Unintended Pregnancy in a Commercially Insured Population

Objectives: While much attention has been focused on unintended pregnancy in disadvantaged populations, few studies have focused on women in lower risk groups. This study, conducted in a national managed care organization, reports the prevalence of unintended pregnancy resulting in live births and examines associated factors. Methods: Women ages 18–49 who delivered a live infant during a 6-month interval were eligible for the study. Telephone surveys were conducted after delivery. We report the rate of unintended pregnancy resulting in a live birth, and describe its association with sociodemographic and pregnancy-related factors, partner's intention status, and contraceptive use. Results: Of 1173 births, 29% were unintended. Women who reported that the partner did not want the pregnancy were 7.4 times more likely than women whose partner wanted the pregnancy to regard the pregnancy as unintended. Only 40% of the women with an unintended birth used birth control and 64% of those used less effective methods such as condoms and diaphragms. Conclusions: In a population where the majority of women were married, educated, and with incomes over $40,000, almost 1/3 of the births resulted from unintended pregnancies. Future research is needed to help us better understand contradictions in pregnancy intention and contraceptive behavior. Comprehensive efforts are needed to promote consistent and correct use of contraception by women at risk for unintended pregnancy, and to involve male partners in family planning.     

Assessment of urgent and ongoing contraceptive needs in an OB/GYN urgent care setting

BACKGROUND: The potential that ongoing contraception and emergency contraception (EC) offer to reduce unplanned pregnancy and abortion is diminished by many barriers. Even when women seek care, their acute needs for those interventions may not be assessed. STUDY DESIGN: This is a retrospective chart review of charts of women potentially at risk for unplanned pregnancy who were provided care in an OB-GYN urgent care clinic in a tertiary care, training hospital. Information was collected about the patient's age group, her presenting complaint, the specialty of the resident who saw her and whether or not her needs for EC and ongoing contraception were assessed and/or met. RESULTS: Charts of 1006 visits were assessed; the visits of 666 potentially at-risk women were included. Slightly more than one third (37.5%) of women were asked about contraception. Only 11% of women were asked about recent unprotected intercourse; 20% of women with recent unprotected intercourse were given EC. CONCLUSIONS: Even in centers dedicated to women's reproductive health, the acute need for fertility control and EC is not adequately assessed. Many opportunities to reduce unintended pregnancy are missed.     

Provision of emergency contraception: a pilot study comparing access through pharmacies and clinical settings

OBJECTIVE: The study was conducted to compare the provision of emergency hormonal contraception (EHC) through pharmacies and clinical services to determine whether aspects of client satisfaction and subsequent sexual health outcomes vary significantly between these services. STUDY DESIGN: A pilot observational study was conducted in South London. Participants were recruited from pharmacies and clinical services when they presented requesting EHC and met with the researcher to complete a structured questionnaire 4 months later. RESULTS: One hundred thirty-three women were enrolled in the study, 50 of whom accessed a community pharmacy for EHC plus 83 women who obtained EHC from a clinical service. Seventy percent of women who went to a pharmacy and 43.9% who went to a clinical service obtained EHC within 24 h (p=.004). A greater proportion of women attending a clinical service felt at least quite comfortable asking for EHC, compared to those who went to a pharmacy (p=.007). Those who obtained EHC from a clinic also felt significantly better informed about both EHC (p=.015) and their future contraceptive options (p=.000), compared to the women who attended a pharmacy. CONCLUSIONS: This pilot study found that women who went to a pharmacy had more rapid access to EHC compared to those who chose to attend a clinical service. Other aspects of provision and client satisfaction seem to favor attendance at a clinical setting over a pharmacy as a venue for obtaining EHC.     

Older male sexual partner as a marker for sexual risk-taking in adolescent females in Nova Scotia

PURPOSE: To examine age differences between Nova Scotia women aged 15-19 and their male sexual partners, and to determine if those adolescents with older partners were more likely to have engaged in sexual risk-taking behaviours. METHODS: A cross-sectional survey (response rate=91%) administered in May 2003 assessed the following sexual risk behaviours: (a) not using condom/hormonal contraception at last vaginal intercourse; (b) having unplanned vaginal intercourse while using alcohol or drugs; (c) having more than one partner in the previous year; (d) vaginal intercourse before age 15; and (e) ever having anal intercourse. Univariate analysis was carried out to determine associations of sexual risk behaviours with partner age difference. Logistic regression was then used to examine behaviours associated with partner age (p < 0.15) in univariate analysis. RESULTS: Of the young women surveyed, 520 (47.7%) had had vaginal intercourse in the previous year; 515 of these provided information on their last partner's age. Over 10% had partners four or more years older. In multivariate analysis, having a partner > or =4 years older was associated with not using a condom at last intercourse (OR 2.15; 95% Cl 1.10-4.20), having more than one partner in the previous year (OR 21.9; 95% Cl 1.13-4.28) and having unplanned vaginal intercourse while using alcohol or drugs (OR 2.66; 95% Cl 1.34-5.28). CONCLUSIONS: A significant number of female adolescents have older male sexual partners, and such relationships are markers for high-risk sexual behaviours. Partner age is an important consideration for health professionals providing sexual health advice to young women.     

