Depression, Contraception, and Ambivalence Concerning Fertility.

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Relationship between reproductive health literacy and components of healthy fertility in women of the reproductive age.

BACKGROUND AND AIM: One of the key factors affecting women's behavior with fertility issues is their health literacy, but this topic has been less addressed in the existing studies. We aimed to determine the relationship between reproductive health literacy and components of healthy fertility in women of reproductive age. MATERIALS AND METHODS: This cross-sectional study was conducted from March 2019 to September 2014 on 230 married women who were referred to comprehensive health centers in Lordegan city. Data were collected using a reproductive health literacy questionnaire, demographic and fertility information checklist, and components of healthy fertility. Data analysis was done using SPSS software, version 20. Pearson, Spearman, and independent t-tests were used as appropriate. RESULTS: The mean ± SD reproductive health literacy score in the participants was 43.80 ± 18.99 depicting an average literacy level in more than half of the women. Also, the reproductive health literacy score had a statistically significant relationship with the use of low-failure contraceptive methods (P < 0.001) and planned pregnancy (P = 0.03). However, this relationship was not significant regarding pre-pregnancy care (P = 0.88) and observing the interval between pregnancies (P = 0.57). CONCLUSION: We found a relationship between the level of reproductive health literacy and the use of family planning methods with low failure and planned pregnancy. Hence, it seems that interventions to improve reproductive health literacy are effective in reducing the occurrence of high-risk pregnancies and unwanted and unplanned pregnancies. Therefore, it is suggested that the health system consider and provide education related to reproductive health literacy as a part of healthy reproductive services.

Use of Contraceptive Methods Among Women in the General Population and Female Gynecologists in Spain: the ELEGIAN Survey.

Background: The contraceptive preferences of obstetricians and gynecologists (OB/GYNs) are thought to influence the contraceptive counseling they provide. The purpose of this study was to assess contraceptive preferences of OB/GYNs and women in the general population (WGP) in the current Spanish contraceptive scenario. Materials and Methods: Anonymous online survey of 100 OB/GYNs and 1,217 WGP aged 23-49 years. Results: WGP were younger (35.3 ± 7.3 vs. 37.9 ± 6.2 years, respectively) and less likely to have stable partners (64.7% vs. 84.0%) and children (49.1% vs. 62.0%) (all p < 0.05 vs. OB/GYNs). Seventy-nine percent versus 82%, respectively, used contraceptive methods, with condoms used most frequently by WGP (37% vs. 22% by OB/GYNs; p < 0.05) and pills by OB/GYNs (26% vs. 21% by WGP; p > 0.05). Intrauterine devices (IUDs) were more frequently used by OB/GYNs (20% vs. 5%; p < 0.05), especially the levonorgestrel-releasing intrauterine devices (LNG-IUDs) (18% vs. 2.6%; p < 0.05). The highest-rated methods were condoms among WGP and LNG-IUDs among OB/GYNs. Effectiveness was the most valued attribute of contraceptive methods for both. Reasons related to convenience were the main reason for choosing IUDs. OB/GYNs prescribed the contraceptive method in 40% of cases. Conclusions: Our study reveals differences between female OB/GYNs and WGP in contraceptive methods use and rating. The use of LNG-IUDs was much higher among OB/GYNs.

Willingness to use novel reversible methods of male birth control: a community-based survey of cisgender men in the United States.

