Trends in Contraceptive Use Worldwide, 2015

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Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

Background

Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders.

Materials and Methods

A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss.

Results

Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia.

Conclusion

We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

Comparison of menstrual disorders between groups

Parameters	Non-TL	TL	Sig
Menstrual irregularities*	14 (10)	34 (24.3)	0.002a
Oligomenorrhea*	12 (8.6)	21 (15)	0.12a
Polymenorrhea*	2 (1.4)	13 (9.3)	0.006a
Hypermenorrhea*	3 (2.1)	17 (12.1)	0. 002a
Metrorrhagia*	9 (6.4)	12 (8.6)	0.64a
Menorrhagia*	31 (22.1)	88 (62.9)	<0.0001a
Menometrorrhagia*	5 (3.6)	22 (15.7)	0.001a
PBLAC score**	87.91 ± 51.06	137.72 ± 90.91	<0.0001b

*; n (%), **; Values are mean ± SD, a; Chi-square test, b; T test, TL; Tubal ligation, and PBLAC; Pictorial blood loss assessment chart.

Full article at:   http://goo.gl/m3gdFa

By:  Shahideh Jahanian Sadatmahalleh, M.Sc,¹ Saeideh Ziaei, M.D,^1,* Anoshirvan Kazemnejad, Ph.D,² and Eesa Mohamadi, Ph.D³

¹Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

²Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

1 Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University,  Tehran, Iran

² Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³ Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

* Corresponding Address:P.O. Box: 1415-111, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,

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Non-Barrier Contraceptive Use & Relation to Condom Use Behavior by Partner Type among Female Sex Workers in Andhra Pradesh, India

OBJECTIVE:

The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners.

METHODS:

FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients.

RESULTS:

Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) and with an occasional client (past week), as well as accepting more money for sex without a condom (past 30 days). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners.

CONCLUSIONS:

Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.

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

By:  Reed E1, Erausquin JT2, Biradavolu M3, Servin AE4, Blankenship KM5.

• 1Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 2Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA.
• 3Scholar in Residence, Department of Sociology, American University, Washington, DC, USA.
• 4Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 5Professor and Chair, Department of Sociology, American University, Washington, DC, USA. 
• J Fam Plann Reprod Health Care. 2015 Dec 23. pii: jfprhc-2014-100918. doi: 10.1136/jfprhc-2014-100918.

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Associations of Marital Violence with Different Forms of Contraception: Cross-Sectional Findings from South Asia

Cross-sectional analyses were conducted using marital violence data collected during the most recent Demographic and Health Surveys from Bangladesh (n = 3665), India (n = 56 357), and Nepal (n = 3037). Data were pooled to assess associations of marital violence (physical or sexual) with modern contraception use (current spacing or sterilization).

Sexual marital violence was associated with both modern spacing contraception and sterilization. Sexual violence was reported more often by pill users (9.8% vs 5.5% for non-users) but less often by condom users (4.5% vs 5.8% for non-users).

Sexual marital violence might increase use of contraception that need not require husband involvement (pill) but decrease use of methods that require his cooperation (condom) or support for mobility, funds, or time (sterilization).

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By: Anita Raj,a,b,c,* Lotus McDougal,a,b Elizabeth Reed,a,b and Jay G. Silvermana,b

aDivision of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA

bCenter on Gender Equity and Health, University of California, San Diego, CA, USA

cDepartment of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA

Family Planning for Strangers: An Experiment on the Validity of Reported Contraceptive Use

Below:  Scatterplot for Reported Sterilization and TFR in Urban Latin American DHS data, 42 surveys from 15 countries, including OLS Regression Prediction Line (R2 = 0.14; p = 0.015).

Sterilization levels reported in the Dominican Republic appear well above what we would normally expect given prevailing patterns in the region. We suspect that the use of strangers as interviewers—the normative approach in data collection in both developed and developing country settings—may be partly responsible for this result, and may underlie a long history of bias in family planning data. We present findings from a field experiment conducted in a Dominican town in 2010, where interviewer assignment was randomized by level of preexisting level of familiarity between interviewer and respondent. In our data, sterilization use is higher when the interviewer is an outsider, as opposed to someone known to the respondent or from the same community. In addition, high sterilization use is correlated with a propensity of respondents to present themselves in a positive light to interviewers. These results call into question the routine use of strangers and outsiders as interviewers in demographic and health surveys.

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