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Youth is a key period of life to ensure future well-being, especially in relation to sexuality. The general objective is to analyze the sexual education of young people today regarding sexual practices and to study the use of contraceptive methods. Material(s) and Method(s): It is a cross-sectional, observational study of cases. Designed a digital questionnaire made with Google consisting of 26 items and 3 blocks: social-demographic data, female sexuality and sexual health. Data analysis the statistical program SPSS 25.0. Result(s): The sample obtained: 1320 women. Social-demographic data: ages between 15 and 29 years and 58.3% of the women had a partner. The most frequent sexual orientation: 77% heterosexual. Female sexuality: for 63.9% of women, sex is an important part of their relationships and 43.3% consider themselves attractive people. The most rejected practices: anal sex, during menstruation or with the light on. 4.7% do not feel prepared to require their sexual partner to use a condom. 9.7% are not able to request sexual practices that they want. 6.2% state that they do not avoid any practice despite the fact that some of them cause discomfort. During the Covid-19 situation, the frequency of sexual relations decreases by 49% and the absent practices of viral transmission via online increase. Regarding sexual education, we observe that the majority have been provided by friends, that is, unqualified personnel. The most explained topics are focused on the traditional aspects of sexual health and human development, therefore it is an education that is not of quality, data confirmed by 58% of women. The contraceptive methods most used by women are condoms and oral contraceptives, whose main purpose is the prevention of pregnancy and sexually transmitted infections (condoms). Its use can have negative connotations such as decreased sexual desire, excitement, sensitivity and orgasm disorders. Conclusion(s): Currently, young women perceive sexuality more and more naturally, talking about it without fear or censorship. Sex educators are mostly not qualified personnel. The SARS-CoV2 (Covid-19) situation increases the number of sexual practices online, decreasing it. The contraceptive methods most used by women are condoms and oral contraceptives.Copyright © 2023
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Objectives: To determine the relationship between the COVID-19 vaccine and the menstruation and to determine the factors associated with menstrual abnormalities after COVID-19 Vaccine. Method(s): Female students from the Unaizah College of Pharmacy and Medicine at Qassim University who were over the age of menarche, had received the vaccine, were not pregnant or nursing, were not using contraceptives, did not have a history of primary ovarian insufficiency, hypothalamic menopause, or had undergone a hysterectomy were invited to participate. A universal sampling method was used to collect the data using an online method. Consequently, a total of 299 enrolled students participated in the survey. Result(s): Out of 329 registered students, 299 agreed to participate, giving a response rate of 90.88%. The mean age of the participants was 22.1 +/- 1.70, majority were unmarried (n=255;85.3%) and were from PharmD (n=206;69.8%). A total of 70(26.1%) reported to have COVID-19 infection. About 258(86.2 %) reported menstrual symptoms post-vaccination, of which 108(41.8%) reported irregular, 94(36.4 %)length of menstruation changed, for 56(21.7%) mensuration completely stopped. Only 16(6.20%) required a hospital visit to resolve post COVID vaccination menstrual symptoms. Previous COVID 19 infection significantly influenced the incidence of mensural abnormalities (p=0.03). After the second dose of the vaccine, Pfizer-BioNTech (91.3%) followed by Johnson and Johnson (66.7%), there were significant variations in the menstrual abnormalities across different vaccination types (p = 0.014). Conclusion(s): The study showed a possible link between the COVID-19 vaccine and menstrual abnormalities which needs further investigation regarding its impact on their quality of life.Copyright © 2023
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Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.
