Acesso ampliado ao dispositivo intrauterino: impacto de um processo de trabalho promotor da autonomia na anticoncepção / Expanded access to intra-uterine devices: impact of a work process promoting autonomy in contraception / Acceso ampliado al dispositivo intrauterino: impacto de un proceso de trabajo que promueve la autonomía en la anticoncepción

Introdução: O dispositivo intrauterino (DIU) é uma das estratégias contraceptivas mais eficazes. Porém, apesar de ser amplamente distribuído pelo Sistema Único de Saúde (SUS), há baixa adesão ao método. São constatadas diversas barreiras para esse quadro, tais como desconhecimento acerca do dispositivo, além da reduzida oferta para inserção do contraceptivo por parte das Equipes de Saúde da Família (eSF). Tendo em vista que a ampliação do acesso ao DIU pode contribuir para a diminuição das gravidezes não planejadas, bem como para a autonomia e para o empoderamento das mulheres, algumas estratégias foram desenvolvidas por uma eSF para facilitar o acesso ao DIU. Objetivo: Refletir a respeito do impacto da incorporação de estratégias de educação em saúde para divulgar o método dentro da própria equipe, de sua área de cobertura e da diminuição de barreiras para a inserção, na ampliação do acesso ao DIU, no quantitativo de dispositivos inseridos, no número de gestações não planejadas e na possibilidade de aumento do empoderamento feminino. Métodos: Os dados coletados foram extraídos das informações presentes em planilhas e relatórios produzidos pela própria eSF. Utilizou-se da estatística descritiva para apresentar e analisar os dados obtidos, a partir de ferramentas de formulação de gráficos e tabelas. Resultados: Após mudança no processo de trabalho, visando ao acesso ampliado à inserção do DIU, observou-se um aumento no quantitativo do procedimento assim como na percentagem de gravidezes desejadas. Conclusões: O DIU surge como um instrumento para possibilitar o exercício dos direitos sexuais e reprodutivos e para alavancar atitudes emancipatórias das mulheres. Quanto menos barreiras as mulheres encontram para a inserção do DIU, maior é a escolha por este método, sendo a inserção por demanda espontânea, ou seja, no momento em que a mulher procura a eSF para fazê-la. Nesse sentido, as atividades de educação continuada tornam-se potentes ferramentas para possibilitar maior acesso ao método. Fazem-se necessários estudos de longa duração para que essas hipóteses sejam avaliadas, todavia, parece haver uma ligação positiva entre essas duas variáveis.

Introduction: Intrauterine device (IUD) is one of the most effective contraceptive strategies. Despite being widely distributed by the Brazilian Unified Health System (Sistema Único de Saúde ­ SUS), there is low adherence to the method. There are several barriers to this situation, such as lack of knowledge about the device, in addition to the reduced offer for contraceptive insertion by primary health care providers. Given that increased access to the IUD can contribute to reducing unplanned pregnancies, as well as empowering women, some strategies have been developed by a primary health care team to facilitate access to IUDs. Objective: This research reflected on the impact of incorporating health education strategies to disseminate the method and reduction of barriers to insertion, broadening IUD access, the number of devices inserted, the number of unplanned pregnancy and the possibility of increased female empowerment. Methods: Data were extracted from information present in spreadsheets and reports produced by the team itself. Descriptive statistics were used to present and analyze the data obtained, using tools for formulating graphics and tables. Results: After changing the work process to expanded access to IUD insertion, an increase in the number of procedures and the percentage of planned pregnancies was observed. Conclusions: The IUD appears as an instrument to enable the exercise of sexual and reproductive rights and to leverage women's emancipatory attitudes. The fewer barriers women encounter when inserting an IUD, the greater the choice for this method, with insertion being on spontaneous demand and continuing education activities, powerful tools to enable greater access to it. Long-term studies are necessary for these hypotheses to be evaluated, however, there appears to be a positive link between these two variables.

Introducción: El dispositivo intrauterino (DIU) es una de las estrategias anticonceptivas más efectivas. Sin embargo, a pesar de su amplia distribución a través del Sistema Único de Salud, existe una baja adhesión a este método. Se han identificado diversas barreras para esta situación, como el desconocimiento sobre el dispositivo y la oferta limitada de su inserción por parte de los equipos de salud familiar (eSF). Con el objetivo de ampliar el acceso al DIU y reducir los embarazos no deseados, así como promover la autonomía y empoderamiento de las mujeres, algunos equipos de eSF han desarrollado estrategias para facilitar su acceso. Objetivo: Reflexionar sobre el impacto de la incorporación de estrategias de educación en salud para difundir el método dentro del propio equipo y su área de cobertura, así como la eliminación de barreras para la inserción, en la ampliación del acceso al DIU, en la cantidad de dispositivos insertados, en el número de embarazos no planeados y en la posibilidad de aumentar el empoderamiento femenino. Métodos: Los datos recopilados se extrajeron de las hojas de cálculo e informes producidos por el propio eSF. Se utilizó estadística descriptiva para presentar y analizar los datos obtenidos mediante herramientas de creación de gráficos y tablas. Resultados: Después de un cambio en el proceso de trabajo destinado a ampliar el acceso a la inserción del DIU, se observó un aumento en la cantidad de procedimientos realizados. También se registró un aumento en el porcentaje de embarazos deseados. Conclusiones: El DIU se presenta como una herramienta que permite el ejercicio de los derechos sexuales y reproductivos y promueve actitudes emancipatorias en las mujeres. Cuantas menos barreras encuentren las mujeres para la inserción del DIU, mayor será la elección de este método, con la inserción a demanda, es decir, cuando la mujer lo solicita al eSF, y las actividades de educación continua como poderosas herramientas para facilitar un mayor acceso. Se necesitan estudios a largo plazo para evaluar estas hipótesis, aunque parece existir una relación positiva entre estas dos variables.

Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Unmet need for contraception among married women of reproductive age in the slums of Burdwan municipality, West Bengal

Background: Use of inappropriate family planning (FP) methods is one of the major reasons for population growth in India. If the determinants of FP methods were understood, it would help to improve the acceptance of the FP methods among the users and thus contribute to a stable population. The study was conducted to assess the unmet need for contraception and its determinants among married women of reproductive age (WRA) group in the slums of Burdwan municipality.Methods: A community based descriptive and cross-sectional study conducted among 330 married WRA in the slums of Burdwan municipality, West Bengal, from November, 2022 to January, 2023. Fifteen slums were selected from 144 slums in the municipality, by simple random sampling (SRS) and from each slum, study subjects were selected by SRS, from a list of married WRA. A pre-designed, pre-tested, semi-structured schedule was used for data collection and data analyse using SPSS-23.Results: Around 51% couples used some methods of FP and 49% did not use any methods. Among non-users, the unmet need was 18.2% for spacing and 15.1% for limiting births. Significant association (p<0.05) among the determinants of FP, was observed with educational status of respondents and age at marriage.Conclusions: Age, education, socio-economic status, age at marriage, age at 1st pregnancy, types and adverse effects of contraception are important determinants both FP methods and unmet need. So proper counselling and assessment of WRA is essential.

Depot medroxyprogesterone acetate injection as contraceptive method

Background: Depot medroxyprogesterone acetate (DMPA) injection is a reversible longer acting contraceptive method. One injection every three months makes compliance better and lesser side effects makes this contraception acceptable.Methods: This is a prospective study done at our institute between July 2021 to September 2023. After prior approvals, each patient of study group had been given Inj. DMPA 150 mg intramuscularly at the time of enrolment. They were given DMPA every 3 months. All participants were followed for efficacy, side effects and continuation rates.Results: Out of 104 participants, 49.05% belonged to 18-25 years of age group, 36.53% were 2nd paras and 41.35% took injections post-delivery. In this study 51.92% patients took >=4 injections where as 45.19% discontinuation rate was found at the end of 1 year. Irregular bleeding seen in 50.96% was the most common side effect. 40.42% of total drop out was due to irregular bleeding. Efficacy of DMPA was found to be 100% in this study.Conclusions: The study concludes that DMPA is a preferable contraceptive method in all the groups of patients for spacing and to avoid unplanned pregnancy. Education and socio-economic factors play key role in acceptance and continuation of DMPA. Menstrual irregularities were found to be most common cause of discontinuation. Use of DMPA has no permanent impact on fertility and it was found to be a safe alternative method with no deleterious effect on mother's milk secretion in lactating participants. It is reversible, non coitus dependent and long acting.

Factores asociados al rechazo de contracepción posparto en un Hospital Público / Factors associated with postpartum contraceptive refusal in a public hospital, 2021

Objetivo: Determinar los factores asociados al rechazo de la contracepción posparto en un Hospital Público, 2021. Métodos: Estudio observacional, analítico, transversal; incluyó 251 puérperas inmediatas atendidas en un Hospital Público entre mayo y junio del 2021. La variable principal fue rechazo de la contracepción posparto y factores asociados: sociodemográficos, obstétricos, personal-cultural, institucional. Se usó un cuestionario válido y confiable. Además, la prueba Chi cuadrado de Pearson y Regresión de Poisson para el análisis estadístico y se tuvo aprobación de Comité de Ética. Resultados: El 16,7 % rechazó los contraceptivos modernos. El nivel educativo bajo (p < 0,011; RPa: 4,51; IC: 1,42-14,35), la percepción de una mala situación económica (p = 0,001; RPa: 3,65; IC: 1,72-7,76), las complicaciones durante el trabajo de parto y dos horas posparto (p = 0,041; RPa: 8,16; IC: 1,09-61,19), el embarazo planificado (p = 0,002; RPa: 2,51; IC: 1,38-4,55), la experiencia negativa de contracepción (p = 0,000; RPa: 11,26; IC: 5,85-21,66), la actitud negativa de la pareja (p = 0,006; RPa: 4,90; IC: 1,57-15,31) y la percepción de conocimiento insuficiente sobre contracepción (p = 0,049; RPa: 0,53; IC: 0,28-0,996); se asociaron al rechazo de contracepción en el posparto. Conclusión: El nivel educativo bajo, la percepción de una mala situación económica, las complicaciones durante el trabajo de parto y dos horas posparto, el embarazo planificado, la experiencia negativa de contracepción, la actitud negativa de la pareja, se asocian al rechazo de contracepción posparto; la percepción de conocimiento insuficiente sobre contracepción se asoció a la disminución de rechazo(AU)

Objective: To determine the factors associated with the refusal of postpartum contraception in a Public Hospital, 2021. Methods: Observational, analytical, cross-sectional study; included 251 immediate postpartum women treated in a Public Hospital between May and June 2021. The main variable was rejection of postpartum contraception and associated factors: sociodemographic, obstetric, personal-cultural, and institutional. A valid and reliable questionnaire was used. In addition, Pearson's Chi-square test and Poisson's regression were used for statistical analysis and the Ethics Committee was approved. Results: 16.7% rejected modern contraceptives. Low educational level (p < 0.011; PRa: 4.51; CI: 1.42-14.35), the perception of a bad economic situation (p = 0.001; RPa: 3.65; CI: 1.72-7.76), complications during labor and two hours postpartum (p = 0.041; PRa: 8.16; CI: 1.09-61.19), planned pregnancy (p = 0.002; PRa: 2.51; CI: 1.38-4.55), negative experience of contraception (p = 0.000; PRa: 11.26; CI: 5.85-21.66), the negative attitude of the partner (p = 0.006; RPa: 4.90; CI: 1.57-15.31) and the perception of insufficient knowledge about contraception (p = 0.049; RPa: 0.53; CI: 0.28-0.996); were associated with contraceptive rejection in the postpartum period. Conclusion: Low educational level, perception of a poor economic situation, complications during labor and two hours postpartum, planned pregnancy, negative contraceptive experience, negative partner attitude, are associated with postpartum contraceptive rejection; The perception of insufficient knowledge about contraception was associated with a decrease in rejection(AU)

