Postabortion Contraceptive Acceptance Rate and Its Determinants among Women Receiving Abortion Service before Discharge from the Health Facilities in Harar, Eastern Ethiopia

Background. Annually, around 121 million unintended pregnancies occur in the world and more than 73 million encountered abortion. Ethiopia is also losing 19.6% of mothers due to unsafe abortion. Despite that postabortion contraceptive service is a climactic entry point for the prevention of unwanted pregnancy and associated deaths, the service magnitude and determinants immediately before discharge are not characterized well in Ethiopia. Hence, this study aimed to assess the magnitude of postabortion contraceptive utilization and associated factors among women receiving abortion care service before being discharged from health facilities in Harar, Eastern Ethiopia. Methods. A facility-based cross-sectional study was conducted among 390 women receiving abortion care services. At discharge, data about contraceptive acceptance and related maternal characteristics were collected. A binary logistic regression model was used to assess the association between independent and dependent variables (postabortion contraceptive utilization). Analysis was done with SPSS 22. Statistical significance was considered at P < 0.05 . Result. The overall prevalence of postabortion contraceptive utilization was 81.5% (95% CI: 77.9, 85.4). Being unmarried (AOR, 0.05; 95% CI (0.02, 0.16)), having no history of previous abortion (AOR, 0.11; 95% CI (0.04, 0.34)), being multigravida (AOR 8.1; 95% CI (2.20, 13.40), lacking desire to have an additional child (AOR, 6.3; 95% CI (2.65, 15.34), and history of family planning use (AOR, 17.20; 95% CI (6.5, 38.60)) were determinants of postabortion contraceptive utilization before being discharged from the health facilities. Conclusion. Postabortion contraceptive utilization in Harar health facilities still needs improvement as per the WHO and national recommendations. Therefore, the family planning provision strategies should be convincing and friendly, especially for unmarried mothers, and those who had no history of abortion should be counseled in friendly and systematically convincing schemes for enabling them to take the service before discharge from the health facility.

Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey

Background Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. Methods The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. Results Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30–34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15–19 years (AOR = 0.55; 95% CI: 0.32–0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3–4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1–2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. Conclusion The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.

Use of open-text responses to recode categorical survey data on postpartum contraception use among women in the United States: A mixed-methods inquiry of Pregnancy Risk Assessment Monitoring System data

Background Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses. Methods and findings We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term “pregnancy prevention.” Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores. Conclusions In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data.

Mercy Procedure or a Nightmare? Attitude towards Pregnancy Termination among Polish University Students

Worldwide, there are about 121 million unintended pregnancies per year. The aim of the study was to assess the attitudes in different groups of students from 40 Polish universities towards pregnancy termination. In total, 9686 university students (20.1% male and 79.9% female) took part in our research. Questions about attitudes towards abortion in all possible circumstances were involved in the survey, which also included a socio-demographic questionnaire. Overall, 94.5% of women and 90.7% of men consider that abortion should be legal in the situation of a threat to the mother’s life, while only 52% of women and 38.7% of men accept it in the case of a hard financial situation for the mother. Most students stand for abortion in the situation of a threat to the mother’s life, in the case of rape, or in the case of a mortal fetus defect. Less than half of the students interviewed consider that abortion should be legal in the case of a hard financial situation for the mother or on the mother’s demand. People who declare a religious affiliation more often disagree with abortion, even in the hardest cases such as a danger to the mother’s life or a mortal fetus defect. The factor that influences the strongest on attitudes towards abortion is being an active Roman Catholic. The majority of students have a pro-choice attitude in respect of pregnancy termination.

