Impact of a Provider Job Aid Intervention on Injectable Contraceptive Continuation in South Africa

Arriving late for scheduled contraceptive reinjections is common in many countries and contributes to discontinuation when providers are unsure how to manage such clients. A clinic‐randomized cohort and cross‐sectional study with more than 5,000 clients using injectable contraceptives was conducted in the Eastern Cape province of South Africa to test the effectiveness of a provider job aid for managing late‐returning clients and promoting continued use of the method. A marginally significant difference in reinjection rates between intervention and control groups was found for those up to two weeks late, and reanalysis excluding one clinic that experienced stockout issues revealed a significant difference. The difference in reinjection rates for those 2–12 weeks late was also found to be significant. The one‐reinjection cycle continuation rate for the intervention group was higher than that for the control group, but the difference was not statistically significant. Appropriate management of late‐returning clients is critical, and this study illustrates that reinjection rates can be significantly increased with a low‐resource provider job aid.     

三种长效避孕皮下埋植剂对妇女月经血量的影响

为探讨国产Ⅰ、Ⅱ型和Norplant皮下埋植剂对妇女月经血量的影响,对89例健康妇女按随机分配原则,埋植国产Ⅰ型、Ⅱ型和Norplant三种长效避孕皮下埋植剂,测定埋植前及埋植后3,6,12月月经失血量及血红蛋白。埋植前3组平均月经血量(MBL)分别为43.3±6.9ml,48.9±4.3ml,43.7±5.5ml,埋植后MBL在第3周期分别为32.8±13.2ml,24.8±5.5ml,19.7±9.3ml,在第12周期分别为23.9±5.9ml,40.8±10.4ml,25.9±6.0ml,明显低于埋前水平(P<0.05～P<0.001)血红蛋白在埋植后有上升趋势。本研究提示使用长效皮下埋植剂减少妇女月经血量,增加血红蛋白,可以作为妇女选用的高效节育避孕措施。     

上海市夫妇产后首选避孕措施社会心理行为学影响因素的研究

对7101对上海市80年末初婚并已生育的队列夫妇进行8年的前瞻性调查。选择14项夫妇社会心理性学变量,拟合多项分布Logistic回归模型,分析影响夫妇产后首选避孕措施因素的重要性。结果显示妻子单位的性质及医务人员掌握放置宫内节育器指征为两项重要外界因素,白领阶层、避孕知识得分较高的妻子、愿意接受新式男用避孕法的丈夫;具有明确避孕动机者或了解避孕套能预防性病或艾滋病的夫妇均明显倾向非首选放置宫内节育器(包括人工流产后)。分析提示单位管理者及医务人员除应继续掌握指征对妇女于产后放置宫内节育器外,有必要结合夫妇特性指导使用各类她们所乐意使用的避孕措施,及进一步开展有关避孕措施健康效益的教育,以增加夫妇对各类常用避孕措施的可接受性和使用效果。     

边疆少数民族地区开展避孕节育知情选择咨询服务

<正> 1994年联合国人口与发展大会通过的《行动纲领》就改进各种生殖健康项目的服务质量问题提出8点建议,其中指出:“确保男子和妇女能够获得有关信息和尽可能广泛的安全有效的计划生育方法,以使夫妇和个人能够进行自由和知情选择”。在知情选择理论研究和实践中必须充分考虑文化背景、伦理价值观和本国国情,根据当地实际情况开展工作。在中国研究和实施知情选择时,用“中国话”加以阐释,才更容易被国人接受。在少数民族地区开展避孕节育知情选择难度     

Effect of Village Midwife Program on Contraceptive Prevalence and Method Choice in Indonesia

Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer‐lasting methods, the women's “switching behavior” indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.     

The Impact of Emotional,Physical, and Sexual Abuse on Contraceptive Method Selection and Discontinuation

