Interconception Care for Adolescent Women During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVE: Interconception care (ICC) is a means of improving health outcomes for women and children by mitigating maternal risks between pregnancies. Within a pediatric medical home ICC is reliant on adherence to well-child visits (WCVs). We hypothesized that a pediatric-based ICC model would remain successful in providing access to services for adolescent women for those seen during the COVID19 pandemic. The objective of this study was to determine if the COVID19 pandemic influenced LARC use and repeat pregnancy for those seen for ICC in a dyadic pediatric medical home. METHODS: The pre-COVID cohort was comprised of adolescent women seen for ICC from September 2018-October 2019. The COVID cohort was comprised of adolescent women seen for ICC from March 2020-March 2021. The two cohorts were compared across multiple characteristics including sociodemographic factors, age, education, number of visits, contraceptive choice and repeat pregnancy during the study interval. RESULTS: The COVID cohort were significantly more likely to be primiparous, seen with a younger infant, and attend fewer visits than the pre-COVID cohort. The COVID cohort were equally likely to initiate long-acting reversible contraception but less likely to experience a repeat pregnancy. CONCLUSIONS: The COVID19 pandemic limited access to routine healthcare and likely impacted access to ICC for many women. ICC provided during WCVs allowed access to care even amid the restrictions of the COVID19 pandemic. Both effective contraception and decreased repeat pregnancy were maintained, highlighting the effectiveness of this approach for ICC within a dyadic pediatric medical home.

Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine.

OBJECTIVE: Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. METHODS: We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. RESULTS: The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. CONCLUSION: Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand.

Objective: This study sought to identify the impact of implementing the new postpartum care (individualized rescheduling postpartum visit) with telemedicine on postpartum services during the COVID-19 pandemic. Study design: This is a retrospective cohort study conducted at Srinagarind Hospital, a tertiary hospital in northeast Thailand, to compare patient data before and after implementation. Delivery and postpartum data from May 2019 to December 2020 were retrieved from the hospital database. Intervention was implemented in March 2020. Data were analyzed to evaluate postpartum contact, contraceptive use, and breastfeeding using Wilcoxon rank sum and Chi-squared tests. Results: There was a significant increase in postpartum contact from 48.0% (95% CI. 45.8 to 50.3) before the implementation of telemedicine to 64.6% (95% CI. 61.9 25 to 67.2) after (adjusted OR 1.5, 95% CI. 1.2 to 1.8). In the post-intervention group, contraception use also increased significantly (84.7% vs 49.7%; p < 0.001), and a higher proportion of women relied on long-acting reversible contraception (16.6% vs 5.7%; p < 0.001). However, patients in the post-intervention group were less likely to practice exclusive breastfeeding (46.6% vs 75.1%; p < 0.001). Conclusion: Rescheduling the timing of a comprehensive visit accompanied by telemedicine support improved postpartum contact and contraceptive utilization, especially during the coronavirus pandemic. However, the observed decrease in exclusive breastfeeding highlights the need for better telehealth support.ImplicationOur findings support that individualized postpartum care with telemedicine is a feasible and useful approach to sustain services during a pandemic.

Male and female sterilisation

Male and female sterilisation are important forms of contraception worldwide despite declining popularity in developed countries and limited access during the Covid-19 global pandemic. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilisation, particularly long-acting reversible contraception (LARC), should be discussed in detail as they are at least as effective and have the advantage of reversibility. Hysteroscopic techniques for female sterilisation are no longer available. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilisation and requests for reversal are more common in patients under 30 years and in men with no children.Copyright © 2023

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023

The association between the COVID-19 pandemic and postpartum care provision.