BACKGROUND: There is high global demand for new methods of male birth control (MBC). However, contemporary evidence regarding men's method-specific attitudes and their determinants is sparse. METHODS: Non-sterilized cisgender men ages 18-45 with recent history of female sex partners were surveyed at a large community event in the Midwestern US. We examined variation in participants' willingness to use MBC by method (gel, pill, injection, implant, and vas occlusion), potential side effects, and potential barriers. We estimated crude and adjusted prevalence ratios (aPRs) for associations between participant characteristics and willingness to use ≥ 1 MBC method. RESULTS: Overall, 72% of participants (n = 187; mean age, 29) were very willing to use ≥ 1 MBC method although support for individual methods ranged widely from 62% (pill) to 24% (vas occlusion). In bivariate analysis of sociodemographic and health characteristics, few demonstrated associations with MBC willingness. In a multivariable model, willingness was independently related to age (30-39 vs. 18-29 years old, aPR = 1.24, 95% CI 1.04-1.48) and having ever been tested for HIV (aPR = 1.27, 95% CI 1.07-1.51). Willingness to tolerate side effects was < 10% for most items. The most commonly endorsed barriers to MBC use were high cost (77%) and side effects (66%). CONCLUSIONS: Enthusiasm for MBC was high but waned in the context of potential side effects and barriers. Additional research on MBC attitudes in socioeconomically and culturally diverse populations worldwide is sorely needed.

Understanding contraceptive failure: an analysis of qualitative narratives.

Most American women wanting to avoid pregnancy use contraception, yet contraceptive failures are common. Guided by the Health Belief Model (HBM), we conducted a secondary qualitative analysis of interviews with women who described experiencing a contraceptive failure (n=69) to examine why and how this outcome occurs. We found three primary drivers of contraceptive failures (health literacy and beliefs, partners and relationships, and structural barriers), and we identified pathways through which these drivers led to contraceptive failures that resulted in pregnancy. These findings have implications for how individuals can be better supported to select their preferred contraception during clinical contraceptive discussions.

Subestructuración teórica: Modelo de Conducta Anticonceptiva en Madres Adolescentes / Theoretical Substructuring: Model of Contraceptive Behaviour in Adolescent Mothers

Objetivo principal: Describir el desarrollo de un modelo de conducta anticonceptiva en madres adolescentes. Metodología: La construcción del modelo fue a través de la metodología propuesta por Dulock y Holzemer (1991), compuesta por cuatro pasos: (1) Búsqueda, revisión de la literatura e identificación de conceptos, (2) Especificación de las relaciones entre los conceptos, (3) Orden jerárquico de los conceptos de acuerdo al nivel de abstracción, y finalmente (4) Ilustrar las relaciones actuales entre variables. Resultados principales: Se integraron nuevos conceptos a la teoría madre de la Conducta Planeada como: factores psicológicos, factores cognitivos, factores sociales y la influencia familiar. Conclusión principal: El modelo puede ser de utilidad en la explicación de la conducta anticonceptiva en madres adolescentes y contribuir en la formulación de nuevas intervenciones para disminuir el embarazo no planeado.(AU)

Objective: Describe the development of a contraceptive behavior model in adolescent mothers. Methods: The construction of the model was through the methodology proposed by Dulock and Holzemer (1991), composed of four steps, (1) Search, review of the literature and identification of concepts, (2) specification of the relationships between the concepts, (3) hierarchical order of the concepts according to the level of abstraction and (4) Illustrate the current relationships between variables. Results: New concepts were integrated into the mother theory of Planned Behavior, such as: New concepts were integrated into the mother theory of Planned Behavior such as: psychological factors, cognitive factors, social factors and family influence. Conclusion: The model can be useful in explaining contraceptive behavior in adolescent mothers and contribute to the formulation of new interventions to reduce unplanned pregnancy.(AU)

Contraceptive Use and Missed Opportunities for Family Planning Discussions in Women Living with Human Immunodeficiency Virus at an HIV Clinic.

The objective of this study was to examine contraception use and family planning discussions (FPD) in female people living with HIV (PLWH). A retrospective cohort study was conducted. Female PLWH were included if they were 18-44 years and received care in 2019 at an HIV clinic. 74 patients met inclusion; mean age was 35 years, 53% were white. All patients were prescribed antiretroviral therapy. 48.6% of patients had documented FPD. 64.9% of patients were using contraception; sterilization was most common (41.7%). Only five patients had a contraindication to hormonal contraception. No differences in contraception use were observed based on age, race, HIV viral load, number of visits, or past pregnancies. However, patients with documented FPD were more likely to use contraception (OR 4.55; 95% CI 1.35-15.29). Routine FPD and contraception use in female PLWH were low. Rates of sterilization were high in female PLWH. Providing quality family planning services is critical to increase contraception use and selection of the most appropriate contraception form.

