Contraceptive Failure Rates in the Developing World

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Contraception Usage and Timing of Pregnancy among Pregnant Teenagers in Cape Town, South Africa

OBJECTIVE:

To evaluate knowledge and use of contraception among pregnant teenagers in the Cape Town metropolitan area.

METHODS:

A cross-sectional study enrolled women aged 16 to 19 years who were pregnant and attending prenatal clinics, and prenatal and labor wards at regional hospitals and midwife-run obstetric clinics in the Cape Town area between March 1, 2011 and September 30, 2011. Data were collected using an administered questionnaire.

RESULTS:

The study enrolled 314 participants. Of the participants, 240 (76.4%) felt their pregnancies had occurred at the "wrong time" but only 38 (12.1%) were using contraception at the time of conception. The form of contraception that participants most commonly had knowledge of was injectable hormonal contraception (274 [87.3%]). Contraception use was low, with 126 (40.1%) participants having never used contraception. The forms of contraception used most commonly were the male condom (106 [33.8%]) and injectable contraception (98 [31.2%]). The majority of participants found it easy to get contraception (192 [61.1%]) and felt that information regarding contraception was readily available (233 [74.2%]).

CONCLUSION:

Contraception use is suboptimal but this may not simply be a reflection of ineffective family-planning services. Further research is needed to fully explain the lack of contraceptive use in this population.

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By:  Vollmer LR1, van der Spuy ZM2.

• 1Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. Electronic address: lindivollmer@hotmail.com.
• 2Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00039-4. doi: 10.1016/j.ijgo.2015.10.011. 

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PrEP as Peri-Conception HIV Prevention for Women and Men

Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. 

The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. 

Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. 

As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. 

The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men, and children during the peri-conception period.

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By:  Heffron R1, Pintye J2, Matthews LT3, Weber S4, Mugo N5.

• 1Departments of Global Health and Epidemiology, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA. rheffron@uw.edu.
• 2School of Nursing, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
• 3Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA.
• 4University of California San Francisco, 1001 Potrero Ave, 6D-33, San Francisco, CA, 94110, USA.
• 5Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. 
• Curr HIV/AIDS Rep. 2016 Mar 18. 

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Impact of Parental Notification on Illinois Minors Seeking Abortion

PURPOSE:

To describe the impact of the Illinois Parental Notification of Abortion Act on minors presenting for first-trimester abortion at an urban clinic in Chicago, Illinois.

METHODS:

Descriptive, retrospective review looked at minors obtaining a first-trimester abortion at John H. Stroger Jr. Hospital Reproductive Health Services during the 12 months prior (August 15, 2012-August 14, 2013) and after (August 15, 2013-August 14, 2014) the Illinois Parental Notification Act was in effect. Young women, ages 18-21 years, unaffected by the law, served as the control group.

RESULTS:

Before the law, 320 minors of a total of 5,505 patients (5.8%) obtained a first-trimester abortion and after the law went into effect, 311 minors of a total of 6,311 patients (4.9%) obtained an abortion. This constituted a 2.8% decrease in procedures among minors before and after the law went into effect (p = .003). However, this decrease was not significant when compared to an 8.8% growth in procedures among the control group, ages 18-21 years (p = .079). Among minors, there was no difference in race/ethnicity, age, and mean gestational age at the time of abortion before and after the law (p = .189, p = .116, and p = .961). There was a trend toward a larger decline in the youngest minors, aged 12-15 years and in those with at least one prior abortion.

CONCLUSIONS:

The impact of a parental notification law on minors at an urban, public clinic is unclear. The 3% decrease warrants further study of both teen pregnancy rates and legislative barriers to minors' abortion access.

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By:  Ramesh S1, Zimmerman L2, Patel A3.

1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: Shanthi_Ramesh@med.unc.edu.
2Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
3Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.

J Adolesc Health. 2016 Mar;58(3):290-4. doi: 10.1016/j.jadohealth.2015.11.004. Epub 2016 Jan 13.

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Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis

The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.

...Ah, it's just always in the bedroom, HIV. It's always there^33, p.7

...In holistic care, it is important for health care professionals to see the women as whole individuals and not only focus on the disease. The result emphasizes the strength of support from health care professionals. But support is not only offering information; support is also about listening. There were narratives in the included studies of experiences of violence, which the women might need help to handle. As health care professionals, we have to ask and be open to stories of, for example, rape, or abuse. Supporting self-acceptance and awareness are only a few of the many areas where care providers outside the medical context can be important for patients' ongoing well-being.⁸ The importance of support from other HIV-positive women is emphasized in the meta-synthesis.^{20,22,30,34,36} Even though it is difficult for some women to attend support meetings like this, as it means they have to disclose their HIV-positive status, it is important to motivate women to meet other HIV-positive persons.

