Four out of ten married women utilized modern contraceptive method in Ethiopia: A Multilevel analysis of the 2019 Ethiopia mini demographic and health survey

Background Modern contraceptive method is a product or medical procedure that interferes with reproduction from acts of sexual intercourse. Globally in 2019, 44% of women of reproductive age were using a modern method of contraception but it was 29% in sub-Saharan Africa. Therefore, the main aim of this analysis was to assess the prevalence of modern contraceptive utilization and associated factors among married women in Ethiopia. Method The current study used the 2019 Ethiopia mini demographic and health survey dataset. Both descriptive and multilevel mixed-effect logistic regression analysis were done using STATA version 14. A p-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were used to report statistically significant factors with modern contraceptive utilization. Result The overall modern contraceptive utilization among married women in Ethiopia was 38.7% (95% CI: 37.3% to 40.0%). Among the modern contraceptive methods, injectables were the most widely utilized modern contraceptive method (22.82%) followed by implants (9.65%) and pills (2.71%). Maternal age, educational level, wealth index, number of living children, number of births in the last three years, number of under 5 children in the household, religion, and geographic region were independent predictors of modern contraceptive utilization. Conclusion In the current study only four out of ten married non-pregnant women of reproductive age utilized modern contraceptive methods. Furthermore, the study has identified both individual and community-level factors that can affect the utilization of modern contraceptive methods by married women in the country. Therefore, concerned bodies need to improve access to reproductive health services, empower women through community-based approaches, and minimize region wise discrepancy to optimize the utilization.

New Contraception Update — Annovera, Phexxi, Slynd, and Twirla

Purpose of Review In this review, we discuss the efficacy, safety, and benefits of four new contraceptive products available in the USA, specifically Annovera, Phexxi, Slynd, and Twirla. Recent Findings Annovera is a vaginal ring releasing ethinyl estradiol and segesterone acetate that can be used for up to one year (13 cycles), offering patients an effective, user-controlled option that may improve contraceptive access for those in low-resource settings or those with barriers to retrieving monthly prescriptions; however, given limited efficacy and safety data in people with body mass index (BMI) > 29 kg/m2, clinicians may consider whether Annovera is an appropriate contraceptive method for obese patients if there are other acceptable alternatives. Phexxi prescription-only vaginal gel is a user-controlled, non-hormonal, on-demand contraceptive method that represents a novel addition to the market with its additional uses as a personal lubricant and as a potential microbicide for urogenital infection prevention. Slynd, a drospirenone-only pill, provides more flexibility for delayed or missed pills while maintaining efficacy and a more favorable bleeding profile compared with previously available progestin-only pills. Lastly, Twirla is a transdermal patch releasing ethinyl estradiol and levonorgestrel that offers users an additional option for a user-controlled, combined hormonal contraceptive method without daily dosing; however, prescription is limited to patients with BMI < 30 kg/m2 due to decreased efficacy and VTE events in people with obesity. Summary The addition of these products expands the available options for pregnancy prevention to address unmet contraceptive needs.

Impact of contraceptive counselling, an essential element of post-abortion care, on uptake of contraceptives: a cross-sectional study of adolescents who received post-abortion care services in Makueni County, Kenya

Background: Contraceptive counselling and provision of contraceptives are essential elements of the post-abortion care model which was first published in 1994 with an aim of promoting post-abortion care as an effective public health strategy. Despite being core elements of this model, they are often overlooked during provision of post-abortion care services as health care workers focus on emergency services and removing the retained products of conception. The aim of this study was to assess the impact of contraceptive counselling on uptake of contraceptives among adolescents presenting for post-abortion care.Methods: A cross-sectional study involving 100 adolescent girls who presented for post-abortion care at the Kibwezi-east sub-county hospital, Makueni county, Kenya. Self- administered questionnaires were used for data collection and data was analyzed using SPSS version 25. Chi-square was used to compare study participants who received/did not receive contraceptive counselling and their uptake of contraceptives.Results: The mean age of the 100 participants was 17 years (SD=1.457). 98% of them were formally educated, 57% had the mother as their only guardian and majority of them were of Christian religion (56%). 41% (n=41) received contraceptive counselling services and 59% (n=59) were not counselled. Among the 41 participants who received contraceptive counselling, 92% (n=37) of them took up a contraceptive method and 8% (n=4) did not take up any method and among the 59 participants who did not receive contraceptive counselling, 51% (n=30) of them took up a contraceptive method while 49% (n=29) did not.Conclusions: Contraceptive counselling remains an integral part of post abortion care and in this study it was found to have a positive correlation with utilization of post abortion contraceptives (rs=0.412, p=0.000).