BACKGROUND: The COVID-19 pandemic led to a rapid transformation in the healthcare system to mitigate viral exposure. In the perinatal context, one change included altering the prenatal visit cadence and increasing the utilization of telehealth methods. Whether this approach had inadvertent negative implications for postpartum care, including postpartum depression screening and contraceptive utilization, is unknown. OBJECTIVE: This study aimed to examine whether preventative health service utilization, including postpartum depression screening and contraceptive utilization, differed during the COVID-19 pandemic when compared with the prepandemic period. STUDY DESIGN: This retrospective cohort study included all pregnant patients who received prenatal care at 1 of 5 academic obstetrical practices and who delivered at Northwestern Memorial Hospital either before (delivery from September 1, 2018, to January 1, 2019) or during (delivery from February 1, 2020, to May 15, 2020) the COVID-19 pandemic. Completion of postpartum depression screening was assessed by reviewing standardized fields in the documentation associated with the screening in the electronic health record system. The method of contraception used was ascertained from the postpartum clinical documentation. Patients were classified as initiating long-acting reversible contraception use if they received NEXPLANON (etonogestrel implant) or an intrauterine device during the hospitalization for delivery or within 3 months following delivery. Bivariable and multivariable analyses were performed. RESULTS: Of the 2375 pregnant patients included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Pregnant patients who delivered during the COVID-19 pandemic were significantly less likely to have undergone postpartum depression screening (45.5% vs 86.2%; P<.01); this association persisted after adjusting for potential confounders (adjusted odds ratio, 0.13; 95% confidence interval, 0.11-0.16). Pregnant patients who delivered during the COVID-19 pandemic also were significantly less likely to initiate long-acting reversible contraception use within 3 months of delivery (13.5% vs 19.6%; adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.84). CONCLUSION: The onset of the COVID-19 pandemic was associated with a decrease in the completion of postpartum depression screenings and fewer patients initiating long-acting reversible contraception use overall. These results can inform adaptations in healthcare delivery in the midst of the ongoing COVID-19 pandemic.

Understanding barriers to using long-acting reversible contraceptives (LARCs) in primary care: a qualitative evidence synthesis.

BACKGROUND: Long-acting reversible contraceptives (LARCs) are highly effective. In primary care, LARCs are prescribed less frequently than user-dependent contraceptives despite higher efficacy rates. Unplanned pregnancies are rising in the UK, and LARCs may have a role in reducing these through and redressing inequitable contraceptive access. To provide contraceptive services that offer maximal choice and patient benefit, we must understand what contraception users and healthcare professionals (HCPs) think about LARCs and uncover barriers to their use. METHODS: A systematic search using CINAHL, MEDLINE via Ovid, PsycINFO, Web of Science and EMBASE identified research about LARC use for pregnancy prevention in primary care. The approach adhered to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' methodology, critically appraised the literature, and used NVivo software to organise data and perform thematic analysis to determine key themes. RESULTS: Sixteen studies met our inclusion criteria. Three themes were identified: (1) trustworthiness (where and from whom participants obtained information regarding LARCs), (2) control (whether LARCs detract from personal autonomy) and (3) systems (how HCPs influenced LARC access). Misgivings about LARCs frequently arose from social networks and fears of surrendering control over fertility were prominent. HCPs perceived access issues and lack of familiarity or training as the main barriers to prescribing LARCs. CONCLUSIONS: Primary care plays a key role in improving access to LARC but barriers need to be addressed especially those involving misconception and misinformation. Access to LARC removal services are key to empower choice and prevent coercion. Facilitating trust within patient-centred contraceptive consult is essential.

136. Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Purpose: Telemedicine for adolescent and young adult (AYA) care, including long-acting reversible contraception (LARC) care, was quickly implemented in response to the COVID-19 pandemic. Therefore, outcomes of telemedicine LARC care is understudied. We compare outcomes of AYAs receiving LARC follow-up care via telemedicine and in-person over 1 year. Methods: This cohort study includes patients who had LARC, intrauterine device (IUD) or implant, inserted between 4/1/20-3/31/21 and attended an initial LARC follow-up visit at 4 US Adolescent Medicine clinics. Initial LARC follow-up visit was defined as the first visit within 12 weeks of insertion. Eligible patients were 13-26 years old, had LARC inserted without sedation, and had LARC in place for at least 12 weeks. We compared outcomes over 1 year between patients attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported side effects, medical menstrual management, acne management, IUD malposition or expulsion, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of medical menstrual management. Site-specific institutional review board approvals were obtained. Results: Our study included 194 AYAs, ages 13.9-25.7 years (mean 18.7 years, SD = 2.3) who attended an initial follow-up visit. Most AYAs (n = 168, 86.6%) attended only one visit in the 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site of LARC insertion (p =.43), age (p =.17), race/ethnicity (p =.25), prior pregnancy (p =.95), complex medical diagnoses (p =.32), menstrual diagnoses (p =.11), and reason for LARC (p =.82). In-person attendees were more likely to have the IUD than telemedicine attendees (p =.003). Bivariate analyses showed similar frequency of patient-reported symptoms over 1 year between groups. Outcomes of menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), IUD expulsion (p =.13), IUD malposition (p =.51), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing done (p =.001) than telemedicine attendees. However, no positive STI tests were captured in either group. Conclusions: Roughly two-fifths of patients presenting to an initial LARC follow-up visit did so via telemedicine. Type of LARC may influence modality of follow-up visit. Except for STI testing, outcomes over 1 year were similar regardless of the first visit modality. Reassuringly, no positive STI tests were detected in either group over 1 year of follow-up. More research is needed to determine if the decrease in STI testing for patients seeking care via telemedicine is clinically significant. Telemedicine may play an important role in AYA LARC follow-up care, and more research is needed in this area. Sources of Support: N/a.

Telemedicine for Adolescent and Young Adult Long-Acting Reversible Contraception Follow-Up Care amidst a Global Pandemic.

STUDY OBJECTIVE: To describe adolescent and young adult (AYA) long-acting reversible contraception (LARC) follow-up care via telemedicine in the year following the COVID-19 pandemic onset DESIGN: Longitudinal cohort study SETTING: Three academic adolescent medicine clinics in the United States PARTICIPANTS: AYAs using LARC INTERVENTIONS: None MAIN OUTCOME MEASURES: The main outcome measures were patient characteristics, visit information (frequency, timing, and modality), patient-reported symptoms, and outcomes for those presenting for LARC follow-up care between April 1, 2020, and March 31, 2021. Descriptive statistics were used to describe the sample. χ2 tests and t tests were used to compare groups. Adjusted logistic regression models using general estimating equations were applied to assess factors associated with telemedicine visits and to examine visit outcomes. RESULTS: Of the 319 AYAs (ages 13.6-25.7 years), 40.1% attended at least one LARC telemedicine visit. Patients attending any telemedicine encounter vs only in-person visits had similar demographic and clinical characteristics. Of the 426 follow-up visits, 270 (63.4%) were conducted in person and 156 (36.6%) were performed via telemedicine. Most visits (62.7%) occurred within 12 months of device insertion. Reports of bothersome uterine bleeding beyond patient expectations (OR = 1.26; 95% CI, 0.80-1.96), any symptom (OR = 1.40; 95% CI, 0.94-2.10), or 2 or more symptoms (OR = 1.22; 95% CI, 0.67-2.22) at follow-up was not associated, positively or negatively, with mode of follow-up. Management of bleeding (OR = 1.27; 95% CI, 0.56-2.89), management of acne (P = .46), and need for rapid follow-up (P = .33) were similar between follow-up modalities. CONCLUSIONS: Patient demographic/clinical characteristics and visit outcomes were similar between telemedicine and in-person LARC follow-up. Telemedicine could play an important role in AYA LARC care.

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Care Amidst a Global Pandemic

