Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the influence of the HIV pandemic.

BACKGROUND: Contraceptive use dynamics continue to be of priority in sub-Saharan Africa because of persistently high levels of fertility. This paper focuses on the use of barrier versus non-barrier contraceptive use in sub-Saharan Africa hypothesizing that the HIV pandemic in the region would be responsible for increases in the use of barrier methods over time. METHODS: This paper uses Demographic and Heath Survey (DHS) data from 32 countries to conduct extensive analysis of trends in contraceptive use and method mix that refers to the distribution of contraceptive methods use among the sexually active population. The paper examines how contraceptive method mix dynamics have changed over time and whether the trends differ by marital status and gender using cross-tabulations. It furthers examines the determinants of method choice using logistic regressions. RESULTS: The findings indicate that the use of barrier methods, most markedly for unmarried women and men, rose substantially between the late 1980s and late 2000s in the region in tandem with trends in HIV prevalence. The results further show marked differences in method mix by gender with men being more likely to report barrier method use than women. CONCLUSIONS: The findings indicate shifting preferences in contraceptive choice. The time trend analyses highlight the importance of expanding the focus of contraceptive use studies beyond women in this context as the study finds differing trends for men.

Contraceptive plans and purchase after an induced abortion: A nationwide register study from Finland.

OBJECTIVES: To examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase. STUDY DESIGN: This was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1, 2017 and December 31, 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish National Register of Induced Abortions. From the Register of Induced Abortions, we gathered information on planned post-abortion contraception. The redeemed prescriptions of hormonal contraception were identified from the Prescription Centre until December 31, 2019. We analyzed the hormonal contraceptive methods planned at the time of the abortion, and how they corresponded to hormonal contraceptive purchase during the 1-year follow-up. We also assessed factors (age, socioeconomic status, education, civil status, and reproductive history) affecting post-abortion contraceptive purchase by using Poisson regression models. RESULTS: At the time of the abortion, 83% (n = 7023) of the women were planning to start using hormonal contraception. Planning any hormonal contraception at the time of the abortion was associated with a higher probability to purchase hormonal contraception after the abortion (incidence rate ratio [IRR] 2.30, 95% confidence intervals [CI] 2.07-2.55), especially in cases of the vaginal ring (IRR 42.66, 95% CI 33.89-53.71) and contraceptive patch (IRR 156.33, 95% CI 111.31-219.55). The following variables were associated with lower incidence rates for purchasing hormonal contraception after the abortion: educational level of bachelor at the highest or missing information on education, civil status as married or divorced, and history of delivery or induced abortion. CONCLUSIONS: The majority of women undergoing abortion plan to use hormonal contraceptive method for post-abortion contraception. Planning any hormonal contraceptive method at the time of an induced abortion is an important predictor of purchasing the method within the year after the abortion. IMPLICATIONS: Hormonal contraceptive purchase after an abortion is associated with pre-abortion contraceptive planning. Many background factors for not purchasing hormonal contraception can be identified, which may guide counseling dedicated to these groups.

Interrogating the pill: Rising distrust and the reshaping of health risk perceptions in the social media age.

Since its introduction in 1960, the combined oral contraceptive pill has become the dominant reversible contraceptive technology for controlling female fertility in spite of early and ongoing ethical, critical medical, and societal disapproval. Over the last decade, prescription rates among young women in Western Europe have declined alongside the rise of social media use. This article investigates the mechanisms underlying this change in contraceptive choices and the role played by social media in this trend. Via exploratory online observation and an in-depth interview study with 19 informants in Germany and Denmark, we find social media consolidates the social construction of hazards associated with the contraceptive pill by reshaping young women's risk perception from questions around drug reliability and safety to those of individual physical, mental, and social well-being. We shed light on how social media contributes to the delegitimation of health professionals such as gynaecologists and general practitioners and adds to wider debates on the erosion of medical authority and the attendant rise of peer influencers. We condense our findings into a framework for health-related attitude formation and decision-making in the social media age, which elucidates how social media amplifies and reshapes societal discourses regarding health-related technologies, choices, and risks.

The association of quality contraceptive counseling measures with postabortion contraceptive method acceptance and choice: results from client exit interviews across eight countries.

The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client's perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients.

The preferences of women in Australia for the features of long-acting reversible contraception: results of a discrete choice experiment.