Multilevel Influences on Providers' Delivery of Contraceptive Services: A Qualitative Thematic Analysis.

Introduction: Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settings is critical for advancing quality care. This study offers an in-depth examination of influences on providers' delivery of contraceptive services across multiple primary care specialties and practice settings to identify issues and strategies to improve care. Materials and Methods: Twenty-four in-depth face-to-face interviews were conducted in 2017 with primary care providers, including family physicians, gynecologists, pediatricians, and nurse practitioners from academic settings, private practices, and health centers. Interviews were transcribed and analyzed thematically. Results: Providers described a complex set of influences on their provision of contraception across multiple ecological contexts. Seven major themes emerged from the qualitative analysis, including six types of influence on provision of contraception: organizational, individual provider-related, structural and policy, individual patient-related, community, and the lack of influences or barriers. Providers also discussed the sources they access for information about evidence-based contraception counseling. Conclusions: A diverse set of providers described a complex system in which multiple concentric ecological contexts both positively and negatively influence the ways in which they provide contraceptive services to their patients. To close the gaps in contraceptive service delivery, it is important to recognize that both barriers and facilitators to patient-centered contraceptive counseling exist simultaneously across multiple ecological contexts.

The abortion and contraceptive behavior: results of the all-Russian Research.

The problem of abortion is actual in all spheres of public life. Despite the fact that in Russia, according to the Ministry of Health, the number of abortions has decreased by 30% over the past five years, there is demand from society and public authorities to strengthen the national demographic security, to search for corresponding reserves and to strengthen positive dynamics of demographic indices on permanent long-term basis. The abortions significantly and negatively affect birth rate and woman health. To make proper managerial decisions in this area requires analyzing such complex social phenomenon as abortion behavior and its alternatives, including contraceptive behavior based on family planning technologies. The purpose of study is to analyze characteristics of abortive and contraceptive behavior and their relationship with matrimonial and reproductive behavior in Russia to strengthen national demographic security. The official public data of Rosstat, Minzdrav of Russia, etc. was used. Also the data of the All-Russian sociological study "Demographic well-being of Russia" was attracted. The methodology included questionnaire survey in late 2019 - early 2020 carried out in 10 Subjects of the Russian Federation: Moscow, Republic of Bashkortostan, Republic of Tatarstan, Vologda Oblast, Volgograd Oblast, Ivanovo Oblast, etc. The total sampling consisted of 5 616 respondents. The study implemented such scientific research methods as: analysis, synthesis, generalization, statistical analysis, sociological analysis. The state policy implementation related to the decrees of the President of the Russian Federation "On measures to implement the Demographic Policy of the Russian Federation" (2012): "On national goals and strategic objectives of the development of the Russian Federation for the period up to 2024" (2018, national project "Demography"), Government orders "On approval of the Concept of State family Policy in the Russian Federation for the period up to 2025" (2014), "On the basics of State youth policy of the Russian Federation for the period up to 2025" (2014), etc. On national level, it resulted in decreasing of the number of abortions and increasing attention of society and the public authorities to problems of the family. in Russia, since 2007, the absolute number of abortions has been declining, and from 2015 to the present, the absolute number of abortions has decreased below the millionth value. The leaders in positive rate of abortions decreasing are the North Caucasus, the Central and Southern Federal Okrugs. The higher rates of abortions remain In the Far Eastern, Siberian and Ural Federal Okrugs. It is established that abortion and reproductive behavior depends on aging of motherhood, low contraceptive culture at early start of sexual life and various social economic factors. A significant part of Russian population is characterized by low awareness of reproduction issues and contraceptives. The study revealed certain relationship between contraceptive and matrimonial and reproductive behavior. The hypothesis was confirmed for the Republics of Bashkortostan and Tatarstan. The additional research in this area is required to identify effective measures to fully implement demographic potential of the Russian family. Even though the official statistics of Russia indicate positive trends in population abortion behavior, abortions make up significant part of reproductive losses. For majority of Russians, abortion remains acceptable mean of regulating childbearing. Russia has the highest rate of abortions in the age ranges of 30-34 and 35-39 years. In Russia, improvement of medical and contraceptive literacy and formation of responsible health self-attitude will increase quality of life, implement population's demographic potential and improve demographic security.