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic

Objectives

To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.

Methods

An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic.

Results

After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using “very effective” contraception (intrauterine contraception, implant or sterilization) and 26% were using “effective” contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5–30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days.

Conclusion

Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.     

重复人工流产女性避孕态度及行为的调查分析

目的了解重复人工流产女性、避孕态度及避孕行为,为制定相应干预措施提供依据.方法 对2005年9月至2006年8月间,参与北京海淀区“早孕终止妊娠后避孕干预效果分析”项目的1098例早孕重复人工流产女性进行问卷调查,干预后6个月时进行随访,了解其避孕行为.结果 对于是否避孕及避孕方法的选择,仅65.0％的已婚者及57...     

Contraception and sexually transmitted infections

This contribution considers links between different methods of contraception and the risk of acquiring sexually transmitted infections (STIs). This is a major public health issue, because STIs cause a huge disease burden that affects women disproportionately. Worldwide each year, there are 340 million new cases of curable STIs in 15-49-year-olds. In developing countries, STIs, even excluding HIV, are second only to maternal factors as causes of disease, death and life lost. There is particular concern about a putative link between hormonal contraception and STIs. However, the methodological problems facing investigation of a putative link are formidable. They include confounding between sexual behaviour and choice of contraceptive, choice of appropriate control group, and lack of precise measures of level of HIV/STI exposure and other risk factors. The current situation can be summarized as follows. The risk of acquiring HIV/STIs is substatially reduced by barrier methods of contraception. Hormonal contraception is a widely used, safe and highly effective method of preventing unintended pregnancy. Its relationship to HIV/STI transmission remains uncertain. In the absence of better evidence, current approaches to promoting hormonal contraception should continue. The importance and effectiveness of consistent condom use to protect against HIV/STI should be stressed, regardless of whether other contraceptive methods are being used. Future contraceptive research should focus on the dual goal of protection against HIV/STIs and unintended pregnancy.     

Peripartum contraceptive attitudes and practices

During pregnancy and the postpartum period, women may be more receptive to different methods of contraception for postpartum use. Few studies have focused on the peripartum population. In this study, currently pregnant and postpartum women were surveyed about their attitudes toward contraception, particularly in relation to the index pregnancy. Important contraceptive attributes for women included reliability, efficacy, and safety during breast-feeding, especially in the postpartum period. Over 80% of women surveyed were using contraception prior to pregnancy, but nearly 20% were not satisfied with the method used. Dissatisfaction with their method was more likely among women whose pregnancy was unplanned (36% vs. 9%). Over 40% of peripartum women indicated a desire to change their contraceptive after delivery. Sixty-five percent of women had received only limited information about intrauterine contraception before the survey. The results indicate that childbirth has a profound effect on contraceptive priorities and desires, especially toward long-term methods.     

Awareness,Prior Use,and Intent to Use Emergency Contraception Among Montana Women at the Time of Pregnancy Testing

Objectives: To identify factors associated with awareness of emergency contraception (EC), prior use of EC, and intent to use EC in the future among women at the time of pregnancy testing. Methods: A convenience sample of women presenting for pregnancy testing and being found to be pregnant in 38 primary health care facilities completed a self-administered, anonymous questionnaire. Information regarding demography, pregnancy intentions, use of any contraception, awareness of EC, prior use of EC, and intent to use EC in the future was collected. Results: Of the 583 women that completed the questionnaire, 62% were aware of EC, 4% had previously used EC, and 13% considered using EC in the future. Women aware of EC were more likely to be white, have 12 years of education, and report use of birth control prior to the current pregnancy. Younger women, those with <12 years of education, and those not currently living with a partner were more likely to have previously used EC. Women who considered using EC in the future were more likely to be younger, non-white, have <12 years of education, not currently living with a partner, and their usual source of care was a public clinic. Women who considered using EC in the future were also more likely to not want to be pregnant now or ever (21%) compared to women who wanted to be pregnant now or sooner (12%), or with those who were unsure of their current pregnancy (7%). Conclusion: Strategies need to be developed to increase the awareness of EC and determine the factors that would assist in enhancing its utilization.     