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Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but potentially debilitating thrombosis affecting 3-4 cases per million adults in the United States. Risk factors are thought similar to venous thrombosis, but there is little epidemiologic data corroborating this assertion. Concern about a possible association between the Janssen (Johnson and Johnson) and Oxford-AztraZenaca COVID-19 vaccines and cases of CVST resulted in increased global attention to this condition. Thus, large epidemiological assessment of the risk factors, treatment and outcomes of CVST are needed. Objective(s): Estimate the distributions of risk factors antecedent to CVST diagnosis, report CVST treatments in clinical practice, and potential sequelae of CVST in a large retrospective cohort of adults with CVST in the United States. Method(s): MarketScan Commercial and Medicare Supplemental administrative databases were employed to assess CVST diagnosed between 2011 and 2019 in the U.S. Validated International Classification of Disease (ICD) codes and receipt of an outpatient anticoagulant (either oral or subcutaneous anticoagulant) prescription within 30 days of the ICD code identified incident CVST. Antecedent clinical characteristics, treatments, and sequelae of CVST were identified using inpatient, outpatient, and prescription data. For outcomes, proportions and incidence with 95% confidence intervals (CIs) were calculated, stratified by sex. Result(s): We identified 1,869 CVST patients. Of these 1,314 (70%) were female, with 200 (10%) events identified as a pregnancy-related CVST. The average age was 41 years for females and 48 years for men. Among women, 24.7% were on hormonal therapy (oral contraceptive, estrogen, and progestin) prior to diagnosis. Men had a higher prevalence of comorbidities, such as diabetes (15% men vs. 9% women) and cancer (19% men vs. 10% women). Oral anticoagulant (OAC) use was the most common treatment for CVST in both men (88%) and women (85%) and did not vary by sex. Use of procedures to treat CVST, optic nerve fenestration and catheter directed thrombolysis, were 0.5% and 4.1%, respectively. The most common sequela after CVST was incidence of intracranial hypertension (Incidence: 4.2 per 100 person-years;95% CI: 3.3, 5.1) and palliedema was rare. Conclusion(s): Overall, a majority of CVST patients were women of reproductive age. Our findings suggest a potential association with both endogenous (pregnancy) and exogenous (oral contraceptives, HRT) hormones which needs further study. In our sample, CVST was managed with oral anticoagulants, regardless of sex, and intracranial hypertension was elevated following CVST. This large claims-based analysis is a descriptive insight into the risk factors and management of CVST, a rare and debilitating condition.
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The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.
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Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
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Background: The covid-19 pandemic affected family planning management and the sexual and reproductive rights of couples. Objective(s): To determine the factors associated with the interruption of the use of contraceptive methods during the quarantine by COVID-19 in Peruvian women. Method(s): Analytical and cross-sectional study, which included 342 women who used a contraceptive method before the COVID-19 quarantine, to whom a virtual questionnaire disseminated on social networks was applied. Pearson's chi-square evaluated associations between method discontinuation and the factors studied. Result(s): Of the total number of women, 45% discontinued the use of contraceptive methods during the COVID-19 quarantine. The predominant age range was from 18 to 34 years (93.9%). The factors associated with this interruption were age (p = 0.044), marital status (p < 0.001), parity (p < 0.001), sexual relations (p < 0.001), and searching for information by digital means (p = 0.044). The main reason for stopping use was fear of contagion by COVID-19 (42.8%). Conclusion(s): About half of contraceptive method users interrupted their use during the COVID-19 quarantine, and the factors associated with said interruption were personal, reproductive, and informa-tional. Therefore, health personnel must provide comprehensive care for women, especially in health emergencies.Copyright © 2023 Bentham Science Publishers.
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Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
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Background: Contraceptives are an important component of women's reproductive health care, as they not only reduce the number of unwanted pregnancies, but also improve reproductive function. However, oral contraceptives are known to increase the risk of venous thromboembolism. This risk is increased by infection with the COVID-19 virus that predisposes patients to both venous and arterial thrombosis as a result of excessive inflammation, platelet activation, aggravated endothelial dysfunction, and congestive events. If these patients have hereditary thrombophilia, the risk of venous thromboembolism becomes fatal. Case report: The paper describes a clinical case of a patient with total portal vein thrombosis, who have been taking oral contraceptives for a long time and recovering from the novel coronavirus infection. Studying the blood coagulation system and folate cycle genes, by using PCR, has revealed a gene mutation in the plasminogen activator inhibitor (serpine). The authors demonstrate the data of spiral computed tomography of the abdominal organs, as well as changes in laboratory parameters. Conclusion(s): A balanced approach is required when prescribing combined oral contraceptives during the COVID-19 pandemic, especially in women with prothrombotic mutations.Copyright © A group of authors, 2023.