Contraceptive decisions among individuals with medical conditions in Michigan, USA: A qualitative explanatory model informed by the Health Belief Model and the principle of respect for patient autonomy.

OBJECTIVE: We aimed to qualitatively describe the contraceptive experiences of individuals with medical conditions and develop an explanatory model of contraceptive decision-making in this context. STUDY DESIGN: We conducted 41 interviews with pre-menopausal patients with a range of medical conditions from Michigan, United States. We identified themes through open coding and comparative analysis until we reached theoretical saturation. We analyzed the themes in the context of the Health Belief Model constructs and patient autonomy. To develop the explanatory model, we qualitatively mapped out relationships between constructs and how they informed contraceptive-decision making. RESULTS: The model posits that contraceptive decisions are affected by the perceived impact of chronic disease on pregnancy, parenting, and contraceptive options. These perceptions were strongly affected by others, particularly health care providers (HCPs). Most worried that pregnancy could threaten their health, fetal health, or ability to parent. Active symptoms of chronic disease (e.g., pain, fatigue) amplified this perceived threat. Patients appreciated when their HCPs acknowledged, rather than dismissed, their concerns about contraceptive side effects that affected their chronic disease symptoms and management (e.g., headaches, worsening mood). Patients with medical contraindications to hormonal contraception and preferred to use coital-dependent methods (e.g., condoms) did not feel supported to do so by their HCPs. Patients who were Black, young, living on low-incomes, or considered medically "high risk" felt discriminated against by HCPs who limited or coerced their contraceptive decisions. CONCLUSIONS: This explanatory model synthesizes factors that underlie, constrain, or promote reproductive and contraceptive decisions and autonomy for individuals with medical conditions. IMPLICATIONS: This new explanatory model can guide the development and evaluation of interventions that support the contraceptive decisions and autonomy of individuals with medical conditions.

Estrategias para empoderar a las mujeres en relación con los derechos reproductivos y la planificación familiar: revisión sistemática desde las corrientes bioéticas / Strategies to empower women in relation to reproductive rights and family planning: a systematic review from bioethical currents / Estratégias para empoderar as mulheres em relação aos direitos reprodutivo e de planejamento familiar: revisão sistemática desde las correntes bioéticas

Resumen El presente artículo informa de una investigación cuyo objetivo fue definir las estrategias para empoderar a las mujeres mexicanas en sus decisiones de planificación familiar y de establecer compromisos y responsabilidades con sus parejas. Se realizó una revisión sistemática, incluyendo PubMed, Redalyc y Scopus, y se incluyeron diez artículos originales de dos continentes y diversas poblaciones. De los estudios realizados en México y Latinoamérica ninguno proporcionó una propuesta para implementar mejoras en la adopción de un método de planificación familiar entre las mujeres que viven violencia de pareja. Se concluye que la capacitación y formación bioética del personal de salud puede abonar a lograr que el proceso de información y decisión por parte de la mujer o de la pareja sean llevados a cabo con apego a la bioética, buscando el beneficio individual y protección del bienestar de la mujer y, por ende, de su familia.