Background: The COVID-19 pandemic necessitated telemedicine contraception care, including long-acting reversible contraception (LARC) follow-up, and use of telemedicine services for adolescents and young adults (AYAs) is understudied. We describe virtual LARC care and assess patient outcomes over 1 year. Methods: This retrospective cohort study (IRBP00030775) includes patients seeking LARC follow-up at any time point within 1 year of telemedicine initiation (4/1/20-3/31/21) at 3 US Adolescent Medicine clinics. Eligible patients were 13-26 years old and had LARC inserted at a participating site without sedation. Covariates included demographics, clinical characteristics, and side effects. Outcomes were LARC-related bleeding management and need for rapid follow-up after the index visit (within 2 weeks of the first follow-up in the study period). A sub-analysis compared rates of initial follow-up visit (within 3 months of insertion) pre- and post-COVID (insertions 3/1/19-11/30/19 vs. 4/1/20-12/31/20). Descriptive statistics, χ2 tests, and t-tests were used to describe the sample and to compare groups. General estimating equations were used to determine predictors of telemedicine visit and to examine outcomes. Results: Our study included 319 patients, ages 13.6-25.7 years (mean 18.7 +/- 2.3), of whom 180 (56.4%) received the intrauterine device and 139 (43.6%) received the implant (Table 1). 128 (40.1%) patients attended at least 1 LARC telemedicine visit. Of the 426 LARC follow-up visits, 36.6% were via telemedicine. Unadjusted bivariate analyses showed telemedicine visits had higher reports of any reported patient side effect;however, reports of the most common side effects were similar between modalities (Table 2). Menstrual concern at insertion (OR 0.74, p =.26), uterine bleeding at follow-up (OR 1.26, p =.32), or report of any (OR 1.40, p =.10) or more than 2 LARC side effects (OR 1.22, p =.52) did not predict modality of follow-up. Telemedicine did not influence bleeding management (OR 1.27, p =.57). Few patients (2.8%) required rapid follow-up;index visit modality did not influence this rate (3.8% telemedicine vs. 2.2% in-person, p =.33). Follow-up within 3 months of insertion increased post-COVID (n = 525, 30% vs. 46%, p = <.001). Patients seeking LARC care pre- and post-COVID did not differ with respect to age (p =.28), race/ethnicity (p =.07), indication for LARC (p =.94), or prior use of hormonal contraception (p =.28). Conclusions: Patients seeking virtual and in-person LARC follow-up care and outcomes associated with visits were similar. Follow-up rates were higher post-COVID, which may have been influenced by the availability of telemedicine. Telemedicine may play an important role in increasing access to AYA LARC care.

EXPANSION OF SEXUAL HEALTH OUTREACH DURING COVID

Introduction Our service expanded its outreach delivery in 2021 during the COVID pandemic. We commenced home visits, and in collaboration with other organisations delivered care in a mobile clinic and alternative non-clinical venues. Methods Retrospective electronic patient records review of patients seen in an outreach setting between March 2021 - March 2022. Results 134 patients were referred to outreach and 106 were seen. The most frequently encountered characteristics, or vulnerabilities, of patients referred to outreach are highlighted in the table. 53% of patients were of White British ethnicity;76% female. STI screening was offered to 104 patients and 43 had positive infections. Vaccinations were offered to 56 patients. Contraception was discussed with 59 patients and LARC initiated in 19. Discussion Implementing new modes of delivery of sexual health care has been possible during the pandemic, meeting the needs of vulnerable populations. There was a high rate of infection positivity and LARC uptake. By working with local organisations we provide holistic care by addressing multiple issues, such as mental health assessment and substance misuse support, in one visit. (Table Presented).

Contraception immediately after having a baby: What do women want?

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.

Effects of the COVID-19 Pandemic on Contraceptive Access at Planned Parenthood of Illinois

INTRODUCTION: Prior to the COVID-19 pandemic, Planned Parenthood of Illinois (PPIL) provided in-clinic contraceptive services to over 10,000 patients/year. At pandemic onset, PPIL rapidly consolidated services to six health centers and launched telehealth. This study aims to understand the disruptions of the pandemic on contraceptive access and to understand the impact of telehealth as measured by changes in time to appointment and method mix. METHODS: Retrospective contraceptive service delivery data were analyzed before (March 2019-March 2020) and during (March- October 2020) the pandemic. Time to appointment was defined as days from date appointment was made to originally scheduled appointment date. Method mix was dichotomized as pill/patch/ring or long-acting reversible contraception (LARC). Other methods were excluded. Descriptive and comparative statistics were generated. Institutional review board approval was received from the University of Chicago. RESULTS: Before the pandemic, median (IQR) time to in-clinic appointment was 5 (2-9) days compared to 11 (5-15) days during the pandemic. Median time to telehealth appointment was 4 (2-8) days. During the pandemic, 6,615 patients received contraceptive services, 1,701 through telehealth and 4,914 in-clinic, with 91.9% choosing pill/patch/ring or LARC methods. When dichotomized, method mix slightly changed with 57.0% of patients, prepandemic, choosing pill/patch/ring methods compared to 54.9% patients during the pandemic (P=.006). During the pandemic, 41.4% of pill/patch/ring visits were through telehealth and 58.6% through in-clinic visit. CONCLUSION: Telehealth appointments were available sooner than in-clinic visits and uptake of telehealth visits for patients obtaining pill/patch/ring was substantial. The small change in method mix is likely not clinically significant.

