Reasons for discontinuation of contraception among women with a current unintended pregnancy in 36 low and middle-income countries.

OBJECTIVES: To explore the reasons for discontinuation of the last contraceptive method used in women with a current unintended pregnancy. STUDY DESIGN: We conducted a retrospective analysis using contraceptive calendar data from Demographic and Health Surveys from 36 low- and middle-income countries from 2005 through 2014. The prevalence of contraception utilization and the contribution of each reason for contraceptive discontinuation was calculated, at country level as well as for the pooled dataset, for 10,901 women aged 15-49 before the current unintended pregnancies. RESULTS: Unintended pregnancies ranged from 5.5% of all pregnancies in the Kyrgyz Republic to 60.0% in Colombia and Peru. In Central Asian and in six African countries, over 80% of women with a current unintended pregnancy had not used any contraceptives in the previous five years. Use of long-acting modern methods remained consistently low across all countries. Among women who last used a traditional method, 83.8% discontinued due to failure. Among women who last used a long-acting modern method, 40.2% discontinued because of side effects. CONCLUSIONS: Our findings confirm that more than 65.0% of women with an unintended pregnancy in 36 low and middle-income countries were either non-users or using traditional methods. An additional 31.2% were using short-acting modern methods. Long-acting methods would have prevented the overwhelming majority of unintended pregnancies. IMPLICATIONS: This paper shows the need for the health system to support use of suitable methods, reduce switching failure and identify early when women are having concerns about the method they are using.

Does place and attendance at birth improve early neonatal mortality? Secondary analysis of nine Demographic and Health Surveys.

OBJECTIVES: To determine the relation between place and skilled birth attendance at birth and early neonatal mortality. DESIGN: Retrospective analysis using data from Demographic and Health Surveys on obstetric complications. SETTING: Nine low and middle income countries between 2006 and 2013. POPULATION: 71 758 women aged 15-49 years. METHODS: A secondary analysis was carried out to investigate the occurrence and effect of obstetric complications on early neonatal mortality and association with place and attendance at birth. Obstetric complications studied were prolonged labour, puerperal infection and eclampsia. MAIN OUTCOME MEASURES: Association between early neonatal mortality and place and attendance at birth, unadjusted and adjusted for presence of severe obstetric complications. RESULTS: Thirty-five percent of all births were at home: 70% of these were without skilled attendamts. Obstetric complications were reported in 17 079 women: 82% of these women gave birth in health facilities. Overall, no association was observed between place of birth or attendance at birth and early neonatal mortality. When adjusted for obstetric complications, the odds of early neonatal deaths for births at home without a skilled attendant were 1.3 (95% CI 1.1-1.5) compared with 1.2 (95% CI 1.0-1.5) with a skilled attendant and births in health facilities. CONCLUSIONS: When adjusted for obstetric complications, births in health facilities were associated with reduced early neonatal mortality. However, reporting and referral bias account for at least part of the association. TWEETABLE ABSTRACT: Births in health facilities are linked with fewer early newborn deaths when adjusted for obstetric complications.

The adverse health effects of tobacco and tobacco-related products.

Tobacco use continues to occur in epidemic proportions and with it, significant morbidity and mortality. One third of smokers will die prematurely of a smoking-related disease. This article reviews the adverse health effects of tobacco use so that clinicians can be aware of the benefits patients will reap when they stop using this lethal substance.