PURPOSE: Long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and implants, are highly effective. However, the uptake of LARC in Australia has been slow and the oral contraceptive pill (OC) remains the best known and most widely used contraceptive. Our aim was to investigate women's preferences for the features of LARC. METHODS: We used a discrete choice experiment (DCE) in which each respondent completed 12 choice tasks. We recruited a general population sample of 621 women in Australia aged 18-49 using an online survey panel. A mixed logit model was used to analyse DCE responses; a latent class model explored preference heterogeneity. RESULTS: Overall, 391 (63%) of women were currently using contraception; 49.3% were using an OC. About 22% of women were using a LARC. Women prefer products that are more effective in preventing pregnancy, have low levels of adverse events (including negative effects on mood), and which their general practitioner (GP) recommends or says is suitable for them. CONCLUSIONS: Women have strong preferences for contraceptive products that are effective, safe, and recommended by their GP. The results indicate which characteristics of LARCs need to be front and centre in information material and in discussions between women and healthcare professionals.

Drivers of contraceptive use choice in Zambia

Modern approaches of birth control have emerged as broadly accepted family planning methods in replacement of traditional alternatives. However, the effectiveness of modern contraceptives has been challenged by serious side effects, either experienced or expected, with inhibiting consequences on the acceptability and utilisation of family planning service. This paper disentangles the drivers of none-use, traditional and modern contraceptive use in Zambia using the 2018 Zambian Demographic Health Surveys (DHS) data. The Conditional logit choice modelling technique is employed to account not only for the differences in alternative contraceptive options but also the socioeconomic and demographic characteristics of individual woman making the choice. Empirical results indicate that educated, older and poorer women are likely to adopt the traditional contraceptive methods whereas employed women are indifferent between traditional and modern birth control options. Furthermore, Christian women and those from other religions as well as women with no education prefer no birth control method. The study concludes that employment has the potential to serve as an alternative and safer birth control tool in developing countries and namely in Zambia. Therefore, government's effort to expand family planning program should mainly target non-educated women while promoting safer contraceptive methods. This can be achieved through women education and job creation. (Afr J Reprod Health 2022; 26[5]:13- 27).

Women's socioeconomic status and choice of birth control method: an investigation for the case of Turkey.

This study investigated whether woman's education, labour market status and the status within the household have any impact on their birth control behaviour in Turkey. Empirical analyses were implemented using the 2013 Demographic and Health Survey dataset, which includes information on women's socioeconomic status and their current choice of contraceptives: whether they used any method, and if so, what method they used. Using a bivariate probit model with selection to control for any possible selection bias, the results suggest that whether a woman uses any birth control method, and whether the woman chooses modern methods over traditional methods, are primarily explained by education level and urban/rural residence, and that the determinants of contraceptive use vary across college-educated and non-college-educated women. The results also indicate that non-employed women are less likely to use any birth control method compared with women with regular, full-time jobs. However the effect was statistically insignificant.

Motivational interviewing to promote long-acting reversible contraception among Rwandan couples wishing to prevent or delay pregnancy.