Determinants of reversible contraceptive method discontinuation among women of reproductive age in Kano metropolis, Nigeria

Contraceptive discontinuation contributes substantially to the total fertility rate, unwanted pregnancies and induced abortions thereby increasing the already high maternal morbidity and mortality. This study aimed to access contraceptive discontinuation among women of reproductive age in Kano metropolis. Using a cross-sectional study design with concurrent mixed method of data collection, 350 women were studied. Data was collected using a structured interviewer administered questionnaire, focus group discussion and key informant interview guides. Of the 350 participants, 168 of them had discontinued a method of contraception giving a total discontinuation rate was 48%, with method specific discontinuation rate of 35.1% for implants, 33.9% for injectables, 21.4% for pills, and IUD having the lowest rate (15.5%). The study also found side effects to be the most common reason why women discontinued contraception (67.1%), intention to get pregnant (59.5%), method failure (16.7%), method switch (12.0%), and husband’s disapproval (9.5%). Factors significantly associated with discontinuation at bivariate level were ethnicity, influence on method choice, type of facility where method was obtained, and the type of contraceptive method. These factors were found not to be significant at multivariate level. Contraceptive discontinuation is prevalent in Kano metropolis, meaning that women are at high risk of unintended, mistimed pregnancies, and unsafe abortions, increasing maternal morbidity and mortality. Efforts should be made to tackle the problem of discontinuation through effective educational strategies and counselling techniques.

Pengetahuan Kader Keluarga Berencana tentang Kontrasepsi Jangka Panjang dalam Peningkatkan Minat Pasangan Usia Subur di Kabupaten Banyuwangi

ABSTRAKPeran kader KB bagian dari masyarakat dimana sangat penting dapat memberikan motivasi kepada masyarakat terutama pada keluarga berencana dalam penggunaan kontrasepsi. Metode Kontrasepsi Jangka Panjang (MJKP) merupakan bagian dari program keluarga berencana sebagai upaya mengatur jarak kehamilan. Penggunaan MKJP yang masih rendah sekitar 37% diperlukan Kader memiliki peranan dalam meningkatkan minat aseptor KB jangka Panjang dengan sasaran PUS di Desa Karangrejo Kecamatan Blimbingsari, Tujuan penelitian ini untuk mengetahui gambaran pengetahuan kader KB tentang kontrasepsi jangka Panjang untuk meningkatkan minat Pasangan Usia Subur (PUS). Metode penelitian adalah penelitian deskriptif kuantitatif. Sampel yang diambil adalah semua kader KB di Desa Karangrejo kecamatan Blimbingsari tahun 2020 sebanyak 86 responden. Pengambilan sampel menggunakan total sampling. Hasil Penelitian menunjukkan bahwa pengetahuan kader KB tentang MKJP secara keseluruhan kategori baik 21%, cukup 34,8% dan kurang 44,2% . Gambaran pengetahuan kader menunjukkan kemampuan kader dalam memberikan informasi kepada PUS tentang kontrasepsi jangka panjang yang nantinya akan berdampak pada peningkatan minat PUS dalam penggunaan kontrasepsi jangka panjang. Kesimpulannya dari hasil penelitian bahwa pengetahuan kader sangat penting dalam keaktifan kader dalam memberikan motivasi kepada PUS. Disarankan bagi setiap kader diberikan pelatihan dan penyuluhan tentang MKJP dalam meningkatkan pengetahuan kader KB untuk bisa lebih aktif dalam memberikan informasi dan motivasi kepada semua ibu PUS tentang kontrasepsi jangka Panjang dan bagi Bidan dapat melakukan pendampingan secara kontinyu kepada kader sebagai upaya dalam meningkatkan cakupan akseptor KB jangka Panjang seperti IUD,Implan dan MOW.Kata Kunci : kade; pengetahuan; kontrasepsi ABSTRACTThe role of family planning cadres as part of the community is very important to be able to motivate the community, especially for family planning in using contraception. Long-Term Contraceptive Method is part of the family planning program as an effort to regulate pregnancy spacing. The use of Long-Term Contraceptive Method which is still low around 37% is needed cadres’ roles in increasing the interest of long-term family planning acceptors with the target couples of childbearing age in Karangrejo Village, Blimbingsari District. The method was quantitative descriptive research. The samples taken were all family planning cadres in Karangrejo Village, Blimbingsari 2020 as many as 86 respondents by using total sampling. The results showed that the knowledge of family planning cadres about Long-Term Contraceptive Method was in the good category of 21%, 34.8% sufficient and 44.2% less. The overview of cadres’ knowledge showed their ability to provide information to the couples of childbearing age about long-term contraception which will have an impact on increasing their interest in using long-term contraception. The conclusion showed that the cadres’ knowledge is very important in providing motivation to the couples of childbearing age. It is recommended for every cadre to be given training and counseling about Long-Term Contraceptive Method in increasing their knowledge to be more active in providing information and motivation to all women of reproductive age about long-term contraception and for midwives to provide continuous assistance to cadres as an effort to increase the coverage of long-term family planning acceptors such as IUD, Implant and Female Operation Medical.Key Words : cadres; knowledge; contraception.