Objectives. We evaluated the impact of exposure to emotional, physical, or sexual abuse on contraceptive method selection and discontinuation.Methods. We performed a secondary analysis of 7170 women enrolled in the Contraceptive CHOICE Project in St. Louis, Missouri, a prospective cohort study in which 9256 women were provided their preferred method of contraception at no cost from 2007 to 2011. We defined contraceptive discontinuation as device removal or nonuse for at least 4 weeks within the first 12 months after initiation.Results. One third of women experienced some abuse in their lifetimes. Women with an abuse history were as likely as those without to select a long-acting reversible contraceptive method and more likely to choose a contraceptive injection, the patch, or the ring. When we compared women who were abused to those who were not, rates of discontinuation at 12 months were higher among women who selected long-acting reversible contraception (17% vs 14%; P = .04) and significantly higher among women who selected non–long-acting methods (56% vs 47%; P < .001). Type of abuse did not alter the association between abuse and contraceptive continuation.Conclusions. Previous experiences of abuse are associated with both contraceptive method selection and continuation.Research has shown that violence against women is disturbingly common.1,2 A 2000 Centers for Disease Control and Prevention nationally representative survey of 8000 women aged 18 years and older found that the lifetime prevalence of physical intimate partner violence was 25%, and 56% of women reported at least 1 incident of physical or sexual assault.1 A 2010 survey conducted by the National Center for Injury Prevention and Control found that 36% of women reported intimate partner violence during their lifetime, 18% of women had been raped, and 45% of women reported some other form of sexual violence.2A developing body of evidence suggests that childhood and adulthood violence has far-reaching effects on women’s lives.1,3,4 Women with a history of violence report more high-risk health behaviors, such as early age at first intercourse or more lifetime sexual partners,5,6 more psychological effects including posttraumatic stress disorder and depression, higher rates of physical injury, and decreased access to social networks than women with no history of violence.1,7 In addition, women with current or past histories of violence may face unwanted or mistimed pregnancies, are at an increased risk of acquiring sexually transmitted infections (STIs), and are more likely to undergo repeat abortions.1,8–14Exposure to all forms of violence may influence the choices that women make regarding contraceptive use.10,12,15,16 Women’s perceptions and experience of loss of reproductive control may affect their decisions to use contraception, lead to decreased conviction to use condoms, or result in partner control over administration and type of contraception used.11,16 Gee et al. demonstrated that, because of difficulties imposed by their partners, women with exposure to intimate partner violence were less likely than nonexposed women to use birth control.9 Compared with women without violence exposure, women with a history of intimate partner violence reported that their male partners were more likely to refuse to use condoms (21% vs 7%; P < .001) and to refuse to allow contraception (5% vs 1%; P < .001).15 Women exposed to violence were also less likely than their nonexposed peers to ask their partners to wear condoms (35% vs 56%; P < .001).15 Finally, previous experiences of abuse, particularly those occurring in childhood, might have an impact on contraceptive choices via alternate pathways including depression, substance abuse, and alcohol use.17–19In light of these findings, women who experience histories of abuse may benefit from contraceptive methods that are independent of their partners. In this analysis, we sought to estimate the association of childhood, adult, and lifetime exposure to physical, emotional, or sexual abuse with contraceptive method selection and duration of use for both long-acting reversible contraception (LARC; intrauterine devices and hormonal implant) and non–long-acting methods of contraception (non-LARC; birth-control pill, injection, ring, or patch) in the Contraceptive CHOICE Project (CHOICE).     

性别在避孕方法认识、选择与决定中的作用

目的：了解并分析性别在避孕方法认识、选择与决定中的作用。方法：在四川省内采用分层、整群抽样及结构式问卷方法调查。结果：有效调查已婚育龄男女2631人,男、女对避孕方法的认识较一致;避孕方法使用比例居前3位的依次是宫内节育器（55.8％）、避孕套（24.2％）和男性绝育（5.7％）;选择男／女用避孕方法与调查对象对避孕方法、计划生育责任的认识以及男、女在家庭中的角色有关;避孕选择决定方式与性别因素和夫妻之间的沟通交流有关。结论：男性优势的传统观念仍然根深蒂固,调查人群对男性参与计划生育／生殖健康重要性的认识不足。社会各界需共同努力,促进性别的公平与公正及对妇女的赋权,构建合谐健康的两性关系、家庭和社区环境。     

The Impact on Breastfeeding and Pregnancy Status of Household Contraceptive Distribution in Rural Haiti

This paper presents data from an experimental project which distributed oral contraceptives, foam, and condoms to households in three rural areas of Haiti between January 1978 and March 1980. The contraceptive distribution had little apparent impact on traditional, prolonged breastfeeding patterns, and the percentage of women pregnant after eight months of field operations declined over 35 per cent in the two areas where contraceptive acceptance and use were highest. (Am J Public Health 1982; 72:825-838.)     