BACKGROUND: Few family-planning programs in Africa base demand creation and service delivery on theoretical models. Motivational interviewing is a counseling modality that facilitates reflection on the benefits and disadvantages of a health outcome to encourage behavior change. OBJECTIVES: We evaluate a couples-focused joint family-planning and HIV counseling intervention using motivational interviewing to enhance uptake of long-acting reversible contraception (Paragard copper intrauterine device or Jadelle hormonal implant) among Rwandan couples. STUDY DESIGN: In this experimental study, couples receiving care at 8 government health clinics in Kigali, the capital city, were referred from a parent study of couples who did not want more children or wanted to wait at least 2 years for their next pregnancy. Long-acting reversible contraception methods were offered on site following joint HIV testing and family-planning counseling. At the first follow-up visit 1 month after enrollment in the parent study, couples who had not yet chosen a long-acting reversible contraception method were interviewed separately using motivational interviewing and then brought together and again offered long-acting reversible contraception. RESULTS: Following motivational interviewing, 78 of 229 couples (34%) requested a long-acting reversible contraception method (68 implant and 10 intrauterine device). Long-acting reversible contraception uptake after motivational interviewing was associated with the woman being Catholic (vs Protestant/Muslim/other, adjusted odds ratio, 2.87, 95% confidence interval, 1.19-6.96, P = .019) or having an income (vs no income, adjusted odds ratio, 2.54, 95% confidence interval, 1.12-5.73, P = .025); the couple having previously discussed long-acting reversible contraception (adjusted odds ratio, 8.38, 95% confidence interval, 2.54-27.59, P = .0005); either partner believing that unplanned pregnancy was likely with their current method (adjusted odds ratio, 6.67, 95% confidence interval, 2.77-16.11, P < .0001); or that they might forget to take or make an appointment for their current method (adjusted odds ratio, 4.04, 95% confidence interval, 1.32-12.34, P = .014). Neither partner mentioning that condoms also prevent HIV/sexually transmitted infection was associated with long-acting reversible contraception uptake (adjusted odds ratio, 2.86, 95% confidence interval, 1.17-7.03, P = .022), as was the woman citing long-term duration of action of the implant as an advantage (adjusted odds ratio, 5.41, 95% confidence interval, 1.86-15.76, P = .002). The woman not listing any side effects or disadvantages of implants was associated with long-acting reversible contraception uptake (adjusted odds ratio, 5.42, 95% confidence interval, 2.33-12.59, P < .0001). Clinic location (rural vs urban), couple HIV status, and concerns about negative economic effects of an unplanned pregnancy were significant in bivariate but not multivariate analysis. CONCLUSION: Encouraging couples to reflect on the benefits and disadvantages of long-acting reversible contraception methods, the likelihood of unplanned pregnancy with their current contraception, and the impact of an unplanned pregnancy is an effective motivational interviewing technique in family-planning counseling. One third of couples who did not want a pregnancy for at least 2 years but had not chosen a long-acting reversible contraception method when provided with standard family-planning counseling did so after motivational interviewing. Involving the male partner in family-planning discussions facilitates joint decision making about fertility goals and contraceptive choice. Combining family planning and joint HIV testing for couples allows targeted focus on dual-method use with discordant couples, who are advised to use condoms for HIV/sexually transmitted infection prevention along with a more effective contraceptive for added protection against unplanned pregnancy.

End-user involvement in developing and field testing an online contraceptive decision aid.

OBJECTIVES: Decision aids in the field of healthcare contribute to informed decision making. To increase the usefulness and effectiveness of decision aids, it is important to involve end-users in the development of these tools. This article reports on the development of an online contraceptive decision aid. METHODS: An exploratory, qualitative study was conducted in the Netherlands between 2014 and 2016. The development process of the decision aid consisted of six steps and included a needs assessment and field test. Interviews were conducted with 17 female students. RESULTS: The needs assessment provided information on the preferred content and structure of a contraceptive decision aid and guided the development of the online contraceptive decision aid prototype. Participants had an overall positive impression of the decision aid prototype during the field test. Minor revisions were made based on participants' feedback. Participants expected that the decision aid would positively contribute to decision making by increasing knowledge and awareness regarding the available contraceptive methods and their features and attributes, and by opening up to other options than the known methods. CONCLUSION: The developed contraceptive decision aid can contribute to better informed decision making and consultation preparation. Involving end-users in development seems valuable to adapt decision aids to specific needs and to identify in what way a decision aid influences decision making.

Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services.

RATIONALE: More thoroughly understanding the association between elevated depressive symptoms and effectiveness level of contraceptive method selected at a reproductive health visit could help women prevent unintended pregnancy. OBJECTIVE: This study examined how the association between both current and past depressive symptoms and effectiveness level of contraceptive method selected at a clinic visit varies by type of reproductive health visit. METHODS: Current and past depressive symptoms and contraceptive method selected were assessed among 1215 women aged 18-25 years seeking general reproductive health or abortion services at 40 community clinics throughout the United States. Using standard categories of effectiveness based on pregnancy rates during typical use, women's contraceptive method selected was coded as a low (e.g., no method, withdrawal, condoms), moderately (pill, patch, ring, or shot), or highly effective method (IUD, sterilization, implant). Depression status was divided into four categories: 1) no elevated depressive symptoms ever, 2) current elevated depressive symptoms only, 3) past elevated depressive symptoms only, and 4) past and current elevated depressive symptoms. Visit type, general reproductive health versus abortion care, was a moderator. The interaction effect between depressive symptoms and visit type on contraceptive method effectiveness level chosen was estimated with multinomial logistic regression analyses. RESULTS: In general reproductive health visits, having both elevated current and past depressive symptoms increased women's likelihood of choosing low versus moderately effective methods (RRR = 5.63, 95% CI = 2.31 to 13.71, p < .0005). In contrast, among abortion patients, only current elevated depressive symptoms were associated with choosing high versus moderate effectiveness methods (RRR = 1.74, 95% CI = 1.06 to 2.86, p = .029). CONCLUSION: Results suggest that considering both women's current and past elevated depressive symptoms and the type of reproductive health visit may assist providers in helping women prevent unintended pregnancy.