Contraceptive Use in Women with Inherited Metabolic Disorders: A Retrospective Study and Literature Review

Background Reproductive planning is an emerging concern for women with inherited metabolic disease (IMD). Anticipatory guidance on contraception is necessary to prevent unintended pregnancies in this population. Few resources exist to aid informed decision-making on contraceptive choice. A retrospective case-control study was performed to examine trends in reproductive planning for adolescent and adult women seen at the Children’s Hospital of Philadelphia (CHOP). Literature review on contraception and IMD was performed to assess global use. Results In a cohort of 221 reproductive-aged female IMD patients, 29.4% reported routine contraceptive use. Anticipatory guidance on contraception was provided by metabolism doctors to 36.8% of patients during the study period. Contraception discussion was more likely to occur in women older than 21 years, who lived independently and were followed by gynecology. Women who received contraception counseling from their metabolism provider were 40-fold more likely to use regular contraception. Use of combined hormonal contraceptives was most commonly reported, but contraception choice varied by age and IMD. Conclusion Metabolism providers are ideally suited to provide guidance on contraception to women with IMD. Reproductive planning should be addressed routinely using shared decision-making. Contraceptives should be selected for their efficacy, effects on metabolism, and likelihood of patient adherence.

Faktor-Faktor yang Memengaruhi Kehamilan Tidak Diinginkan di Indonesia

Unintended pregnancy can cause pregnancy termination, which leads to safety risks. This study analyzed factors affecting unintended pregnancy in Indonesia. The analysis units were women aged 15-49 who gave birth in the past five years. The sample size was 36,472 women. The research variable was unintended pregnancy, residence, age, education, husbands/partners, employment, wealth, parity, pregnancy termination, decision-maker in woman's access to health care, access to family planning information on radio, television, and newspapers/magazines. The final stage analysis used binary logistic regression. Women in urban were 1.834 times more likely to experience an unintended pregnancy than women in rural. The 20-24 age group was 0.202 times more likely to experience an unintended pregnancy than the 15-19 age group. Women with secondary education were 1.447 times more likely to experience an unintended pregnancy than no education women. The poorer were 1.190 times more likely to experience an unintended pregnancy than the poorest. Multiparity was a strong determinant of unintended pregnancy. History of pregnancy, a decision by husbands, and access to family planning information on radio and television in the last few months were risk factors for unintended pregnancies. The study concluded that eight variables affected unintended pregnancies. Keywords: unintended pregnancy, women of childbearing age, contraceptive use, family planning, maternal health. Abstrak Kehamilan yang tidak diinginkan dapat menyebabkan terminasi kehamilan, yang berujung pada risiko. Studi menganalisis faktor yang mempengaruhi kehamilan tidak diinginkan di Indonesia. Unit analisis wanita usia 15-49 tahun yang melahirkan dalam lima tahun terakhir. Besar sampel 36.472 responden. Variabel penelitian adalah kehamilan tidak diinginkan, tempat tinggal, usia, pendidikan, pasangan, pekerjaan, kekayaan, paritas, terminasi kehamilan, pengambil keputusan akses perempuan terhadap pelayanan kesehatan, akses informasi KB di radio, televisi, dan surat kabar/majalah. Analisis tahap akhir menggunakan regresi logistik biner. Hasil penelitian menunjukkan bahwa perempuan di perkotaan 1,834 kali lebih mungkin mengalami kehamilan yang tidak diinginkan dibandingkan perempuan di perdesaan. Usia 20-24 tahun 0,202 kali lebih mungkin mengalami kehamilan yang tidak diinginkan dibandingkan kelompok 15-19 tahun. Wanita dengan pendidikan menengah 1,447 kali lebih mungkin mengalami kehamilan yang tidak diinginkan daripada yang tidak berpendidikan. Kelompok yang lebih miskin 1,190 kali lebih mungkin mengalami kehamilan yang tidak diinginkan daripada yang paling miskin. Multiparitas adalah determinan kuat dari kehamilan yang tidak diinginkan. Riwayat kehamilan, keputusan suami, dan akses informasi KB di radio/televisi merupakan faktor risiko terjadinya kehamilan yang tidak diinginkan. Studi menyimpulkan delapan variabel yang mempengaruhi kehamilan yang tidak diinginkan. Kata kunci: kehamilan tidak diinginkan, wanita usia subur, penggunaan kontrasepsi, keluarga berencana, kesehatan ibu

Condom use education, promotion and reasons for condom use: Perspectives of healthcare providers and young adults in Vhembe district, Limpopo province