Unsafe abortion: journey from unmet needs to denial for contraception

Background: Easy over the counter availability of abortion pills leads to unsupervised rampant use of the pills which further results in physical and mental health complications and social and financial burdens for women, communities and health systems. Aims and objectives were to study the sociodemographic, obstetric and clinical profile of the women presenting with unsupervised intake of abortifacient, and to study the acceptance of post abortal contraception and also the method of contraception accepted.Methods: This present study was carried out in women with history of unsupervised self-intake of abortifacient and presenting with complain of bleeding per vaginum and various other complications in the emergency or outpatient department of obstetrics and gynaecology between October 2022 to September 2023 at Nehru Hospital, BRD Medical college, Gorakhpur. Complete personal, sociodemographic and obstetric history was obtained. Complete general and systemic examination was done and all routine investigations were sent.Results: A total of 197 women were enrolled in this study. In our study majority 39.48% (n=77) of women were between 25-30 years age. 56.34% (n=111) belonged to low socioeconomic strata and 69.54% (n=137) resided in urban area. 42.63% (n=84) were gravida 3 or more. 22.8% cases took abortifacient pills beyond 9 weeks of gestation. All patients procured the contraceptive from local practitioner, quacks, medical stores and chemists without any consultation from gynecologist. Most frequent complain was Chronic bleeding per vaginum with RPOC (n=112, 56.85%). Majority patients had moderate to severe anemia and 53.8% (n=106) required blood transfusion. 2.03% (n=4) presented with features of sepsis and 2.03% (n=4) presented with ruptured ectopic. Majority (n=160, 81.21%) didn抰 opt for post abortion contraception.Conclusions: One major contributor to unsafe abortions is the easy availability of abortion pills. These pills should be restricted from over-the-counter sales and made available to the public only through authorized MTP centres with a proper prescription.

Incidental discovery of a copper-migrated intrauterine device in the rectum during abdominal hysterectomy

The objective of the study is to report a case of IUDs migrating into the rectum that were accidentally discovered during an abdominal hysterectomy. This was a 47-year-old G9P8 patient with eight live vaginal births and one abortion dating back 7 years. As management, she would have received intrauterine suctioning followed by IUD insertion. The diagnosis of IUD migration was made during an abdominal hysterectomy for high grade cervical dysplasia CIN2. The migrating IUD perforated the right end of the posterior aspect of the uterine isthmus and the anterior aspect of the upper rectum. It was removed using forceps with its "T" that was lodged in the uterine wall and its body and thread in the rectum. The rectal breach was sutured with vicryl and total hysterectomy with bilateral adnexectomy could be performed without any other particularities. Migration of a copper IUD into the rectum is exceptional. However, it should be considered in a patient with digestive disorders in the days following the insertion of an IUD. The absence of the son should be a warning, and imaging and especially the digestive endoscopy allow the diagnosis to be made and at the same time its extraction to be carried out as soon as possible.

Acceptance of post-abortion contraception following unsupervised intake of abortion pills at tertiary care teaching institute: an eye opener

Background: Women opting for unsupervised abortion pill intake over contraceptive measures shows a lack of awareness about the effectiveness of family planning methods. There is an urgent need to promote awareness and acceptance of various family planning methods. There is an urgent need to promote awareness and acceptance of various family planning methods, especially by the survivors of adverse consequences of over-the-counter use of medical termination of pregnancy (MTP) pills.Methods: The prospective study was conducted at the obstetrics and gynecology department of Rajendra Institute of Medical Sciences, Ranchi from June 2020 to October 2021. Out of 98 patients reported after unsupervised intake of MTP pills, with complications. 56 patients opted for various methods of family planning, post-abortion after counselling Statistical analysis was done using statistical package for the social sciences (SPSS) 20.0 software, and results were calculated.Results: Out of 56 patients, the majority were educated, and had education up to primary, matriculation, and above matriculation with 23.21%, 28.57%, and 26.79% respectively. Most of the women belonged to upper- lower class (50%). 53.17% took pills at gestation age between 7 weeks to 12 weeks. the majority had an incomplete abortion (69.64%) with stable vitals. 1 case of uterine perforation, 4 cases of rupture ectopics, and 2 cases of chronic ectopic pregnancy were also reported. Most patients opted for DMPA injectables (44.64%). 23.14% chose other methods of family planning such as barriers, patches, and vaginal rings. 4 women opted for intrauterine contraceptive device (IUCD), 5 accepted the use of oral contraceptive pills (OCP) and 9 cases went for permanent female sterilization.Conclusions: Gynecologists and obstetricians have an ethical obligation to ensure that post-abortion contraception, becomes an integral part of abortion and post-abortion care, in view with the recommendations of the International Federation of Gynaecology and Obstetrics and several other organizations. Government needs to take steps to enforce the adoption of various contraceptive methods, thereby decreasing the incidence of unsafe abortion and maternal mortality.