Clinical oversight and the avoidance of repeat induced abortion.

OBJECTIVE: To evaluate the impact of patient counseling, demographics, and contraceptive methods on repeat induced abortion in women attending family planning clinics. METHODS: A retrospective chart review of repeat induced abortions was performed. The analysis included patients with an initial induced abortion obtained between January 1, 2001, and March 31, 2014, at New York City Health + Hospitals/Metropolitan. The duration of involvement in the family planning program, the use of contraceptive interventions, and 18 patient factors were analyzed for their correlation with the incidence of repeat induced abortions per year of follow-up. RESULTS: A decreased rate of repeat induced abortions was associated with a longer duration of clinical oversight (r2 =0.449, P<0.001), a higher contraceptive efficacy score (r=0.280, P=0.025), and a larger number of clinic visits for contraception (r=0.333, P=0.007). CONCLUSION: A continuum of contact with all of the services of a family planning clinic demonstrated a strong efficacy to limit repeat induced abortions. By determining the patient characteristics that most influence repeat induced abortion rates, providers can best choose the most efficacious method of contraception available.

The effects of preabortion depressive symptoms on postabortion contraceptive effectiveness level chosen among women seeking abortions.

OBJECTIVE: We examined whether preabortion depressive symptoms were associated with contraceptive method effectiveness level chosen among women seeking abortions. STUDY DESIGN: Three-hundred and forty-seven young, low-income women 18 years or older who were seeking abortions at 3 community reproductive health clinics in Northern California were recruited to participate in a study on contraceptive decision making. We classified women into choosing low-, moderate- or high-effectiveness contraceptive methods based on typical-use failure rates. We used the Center for Epidemiologic Studies Depression scale to assess depressive symptoms as a continuous and dichotomous variable. Using the standard cutoff of 20, women who scored at or above this were considered depressed for the dichotomous measure. We used multinomial logistic regression to examine the association between preabortion depressive symptoms and contraceptive effectiveness level chosen to use after an abortion, adjusting for sociodemographics, abortion characteristics, pregnancy history, future pregnancy desires, relationship characteristics and adverse experiences. RESULTS: After adjusting for covariates, we found that a one-unit increase in depressive symptoms was associated with a higher likelihood of choosing low- versus moderate- [adjusted odd ratio (aOR)=1.05, 95% confidence interval (CI): 1.01-1.10, p<.02] and high-effectiveness methods (aOR=1.05, 95% CI: 1.002-1.10, p<.05). Furthermore, women scoring above the cutoff for depression were more likely to choose low- versus moderate-effectiveness methods (aOR=4.56, 95% CI: 1.27-16.32, p=.02). CONCLUSIONS: More preabortion depressive symptoms were independently associated with choosing low- versus moderate- and high-effectiveness contraceptives. IMPLICATIONS: These findings together with other findings show that preabortion depressive symptoms do not uniformly influence effectiveness level of contraceptive method selected to use after an abortion. Reproductive health care providers should consider the impact of women's psychological symptoms on their contraceptive decision making.

Choice of contraceptive methods by women's status: Evidence from large-scale microdata in Nepal.

OBJECTIVE: We aimed to investigate how improvement in women's status affects the choice of contraceptive methods in Nepal. STUDY DESIGN: We regressed the choice of contraceptive methods on women's status and other controlling variables by employing large-scale microdata representing over 12,000 married women aged 15-49 years in Nepal. Years of schooling and literacy were defined as women's status variables. We estimated how educational attainment affects the choice of contraceptive methods. We also analyzed how fear of their partners affected women's choices. RESULTS: Female sterilization was the most common choice among the contraceptive methods (25.5% of contraceptive users) in Nepal, followed by injections (19.9%). However, our estimation results showed that these options change with an improvement in women's status. An additional year of education increased the probability that women would choose condoms by 1.2 percentage points (95% confidence interval [CI]: 0.7, 1.6) and decreased the probability of choosing female sterilization by 1.4 percentage points (95% CI: -1.9, -0.8). For the well-educated women, injections and condoms became the first and second choices (29.5% and 21.5%), respectively, while female sterilization was the third option (17.9%) for contraceptive methods. Women's fear of their partners also affected the choice of contraceptive methods. The women who feared their partners were 7.0 percentage points more likely to choose female sterilization than condoms. CONCLUSION: Improvement in women's status (more education and less fear of their partners) changed their contraceptive behaviors by increasing the probability of choosing condoms and decreasing the probability of choosing female sterilization in Nepal.