Abstract This article reports on research aimed at defining strategies to empower Mexican women in their family planning decisions and to establish commitments and responsibilities with their partners. A systematic review was conducted, including PubMed, Redalyc and Scopus, and ten original articles from two continents and diverse populations were included. Of the studies conducted in Mexico and Latin America, none provided a proposal to implement improvements in the adoption of a family planning method among women who experience intimate partner violence. It is concluded that bioethical training and education of health personnel can contribute to ensure that the information and decision-making process by the woman or the couple is carried out in accordance with bioethics, seeking individual benefit and protection of the wellbeing of the woman and, therefore, of her family.

Resumo O presente artigo informa sobre uma pesquisa cujo objetivo foi definir as estratégias para empoderar as mulheres mexicanas em suas decisões de planejamento familiar e de estabelecer compromissos e responsabilidades com seus companheiros. Foi realizada uma revisão sistemática, incluindo PubMed, Redalyc e Scopus, e se incluíram dez artigos originais de dois continentes e diversas populações. Dos estudos realizados no México e na América Latina nenhum proporcionou uma proposta para implementar melhorias na adoção de um método de planejamento familiar entre as mulheres que sofrem violência conjugal. Conclui-se que a capacitação e formação bioética do pessoal de saúde pode lograr alcançar que o processo de informação e decisão por parte da mulher ou do casal sejam levados a cabo com apego à bioética, buscando o beneficio individual e a proteção do bem estar da mulher e, por conseguinte, de sua família.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal.

BACKGROUND: Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. OBJECTIVES: : This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants. METHODS: : A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. RESULTS: : All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. CONCLUSION: Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women.

Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.

Contraception Use and Attitudes Among Women Seeking Pregnancy Termination: Descriptive Cross-Sectional Survey.

OBJECTIVE: Unintended pregnancy has been linked to poor health and social outcomes for both mother and child. Efforts to reduce unintended pregnancies have been challenged by many financial, social, religious, and cultural factors. This study aimed to investigate how contraception use and misuse in a cohort of females seeking termination of pregnancy contribute to unintended pregnancies. METHODS: We conducted a cross-sectional study with women presenting to a women's health clinic for pregnancy termination from April to December 2017. Consenting participants completed a self-administered, confidential questionnaire that included questions on demographic, ethnic, and social characteristics, as well as behaviours and attitudes related to contraception. Data analysis used descriptive statistics. RESULTS: Data were collected from 334 women; about half (45%) had used contraception at the time of conception, representing a variety of different methods. Contraceptive use was associated with higher education, stable relationship status, and ethnic majority status but not with previous pregnancies or immigration status. Among contraceptive users, imperfect and inconsistent use of contraception (50% and 31%, respectively), and method failure (48%), including condom breakage, were cited as reasons for the current pregnancy. Non-users reported perceived low risk of pregnancy (55%), concerns about contraception (47%), and problems accessing contraception (27%). While the majority of participants were aware of emergency contraception, only 52% reported ever using it. Most participants (89%) planned to use contraception in the future. CONCLUSION: Our study highlights contraceptive behaviours and patterns of individuals seeking abortion. Patient-centered contraceptive counselling in order to facilitate contraceptive choice and access can include information about the most effective contraceptives and the need for back-up contraception methods.

'He supported me 100%': Mexican-immigrant fathers, daughters, and adolescent sexual health.

Objective: First and second generation Mexican-origin adolescents in the U.S. face social and economic disadvantage and sexual health disparities. Although fathers can support child and adolescent development, the literature has portrayed Mexican-origin immigrant fathers as emotionally distant and sexist. This study aims to treat migration as a social determinant of health to examine father-daughter relationships and adolescent sexual health in Mexican-origin immigrant families.Methods: Integrating qualitative data from life history interviews with 21 Mexican-origin young women in immigrant families with quantitative data on first and second generation Mexican-origin young women in the National Longitudinal Study of Adolescent to Adult Health, this study describes father-daughter relationships, examines the association between father-daughter relationships and daughters' early sexual initiation, and considers the impact of migration on the father-daughter relationship and sexual health among Mexican-origin young women.Results: Qualitative data identify four types of father-daughter relationships: 'good,' hostile, distant, and conflicted. Supporting the qualitative patterns, quantitative data find that positive or 'good' father-daughter relationship quality is significantly associated with reduced risk of early sexual initiation. Importantly, father-daughter separation across borders and economic inequality facing immigrant families is associated with hostile or distant father-daughter relationship quality and increased risk of early sexual initiation.Conclusions: Reports of good father-daughter relationships are common and may protect against early sexual initiation in Mexican-origin immigrant families. Policies that keep families together and reduce economic inequality among immigrants may also reduce sexual health disparities among immigrant adolescents.