The remaining barriers to the use of emergency contraception: perception of pregnancy risk by women undergoing induced abortions

Although access to and knowledge of emergency contraception (EC) have improved, numerous unplanned pregnancies occur each year. We thus assessed the remaining barriers to EC use in a population of women seeking an abortion in four abortion centers in France in 2002. A self-administered questionnaire was completed by 1365 women. Most women have heard of EC (89%), but access to information remained limited in socially disadvantaged populations. Nevertheless, the unperceived risk of pregnancy appeared to be the most limiting factor to EC use. Only 38.5% of women were aware of pregnancy risk at the time of the intercourse that made them pregnant. Of these women, 48% minimized the risk later, resulting in the decision not to use EC. As the perception of risk is commonly reevaluated by women over time, which probably affects EC use, it could be important to promote advance supply of EC so that women could use it immediately after a recognized unprotected intercourse.     

Unintended Childbearing and Knowledge of Emergency Contraception in a Population-Based Survey of Postpartum Women

Objectives We examined the relationship between unintended childbearing and knowledge of emergency contraception. Methods The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of postpartum women. We analyzed data from the 2001 PRAMS survey using logistic regression to assess the relationship between unintended childbearing and emergency contraception while controlling for maternal characteristics such as age, race/ethnicity, education, marital status, family income, and insurance coverage before pregnancy. Results In 2001, 1,795 women completed the PRAMS survey (78.1% weighted response proportion). Of the women who completed the survey, 38.2% reported that their birth was unintended and 25.3% reported that they did not know about emergency contraception before pregnancy. Unintended childbearing was associated with a lack of knowledge of emergency contraception (OR 1.43, 95% CI 1.00, 2.05) after controlling for marital status and age. Conclusions Women in Oregon who were not aware of emergency contraception before pregnancy were more likely to have had an unintended birth when their marital status and age were taken into account. Unintended birth was more likely among women who were young, unmarried, lower income, and uninsured. Given that emergency contraception is now available over-the-counter in the US to women who are 18 years of age or older, age- and culturally-appropriate public health messages should be developed to expand women’s awareness of, dispel myths around, and encourage appropriate use of emergency contraception as a tool to help prevent unintended pregnancy and birth. An erratum to this article can be found at     

Interest in multipurpose prevention technologies to prevent HIV/STIs and unintended pregnancy among young women in the United States

Objective

High rates of sexually transmitted infections (STIs) and unintended pregnancy suggest a role for multipurpose prevention technologies (MPTs) designed to combine contraception and infection prophylaxis into one unified method. This study aims to determine factors associated with interest in MPTs among US women.

Knowledge and willingness to use emergency contraception among low-income post-partum women

We performed a multivariate analysis to determine factors associated with knowledge and willingness to use emergency contraception in a consecutive sample of 371 post-partum women from an inner-city public hospital. Women were queried about previous contraceptive use, pregnancy history including abortions and unplanned pregnancies, and demographic characteristics. Outcomes included knowledge of emergency contraception and willingness to use it. Questionnaires were conducted in person, in English or Spanish.

Of 371 women, 3% had used emergency contraception, 36% had heard of it, and 7% knew the correct timing for use. Two-thirds of the population indicated a willingness to use emergency contraception in the future. Factors positively associated with knowledge included being a teenager or more than 30 years old, prior use of condoms, and history of an elective abortion. Being multiparous, monolingual Spanish-speaking, or Asian were negatively associated with knowledge. Willingness to use emergency contraception was positively associated with being multiparous and negatively associated with a higher income, moral or religious objections to the use of emergency contraception, a belief that it is unsafe or a perception that it is an abortificient.

Knowledge about emergency contraception, especially correct timing, remains low. Multiparous women should receive increased education given their lack of knowledge but willingness to use emergency contraception. In order to increase the acceptability of emergency contraception, educational efforts must include accurate information about its mechanism of use and safety.     

Emergency contraception – knowledge and attitudes in a group of Australian university students

Objective: To explore first year Australian university students' knowledge and attitudes about emergency contraception and their understanding of the risk for pregnancy.
Method: A self-report questionnaire was completed by a convenience sample of 627 first year on-campus students from both health and non-health disciplines.
Results: Knowledge about emergency contraception (EC) was generally poor including misunderstanding that it can only be used the 'morning after', as well as where it may be accessed. Its potential use was, however, more highly accepted as a preventative measure after unprotected sexual intercourse than abortion in the event of unplanned pregnancy. Women had better knowledge than men, and on a number of measures there were significant differences between these groups.
Conclusions: Poor knowledge about the timing, accessibility, action and side effects of EC may act as a barrier to its use in the event of unprotected sexual intercourse. Although EC has been available in Australia as a Schedule 3 medication since 2004, its availability from pharmacies is not well known, nor is access from other primary health care providers.
Implications: The lack of knowledge about EC may lead to its underutilisation and underlines the need for future educational strategies about EC as well as the need for health professionals who provide contraceptive services to discuss EC with clients. Health promotion campaigns which are both general as well as gender-specific may improve overall community knowledge about this method of contraception.     