American College of Obstetricians and Gynecologists 2022 Annual Clinical and Scientific Meeting

The proceedings contain 344 papers. The topics discussed include: estimating in vivo levonorgestrel release rate and exposure over eight years with levonorgestrel releasing intrauterine system 52 mg use with population pharmacokinetic approach;immediate vs routine postpartum intrauterine device placement after teen pregnancy: a cost-effectiveness analysis;examining the association of immediate postpartum long-acting reversible contraception payment carve-outs and postpartum LARC use in Medicaid;contraceptive congruence: a novel measure of contraceptive use that acknowledges pregnancy ambivalence;charm 2: a gender synchronized family planning intervention for couples in rural India, a cluster randomized trial;telehealth follow-up after medical management for early pregnancy loss;providing mifepristone and misoprostol in emergency departments during the COVID-19 pandemic;and medical students' knowledge of and attitudes towards oocyte cryopreservation.

Potential of LARC to recover loss in satisfied demand for modern contraception after the COVID-19 pandemic: a case scenario analysis of Brazil and Mexico.

Objectives: To estimate inequalities in demand for family planning satisfied with modern methods among women in Latin America and the Caribbean, with an emphasis on Brazil and Mexico, and to calculate the scenario for recovery of modern contraceptive coverage by expanding access to long-acting contraceptives (LARC) after the COVID-19 pandemic. Methods: National health surveys from 2006 to 2018 were used to estimate the demand for family planning satisfied with modern methods and how it was affected by the COVID-19 pandemic. The scenario included three variables: coverage, health outcomes, and costs. Considering coverage, United Nations Population Fund data were used to estimate the impact of COVID-19 on access to contraception in Latin America and the Caribbean. Health outcomes were assessed with the Impact 2 tool. Direct investment was used to evaluate cost-effectiveness. Results: Substantial inequalities were found in the use of modern contraceptive methods before the pandemic. We showed the potential cost-effectiveness of avoiding maternal deaths by introducing LARCs. Conclusions: In the scenario predicted for Brazil and Mexico, the costs of modern family planning and averted disability-adjusted life years are modest. Governments in Latin America and the Caribbean should consider promoting LARCs as a highly efficient and cost-effective intervention.

Perspectives of obstetricians and midwives on the provision of immediate postpartum intrauterine devices: a qualitative service evaluation.

BACKGROUND: Immediate postpartum intrauterine device (PPIUD) insertion is safe and effective but largely unavailable in Europe. Data on maternity staff views on the provision and implementation of PPIUD services are limited. The objective of this qualitative evaluation was to explore the views and experiences of obstetricians and midwives providing PPIUD within a UK maternity setting, in order to identify areas for improvement and inform service provision in other areas. METHODS: Qualitative health services research within two public maternity hospitals in Lothian (Edinburgh and surrounding region), UK. Interviews with 30 maternity staff (obstetricians n=8; midwives n=22) involved in PPIUD provision. Data were analysed thematically. RESULTS: Maternity staff were positive about the benefits of PPIUD for women. Midwives reported initial concerns about PPIUD safety, and the impact on workload; these views shifted following training, and as PPIUD was embedded into practice. Having a large pool of PPIUD-trained staff was identified as an important factor in successful service implementation. Having PPIUD 'champions' was important to address staff concerns, encourage training uptake, and advocate for the service to ensure continued resourcing. CONCLUSIONS: PPIUD in maternity services can help address unmet need for effective contraception in the immediate postpartum period. We emphasise the importance of widespread engagement around PPIUD among all healthcare professionals involved in the care of women, to ensure staff are informed and supported. Clinical champions and leaders play a key role in amplifying the benefits of PPIUD, and advancing organisational learning.