Early Removal of the Etonogestrel Contraceptive Implant and Associated Factors Among Users at the Urban Family Planning Clinic in Siriraj Hospital, Bangkok, Thailand

Objective: To study the rate and reasons for the early removal of etonogestrel contraceptive implants and associated factors at the family planning clinic in Siriraj Hospital. Materials and Methods: This retrospective cohort study was conducted between May 2015 and December 2019 and contained 1,030 women who received the etonogestrel contraceptive implant. The medical records of demographic characteristics and clinical factors i.e., implant insertion date, implant removal date, reason for implant removal, contraceptive use before implant insertion and after implant removal, documented bleeding pattern and acceptability, were identified. Results: The mean age of participants was 28.6 ± 6.9 years. About 21% of women (218/1030) prematurely discontinued their etonogestrel implant. A desire to become pregnant was the most common reason for early removal of the etonogestrel implant (32%). Meanwhile, the most common side-effect contributing to early removal was unscheduled bleeding. The associated variables of early etonogestrel implant removal were low BMI (p-value = 0.021) and unacceptability of bleeding pattern at one year (p-value < 0.001) and two years (p-value < 0.001) after insertion. Conclusion: Early etonogestrel implant discontinuation rate was remarkable and the main reasons for it include a desire to become pregnant and bleeding side effects. Moreover, a lower BMI and unacceptability of bleeding problems also increased the likelihood of early removal of this contraceptive method.

Trends in female sterilization in north central Nigeria

Background: Contraception is key to the reduction of maternal mortality. Tubal ligation is a good option for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. The objective of this study was to determine the trends, uptake, socio-demographic characteristics of acceptors, indications and complications of bilateral tubal ligation (BTL) in our environment.Methods: A retrospective study of BTL at UATH was conducted over a five year period, from 1 January 2015 to 31 December 2019. The records of women who had BTL were retrieved from the medical records department, family planning clinic, and the theatre. The data was analyzed using SPSS 21.Results: The mean age and parity were 36.0±4.0 and 5.0±2.0 respectively. The incidence of BTL was 1.3%. Majority of those that had BTL had at least secondary level of education 100 (83.4%) and 58 (48.3%) were grand multiparous. Majority of cases 87 (72.5%) were done during caesarean section/laparotomy. Postpartum BTL accounted for 15.0%, while interval BTL accounted for 12.5%. Completed family size was the commonest indication 48.3%. No client came back with regrets. There was one case of failed BTL.Conclusions: BTL is a safe and effective method of sterilization. There is an increasing trend in utilization of BTL however the rate is still low.

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

Background: Long-acting reversible contraceptives (LARC) are methods used in the prevention of pregnancy that are long lasting. They are effective and efficacious methods of contraception and return to fertility after removal is prompt. Objectives was to determine the uptake of long-acting reversible contraception and assess the characteristics of acceptors of these methods in the area.Methods: This was a retrospective study of clients’ who visited the family planning unit of the University of Abuja teaching hospital over a 5-year period, from 01 January 2015 to 31 December 2019. Information on socio-demographic characteristics and specific methods selected were extracted from their records and represented on simple tables, graphs, and charts.Results: A total of one thousand eight hundred and ninety-one (1,891) clients accepted available methods of contraceptives during the five-year study period. One thousand seven hundred and twenty-four (1,724) accepted LARC (91.1%) while only one hundred and sixty-seven (167) accepted non-LARC (8.9%). Majority 946 (54.9%) of the clients that accepted LARC were aged between 30-39 years and clients less than 20 years were 22 (1.3%). Clients with parity 3 and above were 1162 (67.7%), and majority of LARC acceptors wanted more children 1145 (66.4%). Amongst the LARC acceptors, most of the clients opted for subdermal implant either Jadelle or Implanon 940(49.7%). Three hundred and ninety-eight (23.1%) discontinued a form of LARC during the study period while 1127 (65.4%) continued with one form of LARC or another.Conclusions: The uptake of LARC in this region is very high. Teenagers and low parity rarely attended the family planning clinic.

Contraceptive Use: Patterns and Preferences among New Acceptors in Malaysia, 1990 to 2018

Family planning is one of the important aspects in the Sustainable Development Goals (SDG's) in Goal 3 on Health and Goal 5 on Gender Equality and Women’s Empowerment. Family planning is the basic need and women’s right to pregnancy, to get optimal health. The use of contraceptive enables women to attain their desired number of children and determine the gap of pregnancies towards the improvement of the families’ well-being of. The aim of this paperisto describe the patterns and preferences of contraceptive use among new acceptors attending a family planning clinic at National Population and Family Development Board (NPFDB) in sixteenstates in Malaysia. The data analysis includes the new acceptors of contraception use among married women aged 15 to 49 years old, who attended a family planning clinic at NPFDB for the year 1990 to 2018. There are various types of contraceptive methods considered: contraceptive pills, Intrauterine Contraceptive Device (IUD), condom, hormone injection, implant, sterilization, rhythm and others. Results of the analysis show that contraceptive pills and sterilization have continued to be the most preferred contraceptive methods among new acceptors at NPFDB clinic, with decreasing pattern from 1990 to 2018.While the use of implant, hormone injection and condom has increased steadily since 2004. The state of Perak has the highest number of new acceptors in most years, whilethe federal territory of Labuan has the lowest number of acceptors in most years within 29 years from 1990 to 2018. In addition, the most popular contraceptive method among women for all states in Malaysia in most years from 1990 to 2018 is contraceptive pills, which is preferred in ten states: Kelantan (83%), Kuala Lumpur (72%), Labuan (40%), Negeri Sembilan (86%), Pahang (66%), Perlis (45%), Pulau Pinang (35%), Sabah (60%), Selangor (69%), and Terengganu (76%). While sterilization is the most popular in four states: Johor (62%), Kedah (59%), Melaka (52%), and Perak (66%). Finally, hormone injection is the most popular method in Putrajaya (100%), and condom is the most popular in Sarawak (40%).As a conclusion, this study has found that although the use of contraceptive pillsisdecreasing, it still becomes the most popular among new acceptors in most of the states in Malaysia since 1990. However, the decreasing pattern of new acceptors for all types of contraceptive methods becomes our concern. Future research should therefore,concentrate on the investigation of the reduction number of new acceptors at NPFDB clinic. This is important to make sure the demands of contraceptive can be met and NPFDB clinics couldprovide better services towards better quality of life and better families’ well-being.

Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use

Objective To evaluate whether continuation rates with the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Family planning clients at a Tertiary hospital in Niger Delta, Nigeria: Where they on any contraceptive method prior to first visit?

Background: Maternal and child morbidity and mortality in developing countries have been shown to be reduced by effective use of contraceptive methods. Contraceptive use also improves the lives of women and children. Experience with previous use of contraceptives may affect the uptake rate of modern contraceptive methods. Aim and objective: To determine the pattern of previous contraceptive usage, uptake rates of the contraceptives, the continuation and discontinuation rates and the sources of prior contraceptives. The socio-demographic characteristics and sources of information on current contraceptive use at the Rivers State University Teaching Hospital during the study period. Methods: This was a retrospective study of clients’ records in family planning clinic at theRivers State University Teaching (RSUTH) over a period of five years. Their cards were retrieved, reviewed; data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version25.0 (Armonk, NY). Results: There were 874 contraceptive acceptors attending family planning clinic between 1st January, 2015 and 31st December, 2019 in the centre. Of this number, 566 (64.8%) were using one form of contraceptive method or the other while 308 (35.2%) were not on any form of contraception. Of this 566 women who used contraceptive method prior to their visit to the family planning clinic, intrauterine contraceptive device (IUCD) use accounted for 118 (20.8%), others were barrier method, 107 (18.9%), oral contraceptive pills (OCPs), 95 (16.8%), depot medroxyprogesterone acetate (DMPA), 72 (12.7%), implanon, 40 (7.1%), noristerat, 36 (6.4%), postinor, 28 (5.0%), withdrawal method, 26 (4.6%) and calendar method, 24 (4.2%). Most of the previous contraceptives used came from Government hospital accounting for 44.4%. Most women (72%) obtained their information concerning current contraception from clinical personnel. More than half of the clients (64.1%) were within the age range of 30-39 years and 2 (0.2%) were below 20 years. Age range for the study was 19-51years. Majority of the clients (70.7%) were multipara while 162 (18.5%) were grandmultipara. Modal parity was para 3. The women with formal education were 867 (99.2%). Married women and Christians accounted for843 (96.5%) and 867 (99.2%) respectively. Conclusion: Most clients were in their thirties, married, educated and multiparous. Thirty five percent of the women were not using any form of contraceptive method which is quite alarming and definitely would have led to unwanted pregnancies and possibly induced abortions with its sequalae.

Prevalence and Pattern of Modern Contraceptive Choices among Women of Reproductive Age 15-49 Years in a Community Health Facility: An Eight Year Retrospective Study

Aims: Utilization of modern contraception to prevent pregnancies is a unique health intervention as unplanned pregnancies expose women to additional health risks and lifetime risk of maternal mortality by increasing the number of lifetime pregnancies and deliveries. This study therefore aims at evaluating the prevalence and pattern of modern contraceptive choices among women of reproductive age and to identify the most commonly used modern contraceptives. Study Design: Retrospective study carried out at family planning clinic of Community Health Centre, Osun State University Teaching Hospital, Osogbo, Osun State, South-West Nigeria between January 2013 to December 2020. Methodology: The clients who had attended family planning clinic for modern contraceptive services during the period of eight (8) years were identified from clinic register. Their case files were retrieved and relevant data extracted with the use of standardized pro forma. Two hundred and twenty-two (222) case notes were available and suitable for analysis. Data were analysed using descriptive statistics and inferential statistics of chi square and ANOVA. Results: The result revealed highest prevalence of modern contraceptive utilization among young women with slight increase in rate of utilization as the age increases and decreases with older age. The most commonly utilized methods of contraception were Injectables: Noristerat and Depo-Provera; and IUCD. Result further showed significant relationship between age, number of children alive, breastfeeding status and desire to have more children and choice of modern contraceptive (P- value < 0.000). Conclusion: Utilization of modern contraceptives can be improved through adequate public health education, thus, this study recommended that health education should be intensified at antenatal clinic, infant welfare clinic, religious places, market places and any place of public gathering.

Intersection of Intimate Partner Violence and Pre-Exposure Prophylaxis: Exploring HIV Worry and PrEP Acceptability Among Women

This article examines the prevalence of recent and lifetime intimate partner violence (IPV) and association with pre-exposure prophylaxis (PrEP) acceptability among women seeking care at an urban family planning clinic ( N = 145). We found high prevalence of recent (40%) and lifetime IPV (71%). Almost a third of participants reported being worried about HIV risk, 70% were willing to take PrEP, and 71% of women who disclosed recent IPV were willing to take PrEP. Findings provide direction for research, practice, and policy attention needed around the context of IPV to focus development of a woman-centered PrEP intervention.