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Purpose: Exacerbated by the COVID-19 pandemic, adolescents from structurally marginalized communities face barriers to accessing sexual and reproductive health (SRH) care. Mobile health units (MHUs) may be effective in reaching these adolescents but few studies have assessed their feasibility in this population. Methods: We assessed the feasibility of an MHU to provide SRH care to adolescents in community settings. Adolescents were invited to community demonstrations of hypothetical MHU care ("Demonstration events”). Adolescents completed surveys (demographics, likelihood of future MHU-based care, and access to health care) and staff documented field notes. We then partnered with adolescents, health care providers, and community leaders to create adolescent-centered SRH care for MHU delivery ("Clinical events”). Free and confidential services provided on the MHU included contraceptive care, condoms, testing for pregnancy, Neisseria gonorrhea (GC), Chlamydia trachomatis (CT), Syphilis, and Human Immunodeficiency virus (HIV). Initially, we provided electronic prescriptions for contraception during MHU visits. We later designed a system to dispense contraception [I.e., emergency contraception (EC) for future use, combined hormonal oral contraceptives (CHOCs), patches and Medroxyprogesterone] in the MHU. After MHU care, adolescents completed surveys to report satisfaction while staff documented feedback through field notes. Results: At 8 community "Demonstration events”, 98 teens (mean age 15.8 years, 67% female at birth, 17% Genderfluid/Non-Binary/Trans, 49% heterosexual, 24% Hispanic, 49% Black, 40% White) were enrolled. Most (70%) reported no previous vaginal/penile sex. Many (46%) had forgone needed health care in the previous year. Most (77%) said they were very/somewhat likely to get care on the MHU if available in the future and 82% would recommend it to friends. Most thought the MHU would be a great way to increase access to SRH care because it eliminated transportation obstacles and appointment delays. Many felt the MHU would provide adequate privacy and advised bringing the MHU to school or community events. Teens recommended collecting urine specimens in nearby restrooms and using a brown bag to transport them to the MHU. Utilizing their feedback, we partnered with teen-serving community organizations and schools to host the MHU. At two "Clinical events”, we provided care for five patients (4 biologic females, 1 biologic male). Accepted health services included condom provision (n=5) and, pregnancy (n=3), GC/CT (n=4), and Syphilis/HIV (n=2) testing. Two MHU patients received contraceptive prescriptions, one received contraception onsite (EC and CHOCs), and one with a positive CT test was contacted and treated. Four adolescents completed a post-care survey. All (100%) were very satisfied with MHU care and said they would recommend it to a friend. All (100%) agreed/strongly agreed they learned something new about SRH and reported the information was helpful. Field notes revealed patients communicated appreciation for the care, felt comfortable on the MHU, and found school-based SRH care acceptable. We plan to host five additional MHU "Clinical events” (Fall 2022). Conclusions: As COVID-19 continues to negatively impact adolescent SRH care-seeking, our work offers key insights to customizing MHU-based SRH care to meet the unique needs of adolescents from structurally marginalized communities. Sources of Support: Institutional expansion of NIH-funded KL2 program (RB), 3R21HD098086-02S1 (MM), K23HD098299 (KM).
