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Amaranta D Craig, Jody Steinauer, Miriam Kuppermann, Julie A Schmittdiel, Christine Dehlendorf
OBJECTIVE: In this study we aimed to investigate the content and process of contraceptive counseling surrounding combined hormonal contraceptive (CHC) methods (combined oral contraceptives, the ring, and the patch). STUDY DESIGN: We performed a mixed methods analysis of data collected as part of the Patient-Provider Communication about Contraception study, in which reproductive age women and their providers were recruited at several San Francisco Bay Area clinics from 2009-2012...
September 15, 2018: Contraception
Andrea Hsu Roe, Deborah Bartz
These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods, and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy...
September 6, 2018: Contraception
Barbara Wilkinson, Mustafa Ascha, Emily Verbus, Mary Montague, Jane Morris, Brian Mercer, Kavita Shah Arora
OBJECTIVE: We sought to evaluate the impact of insurance type on receipt of an interval postpartum LARC, controlling for demographic and clinical factors. STUDY DESIGN: This is a retrospective cohort study of 1072 women with a documented plan of LARC for contraception at time of postpartum discharge. This is a secondary analysis of8654 women who delivered at 20weeks or beyond from January 1, 2012 through December 31, 2014 at an urban teaching hospital in Ohio. LARC receipt within 90days of delivery, time to receipt, and rate of subsequent pregnancy after non-receipt were compared between women with Medicaid and women with private insurance...
September 5, 2018: Contraception
Dawn S Chin-Quee, John Stanback, Tracy Orr
Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of family planning services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops...
August 28, 2018: Contraception
Sara Chace Dwyer, Salisu Mohammed Ishaku, Faizah Okunade, Laura Reichenbach, Aparna Jain
BACKGROUND: Nigerian policymakers are debating task-shifting injectable contraceptive services to Patent and Proprietary Medicine Vendors (PPMVs). METHODOLOGY: 152 PPMVs were trained to provide injectable contraceptives in Oyo and Nasarawa states. Data were collected before and one, three and nine-months post-training. Chi-square tests were conducted to assess associations between survey time-points. MAIN FINDINGS: Few PPMVs had the necessary knowledge to provide injectables pre-training...
August 23, 2018: Contraception
Ian Askew, Elisa Wells
A broad range of options to choose from is essential if women's needs for an acceptable, effective and safe method are to be fully met. A subcutaneous formulation of the injectable depot medroxyprogesterone acetate (DMPA-SC) is a relatively new option, which can support task sharing of injectable hormonal contraception to community health workers (CHWs), as well as the possibility of self-injection by women themselves. This special issue provides new evidence from six countries in Africa that illustrates how this method might expand choices for women through task sharing and self-care, and explores the potential of private-sector social marketing platforms and the costs and cost-effectiveness of different channels for provision...
August 23, 2018: Contraception
Patricia E Korber, Bram H Goldstein
A 28-year-old woman presented with a malpositioned intrauterine device (IUD) that was fragmented and significantly entrenched within the cervical canal and myometrium. IUD malposition with concomitant device fragmentation and embedded segments, albeit rare, should be a consideration given the device's prevalence.
August 20, 2018: Contraception
Claudia Geist, Abigail Ra Aiken, Jessica N Sanders, Bethany G Everett, Kyl Myers, Patty Cason, Rebecca G Simmons, David K Turok
OBJECTIVES: To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. STUDY DESIGN: The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County...
August 17, 2018: Contraception
Ellen MacLachlan, Lynn M Atuyambe, Tieba Millogo, Georges Guiella, Seydou Yaro, Simon Kasasa, Justine Bukenya, Agnes Nyabigambo, Fredrick Mubiru, Justine Tumusiime, Yentéma Onadja, Lonkila Moussa Zan, Clarisse Goeum/Sanon, Seni Kouanda, Allen Namagembe
OBJECTIVE: The aim of this study was to examine continuation of subcutaneous and intramuscular depot medroxyprogesterone acetate (DMPA-SC and DMPA-IM) when administered by facility-based health workers in Burkina Faso and Village Health Teams (VHTs) in Uganda. STUDY DESIGN: Participants were family planning clients of health centers (Burkina Faso) or VHTs (Uganda) who had decided to initiate injectable use. Women selected DMPA-SC or DMPA-IM and study staff followed them for up to four injections (providing 12 months of pregnancy protection) to determine contraceptive continuation...
August 17, 2018: Contraception
Katharine O White, Heidi E Jones, Antonella Lavelanet, Wendy V Norman, Edith Guilbert, E Steve Lichtenberg, Maureen Paul
OBJECTIVES: To assess whether first-trimester aspiration abortion practices of US providers agree with evidence-based policy guidelines. STUDY DESIGN: We sent surveys by mail or electronically to all abortion facilities in the United States identified via professional networks and websites from June through December 2013. Administrators reported on the volume of procedures performed at their site(s) through 13 weeks 6 days' gestation and on clinic services. Clinicians reported on personal demographic characteristics and abortion practices...
August 17, 2018: Contraception
Stephanie Arteaga, Lauren Caton, Anu Manchikanti Gomez
OBJECTIVE: To understand how young people conceptualize planned, unplanned and "in-between" pregnancies. METHODS: We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned...