...There is a need for practical information about contraceptives, medical risks, and interventions related to the risk of HIV transmission and barriers between fertility intentions, and pregnancy seeking behavior also need to be illuminated.⁶⁵ Women actively trying to conceive intend not to talk with their provider about safer conception strategies and they expressed confusion and concern on how to conceive safely.⁶⁶ Reproductive counseling initiated by health care providers is needed to reduce risk of transmission to partners and infants, which can have major health implications.⁶⁶

Disclosure of HIV-positive status seems problematic, and some women may need the presence of a health care professional when the disclosure is made.⁶⁷ Everything has to be done without judgment; it is important for health care professionals not to relate to their personal sexual behaviors as the sexual norm.

In clinical practice, it might be of importance to address all these conditions that make the burden easier, to support pregnancy, to support the desires of these women, and to help them cope with negative feelings, in order to promote the sexual and reproductive health of HIV-positive women.

Full article at:   http://goo.gl/ZjBwDF

By:  Ewa Carlsson-Lalloo, RN, MHCSci,*1,,2 Marie Rusner, RN, MSc, PhD,1,,3 Åsa Mellgren, MD, PhD,2,,3 and Marie Berg, RN, RM, MNSci, MPH, PhD1,,4

¹Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.

²Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden.

³Department of Research, Södra Älvsborg Hospital, Borås, Sweden.

⁴Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.

*Corresponding author.

Address correspondence to:, Ms. Ewa Carlsson-Lalloo, Institute of Health and Care Sciences, Box 457, University of Gothenburg, 405 30 Gothenburg, Sweden,
E-mail:  es.ug@oollal.nosslrac.awe

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Dual Contraceptive Method Use & Pregnancy Intention among People Living with HIV Receiving HIV Care at Six Hospitals in Thailand

Background

Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand.

Methods

From January 2008–March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2–3 months to promote the use of dual contraceptives and were offered family planning services.

Results

A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33–43), 898 (64.7 %) had a steady partner, and 737 (53.1 %) were male. Among those with a steady partner, 862 (96.0 %) did not intend to become pregnant; 709 (82.3 %) had sex during the previous 3 months, 683 (96.3 %) used at least one contraceptive method, and 202 (29.6 %) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8 %) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03).

Conclusion

Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.

Below:  Pregnancy desire assessment and family planning short messages

Full article at:  http://goo.gl/PZxrPH

By:  Warangkana Munsakul¹, Rangsima Lolekha^2*, Boonchai Kowadisaiburana³, Anuvat Roongpisuthipong⁴, Supannee Jirajariyavej⁵, Suvanna Asavapiriyanont⁶, Ubonsri Hancharoenkit⁷, Benjamas Baipluthong², Sarika Pattanasin² and Michael Martin²⁸

*Corresponding author: Rangsima Lolekha hpu8@cdc.gov

¹Faculty of Medicine Vajira Hospital, Navamindharadhiraj University, Bangkok, Thailand

²Thailand Ministry of Public Health-U.S. Center for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand

³Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand

⁴Siriraj Hospital, Mahidol University, Bangkok, Thailand

⁵Taksin Hospital, Bangkok, Thailand

⁶Rajavithi Hospital, Bangkok, Thailand

⁷Wiang Pa Pao Hospital, Chiang Rai, Thailand

⁸Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, USA

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Surgery for Family Planning, Abortion, and Postabortion Care

This chapter discusses two related but conceptually distinct health concerns in low- and middle-income countries (LMICs): (a) voluntary family planning, and (b) abortion, including postabortion care. In the first section, on family planning, the health condition of interest is unmet need: the percentage of women who would like to either stop or delay childbearing but who are not using any contraceptive method to prevent pregnancy. The unmet need for family planning (to either limit family size or determine the intervals between children) results in unintended and unwanted pregnancies, which in turn lead to a broad range of maternal and child conditions that increase morbidity and mortality. Surgical procedures for family planning can help reduce this unmet need, particularly the need to limit childbirth. 