Contraceptive counseling practices and patient experience: Results from a cluster randomized controlled trial at Planned Parenthood.

OBJECTIVES: Systematic reviews of contraceptive counseling interventions have shown inconsistent impact on patient outcomes. The current study assessed the effects of an evidence-informed contraceptive counseling staff training intervention on patient experience, contraceptive selection, and behavior over three months of follow-up. STUDY DESIGN: We randomly assigned 10 Planned Parenthood health centers in the Southeastern US to intervention (staff received contraceptive counseling training) and control (usual counseling) groups. From December 2016-June 2017, patients completed surveys immediately post visit (n = 756) and one and three months after. We compared differences in patients' counseling experience (e.g., number of evidence-informed practices experienced, satisfaction with counseling), contraceptive selection, and behavior (e.g., method discontinuation, accurate pill use, condom use) between study groups using mixed effect models with health center specified as a random effect. RESULTS: Seven hundred and fifty-six participants completed the baseline survey; 579 (77%) completed one or both follow-up surveys. The intervention group was more likely to report experiencing all evidence-informed counseling practices (adj. Prevalence Ratio [aPR] = 2.27, 95% CI 1.27, 4.04) with less variation in the number of practices and higher satisfaction with their counseling than the control group (p < 0.01). We found no sustained differences in contraceptive behaviors at both one- and three-month follow-up. CONCLUSIONS: We found immediate positive effects of the intervention on patients' perceptions of their counseling experience and no differences in changes in contraceptive behavior over time between the study groups. IMPLICATIONS: Evidence-based strategies to improve the quality of contraceptive care and subsequent outcomes, while centering patients' needs and preferences, are needed. The contraceptive counseling intervention offers a tool for increasing consistency in contraceptive counseling practices across health centers and improving patient satisfaction.

Assessment of need for limiting family after two children: A cross-sectional study from a Northern State of India.

BACKGROUND: Success of a programme of free-choice participation, like Family Planning Programme, can be envisaged only when focus is on the needs of the people. Although India was the first country to introduce Family Planning Programme, total fertility rate of 2.1 has not yet been achieved, highlighting that the need of limiting family after two children is not yet felt by the people of India. Therefore, the study was undertaken to assess need for limiting family and permanent methods, and factors influencing it among couples with two or more living children. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in rural and urban areas of Haldwani Tehsil, Uttarakhand. Multistage sampling technique was used for selection of study sample. Data were collected using a pretested questionnaire. Statistical analysis was done using Epi Info version 7.2.2.6. RESULTS: Out of 221 women interviewed, only one-third had adopted permanent methods of contraception for limiting family, one-third were using temporary methods, and remaining were not using any contraception. Merely one-third participants were willing to adopt permanent contraception in future. Unmet need for permanent methods was higher among women of younger age, literate woman, and/or husband and joint families. It was lower in women with three or more living children in comparison with women with two children. Unfelt need for limiting the family was 8.6%. CONCLUSION: Acceptance of permanent methods of contraception was low with temporary methods being equally preferred for limiting family. Unfelt need for limiting still remains in the community despite promotion of small family norm.

[Current knowledge on contraceptive knowledge in France: CNGOF Contraception Guidelines]. / Contexte de la contraception en France. RPC Contraception CNGOF.