Measuring contraceptive use patterns among teenage and adult women

CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.     

向产后妇女事先提供紧急避孕药对意外妊娠率影响的研究

目的:了解对产后妇女事先提供紧急避孕药能否降低产后意外妊娠率,从而明确事先提供紧急避孕药在临床上有无重要意义。方法:随机接纳2000例产后妇女,教育组(1002例)接受常规产后避孕教育,教育+药物组(998 例)除接受常规教育外事先提供3次剂量的10mg米非司酮。两组妇女均在产后16周、32周和52周接受电话随访。结果:产后1年内教育+药物组妇女服用紧急避孕药物的人数较教育组多,但两组产后1年内的意外妊娠率无显著差别;两组妇女的避孕模式基本相同。结论:对产后妇女事先提供紧急避孕药不能显著减低意外妊娠率,在临床上更应加强对产后妇女的避孕指导工作。     

Factors associated with effective contraceptive use among a sample of Latina women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.     

Emergency contraception among university students in Kingston,Jamaica: a survey of knowledge,attitudes, and practices

Emergency contraceptives (ECs) are an important option for young women in Jamaica, where rates of unplanned pregnancy are high. Few previous studies of EC exist in Jamaica. We surveyed a random sample of 205 students living on campus at the University of the West Indies in Kingston, Jamaica, to learn more about students' knowledge and opinions of EC pills (ECPs). General awareness of ECPs was high (84%), although many students were unaware of specific details regarding the method's appropriate use, such as the time frame. Twenty students (10%) had used ECPs themselves or had a partner who had used them. Most had used ECPs for the first time because they lacked contraception or because of contraceptive failure. Following their first use of ECPs, 55% adopted an ongoing method of contraception. Most students felt ECPs were an important option for women in Jamaica; however, some feared ECPs might be overused. Future educational campaigns should provide Jamaican university students with detailed information about this method.     

Pregnancy Attitudes and Contraceptive Plans Among Women Entering Jail

ABSTRACT

Unplanned pregnancies are an important and costly public health problem. Women entering jail are at particularly high risk for unplanned pregnancies when they leave jail, given the high rates of poverty, substance abuse and sexually transmitted infections (STIs) in this population, all of which are associated with unplanned pregnancies. Attitudes toward pregnancy vary substantially, influencing openness of incarcerated women to starting a birth control method. This study was conducted as part of a Title X service evaluation and examined varying attitudes towards pregnancy and associated plans to use contraceptives. The current study included 223 women entering jail who were, under 36 years of age, fertile, sexually active with men, and not planning to become pregnant in the near future. Nearly half of the women had negative pregnancy attitudes (PAs), indicating that they did not want to become pregnant, while 41.3% endorsed ambivalent PAs. Compared to those with ambivalent PAs, those with Negative PAs were more likely to report a previous unplanned pregnancy (90.6% vs. 75.4%), a previous pregnancy termination (40.0% vs. 22.8%), and recent consistent use of contraceptives (37.0% vs. 21.7%). Women with negative PAs were significantly more likely to want to start or to continue a birth control method compared to those with ambivalent PAs (66% vs. 47%). Tailoring services to women's specific pregnancy attitudes during periods of incarceration may aid in preventing unplanned pregnancies in populations of high-risk women.     

Adolescent Males' Combined Use of Condoms with Partners' Use of Female Contraceptive Methods

Objective: Protection from both sexually transmitted diseases and pregnancy is best obtained by the combined use of male condoms and effective female contraceptive methods. This research examines dual contraceptive method use among teenage men. Method: Analyzed data from the 1995 National Survey of Adolescent Males, a nationally representative survey of 15 to 19-year-old males. Used bivariate analyses and logistic regression to examine the correlates of combined use of condoms and female methods. Results: At last intercourse, 17% of sexually active males reported use of a condom and a female method of contraception. Condom use, alone and in combination with a female method, was positively associated with talking with the partner about contraception and condoms, believing that males have a responsibility for contraception, and being in an earlier stage of a relationship. Only high levels of worry about sexually transmitted diseases differentially influenced dual method use, increasing the likelihood of using a condom with a female method, but not using condoms alone. Conclusions: The results suggest that efforts to increase condom use in general should also influence young men's use of condoms when their partner is using a female method. Providing information to young males about the high prevalence and serious consequences of sexually transmitted diseases may increase dual method use among adolescents.