.3% in 2012; P < 0.001); it occurred to a lesser extent among parous women who did not intend to have more children (2.0-9.7% P < 0.001), suggesting that IUDs are more often used for spacing than for ending childbearing in the USA. The most important predictors of IUD use in 2012 were age, parity and intent to have children. Dissatisfaction with a previous method was also associated with IUD use (adjusted odds ratio = 1.89, P < 0.001). LIMITATIONS, REASONS FOR CAUTION: As with all cross-sectional studies, causal inference is limited. Data are self-reported, but the survey had a high response rate and rigorous quality controls. WIDER IMPLICATION OF THE FINDINGS: This study shows promising trends in the use of highly effective contraceptive methods in the USA, which may help to explain recently reported declines in unintended pregnancy in the USA. STUDY FUNDING/COMPETING INTERESTS: Caroline Moreau was supported by the William Robertson endowment funds. The work of Hannah Lantos and William Mosher on this analysis was supported by the Department of Population Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health. The authors declare that no conflict of interest exists.

Using behavioral economic theory to increase use of effective contraceptives among opioid-maintained women at risk of unintended pregnancy.

OBJECTIVE: An unsettling aspect of the US opioid epidemic is the high rate of in utero exposure, especially since most of these pregnancies are unintended, due in part to low rates of effective contraceptive use among opioid-using women. This study tested an intervention informed by behavioral economic theory and aimed at promoting effective contraceptive use among opioid-maintained women at risk of unintended pregnancy in the Burlington, VT, area between 2011 and 2013. METHODS: Thirty-one women were assigned (initial 5 consecutively, subsequent 26 randomly) to either usual care or an experimental intervention. Participants in usual care received condoms, a dose of emergency contraception, and referral to local providers. Participants in the experimental condition received usual care plus the World Health Organization's contraception initiation protocol, including free prescription contraceptives, and financial incentives for attending 13 follow-up visits over 6months to help manage side effects and other issues. RESULTS: Significantly more women in the experimental vs. usual care control conditions initiated prescription contraceptive use (100% vs. 29%) and reported prescription contraceptive use at 1-month (63% vs. 13%), 3-month (88% vs. 20%), and 6-month (94% vs. 13%) assessments. None of the experimental condition participants became pregnant during the 6-month protocol vs. three women (20%) in the control condition. CONCLUSIONS: These results provide the first experimental evidence supporting the efficacy of an intervention for increasing prescription contraceptive use among opioid-maintained women at risk of unintended pregnancy.

Hormonal contraceptive use in Ireland: trends and co-prescribing practices.

Hormonal contraceptives are highly prevalent. Currently, little is known about Irish hormonal contraceptive trends to date since the 1995 British media contraceptive controversy. The aim of this study was to examine recent trends in contraceptive use in Ireland and to determine the frequency of co-prescriptions with important interacting medications. Approximately 40% of the Irish population are prescribed 70% of total medicines under the Irish GMS scheme. Medicines were identified using the WHO Anatomical Therapeutic Chemical (ATC) classification system. Regression analysis was used to examine trends over time. Of all contraceptives dispensed in 2013, oral contraceptives were used the most (74%) and long acting reversible contraceptives (LARCs) the least (7.5%). Fourth generation combined oral contraceptives (COCs) predominated, although a slight significant decline was shown (P < 0.0001). Second and third generation COCs were significantly increasing and decreasing, respectively (P < 0.0001). Progestin-only pills were significantly increasing (P < 0.0001 across age groups). Low rates of contraceptive co-prescribing with important interacting drugs are shown. However, 93.6% of those on enzyme-inducing anti-epileptic medications were co-prescribed ineffective contraception containing <50 µg oestrogen.Irish prescribing trends of second and third generation COCs have remained consistent since 1995. The slow decline in fourth generation COC uptake follows new evidence of an increased risk of venous thromboembolism (VTE) reported in 2011. The low, but increasing, uptake of LARCs is consistent with other countries. Co-prescribing practices involving hormonal contraceptives requires continued vigilance. This study emphasizes the need to optimize co-prescribing practices involving hormonal contraceptives and anti-epileptic medications and highlights the need to address the barriers to the currently low uptake of LARC methods in Ireland.

Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic.

STUDY QUESTION: What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. SUMMARY ANSWER: Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. WHAT IS KNOWN ALREADY: LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. STUDY DESIGN, SIZE AND DURATION: We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. MAIN RESULTS AND THE ROLE OF CHANCE: We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. LIMITATIONS, REASONS FOR CAUTION: The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. WIDER IMPLICATIONS OF THE FINDINGS: LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. STUDY FUNDING/COMPETING INTERESTS: This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study.

"I have come to remove it because of heavy bleeding": a mixed-methods study on early contraceptive implant removal and the underlying factors in eastern Uganda.

BACKGROUND: Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda. METHODS: We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients' serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis. RESULTS: In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding. CONCLUSION: A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants.

An Interpretative Study of LARCs Discontinuation in Ethiopia: The Experiences of Women Accessing Contraceptives in Selected Public Health Facilities.