The second section concerns surgery for induced abortion (as opposed to spontaneous abortion, or miscarriage) and the surgical management of the complications of induced, mostly unsafe, abortion. Unsafe abortion is defined as abortion performed outside of health facilities (or any other place legally recognized for the procedure) or by an unskilled person (WHO 1992). The demand for abortion is high in many LMICs, and the illegality of the procedure in most of these countries increases the likelihood of postabortion complications from clandestine, unsafe procedures (Grimes and others 2006; Shah and Ahman 2009; Singh and others 2006; Singh 2010). Therefore, postabortion care is a significant health issue in LMICs. Timely, safe surgical interventions can reduce the morbidity and mortality associated with unsafe abortions. The same surgical procedures used for abortion are also used to manage incomplete abortion, which is one of the most common postabortion complications and is often accompanied by other complications such as bleeding, sepsis, and genital injury. The surgical procedures used to manage such complications include laparotomy for sepsis and uterine injury and a wide range of minor procedures to repair injuries to the proximal birth canal. Both sections discuss the burden of reproductive health conditions, including morbidity, mortality, and other effects. We discuss surgical procedures (their performance, inputs, and implementation) and the health workforce implications of scaling up those procedures in LMICs. We also explore evidence on the procedures’ effectiveness in reducing morbidity and mortality and improving quality of life as well as evidence on their cost-effectiveness. 

Finally, we outline future directions—including implementation challenges and considerations for increasing access to these surgical interventions—and conclude by summarizing the findings and recommendations.

Sections

• Introduction:  http://goo.gl/iVswFu
• Surgery for Family Planning:  http://goo.gl/iuVhp0
• Surgery for Abortion and Postabortion Care:  http://goo.gl/IOODSg

By:  Babigumira JB, Vlassoff M, Ahimbisibwe A, Stergachis A.

Editors

In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. 

Source

Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Apr. Chapter 7.

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Current Knowledge, Attitude & Patterns of Oral Contraceptives Utilization among Women in Jordan

Background

Studies exploring the knowledge, attitude and patterns of OCs use among women in Jordan are lacking. The aim of this study was to assess knowledge, attitude, and patterns of oral contraceptives (OCs) utilization among women in Jordan.

Methods

A face-to-face questionnaire inquiring demographic information and issues related to knowledge and use of OCs was completed by women (n = 1571), who have had used OCs at least once in their lifetime. A model was created to assess the effects of knowledge, attitude and previous experience on the patterns of OCs utilization.

Results

Jordanian women exhibited positive attitudes towards OCs efficacy and safety. This positive attitude was approvingly associated with the patterns of use. However, only half of participating women reported that they knew how to use OCs. About 60 % of women received recommendations for OCs use from a physician. Moreover, women’s knowledge about OCs mechanism of action was obtained namely from physician (29.9 %). Side effects were reported in 75.1 % of participating women. Reported side effects were headache (41.2 %), mood swings (35.5 %), irritability (33.5 %) and weight gain (28.7 %). Interestingly, the occurrence of side effects was the main reason for OCs discontinuation.

Conclusion

The study showed that women who have positive attitude toward OCs tend to utilize them more appropriately. However, there is still need for educational programs to enhance knowledge about OCs utilization in Jordan.

Below:  Side effects encountered by women using oral contraceptives

Below:  Reasons for oral contraceptives cessation for women in Jordan

Full article at:   http://goo.gl/x21NcO

By:   Sanaa K. Bardaweel^1*, Amal A. Akour² and Maria-Vanessa Z. Kilani¹

¹Department of Pharmaceutical Sciences, Faculty of Pharmacy, The University of Jordan, Queen Rania Street, Amman 11942, Jordan

²Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942, Jordan

 

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Women’s Private Conversations about Abortion: A Qualitative Study

Abortion is a relatively frequent experience, yet public discourse about abortion is contentious and stigmatizing. Little literature is available on private conversations about abortion, which may be distinct from public discourse. 

We explored private discourse by documenting the nature of women’s discussions about abortion with peers in a book club. We recruited thirteen women’s book clubs in nine states. Participants (n = 119) read the book Choice: True Stories of Birth, Contraception, Infertility, Adoption, Single Parenthood, & Abortion, and participated in a book club meeting, which we audio-recorded and transcribed. Data collection occurred between April 2012 and April 2013. In contrast to public discourse of abortion, private discourse was nuanced and included disclosures of multiple kinds of experiences with abortion. 