Background: Condom use is a critical component of a comprehensive and sustainable approach to the prevention of unintended pregnancies and sexually transmitted infections (STIs) (including HIV). Despite government making condoms freely available in the healthcare facilities in Vhembe district, there are reports of an increase in teenage pregnancies and STIs, including HIV, amongst young adults. The aim of the study was to gain an in-depth understanding of condom use promotion and reasons of condom use amongst young adults in Vhembe district, in Limpopo province.Methods: A descriptive phenomenological design was used to explore the reasons for promoting condom use amongst young adults themselves and from the perspectives of healthcare providers who are critical role players in condom education and provision. Purposive sampling was used to sample young adults and healthcare providers at three of Vhembe district’s primary healthcare facilities. Individual semi-structured interviews were conducted, after which thematic data analysis was used to develop themes and subthemes.Results: Two superordinate themes emerged from data analysis, namely approaches to promote condom use and reasons for condom use. Two themes emerged in respect of approaches for promotion of condom use: information sharing in the form of education, the distribution of informative material, and the adoption of a multi-sectoral approach. Self-protection emerged as a reason for condom use, to prevent disease, pregnancy and ‘u wela’, and was indicative of not trusting a sexual partner.Conclusion: To effectively promote condom use, a multidisciplinary team approach involving nurses, lay counsellors and peer educators need to be strengthened at local primary health facilities in order to facilitate the distribution of condoms and educate young adults on consistent condom use.

SRH Needs of Syrian Refugees in Jordan Nine Years Post Crisis: with Emphasis on MISP Implementation and Transition into Comprehensive SRH Services

Background: Millions of Syrians have been forcibly displaced since the start of civil war in March 2011. The vast majority of these refugees live in neighbouring countries including Jordan as one of the affected countries in the Middle East. Adolescent girls and women are among the most vulnerable populations in this humanitarian crisis. MISP/SRH interventions and programs have been implemented by various humanitarian organizations, governments, and other health care providers, to prevent and manage the consequences of sexual violence, reduce HIV transmission, minimize maternal/neonatal morbidity and mortality, reduce unintended pregnancies and unmet family planning needs, and plan for comprehensive SRH services as soon as the situation permits. After almost nine years of the protracted Syrian crisis, it is essential to examine available evidence around the effectiveness of SRH interventions for Syrian refugees in Jordan in order to inform the humanitarian community including the government by identifying best practices, essential gaps, bottlenecks, and lessons learnt. Methods: In 2018, an assessment using a previously validated MISP/SRH survey tool and combining both quantitative and qualitative research methods was conducted in four governorates of Jordan (Amman, Irbid, Zarqa and Mafraq) to evaluate the availability of MISP/SRH interventions and programs. Data were obtained from interviews with key informants (KIs). For the analysis SPSS-IBM statistical software was used.Results: Overall, 58 KIs affiliated with a total of 15 different entities/agencies were were selected for this assessment. KIs/respondents had different levels of knowledge and sources of information about the MISP/SRH services and had variable engagement in implementation. The results of this assessment highlighted significant knowledge gaps about the implementation of the different MISP objectives and priorities, even after almost nine years of the initial onset of the crisis. Among the different MISP activities, family planning, maternal health, condom distribution, and newborn health services had the highest level of preparation and implementation, while availability of antiretrovirals (ARVs) for prevention of mother-to-child transmission (PMTCT) and access to safe blood had the lowest level of preparation and implementation. This assessment also showed lack of national coordination in the provision of the different SRH services, lack of a national plan for capacity building, and lack of adequate logistics support systems and funding. Conclusions: Important gaps in the knowledge and implementation of MISP/SRH activities continue to exist in Jordan, almost nine years into the protracted Syrian displacement. Areas in need of focus included: national coordination in the provision of SRH services, developing a national plan for capacity building, improving logistics support systems, and allocating sufficient funding for the provision of MISP/SRH services. Areas, particularly, in need of additional funding included: Capacity building of services provides with specific focus on MISP training activities around the different MISP/SRH services, facilitating emergency preparedness, improving coordination, and improving referral systems.