不同避孕节育技术对已婚育龄妇女性生活质量影响的观察研究

目的：探讨不同避孕节育技术对已婚育龄女性性生活质量的影响,指导女性选择合适的避孕节育措施。方法：选取已婚育龄女性2384例作为调查对象,对其基本资料进行登记,要求所有被调查者对性生活质量满意程度进行评价,并通过《女性性生活质量量表》对其性生活质量进行评价。结果：被调查者有无生育史所采取的避孕措施存在着明显差异,无生育史者以避孕套、计算排卵期最为常见,分别占54．11％和31．32％,其次是采用避孕药避孕,占14．11％,没有人采用宫内节育器或者是结扎避孕。而有生育者多采用宫内节育器避孕,占59．34％,其次是避孕套和避孕药,分别占21．85％和15．01％,仅有少数患者采取结扎以及计算排卵期避孕。被调查是否有生育史所采取的避孕方式具有明显的差异,且这种差异具有统计学意义（P〈0．05）。未生育女性以及各种分娩方式的已经分娩女性采取不同避孕节育措施对性生活满意程度无明显差异,且《女性性生活质量量表》评分也无明显差异（P〉0．05）。结论：不同的避孕方式不会对女性的性生活质量造成明显的影响,已婚育龄女性可以根据自身的生育需求选择适宜的避孕措施。     

流动已婚育龄妇女避孕方法的使用对性生活满意度的影响

目的：了解城市流动已婚育龄妇女的性生活满意度以及避孕方法使用对满意度的影响。方法：采用分层-整体-随机的方法,于2010年4月至2013年3月,在乌鲁木齐市六区一县流动人口较集中的社区,对18～50岁的流动已婚育龄妇女进行性生活情况与避孕措施使用情况的问卷调查。结果：在105422名对象中,对性生活“满意”的占50.43％、“偶尔满意”的占48.53％、“不满意”的占1.04％。多因素logistic回归分析显示,与未避孕的对象相比,使用宫内节育器、绝育术和药物避孕的对象,其“偶尔满意”的可能性较高,OR值分别为1.96（95％CI：1.86-2.07）、1.88（95％CI：1.69-2.08）、2.08（95％CI：1.97-2.20）;使用宫内节育器的对象性生活“满意”的可能性也较高（OR＝1.44,95％CI：1.16-1.79）。结论：有效的避孕措施,特别是宫内节育器的使用,能够提高流动已婚育龄妇女的性生活满意度。     

Reasons women give for contemplating or undergoing abortion: A qualitative investigation in Victoria,Australia

ObjectiveTo increase understanding of women’s perspectives on considering or undergoing elective abortion.DesignQualitative study.SettingA large public women’s hospital in the state of Victoria, Australia.SampleSixty women who had contacted a public pregnancy advisory service in Victoria, Australia, seeking information, advice, or appointments in relation to an unplanned or unwanted pregnancy.MethodsQualitative telephone interviews. The iterative qualitative analysis employed the five stages of a thematic framework approach.Main outcome measuresThemes in women’s accounts of considering or undergoing elective abortion.ResultsWomen’s accounts emphasized their reasons for considering or seeking abortion. Decisions were made in the context of their lives as a whole; influences were usually contingent and multiple. Reasons related to the woman herself, the potential child, existing children, her partner and other significant relationships, and financial matters.ConclusionsThis research used qualitative methods to produce the only recent study of its kind in Australia. Women’s accounts reveal the complex personal and social contexts within which reproductive events must be comprehended and the thoughtfulness with which they make decisions. Results of this research will assist health-care professionals to increase their insights into women’s reproductive experiences.     

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

ObjectiveWe aimed to investigate how improvement in women’s status affects the choice of contraceptive methods in Nepal.Study designWe 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.ResultsFemale 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.ConclusionImprovement 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.     

Family planning in genitourinary medicine: an opportunistic service?