Contraceptive methods adopted by women in immediate post-partum period in a tertiary care centre in Northern India: an observational study

Background: Contraception is the need of the hour in India. The family planning program in India offers a basket of choices. These choices are governed by the decisions of their partners, socio economic status of patients and even wishes of other family members.Methods: This observational study was carried out in obstetrics and gynaecology department of ESIC medical college and hospital for a period of 1 year from March 2023 to February 2024. All the patients who were in immediate post-partum period after normal vaginal delivery, caesarean section and medical termination of pregnancy were included in the study.Results: With the introduction of PPIUCD in national family programs more women are inclining towards long term spacing methods and not resorting to permanent sterilisation alone.Conclusions: It is undeniable that most women do not desire a pregnancy immediately after delivery but are not informed enough about the methods of contraception they can use.

Factors affecting the use of modern contraception among women of reproductive age in Odigbo local government area, Ondo state, Nigeria

Background: Modern contraception, one of the components of reproductive health, and an essential one for that matter, affects the health of women positively. It consists of modern contraceptive methods which are of different products or medical procedure that inhibits pregnancy following sexual intercourse. The study assessed the factors affecting the use of modern contraception among women of reproductive age in Odigbo local government area (LGA), Ondo State, Nigeria.Methods: A cross sectional descriptive research design was adopted for the study and the study population were women of child-bearing age between the ages of 19-45 years. A formula was used to calculate the sample size, with 420 derived, and a simple random sampling was used to select the respondents. A semi-structured instrument with its reliability tested by test re-test was used for collection of data from the respondents. The data collected was analyzed using frequency and percentage presented in tables.Results: The study revealed a mean age of 27±1.1. Also, it revealed good knowledge (90%) and practices (65.7%) as well as positive attitude (75%) towards the use of modern contraceptives among the respondents, but these were hindered by lack of support from spouses (27.4%), belief that it promotes promiscuity (29.5%), causes infertility (22.4%) and infection (46.2%).Conclusions: Based on these findings, there is need for male involvement in family planning matters and health education on modern contraceptives.

El papel del estetrol en la anticoncepción: una revisión integral / The role of estetrol in contraception: a comprehensive review

Esta revisión narrativa explora el papel potencial del estetrol (E4), un esteroide estrogénico natural, en la anticoncepción, analizando sus propiedades farmacológicas, su efectividad y su seguridad. Se revisaron estudios preclínicos, ensayos clínicos y evaluaciones de seguridad del E4 como anticonceptivo oral combinado (AOC). Se investigó el impacto en parámetros endocrinos, metabólicos y hemostáticos, así como su tolerabilidad. En los resultados, el E4 tiene menor afinidad por el receptor de estrógeno-α de membrana, pero mantiene la actividad agonista en los receptores nucleares. E4/DRSP (drospirenona) demostró ser un AOC eficaz, con ciclos de sangrado regulares y predecibles en la mayoría de las mujeres. La tolerabilidad fue favorable, con eventos adversos leves o moderados y bajas tasas de interrupción. El sangrado fue el evento adverso más común, y se reportaron casos raros de migrañas con aura, trombosis venosa profunda, hiperpotasemia y depresión. E4/DRSP tuvo mínimo impacto en los parámetros lipídicos, hepáticos, de globulina fijadora de hormonas sexuales y de metabolismo de hidratos de carbono, y efecto neutral o mínimo en los parámetros hemostáticos. Se concluye que E4/DRSP parece ser una opción anticonceptiva eficaz y segura, con reducido riesgo trombótico y mínimo impacto en los parámetros endocrinos y metabólicos. Se requiere más investigación para confirmar su seguridad y eficacia a largo plazo.

This narrative review explores the potential role of estetrol (E4), a natural estrogenic steroid, in contraception, analyzing its pharmacological properties, effectiveness, and safety. Preclinical studies, clinical trials, and safety assessments of E4/DRSP (drospirenone) as a combined oral contraceptive (COC) were reviewed. The impact on endocrine, metabolic, and hemostatic parameters, as well as tolerability, was investigated. In results, E4 exhibits lower affinity for estrogen transmembrane receptor-α but maintains agonistic activity on nuclear receptors. E4/DRSP proved to be an effective COC with regular and predictable bleeding cycles in most women. Tolerability was favorable with mild or moderate adverse events and low discontinuation rates. Bleeding was the most common adverse event, and rare cases of aura migraines, deep vein thrombosis, hyperkalemia, and depression were reported. E4/DRSP had minimal impact on lipid, hepatic, sex hormone-binding globulin, and carbohydrate metabolism parameters, with a neutral or minimal effect on hemostatic parameters. The conclusion is that E4/DRSP seems to be an effective and safe contraceptive option, with reduced thrombotic risk and minimal impact on endocrine and metabolic parameters. Further research is needed to confirm long-term safety and efficacy.

Acceptability of contraceptive methods in lactating mothers in a tertiary centre

Background: High fertility rate, high maternal mortality and high infant mortality rates are the shared problems of the all the developing countries of the world. According to Directorate of Health Services surveys, 40% of women who intend to use a family planning method in the first year postpartum are not using one. Contraceptive use is negligible among postpartum women, particularly young mothers. We aimed to determine the reasons for acceptability, non-acceptability, side effects and continuation of four contraceptive methods condoms, Depotmedroxyprogesterone acetate, (DMPA), copper intrauterine contraceptive devices (IUCD), progesterone only pills (POPs) in lactating mother after 6 weeks of delivery.Methods: A total of 200 healthy nursing mothers, who needed contraception were enrolled in this prospective observational study. Women were explained about all four contraceptive methods used for the study. The reason for accepting a particular method was sought. The study participant were followed up at third and sixth month and side effects, failure rate, continuation rates, reasons for discontinuation of method were assessed.Results: The most acceptable method was condom (40.5%) followed by DMPA (31%), IUCD (20.5%) and POPs (8%). The most common reason for selection of condom was fear of side effects with other methods (66%). Long acting method like DMPA and IUCD has good continuation rate of 87% and 85% respectively. Failure of contraception was seen only with condoms (2.8%).Conclusions: This study showed condoms was most acceptable method but had failure whereas DMPA and Cu-IUCD have high continuation rate with no failure.