Traditional and Modern Contraceptive Method Use in the Philippines: Trends and Determinants 2003–2013

This study examines recent levels, patterns, and determinants of traditional contraceptive method use, based on pooled data from the 2003, 2008, and 2013 Philippines Demographic and Health Surveys. Most contraceptive users in the Philippines rely on modern methods, but over the past ten years traditional method use has continued to account for about a third of all contraceptive use. Results show women in 2003 and 2008 were more likely to use periodic abstinence (rhythm) over modern methods compared with women in 2013, while withdrawal rather than modern methods was preferred more by women in 2013 than in 2003. The characteristics of women who use traditional methods have changed little over the past decade. Knowing the characteristics of traditional contraceptive method users can help establish policies and programs that promote more effective contraceptive use, including encouraging users of traditional contraceptive methods to switch to the more effective modern methods.     

Prevalence and Predictors of Prenatal and Postpartum Contraceptive Counseling in Two Texas Cities

ObjectivesWe investigated the prevalence of and sociodemographic associations with receiving prenatal and postpartum contraceptive counseling, including counseling on intrauterine devices (IUDs) and implants.MethodsWe used data from a prospective cohort study of 803 postpartum women in El Paso and Austin, Texas. We examined the prevalence of prenatal and postpartum counseling, provider discouragement of IUDs and implants, and associated sociodemographic characteristics using χ² tests and logistic regression.ResultsOne-half of participants had received any prenatal contraceptive counseling, and 13% and 37% received counseling on both IUDs and implants prenatally and postpartum, respectively. Women with more children were more likely to receive any contraceptive counseling prenatally (odds ratio [OR], 1.99; p < .01). Privately insured women (OR, 0.53; p < .05) had a lower odds of receiving prenatal counseling on IUDs and implants than publicly insured women. Higher education (OR, 2.16; p < .05) and attending a private practice (OR, 2.16; p < .05) were associated with receiving any postpartum counseling. Older age (OR, 0.61; p < .05) was negatively associated with receiving postpartum counseling about IUDs and implants and a family income of $10,000 to $19,000 (OR, 2.21; p < .01) was positively associated. Approximately 20% of women receiving prenatal counseling and 10% receiving postpartum counseling on IUDs and implants were discouraged from using them. The most common reason providers restricted use of these methods was inaccurate medical advice.ConclusionsPrenatal and postpartum counseling, particularly about IUDs and implants, was infrequent and varied by sociodemographics. Providers should implement evidence-based prenatal and postpartum contraceptive counseling to ensure women can make informed choices and access their preferred method of postpartum contraception.     

福建省召开计划生育避孕方法知情选择工作现场会

<正> 2001年7月27～28日,福建省计划生育领导小组在福州市晋安区召开全省避孕方法知情选择工作现场会。会议要求进一步加大改革和创新步伐,积极稳妥地推行避孕方法知情选择工作,加快计划生育工作的“两个转变”,提高计划生育工作整体水平。省计划生育领导小组成员,省计生委、省计生协负责人,9个市的分管计生工作领导、主任、专职副会长,14个优质服务试点县(市、区)、10个人口大县计生委(局)主任(局长)共计125人参加了会议。 这次会议得到了省委、省政府的高度重视,习近平省长特地致信会议,要求在改革创新中不断提高计划生育工作水平,潘心城副省长到会作了重要讲话。与会代表还听取了省计生协会张渝民会长、省计生委张学梅主任的讲话和工作报告,考     

全国避孕节育方法知情选择研讨会议在新疆乌鲁木齐市召开

<正> 为配合国家计生委《关于全面推进计划生育优质服务的意见》的贯彻落实,推动全国避孕节育方法知情选择工作的开展,为各地开展该项工作提供一次全国性交流的机会,由《中国计划生育学杂志》社主办的“全国避孕节育方法知情选择研讨会”于2001年8月17～22日在新疆维吾尔自治区乌鲁木齐市隆重召开。 此次会议受到全国计划生育/生殖健康工作者的热烈欢迎和积极响应,来自全国32个省、市、自治区的计划生育管理、科研、技术服务部门和妇幼保健院、解放军、武警部队以及部分省市医院、厂矿、企事业单位的代表330余人参加了本届研讨会,成为研讨开展避孕节育方法知情选择的一次盛会。     