OBJECTIVE--To evaluate and serve the need for contraception in those not using conventional sources of family planning services. SETTING--South London outpatient genitourinary medicine department at King's College Hospital. DESIGN AND SUBJECTS--Prospective study of 200 women seen consecutively in the clinic by the same doctor (LM) during 1993. Women at risk of unwanted pregnancy were identified, and offered immediate contraceptive provision or referral. RESULTS--15 women (7.5%) were using no contraception, despite being sexually active and not wishing to conceive; of these two presented with an unwanted pregnancy. A further 23 women (11.5%) were not using their chosen contraception effectively, and another 20 women were unclear about contraceptive methods and wanted advice. Young women were most at risk; 14% of those aged 25 years and under were using no contraception. Eight women wished to defer contraceptive advice; of these four defaulted from follow up. Eighteen women (9%) wanted immediate contraceptive supplies. Ten of 18 returned a follow up questionnaire; all these women were satisfied with the contraceptive advice service received. CONCLUSIONS--Absent or ineffective contraception is common in women attending an inner city genitourinary medicine clinic. Immediate provision of contraceptive education, advice and supplies is welcomed by patients.     

We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia

ObjectiveSomalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.MethodsA purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19–25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.FindingsThe findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.ConclusionOur findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.     

Reproductive and sexual health effects of intimate partner violence: A longitudinal and intergenerational analysis

ObjectiveTo examine the prevalence, pattern and predictors of sexual and reproductive adversity among Australian women who report intimate partner violence (IPV).MethodsRepeat measure design employing two cohorts (born between the years of 1973–78 and 1989–95) from the National Australian Longitudinal Study on Women’s Health. Logistic regression was employed to examine the effects of reported IPV exposure on sexual and reproductive outcomes. The analysis conducted throughout 2021–2022 investigated both longitudinal prevalence and outcomes, and the intergenerational differences between these cohorts.ResultsIPV exposure was associated with increased odds of experiencing a range of sexual and reproductive health outcomes, including STI, endometriosis, infertility, termination and miscarriage, which increased with greater exposure to IPV. Our longitudinal results suggest a dose-dependent effect of IPV on STI outcomes. Significant intergenerational trends were also identified in the nature of IPV exposure and dependent outcomes. Sexual orientation had a significant predictive value for IPV, with women who identified as bisexual significantly more likely to report IPV (OR = 2.91, 95% CI).ConclusionWomen who experience IPV are at significant risk of adverse sexual and reproductive outcomes. Healthcare professionals working with women who have diagnosed sexual and reproductive issues should inquire about IPV. Likewise, women who are exposed to IPV should undergo sexual and reproductive healthcare assessments, along with appropriate preventive measures, to assure sexual health. Future research should explore in greater detail the association between IPV and the sexual and reproductive outcomes among sexual minority women.     

The perceived role of clinicians in pregnancy prevention among young Black women

ObjectiveThe purpose of this study is to identify young Black women's attitudes toward clinicians and understand how they affect contraceptive behavior.Study design and main outcome measuresWe conducted semi-structured qualitative interviews with women aged 18–23 who self-identified as Black or African-American and analyzed data using techniques informed by grounded theory. Initial codes were grouped thematically, and these themes into larger concepts.ResultsParticipants discussed two salient concepts related to pregnancy prevention: (1) sexual responsibility and self-efficacy and (2) the perceived limited role of health care clinicians. Women portrayed themselves as in control of their contraceptive decision-making and practices. Many viewed their life plan, to finish school and gain financial stability, as crucial to their resolve to use contraception. Participants gathered information from various sources to make their own independent decision about which method, if any, was most appropriate for their needs. Most had limited expectations of clinicians and considered in-depth conversations about details of contraceptive use to be irrelevant and unnecessary.ConclusionThese findings help understand factors contributing to contraceptive decision-making. The patient–clinician interaction is a necessary focus of future research to improve sexual health discussions and understand if and what aspects of this interaction can influence behavior.     