Factores Socioculturales: Embarazo adolescente subsecuente proyecto de vida, Morelos, México. 2012-2022 / Sociocultural Factors: Subsequent teenage Pregnancy life roject, Morelos, Mexico. 2012-2022

Resumen Objetivo: Describir la dinámica del embarazo adolescente subsecuente en un municipio con comunidades urbanas y rurales del estado de Morelos, y las condicionantes que influyen en el cambio del plan de vida de la madre, mediante una perspectiva cualitativa. Materiales y métodos: Estudio transversal con métodos múltiples, la fase cuantitativa permitió analizar la tendencia y tasas de embarazo adolescente, la fase cualitativa consistió en la aplicación de entrevistas semiestructuradas, previamente elaboradas, vaciadas en una matriz para el análisis, realizado a partir del análisis del discurso. Se construyó una base datos en Microsoft Excel 365. Posteriormente, con Stata v.14.2 se realizó análisis uni-variado y bivariado para obtener media, desviación estándar, proporciones con intervalos de confianza del 95%. Resultados: Se agrupó por edades de 17-20 años (n=160) y 15-16 años (n=5), la escolaridad preponderante, primaria 25.49% y secundaria 52.94%. El 87.18% se ocupa en el hogar como ama de casa. El 69.88% ha cursado 2 embarazos y el 23.49 % 3 embarazos, el 64.46% ha tenido 2 partos y 7.23% 3 o más partos. El 16.88% refiere 2 cesáreas, para el grupo de 17-20 años y el 40% en el grupo de 15-17 años. El 21.69% reportó un aborto. El periodo intergenésico fue de 12 a 24 meses. La mediana de edad de las madres fue de 19 años con un mínimo de edad de 15 y un máximo de 20 años. En el grupo de 17 a 20 años, la mediana fue de 19 años y en el grupo de 15 a 16 años, la mediana fue de 16 años. Conclusiones: Tanto la tasa como la prevalencia de embarazos adolescentes posteriores mostraron un aumento irregular hasta 2019, antes de mostrar una disminución posteriormente. El nivel educativo es un factor determinante para el embarazo adolescente primario y posterior.

Abstract Objective: It consisted of describing the dynamics of subsequent teenage pregnancy in a municipality with urban and rural communities in the state of Morelos, and the conditions that influence the change in the mother's life plan, through a qualitative perspective, the adolescent's perception of dating stage, your first pregnancy, second pregnancy and your social environment in your life plan. Materials and methods: Cross-sectional study with multiple methods, the quantitative phase allowed us to analyze the trend and rates of teenage pregnancy, the qualitative phase consisted of the application of semi-structured interviews, previously prepared, emptied into a matrix for analysis, carried out from discourse analysis. A database was built in Microsoft Excel 365. Subsequently, with Stata v.14.2, univariate and bivariate analysis was performed to obtain mean, standard deviation, proportions with 95% confidence intervals. Results: They were grouped by ages of 17-20 years old (n=160) and 15-16 years old (n=5), the predominant education, primary 25.49% and secondary 52.94%. 87.18% work at home as housewives. 69.88% have had 2 pregnancies and 23.49% have had 3 pregnancies, 64.46% have had 2 births and 7.23% have had 3 or more births. 16.88% reported 2 cesarean sections, for the 17-20 years old group and 40% in the 15-17 years old group. 21.69% reported an abortion. The intergenic period was 12 to 24 months. The median age of the mothers was 19 years old with a minimum age of 15 and a maximum of 20 years. In the 17 to 20 years old group, the median was 19 years old and in the 15 to 16 years old group, the median was 16 years old. Conclusions: Both the rate and prevalence of subsequent teenage pregnancies showed an irregular increase until 2019, before showing a decrease thereafter. Educational level is a determining factor for primary and subsequent teenage pregnancy.

A knowledge, attitude and practices based study to know the awareness and acceptance of contraceptive methods in married couples coming to well-baby clinic of a tertiary care centre in Panvel, Maharashtra, India

Background: Family planning plays a major role in improving the financial, nutritional, educational, social well-being of a family as a unit. To study the level of knowledge, attitude and practices of various family planning methods in eligible couples. Methods: Prospective Qualitative study was carried out from June 2021 - December 2022 on data of 180 eligible couples selected randomly from Well-Baby Clinic, collected through pretested and validated standardized questionnaire. Sample size was estimated scientifically. Results were arrived by descriptive statistical tests and correlational statistics using software’s like excel, SPSS. Results: The level of knowledge of contraceptive methods was 89.44% for OC pills, 67.08% depot medroxyprogesterone, 97.22% condoms, 84.03%, IUCD, 93.56% for female and 98.04% for male sterilization. Overall acceptance of any type of contraception was 55%, most commonly used method being condoms i.e.78.49%, OC pills 12.90%, IUCD 6.35%, depot 1.37% and 45% were using natural methods. Major factors affecting acceptance were desire to have more children, hesitancy to seek, lack of knowledge, decision making power of a woman in the family. Conclusions: Since our research finds contraceptive acceptance at 55% much lower than state average, we look into components of gender dynamics and offer array of choices to couples so that a well informed choice free of gender bias is taken. Continuity of personalized and dignified couple counseling from preconceptional, antenatal to postnatal period is emphasized to increase contraceptive acceptance. We recommend well baby clinics as effective point of delivery for family welfare activities using gender sensitive cafe-teria approach.