Participants disclosed having abortions, considering abortion as an option for past or future pregnancies, and supporting others through an abortion. Distinguishing between public and private discourse enabled us to identify that an “abortion experience” could include personal decisions, hypothetical decisions, or connection with someone having an abortion. The book club atmosphere provided a rare opportunity for participants to explore their relationship to abortion. 

More research is needed to understand the role of private discourse in reducing abortion stigma.

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By:  Stephanie Herold MPH^a*, Katrina Kimport PhD^b & Kate CockrillMPH^a

• ^a The Sea Change Program, Oakland, California, USA
• ^b Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California, USA

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Level, Trend & Correlates of Mistimed & Unwanted Pregnancies among Currently Pregnant Ever Married Women in India

Unintended pregnancy accounts for more than 40% of the total pregnancies worldwide. An Unintended pregnancy can have serious implications on women and their families. With more than one-fourth of the children in India born out of unintended pregnancies such pregnancies are considered to be one of the major public health concerns today. 

The present study is aimed at determining major predictors of unintended pregnancy among currently pregnant ever-married women in India. The present study has used National Family Health Survey (NFHS) data, conducted by the International Institute for Population Sciences (IIPS), Mumbai, to show the trend, pattern and determinants of mistimed and unwanted pregnancies. Bivariate and multinomial logistic regression model have been used with the help of Stata 13 software. 

The results show that the likelihood of a mistimed pregnancy is more prevalent among young women whereas the prevalence of unwanted pregnancy is observed more among the women aged 35 years or more. The results also show that the risk of experiencing mistimed pregnancy decreases if the woman belongs to 'other' castes and has higher education. The likelihood of unwanted pregnancy decreases among married women aged 18 years and above, those women having higher education, some autonomy and access to any mode of mass communication. 

Knowledge of these predictors of mistimed and unwanted pregnancy will be helpful in identifying the most vulnerable group and prioritize the intervention strategies of the reproductive health programmes for the population in need.

Below:  Trend of pregnancy intention among currently pregnant married women

Full article at:  http://goo.gl/TCAeuR

By:  Dutta M1, Shekhar C1, Prashad L2.

• 1Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
• 2School of Social Sciences, Tata Institute of Social Sciences, Mumbai, India. 

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Temporal Trends in Fertility Rates: A Nationwide Registry Based Study from 1901 to 2014

Objective

Increasing age at first childbirth has been suggested to increase the risk for infertility. Our objective is to determine whether women above thirty years of age historically have been able to sustain fertility rates above replacement level.

Design

A descriptive nationwide Danish study using birth registries from 1901–2014.

Setting

Information on women’s age at childbirth was obtained by using records from primary, secondary and tertiary institutions.

Participants

Mothers to 8,024,969 live births.

Main outcome measures

Mothers were stratified according to age at childbirth to determine total and age specific fertility rates.

Results

Total fertility rate (TFR) decreased from 4.1 to 1.8 children per woman and age specific fertility also decreased from 1901 to 2014. Women aged 30–34, 35–39 or 40–44 years in the first decade of the 20th century had higher fertility rates than the corresponding five year younger age groups (25–29, 30–34 and 35–39, respectively) have had for the last 65 years. On average, women gave birth to two children after the age of 30 and one or more child after 35 years of age in the beginning of the 1900s. Furthermore, women more than 40 years of age accounted for 10% of TFR in 1901 compared with 4% in 2014 despite usage of assisted reproduction.

Conclusion

This nationwide study shows that women above 30 years of age historically have been able to sustain fertility rates above replacement level. This implies that other factors besides age are strong determinants of fertility in women above 30 years of age.

Below:  A: Average maternal age at childbirth 1901–2014 and at first childbirth 1960–2014. B: Total fertility rate (TFR) and cumulative fertility rates for selected age groups 1901–2014

Below:  A: Age specific fertility rates 1901–2014. B: Age specific fertility rate 1901–2014. C: Age specific contribution to total fertility rate 1901–2014. D: Cumulative age specific fertility rates 1901–2014

Below:  A: Legal Abortions 1981–2013. B: Age specific fertility rates and estimated pregnancy rates including legal abortions (broken lines) 1993–2013

Full article at:  http://goo.gl/50sfeM

By:  

Martin Blomberg Jensen

Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States of America

Martin Blomberg Jensen, Lærke Priskorn, Tina Kold Jensen, Anders Juul, Niels Erik Skakkebaek

Department of Growth and Reproduction and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

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