Contraception for Adolescents After Abortion

Preventing repeated unplanned pregnancy among adolescents is still a challenge because many of them fail to use effective contraception after abortion. 

To review currently recommended options of methods and counselling for effective prevention of repeat pregnancies in adolescents. Methods Review of the literature that was identified through the Medline, ScienceDirect, Google and Popline databases and relevant expert opinions. 

Counselling needs to be adapted to the needs, values and lifestyle of adolescents. The best results are achieved with nondirective or active contraceptive counselling, followed by regular check-ups and cautious and attentive approach in the management of doubts, prejudices and side effects related to the contraceptive chosen. Adolescents should initiate contraception immediately after abortion: the motivation for choosing an efficacious method is highest at that time; resumption of ovulation following induced abortion occurs on average after three weeks; more than half of these girls will resume sexual activity within two weeks after pregnancy termination. Long-acting reversible contraception use during adolescence is safe and most effective. However, achieving a high long-term continuation rate is especially challenging in adolescents; this is due to developmental and environmental characteristics that influence their contraceptive behaviour. 

Adolescents should immediately after abortion initiate a reliable contraceptive method, preferably one whose efficacy is not user-dependent. Providing an appropriate health care would contribute to achieving continuity in the prevention of repeat pregnancy.

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By:  Sedlecky K1, Stanković Z1.

• 1 Institute for Mother and Child Health Care of Serbia, Republic Family Planning Centre , Belgrade , Serbia.

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Long-Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On-Site Provision

Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods-IUDs and implants-before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described.

A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses.

Eighty-seven LARC devices were inserted during the study period-53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4).

It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.

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By: Sufrin C1, Oxnard T2, Goldenson J3, Simonson K4, Jackson A5.

• 1Assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore. carolynsufrin@gmail.com.
• 2Student at the School of Medicine, University of California, San Francisco.
• 3Director, Jail Health Services, San Francisco Department of Public Health.
• 4Assistant director of program management, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.
• 5Assistant professor, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco.  

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Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria

Contraceptive use remains low in Nigeria, with only 11% of women reporting use of any modern method. Access to long-acting reversible contraceptives (LARCs) is constrained by a severe shortage of human resources. To assess feasibility of task shifting provision of implants, we trained community health extension workers (CHEWs) to insert and remove contraceptive implants in rural communities of Bauchi and Sokoto states in northern Nigeria.

We conducted 2- to 3-week training sessions for 166 selected CHEWs from 82 facilities in Sokoto state (September 2013) and 84 health facilities in Bauchi state (December 2013). To assess feasibility of the task shifting approach, we conducted operations research using a pretest–posttest design using multiple sources of information, including surveys with 151 trained CHEWs (9% were lost to follow-up) and with 150 family planning clients; facility observations using supply checklists (N = 149); direct observation of counseling provided by CHEWs (N = 144) and of their clinical (N = 113) skills; as well as a review of service statistics (N = 151 health facilities). The endline assessment was conducted 6 months after the training in each state.

CHEWs inserted a total of 3,588 implants in 151 health facilities over a period of 6 months, generating 10,088 couple-years of protection (CYP). After practicing on anatomic arm models, most CHEWs achieved competency in implant insertions after insertions with 4–5 actual clients. Clinical observations revealed that CHEWs performed implant insertion tasks correctly 90% of the time or more for nearly all checklist items. The amount of information that CHEWs provided clients increased between baseline and endline, and over 95% of surveyed clients reported being satisfied with CHEWs’ services in both surveys. The study found that supervisors not only observed and corrected insertion skills, as needed, during supervisory visits but also encouraged CHEWs to conduct more community mobilization to generate client demand, thereby promoting access to quality services. CHEWs identified a lack of demand in the communities as the major barrier for providing services.

With adequate training and supportive supervision, CHEWs in northern Nigeria can provide high-quality implant insertion services. If more CHEWs are trained to provide implants and greater community outreach is conducted to generate demand, uptake of LARCs in Nigeria may increase.

Below: A family planning client from Bauchi state receives counseling on Jadelle implants by a Community Health Extension Worker (CHEW). Observation of counseling sessions confirmed that CHEWs provided accurate and complete information.

Below: A Community Health Extension Worker (CHEW) at Dorowa Dispensary, Dambam LGA, in Bauchi state, practices inserting contraceptive implants on an arm model. After achieving competency on the arm model, CHEWs inserted implants under supervision on actual clients.

Below: A male Community Health Extension Worker (CHEW) from Muzuwa Dispensary, Dambam LGA, in Bauchi state, inserts a contraceptive implant. Over 40% of the CHEWs in the pilot task shifting study were men, revealing the acceptance of male providers by women to deliver implant services.

Full article at: http://ht.ly/SONpK 

By: Zulfiya Charyeva,a Olugbenga Oguntunde,a,b Nosa Orobaton,b,c Emmanuel Otolorin,b,d Fatima Inuwa,b,d Olubisi Alalade,b,d Dele Abegunde,b,c and Saba’atu Danladia,b

^b​Targeted States High Impact Project (TSHIP), Bauchi, Nigeria

^c​JSI Research & Training Institute, Arlington, VA, USA

^d​

a​Palladium, Washington, DC, USA

b​Targeted States High Impact Project (TSHIP), Bauchi, Nigeria

c​JSI Research & Training Institute, Arlington, VA, USA

d​Jhpiego – an affiliate of Johns Hopkins University, Abuja, Nigeria 

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Using the Electronic Medical Record to Refer Women Taking Category D or X Medications for Teratogen and Contraceptive Counseling

Read at: http://ht.ly/Q6ysL HT @UCSDHealth 

The primary care physicians who prescribe the potential teratogens should ensure patients know about highly effective contraceptives. However, a study by Eisenberg identified that time constraint is a major barrier to adequate contraceptive counseling. Internists in the Eisenberg study believed that an electronic medical records (EMR) alert would be worthwhile. In addition, two-thirds of the internists agreed that “a referral or telephone consultation service for assistance in providing appropriate contraception for women on potential teratogens would be useful” (Eisenberg et al., 2010).

The EMR provides an opportunity to identify women taking potentially teratogenic medications and offer teratogen and contraceptive counseling. These women specifically may benefit from more counseling about longacting reversible contraception. The purpose of this study was to explore the feasibility and patient satisfaction with an EMR alert, and a referral system for teratogen and contraceptive counseling.