Acceptability and short-term complications of PPIUCD

Background: Intrauterine contraceptive device (IUCD) is an effective form of long-acting reversible contraceptive (LARC). Postpartum IUCD insertion is labelled when IUCD is inserted within 10 minutes to 48 hours of expulsion of placenta. assess the acceptability and short-term complications of postpartum intrauterine contraception device insertion in tertiary care hospital of Bangladesh. The aim of the study was to assess the evaluation of factors associated with acceptability of post-partum intrauterine contraceptive device (PPIUCD).Methods: This was a prospective observational study was conducted at department of obstetrics and gynecology, Dhaka Medical College Hospital (DMCH).Results: Out of 360 eligible counselled postpartum patients, 48 (13.3%) women underwent PPIUCD insertion. Acceptance of PPIUCD was higher in the age group of 25-30 years (43.75%), having former health counselling about PPIUCD (70.8%), multipara (68.75%). The commonest complications were missing thread (8.3%) followed by lower abdominal pain (6.25%), irregular per vaginal bleeding (4.2%).Conclusions: PPIUCD is not very acceptable in our set up but it is a safe, highly effective method of contraception with very few side effects and no major complications and contraindications. The acceptability of PPIUCD can be increased with antenatal counselling and institutional delivery.

Uso de anticonceptivos hormonales y depresión en mujeres adolescentes y jóvenes: una revisión de alcance / Hormonal contraceptive use and depression in adolescent and young women: a scoping review

Se ha señalado al uso de los métodos anticonceptivos hormonales como una de las posibles causas que explican el exceso de depresión en mujeres. Objetivo: Explorar la literatura sobre la asociación entre uso de anticoncepción hormonal y depresión en adolescentes y jóvenes. Método: Se llevó a cabo una revisión de alcance de la literatura identificando estudios empíricos cuantitativos enfocados en la asociación entre uso de anticonceptivos hormonales y depresión en mujeres entre 11 y 24 años, publicados entre enero de 2017 y septiembre de 2022 e indexadas en Web of Science y SCOPUS. Resultados: Se incluyeron 12 artículos que mostraron asociaciones positivas, negativas y no concluyentes o con resultados mixtos. Conclusiones: La relación entre el uso de anticonceptivos hormonales y depresión es compleja y multifacética. Los resultados presentados resaltan la necesidad de una investigación continua y más específica para comprender mejor las posibles asociaciones y proporcionar orientación clínica más precisa.

Abstract. The use of hormonal contraceptive methods has been pointed out as one of the possible causes that explain the excess of depression in women. Objective: To explore the literature on the association between the use of hormonal contraceptives and depression in adolescents and young women. Methods: We conducted a scoping review of the literature identifying quantitative empirical studies focused on the association between hormonal contraceptive use and depression in women aged 11-24 years, published between January 2017 and September 2022, and indexed in Web of Science and SCOPUS. Results: In total, 12 articles showing positive, negative, and inconclusive or mixed associations were included. Conclusions: The relationship between hormonal contraceptive use and depression is complex and multifaceted. The results presented highlight the need for continued and more specific research to better understand possible associations and provide more accurate clinical guidance.

A systematic review of the evidence on the effectiveness of sexuality education interventions on young people's sexual and reproductive health outcomes in Nigeria

Poor sexual and reproductive health (SRH) outcomes among Nigeria's youth necessitate urgent interventions to meet the country's sustainable development goal (SDG) SRH target by 2030. This review evaluates Nigeria's SRH educational interventions, focusing on their effectiveness in improving young people's (YP) SRH outcomes. It highlights the global implications of these outcomes on achieving the SDG by 2030. The review, following PRISMA standards, analyzed peer-reviewed journals and gray literature (from January 2017-June 2023), using narrative synthesis and Joanna Briggs institute (JBI) quality appraisal checklists for quasi-experimental and cross-sectional studies. The search found 1021 studies, with 6 meeting inclusion criteria (4 quasi-experimental and 2 cross-sectional studies). All reported significant improvements in YPSRH outcomes, including knowledge and attitudes towards SRH themes, uptake of SRH and HIV/STI services, parental and societal support, and reduction in risky sexual behaviors. Quality assessment revealed several methodological flaws such as inadequate blinding and contamination measures. The review offers insights for YP interventions, but methodological flaws limit effectiveness. Further studies with rigorous designs and longer follow-up are needed. The absence of economic evaluation data is a knowledge gap with important implications for decision-makers.

A cross-sectional study of contraceptive use and healthcare status among women at different times in the postpartum period / 上海预防医学

ObjectiveTo investigate the use of contraceptive methods， and to evaluate maternal healthcare services utilization among women within 2 years in Pudong New Area of Shanghai. MethodsA cross-sectional survey was conducted using a questionnaire for women at different postpartum periods who visited a community health clinic with their children from June to November 2021. Data were analyzed using χ2 test and binary logistic regression. ResultsAmong the 1 946 postpartum women surveyed， 1 934 were either married or cohabiting， and1 430 had resumed their sexual life. Among women at 4， 6， 12， 18 and 24 months postpartum， the contraceptive prevalence rates （CPR） were 92.34% （193/209）， 92.16% （235/255）， 87.31% （282/323）， 91.95% （297/323） and 90.00% （288/320）， respectively. The modern contraceptive prevalence rates （mCPR） were 87.08% （182/209）， 87.06% （222/255）， 82.04% （265/323）， 83.09% （271/323） and 85.31% （273/320）， respectively， while the unmet contraceptive needs （UMNs） were 7.66% （16/209）， 7.84% （20/255）， 11.46% （37/323）， 6.81% （22/323） and 10.00% （32/320）， respectively. The use rates of long-acting reversible contraceptive （LARC） methods among women at 6， 12， 18 and 24 months postpartum period were 0.39% （1/255）， 2.17% （7/323）， 0.31% （1/323）， and 2.81% （9/320）， respectively. Among all surveyed subjects， 32.17% （626/1 946） had received postpartum contraceptive services only once， while 27.85% （542/1 946） had not received any postpartum contraceptive services. Binary logistic regression analysis indicated that the use of contraceptive methods among postpartum women was associated with whether relevant educational services were received after childbirth and during postpartum home visits （all P<0.05）. ConclusionPostpartum women have unmet needs for contraception. Contraceptive guidance at the 42-day postnatal healthcare visit needs to be further strengthened and postpartum contraceptive education could be integrated into the pregnancy care. The quality and effectiveness of contraceptive education during delivery and postpartum home visits， and even at the 42-day postnatal healthcare visit need to be further explored.