避孕方法知情选择与已婚育龄妇女避孕选择变化

目的：探讨避孕方法知情选择的推行对已婚育龄妇女自愿、知情选择避孕方法的影响。方法：数据来源于2001年、2006年全国计划生育/生殖健康调查。研究对象为1996年6月～2001年7月和2001年8月～2006年9月选择避孕方法的“新使用者”。有效样本量2001年为9 788例,2006年为7 611例。数据主要采用描述性分析和卡方检验。结果：2006年与2001年相比,“新使用者”避孕构成仍以长效措施为主,变化包括男性绝育和女性绝育比例分别下降了1.9%和3.1%,放置宫内节育器比例下降了8.1%,避孕套使用比例上升了11.5%。避孕方法构成变化显著（x2=475.742,P〈0.01）;自主选择避孕方法的比例由2001年的56.8%上升到2006年的82.3%（x2=2 184.422,P〈0.01）;了解避孕方法副作用的比例由2001年的47.9%上升到2006年的71.2%（x2=953.048,P〈0.01）。在控制“新使用者”的人口、社会学及避孕方法等变量后,选择避孕方法的时间对“自主、知情选择避孕方法”仍有显著影响。2001年8月～2006年9月选择避孕方法的“新使用者”自主、知情选择避孕方法的几率为1996年6月～2001年7月选择避孕方法的“新使用者”的3.7倍。结论：知情选择使更多的育龄妇女自主、知情地选择避孕方法,今后应进一步加强这项工作的深入开展。     

Levels,Trends, and Determinants of Unintended Pregnancy in Iran: The Role of Contraceptive Failures

The rate of contraceptive use in Iran is high, but because abortion is illegal, many unintended pregnancies among married women are likely to be terminated by clandestine and often unsafe procedures, resulting in adverse health outcomes. Drawing upon data from the 2009 Tehran Survey of Fertility, this study estimates the levels and trends of unintended pregnancy and examines determinants of pregnancy intentions for the most recent birth, using multinomial logistic regression analysis. The level of unintended pregnancy decreased from 32 percent in 2000 to 21 percent in 2009, while contraceptive use increased. Unintended pregnancies in the five years preceding the 2009 survey resulted from failures of withdrawal (48 percent) and of modern contraceptive use (20 percent), together with contraceptive discontinuation (26 percent) and nonuse (6 percent). Multivariate findings show that, compared with women experiencing withdrawal failures, the risk of unintended pregnancy was higher among women reporting modern contraceptive failure and lower among those reporting contraceptive discontinuation and nonuse. The high risk of unwanted pregnancy among women experiencing failures in practicing withdrawal or using modern contraceptive methods points to an unmet need for family planning counseling and education rather than to a shortage of contraceptive methods.     

The Impact of a Tiered Network on Hospital Choice

Objective

To evaluate the effect of a tiered network on hospital choice for scheduled admissions.

Data

The 2009–2012 patient-level claims data from Blue Cross Blue Shield of Massachusetts (BCBSMA).

Study Design

BCBSMA''s three-tiered hospital network employs large differential cost sharing to encourage patients to seek care at hospitals on the preferred tier. During the study period, 44 percent of hospitals were moved to a different tier based on changes in cost or quality performance. We relied on this longitudinal variation for identification and specified conditional logit models to estimate the effect of the tiered network (TN) on patients'' hospital choices relative to a non-TN comparison group.

Principal Findings

The TN was associated with increased use of hospitals on the preferred and middle tiers relative to the nonpreferred tier for planned admissions. The results suggest that if all members were in a TN plan, relative to all members being in a non-TN plan, scheduled admissions to hospitals on the nonpreferred tier would drop by 7.6 percentage points, while those to middle and preferred tier hospitals would rise by 0.9 and 6.6 percentage points, respectively.

Conclusion

Differential cost sharing can steer patients toward preferred hospitals for planned admissions.     

知情选择对苏州市已婚育龄妇女避孕节育状况的影响调查

目的分析实施避孕节育知情选择对苏州市已婚育龄妇女避孕节育和人工流产发生状况的影响。方法根据实施知情选择前后的常规统计年报资料,对避孕措施现用率和避孕失败的人工流产率进行统计分析。结果实施知情选择后,已婚育龄妇女综合避孕率从1998年的91.39%下降至2005年的88.38%,其中,长效避孕措施现用率从82.70%下降到71.27%,短效避孕措施现用率从8.69%上升至17.11%;避孕失败的人工流产率从9.06‰下降到8.11‰,其中,长效措施避孕失败的人工流产率下降了2.41‰,短效措施避孕失败的人工流产率上升了4.55‰,前后比较均有统计学意义(P<0.01)。结论开展避孕节育方法的知情选择,使已婚育龄妇女的避孕节育方法多样化,降低了避孕失败的人工流产率;但短效措施避孕失败人工流产率有所上升,提示需进一步提高咨询和随访质量、提供满足个性化需求的指导和服务。     