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The COVID-19 crisis could leave significant numbers of women and couples without access to essential sexual and reproductive health care. This research note analyses differences in contraceptive method mix across Sustainable Development Goal regions and applies assumed method-specific declines in use to produce an illustrative scenario of the potential impact of COVID-19 on contraceptive use and on the proportion of the need for family planning satisfied by modern methods. Globally, it had been estimated that 77 per cent of women of reproductive age (15-49 years) would have their need for family planning satisfied with modern contraceptive methods in 2020. However, taking into account the potential impact of COVID-19 on method-specific use, this could fall to 71 per cent, resulting in around 60 million fewer users of modern contraception worldwide in 2020. Overall declines in contraceptive use will depend on the methods used by women and their partners and on the types of disruptions experienced. The analysis concludes with the recommendation that countries should include family planning and reproductive health services in the package of essential services and develop strategies to ensure that women and couples are able to exercise their reproductive rights during the COVID-19 crisis Copyright © 2020. Dasgupta A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
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The FDA has approved tirzepatide (Mounjaro - Lilly), a peptide hormone with activity at both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, to improve glycemic control in adults with type 2 diabetes. Tirzepatide, which is injected subcutaneously once weekly, is the fi rst dual GIP/GLP-1 receptor agonist to become available in the US. Selective GIP receptor agonists are not available in the US;GLP-1 receptor agonists have been available for years. Copyright © 2022, Medical Letter Inc.. All rights reserved.
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Aim: Has lockdown and COVID-19 led to a change into the characteristics of DVT's and patients who have them alongside a review of the DVT service. Method: Data was collected retrospectively from electronic patient records system for the following periods: 1st April until 30th June 2019 and 1st April until 30th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8. Results: 227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution (p= 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 (p=0.1437). Fewer long-haul journeys were made (p=0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 (p=0.0494). However, there were more patients using the contraceptive pill (p=0.0086) with 1 in 2019 and 9 in 2020. Conclusion: There is no significant difference in the characteristics, extent, and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.
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Objectives: Knowledge of trends in adolescent conception rates can aid in delivery of targeted contraceptive and prenatal resources. Conception rates during the COVID-19 pandemic years (2020–2021) are compared to pre-pandemic years (2016–2019) in Kingston, ON. Methods: Patients aged ≤19 at estimated date of conception between 2016–2021 who were seen for a pregnancy related visit at Kingston Health Sciences Centre were included. Pregnancies that ended <20 weeks gestational age (GA) were captured using ICD-10 procedure codes for pregnancy loss or termination. Data for births that occurred ≥20 weeks GA were obtained from the BORN database. Month and year of conception were calculated using chart review based on diagnostic imaging reports or provider estimates of GA. Results: To date, 728 adolescent conceptions have been captured between January 1st, 2016, and July 31st, 2020, with 53.7% of these pregnancies ending <20 weeks GA. Overall, there has been a decline in adolescent conception rates between January 2016–April 2020 (test for trend P < 0.001). Contrary to published trends of peak adolescent conceptions in March 2004–2008, mean conceptions were highest in January (mean 13.5 ± 2.4) during 2016–2019. Conclusions: Conception rates in Kingston’s adolescent population are decreasing. Further, current monthly conception rates differ from previously established trends and provide opportunity to deliver targeted contraceptive and prenatal resources. Data collection will continue until September 2022 and will be correlated with governmental COVID-19 lockdowns to determine if conception rates were affected by public health measures during the pandemic. Keywords: adolescent conception;Kingston, Ontario;COVID-19;trends