Sports gynecology: a new way to improve female athletes care and performance / Ginecología deportiva: una nueva forma de optimizar atención y el rendimiento de la deportist / Ginecologia do esporte: uma nova maneira de otimizar o cuidado e a performance da mulher atleta

ABSTRACT Introduction: Female participation in sports has reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In this context became necessary to understand menstrual cycle, contraceptive use, and its individual responses. Objective: To investigate menstrual cycle characteristics, physical and mood symptoms related to vaginal bleeding, and contraceptives used by Brazilian Olympic athletes. Also, to assess if these athletes relate that vaginal bleeding influences sportive performance, how they manage it and what can be changed to improve their health care and sportive performance. Additionally, we propose specialized female care by a gynaecologist specialized in sports medicine. Methods: Descriptive observational study was conducted from July to August 2016 and included 118 Brazilian Olympic female athletes, in menacme. The athletes completed a self-administered online questionnaire, adapted from Pre-Participation Gynaecological Examination of female athletes. Results: Participants practiced 28 different sports, mean age 27 ± 4.7 years. For 66% it was their first participation in an Olympic Game. Most used contraceptives (54%), mainly oral (61%). Most (76%) believed that vaginal bleeding influenced sports performance, and 63% preferred to compete after bleeding cessation. Fifty-eight percent would compete at preferred time of their cycle. Anxiety symptoms, bloating, increased appetite, depression, and dysmenorrhea were indicated by 52%. Among these, 49% reported that these symptoms deteriorated their sportive performance. Conclusion: Most in their first Olympic participation, Brazilian athletes used hormone contraceptives, mainly oral ones to manage and adapt their vaginal bleeding to the competition calendar because most of them referred those physical and mood symptoms deteriorated their sportive performance. The presence of a Sportive Gynaecologist as part of the Olympic Medical Staff highlighted the female athletes issues and helped them to improve sportive performance. Level of Evidence IV; Cross-sectional observational study

RESUMEN Introducción: La participación femenina en deportes alcanzó un hito en 1972, cuando se implementó una reforma constitucional para garantizar igualdad de oportunidades entre hombres y mujeres. Desde entonces, el porcentaje de participantes en deportes competitivos ha crecido. En este contexto, se hizo necesario comprender el ciclo menstrual, el uso de anticonceptivos y sus respuestas individuales. Objetivo: Investigar características del ciclo menstrual, síntomas físicos, estado de ánimo, quejas relacionadas con el sangrado vaginal y los métodos anticonceptivos utilizados por atletas olímpicas brasileñas. Evaluar si estas deportistas perciben influencia del sangrado vaginal en el rendimiento deportivo, cómo lo controlan y qué se puede cambiar para mejorar. Además, ofrecemos atención especializada por una ginecóloga especialista en medicina deportiva. Métodos: Estudio observacional, descriptivo, realizado de julio a agosto de 2016, que incluyó 118 atletas olímpicas brasileñas, en menacme. Las atletas respondieron un cuestionario en línea autoadministrado y adaptado titulado "Examen ginecológico previo a la participación". Resultados: Practicaban 28 deportes diferentes, con edad media = 27 ± 4,7 años. Para 66%, era su primera participación en un juego olímpico. Anticonceptivos usados r54%), principalmente orales (61%). La mayoría (76%) cree que el sangrado vaginal influye en el rendimiento deportivo y 63% prefirió competir después del. El 58% de los atletas competiría en su momento preferido de su ciclo. Los síntomas de ansiedad, hinchazón, aumento del apetito, depresión y dismenorrea fueron indicados por el 52%. Entre estas, 49% deterioró su rendimiento deportivo. Conclusión: En su primera participación olímpica, las atletas brasileñas utilizaron anticonceptivos hormonales, principalmente orales, para controlar y adaptar el sangrado vaginal al calendario de competición, ya que la mayoría relató que los síntomas físicos y anímicos perjudicaban su desempeño deportivo. La presencia de una Ginecóloga Deportiva como parte del Equipo Médico Olímpico destacó los problemas de las atletas y las ayudó a mejorar su rendimiento. Nivel de Evidencia IV; Estudio Observacional.