干预项目对流动人口避孕节育知识的影响

目的:了解干预活动对四川省流动人口高度集中地区的研究对象避孕节育知识的影响,并分析评估避孕节育知识的影响因素,为进一步制定干预策略与措施提供依据。方法:采用多阶段随机整群抽样抽取18～49岁之间的流动人口,分为干预组和对照组。对干预组实施本项目的各项干预活动。分析避孕节育干预项目对研究对象的影响,采用卡方检验、方差分析以及多元线性回归分析等方法进行统计分析。结果:共调查流动人口2197人;评估调查时随访到有效样本1877人。干预组和对照组9种避孕方法知识得分及总分差异有统计学意义(P0.01),干预组总分平均提高40分(100分为满分),不同婚姻状况、学历、工作场所以及接受计划生育管理状况人群的避孕节育知识差异有统计学意义。多元线性回归显示干预对各避孕方法得分及总分的影响差异有统计学意义。结论:干预措施显著提高了流动人群的避孕节育知识水平;婚姻状况、学历、工作场所以及接受计划生育服务的状况对其避孕节育知识的水平有较大影响,应加强干预,进一步提高计划生育管理和服务水平。     

Meeting the Contraceptive Needs of Teens and Young Adults: Youth-Friendly and Long-Acting Reversible Contraceptive Services in U.S. Family Planning Facilities

PurposeIncreased use of contraceptive services, including long-acting reversible contraceptives (LARCs), among sexually active teens and young adults could significantly reduce unintended pregnancy. Objectives were to describe youth-friendly contraceptive services (including LARC) available to teens and young adults at U.S. publicly funded family planning facilities.MethodsBetween April and September 2011, center directors at a nationally representative sample of 1,196 U.S. publicly funded family planning facilities were surveyed to assess accessibility and provision of contraceptive services for teens and young adults; 584 (52%) responded.ResultsFacilities were accessible to young clients in several ways, including not requiring scheduled appointments for method refills (67%) and having flexible hours (64%). Most facilities provided outreach and/or education to young people (70%), and 27% used social network media to do this. Most facilities took steps to ensure confidentiality for young clients. These youth-friendly practices were more common at Planned Parenthood, Title X, and reproductive health focused facilities than at other facilities. Long-acting reversible contraceptive methods were regularly discussed with younger clients at less than half the facilities. Youth-friendly sites had increased rates of LARC provision among younger clients. The most common challenges to providing contraceptive and LARC services to younger clients were the costs of LARC methods (60%), inconvenient clinic hours (51%), staff concerns about intrauterine device (IUD) use among teens (47%), and limited training on implant insertion (47%).ConclusionsImproving the ability of family planning facilities to provide youth-friendly contraceptive and LARC-specific methods to younger clients may increase the use of highly effective contraception in this population.     

Differences in Quality of Care of Family Planning Services Received by Age and Contraceptive Continuation Among Young Mothers in India

PurposeYouth face barriers that affect their use of family planning (FP) services, including low quality of care and provider bias. Although young women have the highest unmet need for FP in India, little is known about the effect of age on quality of care received. Additionally, although youth have higher contraceptive discontinuation than older women, the factors associated with continuation, including the effect of quality of care, are not well known. This study aims to assess differences in quality of care received by young mothers aged 15–24 and mothers aged 25–48, and to examine factors associated with modern contraceptive continuation 6 months after initiation among young mothers.MethodsData come from a 12-month longitudinal study of married reversible contraceptive users in India. Multinomial logistic regression was conducted to examine adjusted associations of age and reported receipt of low, medium, or high quality of care. Logistic regression was used to assess factors associated with modern contraceptive continuation after 6 months.ResultsResults showed that young mothers were less likely to receive high quality of care than older mothers, and that among young mothers, motivation to prevent pregnancy was significantly associated with continued use after 6 months.DiscussionAs India aims to improve quality of care and increase access to services for youth, special attention should be paid to care received by young mothers, as well as options to support them in continuing to use contraceptive methods as long as they desire to prevent pregnancy.