年轻生育期女性生殖健康现况调查

目的:了解妇科或生殖医学科门诊就诊的年轻生育期女性生殖健康现况。方法:收集本院妇科或生殖医学科门诊咨询或诊治的女性240例进行问卷调查分析。结果:(1)已婚和未婚女性婚前性生活占78.33%,未婚有婚前性生活的女性比例多于已婚者,分别为44.58%和33.75%;(2)有过1次以上流产经历的女性占62.5%,避孕套是使用最多的避孕方法占43.75%;(3)曾患生殖道感染症状的女性占53.33%,希望通过进行生殖健康咨询的途径是医院妇科或生殖医学科门诊占54.58%,最想咨询的是生育保健问题占39.58%,而较少人关心避孕节育方面仅占16.25%。结论:年轻生育期女性已婚和未婚者均存在婚前性生活、1次以上流产经历以及曾患生殖道感染比例占多数情况,加强避孕和生殖道感染防治知识宣传有利于提高该类人群的生殖健康水平。     

Marital violence and sexually transmitted infections among women in post-revolution Egypt

ObjectivesTo explore the relationship between past year physical or sexual partner violence against women and women’s self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men’s and women’s risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship.Study designThis study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women.Main outcome measureswomen’s self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI.ResultsAlmost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12 months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25–3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men’s and women’s behavioural characteristics and factors related to poverty and gender inequality.ConclusionsPublic health interventions that address women’s sexual and reproductive health need to consider violence response and prevention strategies.     

Knowledge,challenges, and standard of care of young women with ADHD at Swedish youth clinics

ObjectivesSexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics.MethodInductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software.ResultsThree main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care.ConclusionsInadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research.     

Motivators of contraceptive method change and implications for long-acting reversible contraception (non-)use: A qualitative free-text analysis

ObjectiveTo develop a greater understanding of the motivators of contraceptive method change over time for young Australian women, with a particular interest in long-acting reversible contraception (LARC) use.MethodFree-text comments from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study were used to explore the reasons for contraceptive method change among women who reported one or more contraceptive changes across the three CUPID surveys.Results512 women reported making at least one contraceptive method change, with 740 comments explaining these changes between them. Participants reported a multitude of reasons motivating their contraceptive change. Five key themes were developed to explain these motivators: the natural, sexual and fertile body, specific contraceptive characteristics and other important people. Findings suggest that women’s decisions to switch or discontinue a contraceptive depended largely on her ability (and desire) to juggle its impact on her sexual, fertile and natural body. Importantly, the transient and fluid nature of contraceptive practices were demonstrated, as the women adjusted their method to suit their needs at the time.ConclusionRegarding LARC use, these findings suggest that rather than being appealing, the ‘temporarily permanent’ nature of these methods may be unappealing and incongruent with the needs of some women.     

Midwives’ experiences of providing contraception counselling to immigrant women

ObjectiveTo describe midwives’ experiences of providing contraception counselling to immigrant women.MethodsThe study was conducted with a qualitative design, based on interviews followed by inductive content analysis. Ten midwives were interviewed, working at midwife-led prenatal clinics in immigrant-dense areas in southern Sweden.ResultsMidwives require knowledge and understanding of cultures and religions in order to provide contraception counselling to immigrant women. It is important for the midwives to be aware that women have different values regarding sexual and reproductive health. The challenge for the midwives is to understand and to be curious about every woman’s lifeworld perspective, culture and religion. The midwives knowledge and understanding of cultures and religions is acquired through experience and shared between them. Knowledge makes a midwife confident in her role as the contraception counselling provider to immigrant women.ConclusionCultural and religious factors affect contraception counselling. According to the midwives, knowledge and awareness of these factors is crucial and leads to improved understanding of midwives providing contraception counselling, better compliance, fewer unwanted pregnancies and improved sexual and reproductive health among women.     