RESUMO Introdução: A participação feminina no esporte teve um marco importante em 1972, quando uma emenda constitucional foi implementada para garantir a igualdade de oportunidades para homens e mulheres. Desde então, o percentual de participantes em esportes competitivos tem crescido. Nesse contexto tornou-se necessário compreender sobre ciclo menstrual, uso de anticoncepcionais e suas respostas individuais. Objetivo: Investigar características do ciclo menstrual, sintomas físicos e de humor, queixas relacionadas ao sangramento vaginal e métodos contraceptivos usados por atletas olímpicas brasileiras. Avaliar se percebem influência do sangramento vaginal no desempenho esportivo, como elas o controlam e o que pode ser mudado para melhorar seus cuidados e desempenho esportivo. Além disso, propõe-se atendimento específico por ginecologista especializada em medicina esportiva. Métodos: Estudo observacional, descritivo, realizado de julho a agosto de 2016 que incluiu 118 atletas olímpicas brasileiras, na menacme. As atletas responderam a um questionário online autoaplicável e adaptado intitulado "Pre-Participation Gynaecological Examination". Resultados: As participantes praticavam 28 esportes diferentes, com média de idade = 27 ± 4,7 anos. Para 66%, foi a primeira participação em um evento olímpico. A maioria usava anticoncepcional (54%), principalmente oral (61%). A maioria (76%) acredita que o sangramento vaginal influencia o desempenho esportivo e 63% preferiam competir após o mesmo. 58% das atletas competiriam no momento preferido de seu ciclo. Sintomas de ansiedade, distensão abdominal, aumento do apetite, depressão e dismenorreia foram indicados por 52%. Entre esses, 49% deterioraram o desempenho esportivo. Conclusão: Em sua primeira participação olímpica, as atletas brasileiras utilizaram anticoncepcionais hormonais, principalmente orais, para controlar e adaptar o sangramento vaginal ao calendário de competição, pois a maioria referiu que os sintomas físicos e de humor prejudicaram o desempenho esportivo. A presença de uma Ginecologista Esportiva como parte da Equipe Médica Olímpica destacou os problemas das atletas femininas e as ajudou a melhorar o desempenho esportivo. Nível de Evidência IV; Estudo Observacional.

Development of a serious game for learning about safe sex and contraception in adolescence / Desarrollo de serious game para el aprendizaje sobre sexo seguro y anticoncepción en la adolescencia / Desenvolvimento de serious game para aprendizagem sobre sexo seguro e contracepção na adolescência

Objectives: to develop a serious game in a mobile application for learning about safe sex and contraception with the active participation of adolescents; and evaluate the content, appearance and usability of the technology with adolescents and experts. Method: this is an applied research project into the development of a serious game, carried out in two stages: development of the technology itself; and evaluation of the content, appearance and usability of the application. Teenagers from a public school in the city of São Paulo-Brazil took part in the technology development stage. The evaluation was carried out by the adolescents and experts in the areas of public health and health technology. The following criteria were used: educational aspects, environment interface and didactic resources. Results: Prinventon App ® was developed, a serious game set in a virtual city, designed to address adolescent sexuality. The app received 90% positive responses and had a Content Validity Index of 0.80, which was considered adequate. The suggestions and notes were accepted and implemented. The serious game was considered interesting and important in terms of the subject matter. Conclusion: it was found that the technology developed can help adolescents learn about safe sex and contraception, by addressing sexuality in adolescence in a playful and realistic way.

Objetivos: desarrollar un serious game en aplicación móvil para el aprendizaje sobre sexo seguro y anticoncepción con la participación activa de los adolescentes; y evaluar contenido, apariencia y usabilidad de la tecnología con adolescentes y expertos. Método: se trata de una investigación aplicada, de producción tecnológica acerca del desarrollo de un serious game , realizada en dos etapas: desarrollo de la tecnología propiamente dicha; y evaluación del contenido, apariencia y usabilidad de la aplicación. Adolescentes de una escuela pública de la ciudad de São Paulo-Brasil participaron en la etapa de desarrollo de la tecnología. Ya la evaluación fue hecha por los adolescentes y expertos en las áreas de salud colectiva y tecnología en salud. Se siguieron los criterios: aspectos educacionales, interfaz del ambiente y recursos didácticos. Resultados: se desarrolló Prinventon App ® , un serious game ambientado en una ciudad virtual, diseñado para abordar la sexualidad en la adolescencia. La aplicación obtuvo 90% de respuestas positivas y presentó Índice de Validez de Contenido de 0,80, siendo considerado adecuado. Las sugerencias y apuntes fueron acogidos e implementados. El serious game fue considerado interesante e importante ante el tema abordado. Conclusión: la tecnología desarrollada puede ayudar a los adolescentes en el aprendizaje sobre sexo seguro y anticoncepción, al apuntar abordar, de manera lúdica y realista, la sexualidad en la adolescencia.

Objetivos: desenvolver um serious game em aplicativo mobile para aprendizagem sobre sexo seguro e contracepção com a participação ativa dos adolescentes; e avaliar conteúdo, aparência e usabilidade da tecnologia com adolescentes e experts . Método: trata-se de uma pesquisa aplicada, de produção tecnológica sobre o desenvolvimento de um serious game , realizada em duas etapas: desenvolvimento da tecnologia propriamente dita; e avaliação do conteúdo, aparência e usabilidade do aplicativo. Adolescentes de uma escola pública da cidade de São Paulo-Brasil participaram da etapa de desenvolvimento da tecnologia . A avaliação foi realizada pelos adolescentes e experts nas áreas de saúde coletiva e tecnologia em saúde. Seguiram-se os critérios: aspectos educacionais, interface do ambiente e recursos didáticos. Resultados: desenvolveu-se Prinventon App ® , um serious game ambientado em uma cidade virtual, projetado para abordar a sexualidade na adolescência. O aplicativo obteve 90% de respostas positivas e apresentou Índice de Validade de Conteúdo de 0,80, sendo considerado adequado. As sugestões e apontamentos foram acatados e implementados. O serious game foi considerado interessante e importante diante do tema abordado. Conclusão: a tecnologia desenvolvida pode auxiliar os adolescentes na aprendizagem sobre sexo seguro e contracepção, ao abordar, de maneira lúdica e realística, a sexualidade na adolescência.