Background: Discontinuation of contraception for reasons other than wanting to become pregnant is a public health concern as it affects women's autonomy in sexual and reproductive health decision making as well as gender equality. Studies identified various factors, including community perception and users' dissatisfaction that limited the reach and impact of contraceptives, primarily LARCs, on women's wellbeing. In Ethiopia, however, the reasons for early discontinuation of LARCCs are not adequately explored. Against this backdrop, this study explores the main reasons for the early discontinuation of LARCs among Ethiopian women in selected public health facilities. Methods: This study used an institution-based qualitative study design and covered selected university hospitals and health centers in Addis Ababa, Gondar, Mekelle, and Jimma. It involved in-depth interviews with 29 women aged 15-49 to gather data and explore the decision-making processes involved in the early discontinuation of LARCs. It used description, narration and thematic interpretation as data analysis procedures. Results: Interviewees reported several reasons for early discontinuation of LARCs, including side effects (eg, weight gain/loss, heavy menses, tiredness, and reduced libido), desire to conceive, and husbands' disapproval. This study found that women were sufficiently aware of alternative contraceptives, including LARCs. Many reported experimenting before deciding on an option. Conversely, others' reports reveal the influences of gender roles and community misconceptions on women's decisions to discontinue LARCs. Discussion and Implications: The common threads in interviewees' narratives highlight the significance of traditional values, gender roles, community perception, and experience with side effects to women's early discontinuation of LARCs. This study concludes with remarks on how to improve the effectiveness of family planning programming by adopting the gender transformative approach (GTA) in their design and implementation.

Perceptions of indigenous ugandan men on the use of long acting reversible contraceptives (LARCs) by rural women.

Worldwide, unintended pregnancies remain a critical public health challenge, with 74 million women in low- and middle-income countries getting these pregnancies yearly. The African continent alone contributes about 25% of all unintended pregnancies globally. Even though not all unintended pregnancies are unwanted, they can lead to many health problems for mothers and children, like malnutrition, sickness, neglect, or abuse, as well as maternal and infant morbidities and mortalities. Globally, many women die due to complications related to childbirth, either during or after pregnancy. Contraceptives, especially for long-acting reversible Contraceptive methods (LARCs), are among the best interventions to reduce maternal death. LARCs help the mother delay pregnancy and allow for longer intervals in childbirth spacing. However, utilising LARCs globally and in Uganda remains low because of limited male partner support.The purpose of this phenomenological qualitative research study was to elicit an understanding of the perceptions and beliefs of rural indigenous Ugandan men towards the use of LARCs by rural women. Ultimately the study designed strategies to enhance the uptake of those methods. Purposive sampling was used to identify 65 participants for focus group interviews and 30 for individual interviews comprising married men aged 20 to 49 years. The study was conducted in the Rubanda and Kiboga Districts of Uganda. The researcher used semi-structured questions for individual and focus group interviews.The data analysis was done by transcribing the interviews, sorting the field notes, organising, and storing the data, listening to recordings, and reading field notes and interviews to look for patterns related to the perceptions and belief systems. Using the identified patterns, the researcher coded and categorised the data to build themes emerging on the phenomenon.The study established negative perceptions and belief systems among rural indigenous Ugandan men regarding the use of LARCs by their rural women, which acted as barriers to utilisation. These perceptions included side effects, fears, desires, and cultural and religious beliefs. The study recommends strengthening social and behavioural change communication, strengthening service provision for LARCs, and monitoring and evaluation systems for LARCs. Additionally, policymakers should provide a conducive environment for LARC services provision, and the Ministry of Education and Sports, through health training institutions and universities, should prepare pre-service and in-service healthcare workers to provide LARC services.

Disparities in readiness of health facilities to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) in Bangladesh.

The considerable success of Bangladesh's family planning programs Slowed in recent years due to the low utilization of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). The low uptake persists despite the fact that these methods are proven to be highly effective in preventing unplanned pregnancies and lowering maternal deaths. This situation causes a daunting challenge for the country to attain sustainable development goals (SDGs) by 2030. The current study provides new insights into the status of LARCs and PMs availability in Bangladesh from the supply-side perspective. The main objective of this study was to assess the readiness of health facilities to provide all LARCs and all PMs in Bangladesh. To assess service readiness, we examined variations in facility types and regions, using data from the Bangladesh Health facility Survey (BHFS) 2017. Out of a total of 1054 health facilities assessed, government health facilities manifested higher availability of items of general service readiness for LARCs and PMs compared to private health facilities. Service readiness included domains including staff and guidelines, equipment, and medicine. Logistic regression models of readiness of LARCs, PMs, and combined LARCs-PMs showed significant variations by facility types and regions. Moreover, the findings of this study highlighted that, Bangladesh government facilities, irrespective of region, were more likely to be ready to provide combined LARCs-PMs, LARCs, and PMs individually than private health facilities. Looking more closely at the overall readiness within private health facilities, we found that it was better in rural areas than in urban areas. The findings of this study provide a basis to develop recommend strategic approaches to family planning programs, investment priorities in family planning services and, training for service providers to reduce regional inequality and disparities by facility types in Bangladesh.