August 16, 2018: Contraception
Jane T Bertrand, Dieudonné Bidashimwa, Paul Bakutuvwidi Makani, Julie H Hernandez, Pierre Akilimali, Arsene Binanga
OBJECTIVES: Given the promise of DMPA-SC to increase community-level access to modern contraception in developing countries, we conducted an observational study to assess the acceptability and feasibility of DMPA-SC self-injection among women in Kinshasa, Democratic Republic of the Congo, and of medical/nursing (M/N) students as instructors for self-injection. STUDY DESIGN: Women who selected DMPA-SC at a community outreach event adjacent to a health center were interviewed upon acceptance (baseline) and then 3, 6 and 12 months later...
August 16, 2018: Contraception
Alison B Edelman, Jeffrey T Jensen, Sara McCrimmon, Marci Messerle-Forbes, Andrea O'Donnell, Jon D Hennebold
OBJECTIVE: To determine if a combined oral contraceptive (COC) initiated shortly after ulipristal acetate (UPA) administration interferes with its mechanism of action. STUDY DESIGN: Healthy, reproductive-age women of normal BMI with proven ovulation (serum progesterone >3 ng/ml) were enrolled for three cycles (Cycle 1, UPA only; Cycle 2 washout; Cycle 3 UPA plus COC). During Cycles 1 and 3, subjects were monitored with transvaginal ultrasound and blood sampling for progesterone and LH every other day until a dominant follicle measuring >15 mm was visualized...
August 14, 2018: Contraception
Albert Mwembo, Rebecca Emel, Tesky Koba, Jacqueline Bapura Sankoko, Aben Ngay, Rianne Gay, Jane T Bertrand
OBJECTIVES: The objective of this research is to assess the acceptability of the provision of subcutaneously administered depo medroxyprogesterone acetate (DMPA-SC) by nonclinically trained community health workers (CHWs) among acceptors in the rural province of Lualaba in the Democratic Republic of the Congo (DRC). STUDY DESIGN: In 2017, 34 CHWs received training in provision of DMPA-SC. Among other methods, DMPA-SC by CHWs was offered during household visits and at community outreach events...
August 14, 2018: Contraception
Anupama Kotha, Beatrice A Chen, Lauren Lewis, Shannon Dunn, Katherine P Himes, Elizabeth E Krans
BACKGROUND: Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD. STUDY DESIGN: This was a retrospective cohort study of 791 pregnant women with OUD on MAT who delivered at an academic institution without immediate postpartum LARC services between 2009 and 2012...
August 13, 2018: Contraception
Katrin Roth, Hans Peter Zahradnik, Wolfgang R Schäfer
OBJECTIVE: To compare the effects of chlormadinone acetate (CMA), dienogest (DNG) and drospirenone (DRSP) on prostaglandin biosynthesis in a human endometrial explants model. STUDY DESIGN: Human endometrial explants obtained by aspiration curettage and human endometrial YHES cells were stimulated with interleukin-1β (IL-1β) and exposed to CMA, DNG, DRSP or dexamethasone (DEX; YHES cells). Cellular messenger RNA (mRNA) levels of cyclooxygenase-2 (COX-2) were analyzed by reverse-transcription quantitative real-time polymerase chain reaction...
August 13, 2018: Contraception
Catherine Cansino, E Steve Lichtenberg, Lisa K Perriera, Melody Y Hou, Juliana Melo, Mitchell D Creinin
OBJECTIVE: To investigate if women desire talking to a counselor or physician about contraception when seeking first-trimester medical or surgical abortion. STUDY DESIGN: We conducted a cross-sectional study by distributing self-administered anonymous surveys to women at three clinics in Sacramento, California; Chicago, Illinois; and Cleveland, Ohio, from October 2014 to February 2015. Participants completed surveys after registration and before any in-office counseling...
August 12, 2018: Contraception
Elizabeth A Sully, Lynn Atuyambe, Justine Bukenya, Hannah S Whitehead, Nakeisha Blades, Akinrinola Bankole
OBJECTIVES: To provide the first estimate of adolescents' abortion incidence in Uganda and to assess differences in the abortion experiences and morbidities of adolescent and non-adolescent postabortion care (PAC) patients. STUDY DESIGN: We used the age-specific Abortion Incidence Complications Method, drawing from three surveys conducted in Uganda in 2013: a nationally representative Health Facilities Survey (n=439), a Health Professionals Survey (n=147) and a Prospective Morbidity Survey of PAC patients (n=2169)...
August 9, 2018: Contraception
Laura Di Giorgio, Mercy Mvundura, Justine Tumusiime, Chloe Morozoff, Jane Cover, Jennifer Kidwell Drake
OBJECTIVE: To assess the cost-effectiveness of self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to health-worker-administered intramuscular DMPA (DMPA-IM) in Uganda. STUDY DESIGN: We developed a decision-tree model with a 12-month time horizon for a hypothetical cohort of approximately 1 million injectable contraceptive users in Uganda to estimate the incremental costs per pregnancy averted and per disability-adjusted life year (DALY) averted...
August 9, 2018: Contraception
Melissa J Chen, Helen Pymar, Mitchell D Creinin
Low but rising serum human chorionic gonadotropin (hCG) levels occur infrequently after an induced abortion. Because this scenario rarely occurs after suction aspiration, clinicians may have higher suspicion for an uncommon diagnosis. The differential diagnosis includes both common and uncommon diagnoses, such as incomplete abortion, heterotopic or ectopic pregnancy, a new intrauterine pregnancy and gestational trophoblastic neoplasia. The etiology of this presentation may be unclear, especially in the absence of abnormal bleeding or pain which would suggest incomplete abortion, or when significant time has passed since the procedure...
August 7, 2018: Contraception
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