OBJECTIVE: To summarize current knowledge on contraceptive coverage in France and worldwide, describe the effectiveness of different types of contraceptives, describe the characteristics of women using contraception, contraceptive failure situations and describe the different medical risks associated with contraceptive methods. METHODS: Consultation of the Medline database and of national or international reports on contraception. RESULTS: Contraceptive coverage in France is high: 97% of women in 2013 use a contraceptive method (among fertile, sexually active women without a desire for pregnancy), with a majority using medical methods (72% using pills and other hormonal contraceptives, intrauterine devices and 25% using natural and traditional barrier methods). The 2013 pill scare called into question the use of estrogen-progestogenic contraception and the information provided by doctors, but the pill remains the first contraceptive method followed by the intrauterine device, condoms and the traditional and natural methods. Lifetime contraceptive coverage changes according to a defined standard in France: condoms for the teen-agers, pills before pregnancy and then intrauterine devices after childbirth. Sterilization is very rarely chosen and offered. Contraception in France remains a predominantly female domain. Women and couples should be informed about all contraceptive methods, allowing them to choose the method that best suits their health, living conditions and sexuality.

Adaptation of the Contraceptive Behavior Scale for Mexican Heterosexual Populations.

INTRODUCTION: The Contraceptive Behavior Scale requires adaptation for use by health professionals among Mexican heterosexual populations of reproductive age. METHODS: Cross-sectional, descriptive, correlational design assessed adaptation of the Contraceptive Behavior Scale. RESULTS: Six hundred Mexican men and women of reproductive age (18-35 years) were recruited from a second-level health care unit in a metropolitan area in Mexico. Exploratory factor analysis identified two factors with an explanatory variance of 69.238%. Confirmatory factor analysis identified acceptable index values. Cronbach alpha of .729 obtained for the scale was acceptable. Significant correlation ( p = .007) was observed between Contraceptive Conduct and participant gender. Component 1 constituted Items 1, 2, and 4, while Component 2 consisted of Items 3 and 5. No items were eliminated as adequate factorial saturation was present. CONCLUSIONS: The Contraceptive Conduct Scale is a reliable assessment tool for Mexican men and women of reproductive age. This scale is potentially useful for health professionals to assess contraceptive behavior in heterosexual couples of reproductive age. Clinicians may use the tool to obtain information for development of strategies responding to sexual and reproductive health needs of both men and women.

Padrões e determinantes das descontinuidades contraceptivas no uso de pílula oral, hormonal injetável e preservativo masculino / Patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injections and condoms