Use of modern contraceptives by women with disabilities in Rajasthan,India: An analysis of the annual health survey

ObjectiveThe objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. Methods: The study uses secondary analysis of the Rajasthan dataset of the 2010–2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 women aged 15–49 years. Logistic regression is used to measure associations between disability status and use of modern contraceptives and female sterilization in the sample. Stratified analyses by age and residence were also conducted. Results: The prevalence of disability among women of reproductive age was 0.9%. Modern contraceptive use was reported by 73.0% of the sample, and female sterilization by 57.7% of the sample. Women with disabilities (WWD) were less likely to report using a modern contraceptive (OR 0.87, 95% CI: 0.78, 0.95). Among modern method users, WWD were not significantly more likely to be using sterilization than another modern method; however, there were significantly higher odds of sterilization versus another modern method for urban WWD (OR 1.57, 95% CI: 1.11, 2.22). Conclusions: In this study, disability was associated with contraceptive use. Additional research is needed to determine if there is a causal relationship between disability and contraceptive use. Family planning providers should be trained to provide care to WWD and the Government of India should ensure the National Family Planning Programme is accessible to people with disabilities.     

Contraception choice for HIV positive women

UNAIDS/WHO estimates that 42 million people are living with HIV/AIDS worldwide and 50% of all adults with HIV infection are women predominantly infected via heterosexual transmission. Women with HIV infection, like other women, may wish to plan pregnancy, limit their family, or avoid pregnancy. Health professionals should enable these reproductive choices by counselling and appropriate contraception provision at the time of HIV diagnosis and during follow up. The aim of this article is to present a global overview of contraception choice for women living with HIV infection including effects on sexual transmission risk.     

Women’s empowerment and use of contraception in India: Macro and micro perspectives emerging from NFHS-4 (2015–16)

Background and objectiveBased on the four-corner stone of population and development programmes recognized by ICPD (1994) this paper envisages the relationship between the recent waves of women's empowerment anduse of contraceptive methods in India.Data and methodsFindings are based on two rounds of NFHS (3 & 4). Liberson’s Diversity Index has been used to assess the inequality in women’s empowerment. Multiple regression analysis is used to portray the relationship and logistic regression is used to access the adjusted effects of various dimensions of women's empowerment on use of contraception.ResultsVarying degrees of equity in women’s empowerment across different states of India builds a combative relationship with uptake of contraceptive methods. Results portray a positive association between inequality in household decision making, engaged in paid work in last 12 months and having 10 years of schooling with use of any modern method. Women who participated in household decision making (OR = 1.17 p < 0.005), using mobile phone (OR = 1.23 p < 0.005) and working and were paid in cash in last 12 months (OR = 1.37 p < 0.005) are significantly more likely to use any method of contraception.ConclusionsStatus of women in India has improved in different dimensions, yet the patriarchal norms influence the decision of using contraception. The current women-centric bottom-top approach in implementation of family planning programme should focus at the women’s right to decision on their own life and health. Such efforts should hinge at strengthening inter personal counseling and capacity building sessions by outreach workers, which may empower women with enhanced knowledge about their health and bodily rights.     

Retinoids and contraception.

The main side effect of the retinoids is teratogenicity. Every dermatologist has a moral obligation to ensure that this effect is avoided, and the present publication is aimed at helping prescribe these drugs. After a review of the key properties of each of the retinoids on the market, the different forms of contraception available and their indication in young patients undergoing retinoid treatment are discussed. Unless otherwise contraindicated, oral contraception with an estrogen-progestogen formulation is the contraceptive method of choice for women undergoing retinoid treatment. The intrauterine device (IUD) is of little or almost no relevance for young women undergoing treatment with a retinoid. IUDs are indicated in older multiparae who have practised this form of contraception before starting retinoid treatment and who refuse to take the pill. Natural and local methods of contraception are totally unsuitable for women undergoing treatment with retinoids. However, they may be used as an additional precautionary measure by IUD users.