Modern Contraceptive Choice Among Patients Seen at the "Cameroon National Planning Association for Family Welfare" Clinic Yaoundé.

BACKGROUND: To understand the low modern contraceptive prevalence in Cameroon, we reviewed the methods chosen and determined their side effects among patients in an urban setting. METHODS: We conducted a cross-sectional study at the "Cameroon National Planning Association for Family Welfare (CAMNAFAW) Clinic" in Yaoundé. Data were processed by SPSS software version 20.0 for Windows, and all tests were considered statistically significant at P < .05. RESULTS: Of the 1180 women sampled, the most chosen methods were as follows: depot medroxy progesterone acetate: 72.1% (787 of 1091), followed by oral combined contraceptives: 21.3% (232 of 1091), subcutaneous implants: 3.2% (35 of 1091), and intrauterine contraceptive devices: 1.9% (21 of 1091). A hundred and forty two (14.5%) of the 977 women received at least once (revisits) at the Center, reported at least one side effect. Irregular vaginal bleeding was the most frequent side effect: 44.6% (84 of 188 total documented side effects). Side effects were most common among users of subcutaneous implants: 28% (7 of the 25 implant users). CONCLUSIONS: Prescription of contraceptives should reflect not only the desire of couples but also the side effects associated with each method. This would optimize observance and adherence, consequently decreasing the failure rate.

Making good on a call to expand method choice for young people - Turning rhetoric into reality for addressing Sustainable Development Goal Three.

BACKGROUND: Investments in the nearly two billion young people, aged 10-24 years, in the world today are necessary to meet global development commitments, specifically the Sustainable Development Goals and Ending Preventable Child and Maternal Deaths. More than 12 million married and unmarried adolescents (aged 15-19) will give birth in 2016. Complications of pregnancy and childbirth are the second leading cause of death among 15-19 year-old women and early childbearing can significantly curtail social and economic prospects for young women. Facilitating the ability of sexually active young people to choose and effectively use a satisfactory contraceptive method will ensure they can exercise their right to prevent, delay or space pregnancy. The Global Consensus Statement, "Expanding Contraceptive Choice for Adolescents and Youth to Include Long Acting and Reversible Contraception" provides evidence on the safety and effectiveness of LARCs for young people. Three inter-dependent actions linking advocacy and policy (advocating for policy and guideline revisions); supply (improving quality and accessibility of an expanded method choice) and an enabling environment (social norms and comprehensive reproductive health information) are suggested as vital to achieving full access and full choice for all sexually active young people. Identified approaches include national advocacy addressing policy guidelines and standard operating procedures that guide providers in the provision of age and developmentally appropriate contraceptive services; pre-service and in-service training for health care providers to be able to effectively communicate and counsel young people, including dispelling myths and misconceptions around LARCs; and partnering with young people to design appropriate, contextually-relevant, and effective strategies to increase their self-efficacy and, at the community level, address broader social norms to dispel stigma and discrimination. CONCLUSION: An immediate call to action for collaborative and coordinated global, regional and national efforts that enable full access and full choice for all young people is paramount to achieve their reproductive health intentions and the Sustainable Development Goal targets.

Reassessing the importance of long-acting contraception.

BACKGROUND: Several recent studies have highlighted the need for greater use of long-acting contraception. The most influential of these studies is the Contraceptive CHOICE Project, which was credited with substantially reducing participants' pregnancy risk by increasing their use of long-acting methods such as intrauterine devices and subdermal implants. However, because participants' rates of nonuse and condom use fell to zero at the outset of the intervention, it is possible that sizable pregnancy reductions could still have been achieved if enrollees had chosen shorter-acting, female-controlled methods such as oral contraception. OBJECTIVE: The objective of the study was to estimate the proportion of the CHOICE Project's fertility impacts that could have been achieved without any increase in long-acting method use. STUDY DESIGN: The FamilyScape 3.0 microsimulation model was used to estimate CHOICE's impact on pregnancy risk and to simulate the counterfactual effect of moving all nonusers and condom users onto shorter-acting, female-controlled methods. FamilyScape models the sexual and contraceptive behaviors of women in the United States between 2006 and 2010, which is the period when CHOICE was implemented. RESULTS: Nearly three quarters of the CHOICE intervention's effects on pregnancy risk could have been achieved if participants had chosen shorter-acting, female-controlled methods over long-acting methods. CONCLUSION: Prioritizing the adoption of long-acting contraception may not be the most advisable strategy for reducing unintended pregnancy. The most impactful interventions will likely be those that increase the use of female-controlled methods, long-acting or otherwise.