Introdução: O uso de métodos anticonceptivos modernos pela maior parte das mulheres brasileiras não diminuiu, conforme esperado, assim como a ocorrência de gestações não desejadas, abortamentos e, consequentemente, mortes maternas, o que revela uso com perfil irregular e descontínuo. No Brasil, há pouca informação sobre os padrões e os determinantes da ocorrência dessas descontinuidades contraceptivas. Devido às inconsistências no uso de métodos serem relativamente comuns, é necessário mensurar o quanto as mulheres interrompem seu uso a despeito de não desejarem engravidar e/ou os alternam inúmeras vezes, nem sempre com opção por um método mais eficaz. Objetivo: Analisar os padrões e os determinantes das descontinuidades contraceptivas no uso da pílula oral, do hormonal injetável e do preservativo masculino. Método: Estudo longitudinal retrospectivo, conduzido com amostra probabilística de 1.551 mulheres de 18 a 49 anos de idade, usuárias de 57 Unidades Básicas de Saúde da cidade de São Paulo/SP (2015) e Aracaju/SE (2016). Os dados foram coletados por entrevista face a face usando o calendário contraceptivo. No Stata 14.2, as análises das taxas de descontinuidade contraceptiva no período de doze meses foram realizadas pelo método de Kaplan-Meier e dos fatores associados por meio dos Modelos de Riscos Proporcionais de Cox, ambos para descontinuidade total, abandono, troca para método menos eficaz e troca para método mais eficaz. Resultados: A taxa de descontinuidade total no uso de métodos foi 41,9% aos doze meses, sendo maior entre usuárias do preservativo masculino (48,1%), seguida de hormonal injetável (39,0%) e pílula oral (38,6%). Entre as usuárias de pílula oral, a taxa de abandono foi a maior; entre as usuárias do hormonal injetável, foi a troca para um método menos eficaz; e, entre as usuárias do preservativo masculino, foi a troca para um método mais eficaz. Os aspectos associados às descontinuidades variam segundo o tipo de método. A descontinuidade no uso da pílula oral foi associada à idade (18-24 anos), vivência de abortamento, incerteza quanto à intenção reprodutiva e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do hormonal injetável foi associada ao maior número de parceiros sexuais, à vivência de abortamento e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do preservativo masculino foi associada à idade (25-34 e 35-49 anos), à união conjugal, ao menor poder aquisitivo (classe econômica D/E) e ao maior número de filhos vivos. Conclusões: Foram observadas altas taxas de descontinuidades no uso de métodos contraceptivos, que variaram conforme o tipo de método. Chama a atenção o papel dos efeitos colaterais na determinação da ocorrência de descontinuidade no uso dos métodos hormonais. Por sua vez, a troca por método mais eficaz foi pouco frequente, com exceção das usuárias de preservativo masculino. Sugere-se ampliar o acesso aos métodos contraceptivos mais eficazes e de longa duração e melhorar a assistência em contracepção nos serviços do Sistema Único de Saúde, de forma a contemplar as necessidades de saúde das mulheres e seus direitos sexuais e reprodutivos.

Introduction: Use of modern contraceptive methods by the majority of Brazilian women did not reduce the occurrence of unintended pregnancies, abortions or maternal deaths as expected, which means that it might be an irregular and discontinuous use. In Brazil, there is a little information on the patterns and determinants of the occurrence of these contraceptive discontinuations. Because inconsistencies in the use of methods are relatively common, it is necessary to measure how much women discontinue their use despite they are willing to get pregnant and/or switching them countless times, not always with the option of a more efficient method. Objective: Our purpose is to investigate patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injection and condom. Method: We conducted a retrospective longitudinal study with probabilistic sample of 1,551 women among 18-49 year old who are primary users of 57 health care facilities, both in Sao Paulo (2015) city and Aracaju city (2016). Data were collected by face-to-face interview in line with contraceptive calendar. In Stata 14.2 analyzes of 12-month contraceptive discontinuation rates were performed using the Kaplan-Meier Survival Estimates method and associated factors using the Cox Proportional Hazards Models, both for total discontinuation, abandonment, and switching to a less efficient method and switching to more efficient method. Results: The discontinuation rate in the use of methods was 41.9% at 12 months, being higher among male condom users (48.1%), followed by hormonal injection (39.0%) and oral pill (38.6%). Among oral pill users, the abandon rate was the highest; among users of hormonal injections, was the switching to a less efficient method; and among male condom users, it was the switching to a more efficient method. The aspects associated to the discontinuations varied according to the type of method. Discontinuation of oral pill users was associated with age (18-24 years old), experience of abortion, uncertainty about reproductive intention and side effects/health concern. Discontinuation in the use of hormonal injections was associated with a greater number of sexual partners, the experience of abortion, and the side effects/health concern. Discontinuation of condom users was associated with age (25-34 and 35-49 years old), marital union, lower income and the highest number of live children. Conclusion: High discontinuation rates were observed in the use of contraceptive methods, which varied according to the type of method. The role of side effects/health concern in determining the occurrence of discontinuation in the use of hormonal methods is noteworthy. On the other hand, switching to more efficient method was infrequent, except for the male condoms users. It is suggested to amplify access to the more effective methods as well as long active also improving care in contraception in the all health care facilities services, in order to take into account both women health needs and their sexual and reproductive rights.