Breastfeeding Perceptions and Behavior Among Postpartum Women Initiating Different Hormonally Systemic Contraceptive Methods.

BACKGROUND: There continues to be controversy regarding the simultaneous encouragement of both breastfeeding and immediate postpartum contraception. RESEARCH AIM: To explore postpartum women's perspectives about breastfeeding and their breastfeeding behaviors, while using one of three different hormonally systemic contraceptive methods immediately postpartum over a 6 month period of time. METHODS: This was a retrospective, longitudinal, three group comparative, secondary analysis of a prospective cohort study (N = 471) of immediate postpartum contraception. Breastfeeding, for this study, was defined as providing any human milk to the infant. Participants who chose one of three different hormonally systemic forms of contraception immediately postpartum (a long-acting hormonal reversible contraceptive (n = 200), depot medroxyprogesterone acetate 150 mg (n = 98), or a non-hormonal method (n = 173)) were compared at hospital discharge, 6 weeks, 3 months, and 6 months postpartum. The primary outcome was any breastfeeding at 6 months. Secondary outcomes included any and exclusive breastfeeding, concerns about breastfeeding while using contraception, and reasons for breastfeeding discontinuation. RESULTS: There was no significant difference in the rate of any breastfeeding between the two hormonal and the non-hormonal contraceptive groups at 6 months postpartum (long-acting hormonal 20.1%, non-hormonal 21.7%, depot medroxyprogesterone acetate 13.9%, p = .77, 0.28, respectively). The number of participants who reported stopping breastfeeding due to decreased milk supply was not significantly different between any groups at all time points (total number who discontinued at 6 months postpartum was long-acting hormonal 24.7%, non-hormonal 25.1%, depot medroxyprogesterone acetate 19.3%, p = .30). CONCLUSIONS: Breastfeeding perspectives and behavioral outcomes over the first 6 months postpartum were not influenced by participants chosen form of immediate postpartum contraception.

Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review.

OBJECTIVE: We sought to systematically review the literature on contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraception, and women seeking abortion services, globally. STUDY DESIGN: We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding users' values and preferences for contraception. Results were divided into four sub-groups. RESULTS: Twenty-three studies from 10 countries met the inclusion criteria. Values and preferences across all four sub-groups were influenced by method effectiveness, access, availability, convenience, cost, side effects, previous experience, partner approval, and societal norms. Similarities and differences were evident across sub-groups, especially concerning contraceptive benefits and side effects. No contraceptive method had all the features users deemed important. Many studies emphasized values and preferences surrounding long-acting reversible contraception (LARC), including convenience of accessing LARCs and concerns about side effect profiles. DISCUSSION: Individuals must have access to a full range of safe and effective modern contraceptive options, allowing people to make decisions based on evolving contraceptive preferences over time. Future contraception guideline development, policy, and programmatic implementation should continue considering the added influence of these specific reproductive experiences on contraceptive values and preferences of users to improve access, counseling, and method choice.

Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management.

Around two-thirds of women who are of reproductive age use some type of contraception. Two of the most effective long-acting reversible contraceptives (LARC) are the intrauterine device (IUD) and the subdermal contraceptive implant (SCI). Despite their effectiveness, women often report abnormal uterine bleeding as the reason for discontinuation. In this review, we analyze key aspects regarding the mechanisms of action of IUDs (both copper-containing and levonorgestrel-releasing) and SCIs, as well as how they change the intrauterine environment in order to provide effective contraception at a physiological level. Additionally, we introduce the pathophysiology of different types of abnormal intrauterine bleeding provoked by the mentioned LARCs. These three contraceptive methods work in diverse ways, thus, the etiology of abnormal uterine bleeding is different and multifactorial according to each LARC. This review intends to provide information in order to better our understanding of bleeding induced by these contraceptive methods, as well as introduce current and potential new therapies. Furthermore, this review intends to provide updated and concise information that could be available firsthand not only to health care providers but scientists who are innovating and revolutionizing this field. In 2013, the American College of Obstetricians and Gynecologists published a management of abnormal uterine bleeding, however, there is limited updated data regarding the physiology and pathophysiology of abnormal uterine bleeding and its treatment based on different LARCs (hormonal and non-hormonal).

The Missing Baby Bust: The Consequences of the COVID-19 Pandemic for Contraceptive Use, Pregnancy, and Childbirth Among Low-Income Women.

Multiple episodes in US history demonstrate that birth rates fall in response to recessions. However, the 2020 COVID-19 recession differed from earlier periods in that employment and access to contraception and abortion fell, as reproductive health centers across the country temporarily closed or reduced their capacity. This paper exploits novel survey and administrative data to examine how reductions in access to reproductive health care during 2020 affected contraceptive efficacy among low-income women. Accounting for 2020's reductions in access to contraception and the economic slowdown, our results predict a modest decline in births of 1.1 percent in 2021 for low-income women. Further accounting for reductions in access to abortion implies that birth rates may even rise for low-income women. These results also suggest that already economically disadvantaged families disproportionately affected by the COVID-19 economy will experience a large increase in unplanned births. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-022-09703-9.