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Objectives: The COVID-19 pandemic necessitated a shift from traditional face-to-face instruction for new technical skills to virtual delivery of medical education training. Our objectives were to develop and validate a virtual simulation training program for Canadian healthcare professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant. Methods: A scientific committee of Canadian family planning experts developed a two-part virtual training program during the COVID-19 pandemic. In Part 1, core educational content was provided in an asynchronous, self-directed, on-line format. Part 2 consisted of synchronous, simulation-based training using web conferencing. HCPs were provided with model arms and training placebo applicators, trainers demonstrated implant insertion/removal techniques, and trainees received individual feedback on technical performance. All trainees were asked to complete an on-line evaluation upon program completion. Results: Between March 2020 and June 30, 2021, 2130 Canadian HCPs had completed Parts 1 and 2 of the training program and 1275 participants completed the program evaluation (response rate 60%). Participants reported high levels of satisfaction with virtual simulation-based training. Ninety-seven percent (1229/1275) of participants agreed the virtual format was effective. Four percent (51/1275) requested additional training prior to inserting the implant in clinical practice. Conclusions: Virtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online delivery of implant training can be scaled to use as needed to reach professionals in remote or underserved locations and for training provision of other technical or surgical procedures. Keywords: simulation-based training;contraceptives;virtual learning
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Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Extensive evidence exists in support of a causal association of elevated triglyceride-rich lipoprotein (TRL) levels with the risk of atherosclerosis progression. Hypertriglyceridemia has been established as a risk factor for venous thrombosis, including a 2- fold increase in the risk of venous thrombosis in postmenopausal women. However, there is limited data on the role of hypertriglyceridemia in the arterial thrombosis. Objective/Purpose: Not Applicable. Methods: Case description: A 51-year-old white female with hypertension and type 2 diabetes (hemoglobin A1C, 7.4%) was transferred for further management of newly diagnosed bilateral renal and splenic infarcts. No risky habits were elicited except for the use of combined hormonal contraceptives over the past two years to control menorrhagia. Family history was significant for hypertriglyceridemia. Her physical exam was unremarkable. Testing for COVID-19 was negative. An extensive hypercoagulable and autoimmune work-up was unremarkable. Fasting lipid profile was significant for elevated levels of triglycerides, 1,274 mg/dL (replicated on two separate occasions), very low-density lipoprotein-cholesterol, 255 mg/dL, and non-high-density lipoprotein-cholesterol, 214 mg/dL, directly measured low-density lipoprotein cholesterol, 39 mg/dL and lipoprotein(a), 6 mg/dL. There was no structural pathology on the echocardiogram, including no interatrial shunt or intracardiac thrombus. Her whole-body computed tomography angiography revealed a focal calcified protruding thrombus in the distal thoracic aorta. No significant plaque was seen elsewhere in the aorta. Results: Decision-making. The posterior thrombus in the distal thoracic and proximal abdominal aorta was determined as a culprit for the visceral organ infarcts. Over the course of the hospital stay her abdominal pain gradually resolved. Treatment with low dose aspirin and therapeutic dose of low-molecular weight heparin was initiated followed by apixaban and aspirin on discharge. She was started on atorvastatin 40 mg, fenofibrate 145 mg, icosapent ethyl 4 g, resulting in a 70% reduction in the triglycerides levels (306 mg/dL). In 3 months, her repeat CT angiography showed significant resolution of the aortic atherothrombosis with no signs of aortic wall inflammation. At the 6-month follow-up visit she was switched to dual antiplatelet therapy with a plan to repeat imaging in 6 months. Conclusions: This case illustrates challenges in managing patients with arterial thrombosis in the setting of familial hypertriglyceridemia. Apart from severely elevated triglycerides no other etiology was evident. We propose further investigation of the prothrombotic properties of TRL and the role of targeted triglyceride-lowering therapies on atherothrombotic outcomes.
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Background and aims: Anticoagulation on CVT is followed until 6 to 12 months according to guidelines. Longer periods of treatment are used in patients with high thrombotic risk. We describe the duration of treatment with OAC and what risk factors are related to longer treatment. Methods: We conducted a retrospective single centre study in a tertiary hospital in México City. Electronic medical files of consecutive patients with CVT were reviewed from January 2018 to June 2020. Clinical, radiological and laboratory variables were obtained. Patients were allocated according to the time of use of OAC (less or more than a year). Results: We collected data from 20 patients. 14 (70%) were female, with a mean age of 33.5 (26-50). 40% (n=8) were smokers, 20% (n=4) used hormonal contraceptives, 15% (n=3) were pregnant or in puerperium and 10% (n=2) referred vaccination for SARS-CoV-2. superior sagittal sinus was the most frequently affected (65%). The median time of AOC treatment was 13 months (6.7-16.7). In the bivariate analysis, the existence of a chronic cause (OR 14;IC95%, 1.25-156;p= 0.028), and prolonged hospitalization (OR 15.7;IC95% 1.7-141.4 p= 0.22) were associated with AOC treatment over a year. Initial NIHSS, mRS at discharge, D-dimer values or seizures al presentation showed no correlation. Conclusion: Use of OAC in a tertiary centre is related to chronic conditions with high thrombotic risk and with long hospital stay, according to the guideline's recommendations.