Explainable analytics: Understanding causes, correcting errors, and increasingly achieving perfect accuracy from nature of distinguishable patterns

In addition to pursue accurate analytics, it is invaluable to clarify how and why inaccuracy exists. We propose a transparent classification method (TC). In training, we discover patterns from positive and negative observations respectively; next, patterns are excluded if they appear in both types. In testing, observations are scored by the pure patterns and connected like social networks. Based on set theory, pure patterns have explanatory power for distinguishing tangled relationship between negative and positive observations. Experimental results demonstrate that TC can identify all positive (e.g., malignant) observations at low ratios of training to testing, e.g., 1:9 in Breast Cancer Wisconsin (Original) and 3:7 in Contraceptive Method Choice dataset. Without fine-tuned parameters and random selection, TC eliminates uncertainty of the methodology. TC can visualize causes, and therefore, prediction errors are traceable and can be corrected. Further, TC shows potential of identifying whether the ground truth is incorrect (e.g., diagnostic errors).

Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk

Many factors must be considered and discussed with women when initiating a contraceptive method and the risk of venous thromboembolism (VTE) is one of them. In this review, we discuss the numerous strategies that have been implemented to reduce the thrombotic risk associated with combined oral contraceptives (COCs) from their arrival on the market until today. Evidences suggesting that COCs were associated with an increased risk of VTE appeared rapidly after their marketing. Identified as the main contributor of this risk, the dosage of the estrogen, i.e., ethinylestradiol (EE), was significantly reduced. New progestins were also synthetized (e.g., desogestrel or gestodene) but their weak androgenic activity did not permit to counterbalance the effect of EE as did the initial progestins such as levonorgestrel. Numerous studies assessed the impact of estroprogestative combinations on hemostasis and demonstrated that women under COC suffered from resistance towards activated protein C (APC). Subsequently, the European Medicines Agency updated its guidelines on clinical investigation of steroid contraceptives in which they recommended to assess this biological marker. In 2009, estradiol-containing COCs were marketed and the use of this natural form of estrogen was found to exert a weaker effect on the synthesis of hepatic proteins compared to EE. In this year 2021, a novel COC based on a native estrogen, i.e., estetrol, will be introduced on the market. Associated with drospirenone, this preparation demonstrated minor effects on coagulation proteins as compared with other drospirenone-containing COCs. At the present time, the standard of care when starting a contraception, consists of identifying the presence of hereditary thrombophilia solely on the basis of familial history of VTE. This strategy has however been reported as poorly predictive of hereditary thrombophilia. One rationale and affordable perspective which has already been considered in the past could be the implementation of a baseline screening of the prothrombotic state to provide health care professionals with objective data to support the prescription of the more appropriate contraceptive method. While this strategy was judged too expensive due to limited laboratory solutions, the endogenous thrombin potential-based APC resistance assay could now represent an interesting alternative.

Explainable analytics: Understanding causes, correcting errors, and increasingly achieving perfect accuracy from nature of distinguishable patterns

In addition to pursue accurate analytics, it is invaluable to clarify how and why inaccuracy exists. We propose a transparent classification method (TC). In training, we discover patterns from positive and negative observations respectively; next, patterns are excluded if they appear in both types. In testing, observations are scored by the pure patterns and connected like social networks. Based on set theory, pure patterns have explanatory power for distinguishing tangled relationship between negative and positive observations. Experimental results demonstrate that TC can identify all positive (e.g., malignant) observations at low ratios of training to testing, e.g., 1:9 in Breast Cancer Wisconsin (Original) and 3:7 in Contraceptive Method Choice dataset. Without fine-tuned parameters and random selection, TC eliminates uncertainty of the methodology. TC can visualize causes, and therefore, prediction errors are traceable and can be corrected. Further, TC shows potential of identifying whether the ground truth is incorrect (e.g., diagnostic errors).

Misplaced intrauterine contraceptive devices: a case report

Contraception is a new topic gaining attention in country like India and a new proposed area of research. Intrauterine contraceptive devices (IUCDs) are one contraceptive method requiring less efforts and having more efficacy. ‘Misplaced IUCD’ is one of the rare and the most dreadful complication of IUCD insertion. Clinically, it can present as having pain, bleeding, recurrent pregnancy loss or can be asymptomatic. This is a case report of a 40 year old P4A1L4 female who presented to us with suspicion of misplaced IUCD without clinical symptoms. Clinical examination and radiological investigations made a diagnosis of misplaced IUCD and laparoscopy confirmed it. Laparoscopically misplaced IUCD was removed.