Contraceptive challenges in adolescents living with or at risk of HIV.

Many adolescents living with or without HIV are sexually active and in need of continuous free access to a variety of contraceptive methods. Dual contraception, condom use together with reversible effective contraception (hormonal contraception [HC] or intrauterine device), seems to be the most effective option for female adolescents for protection from unintended pregnancy and sexually transmitted infections. When counselling on specific contraceptive choice, healthcare providers should be aware about possible interactions of some types of HC with the immune system, with possible changes in infectivity, as well as about drug interactions between mainly efavirenz and some types of progestins. Adding HC to HIV-positive status and antiretroviral therapy could have additive effects on metabolism. At the same time, the possible disadvantages of using HC in women living with HIV should be balanced against the advantages of very reliable methods of preventing unintended pregnancies. To reach and deliver a contraceptive service to more young women, it has proven effective to organise adolescent-friendly clinics and/or integrate them with HIV services. Diverse approaches, including community-based contraceptive service provision and the use of modern technologies, can complement the effort of providing contraceptive services to this target group of female adolescents living with HIV or at risk of HIV.

Contraceptive choice and acceptability: the future for STI risk in Kelantan, Malaysia.

More than 150 million women become pregnant in developing countries annually and an estimated 287,000 die from pregnancy-related causes. Contraception is vital to prevent unnecessary maternal deaths, as well as sexually transmitted infections. The objective of this study was to investigate preferred contraceptive methods and the factors that influence contraceptive choice among women in Kelantan, Malaysia. A cross-sectional study using interview-based questionnaires was conducted, during July and August 2009, in local family planning clinics in Kelantan. The questionnaire was administered to adult women (age 20-50). Prevalence of unplanned pregnancies was high (48%). Contraceptive preference was Depo contraceptive injection (32%), oral contraceptive pills (27%), intrauterine devices (15%) and contraceptive implants (12%); 9% used condoms. Only 2% used contraception to protect against sexually transmitted infections or HIV/AIDS. Younger women (OR 0.90; 95% CI 0.807-0.993) were more likely to use contraception. In conclusion, non-interrupted contraceptive methods were preferred. More than 60% would stop using contraception if it interrupted intercourse. From both a public health and infectious disease perspective, this is extremely worrying.

Association between contraceptive choice and the risk of induced abortion among floating married women of childbearing age / 中华流行病学杂志

Objective To find the association between factors related to contraception,reproductive health and the risk of induced abortion among floating married women of childbearing age,so as to provide basis for improving the access to health services for floating women of childbearing age.Methods Using data from the reproductive health survey on floating population from five cities in 2005,factors as demographic characteristics,contraceptive choice,settings and access to health services,induced abortion among the floating married women of childbearing age were described.Multivariate logistic regression was used to investigate the association the factors relative to contraception,reproductive health and the risk of induced abortion between 543 cases and 1796 controls.Results The risks of induced abortion among those under 30-years-old floating married women of childbearing age were 2.08-fold (95％CI:1.26-3.42) of the group at the age of 40 years old.The risk of abortion among floating married women at childbearing age who were taking short-acting contraceptive methods,was 2.56-fold (95％ CI:1.84-3.56) of those using the long-acting methods of contraception.The induced abortion risk of floating women at childbearing age who paid the contraceptive implement out of their own pockets,was 1.72-fold (95％ CI:1.32-2.24) of those who got it free of charge.The risks of abortion among women who recieved the contraceptive devices through maternal and child health centers,general hospitals or street residential committees were 2.69-fold (95％CI:1.71-4.22),2.49-fold (95％CI:1.68-3.68) and 1.81-fold (95％CI:1.20-2.72) of those who received them from urban or rural family planning stations,respectively.The induced abortion risk for women who were ignorant of emergency contraception,was 1.41-fold (95％ CI:1.12-1.78) of those who had the knowledge.The abortion risks of floating women at childbearing age who get the contraceptive knowledge from the colleagues,relatives or friends were 1.85 times (95％ CI:1.28-2.67) of those from family planning workers.Conclusion Factors,including age,short-acting contraceptive methods,paid access to contraceptive implement,ignorance of emergency contraception might largely contribute to the increased risk of induced abortion among floating married women of childbearing age,which called for future attention.