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Introduction The COVID-19 pandemic presented challenges to delivery of reproductive health services. To explore effects, we examined patterns of contraceptive use, service access and pregnancy planning in the year following the first UK lockdown. Methods The Natsal-COVID Wave 2 survey was conducted in March-April 2021, one year after the first lockdown began in Britain. We analysed a subset of sexually-active participants aged 18-44 years and described as female at birth. We estimated differences in outcomes by age and markers of vulnerability. We examined changing contraception use, access to and unmet need for contraceptive services, and London Measure of Unplanned Pregnancy scores (LMUP;range 0-12). Results Of 1,488 eligible participants, 78.0% were considered at risk of unplanned pregnancies. Of 441 at-risk participants who tried to access contraceptive services, 16.4% faced barriers. Young participants (18-24 years) were most likely to report trying to access contraceptive services (38.4%;(32.2, 45.0);vs 28.4% overall) and to face barriers doing so (OR: 2.87 (1.36, 6.06)). Encountering barriers was more likely among participants reporting no educational qualifications and those reporting symptoms of anxiety or depression. 199 participants reported a pregnancy in the last year. Pregnancies to young participants were less likely to be 'planned' (difference in mean LMUP score: -2.95;(-3.91, -1.99)). Less 'planned' pregnancies were associated with lower social grades and becoming unemployed. Discussion Young and vulnerable participants were more likely to report difficulties accessing reproductive services and less planned pregnancies during the pandemic. In navigating pandemic recovery, sexual health services should consider the needs of these at-risk groups.
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Objective: A short inter-pregnancy interval of less than 18 months increases the risk of subsequent pregnancy and birth-related complications. Our objective was to identify how the use of postnatal contraception can be tailored to individual needs and become a well-integrated component of personalised care in maternity services to reduce this risk. Design & method: A cross-sectional survey was conducted among 103 new mothers on the postnatal ward over a 6-week period between October-November 2020. The participants were selected at random, all within 72 hours of giving birth. They completed a survey on iPads we provided by answering questions on different types of postnatal contraception. More specifically we were interested at establishing the timing during their pregnancy journey and the clinical setting in which postnatal contraception was discussed. We also aimed to identify what additional information they required on the different types of contraception and which clinical setting felt more appropriate for them to access their contraception. We analysed their responses to assess the extent of contraception counselling received during their pregnancy and establish their knowledge and their preferences. Results: Of 103 postnatal women, 10% had not used any method of contraception in the past whilst 40% used long-acting reversible contraception (LARC). Interestingly, 38% had received contraception counselling during their antenatal care with the majority (70%) carried out by a midwife. Only 28% were offered a method of contraception after delivery. Regarding safety of use whilst breastfeeding, 74% believed that all types of oral contraceptives were unsafe, whilst 41% believed that both the implant and the depot injections were unsafe. In terms of timing, 50% wanted to discuss contraception options during antenatal appointments and 44% preferred receiving their contraception of choice before discharge. Finally, 25% of women were likely to accept an intrauterine device as their contraception at the time of their caesarean section. Conclusions: This survey provides evidence that women want to access contraception, including LARC, prior to discharge from maternity services. This should become routine clinical practice. Implementing such a postnatal contraception service has been of greater significance during the COVID-19 pandemic since accessing contraception from GPs or sexual health clinics has become more challenging for new mothers. Therefore, we believe that postnatal contraception counselling should become an integral component of a mother's pregnancy journey, starting at booking and ending with the preferred method of contraception provided prior to discharge.