Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, Accra

Background Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. Methods A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables. Results More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR = 0.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR = 0.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. Conclusion The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.

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.

Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders

Objectives: Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. Methods: We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes. Results: Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09–4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13–0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors. Conclusions: This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women’s expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.

Analysis of Family Planning Services in Mohammad Hoesin Hospital Palembang on 2016

Background. Family planning services in hospitals have been held since 1970 by the functional implementing unit led by obstetric and gynecologist specialists. Situational changes following decentralization in the 1990s caused policymakers and family planning practitioners' lack of attention to family planning services at province, district, and city levels. Data from 2002-2007 showed a decrease in family planning services from 6.2% to 4.9% in government hospitals and from 3.4% to 2.2% in private hospitals. The decrease in contraception use was affected by family planning users and providers. This study aims to analyze the factors contributing to family planning services in Mohammad Hoesin Hospital. Methods. This was a descriptive-analytic study with a cross-sectional design. The author used primary and secondary data with quantitative and qualitative approaches through the study of documents, observation, questionnaire, in-depth interview, and focused group discussion. Results. We identified various factors that play a role in the implementation of family planning services in almost all aspects, such as policy system, incomplete infrastructures; competence and the number of health workers; standard service procedure; sources and mechanism of the contraceptive tools; financial problems; recording and reporting system; quality control services; monitoring and evaluation; development services; also knowledge and behavior of the health workers. Conclusion. Family planning services need support and more serious attention from the directors to improve and overcome the problems and obstacles. In addition, the board of directors requires better coordination effort and cooperation on the internal level (between divisions or departments within the hospital) and with the relevant instance.

Availability And Readiness of Healthcare Facilities And Their Effects On Long-Acting Modern Contraception Use In Bangladesh: Analysis of Linked Data

Aim: Evidence on the availability and accessibility of health facilities and their impacts on long-acting modern contraceptives (LAMC) use in low- and middle-Income countries are scarce. This study examined the influence of the availability and readiness of health facilities in determining the use of LAMC in Bangladesh.Methods: We linked data of the Bangladesh Demographic and Health Survey and the Health Facility Survey using the administrative-boundary linkage method. Mixed effect multilevel logistic regression was conducted. The sample comprised 10,938 married women of 15-49 years of age, who were fertile but did not desire a child within two years of the date of survey. The outcome variable was the current use of LAMC (yes, no) and the explanatory variables were health facility-, individual-, household- and community-level factors.Results: Nearly 34% of participants used LAMC with significant variations across areas in Bangladesh. The average distance between the nearest LAMC-providing health facilities and women’s homes was 6.36 km, higher in the Sylhet division (8.34 km) and lower in the Dhaka division (4.34 km). Increased scores for the management (adjusted odds ratio (AOR) 1.59; 95% CI, 1.21-2.42) and infrastructure (AOR, 1.44; 95% CI, 1.01-1.69) of health facilities were positively associated with the overall uptake of LAMC. AORs for women to report using LMAC were 2.16 (95% CI, 1.18-3.21) and 1.74 (95% CI, 1.15-3.20), respectively, for per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities. Nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometer increase in the average regional-level distance between women’s homes and the nearest health facilities.Conclusion: The availability of health facilities close to residence and their improved management, infrastructure, and readiness to provide LAMC play a significant role in increasing LAMC uptake among women. Policies and programs should prioritize increasing the availability and accessibility of health facilities that provide LAMC services.

Contraception in breast cancer survivors from the FEERIC case-control study (performed on behalf of the Seintinelles research network)

Objective: To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. Design: The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study. Data were collected through online questionnaires completed on the Seintinelles* research platform. Setting: Not applicable Patient(s): BC patients aged from 18 to 43 years, matched for age and parity to cancer free volunteer controls in a 1:2 ratio. Intervention(s): None Results: In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p=0.97). However, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p<0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy induced ovary damage at BC diagnosis (OR= 2.47 95%CI [ 1.39 - 4.37] and anti-HER2 treatment (OR=2.46, 95% CI [ 1.14 - 6.16]) were significantly associated with the use of a contraception in multivariate analysis. Discussion: In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling.

Pregnancy Outcomes in Young Women With Youth-Onset Type 2 Diabetes Followed in the TODAY Study

<b>Objective:</b> To assess pregnancy outcomes in young women with youth-onset type 2 diabetes followed in the TODAY study. <p><em><b>Research Design and Methods:</b></em><em> </em>Pregnancy information (outcome, any maternal or fetal complications) was obtained from the female participants by self-report. Additionally, medical records for the pregnancy and the child’s neonatal course were obtained with data abstracted into standardized forms.<em></em></p> <p><b>Results:</b> Over a maximum of 15 years, 260 pregnancies were reported by 141 women (age 21.5 years ± 3.2 years, BMI 35.6 ± 7.2 kg/m², diabetes duration 8.1 ± 3.2 years). Contraception use prior to pregnancy reported by 13.5% of the women. Complications were reported by 65% of the women during their pregnancy. Pregnancy loss was observed in 25.3% and preterm birth in 32.6% of pregnancies. HbA1c ≥ 8% was observed in 31.9% of the pregnancies and 35% of the pregnancies were complicated by chronic hypertension. Nephropathy prior to pregnancy was observed in 25% of the women. In the offspring, 7.8% were classified as small for gestational age, 26.8% large for gestational age, and 17.9% in the macrosomic range.</p> <b>Conclusion:</b> Based on observations from the TODAY cohort, young women with pre-gestational, youth-onset type 2 diabetes had very high rates of maternal complications stemming from significant socioeconomic disadvantage. The substantial maternal and infant complications seen in these young moms could potentially be avoided with improved contraception rates and reproductive planning.