Usage patterns and attitudes towards emergency contraception: the International Emergency Contraception Research Initiative

Objectives:?The aim of the survey was to gain understanding of women’s usage patterns and attitudes towards emergency contraception (i.e., the ‘morning after pill’) and to gain insight into the role and attitudes of pharmacists as providers of emergency contraception.

Methods:?As part of the International Emergency Contraception Research Initiative, approximately 6500 women (15–49 years) and nearly 500 pharmacists from 14 countries in Western, Central and Eastern Europe, and Central Asia completed questionnaires via web-based interrogation or computer-assisted/paper-assisted personal interviews.

Results:?Common to almost all countries and cultures was that, while awareness of emergency contraception was high (≥84% of respondents, except in Kazakhstan), usage was generally low (4–18%). In Austria, the Czech Republic, Spain, and the UK, better underlying protection with hormonal contraceptives or male condoms would have meant less need for emergency contraception. In Bulgaria, Lithuania, Romania, and Russia, greater dependence on less reliable contraceptive methods such as calendar?+?withdrawal was associated with higher use of the emergency contraceptive pill (11–18%) but also with higher abortion rates (19–21%). Overt rejection of emergency contraception in the event of an accident was low, except in countries (e.g., Austria, Poland) where the misperception that it acts as an abortifacient was common. Except for Bulgaria, pharmacists elsewhere tended to have limited knowledge and moralistic attitudes towards emergency contraception.

Conclusions:?Improved educational efforts, probably country-specific, are required to increase the use of highly effective methods of regular contraception and overcome barriers to acceptance of emergency contraception as a suitable postcoital solution to avoid unwanted pregnancy or abortion.     

Risk factors for induced abortions in St Petersburg,Estonia and Finland. Results from surveys among women of reproductive age

Objectives?To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates.

Methods?Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia.

Results?The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives.

Conclusion?The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.     

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

Abstract

Objectives: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

Methods: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15–49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

Results: Catholic women were significantly more likely to have misconceptions compared with Muslim women (β?=?1.09; 95% confidence interval [CI] 0.58, 1.60; p?<?.001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β=??0.06; 95% CI ?0.96, ?0.29; p?<?.001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p?>?.05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p?<?.001).

Conclusion: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.     

Abortions and Contraception Use among Czech and Romanian Women: Comparison of Representative National Studies

IntroductionThis article presents the results of representative national studies comparing the behavior and attitudes of Czech and Romanian women regarding abortion and contraception use.AimDescribe the attitudes to abortion and incidence of abortion in female population of these countries.MethodsIndependently and anonymously conducted questionnaire with 1,011 Czech and 1,001 Romanian women, with the participants' age from 15 to 50 years. The sample represented both Czech and Romanian female populations with respect to age, education, and the size of their place of residence.Main Outcome MeasuresQuestionnaire studies awareness, attitudes, and behavior related to the area of sexual life, contraception, and family planning.ResultsBased on the acquired information, it can be postulated that Romanian women, despite having a less liberal opinion on abortions than their Czech peers, undergo abortion more often than Czech women (Romanian 28%, Czech 16%), are less informed about potential side effects, and more often use less reliable methods of contraception (the so‐called “natural contraception”—vs. hormonal contraception, which is the method of choice of Czech women).ConclusionThese results indicate that despite more liberal attitudes toward abortion, Czech women have less frequent incidence of abortion than Romanian women and they have more relevant information about contraception and their sexual behavior is more conscious and responsible. Hollá K, Weiss P, Unzeitig V, and Cibula D. Abortions and contraception use among Czech and Romanian women: Comparison of representative national studies.     

Supply and demand challenges to modern contraceptive use in Azerbaijan

Objectives?We conducted a survey of health facilities and household members to determine supply and demand aspects of contraceptive use in Azerbaijan.

Methods?In June 2005, we conducted interviews with 758 women and 253 men in a community-based survey in 40 communities in five districts. We also surveyed a sample of health facilities and pharmacies and conducted interviews with key informants.

Results?Both men and women in these communities desire small families, yet significant supply and demand impediments exist. Despite community interest, lack of knowledge of contraception is prevalent. Fear of side effects plays a role in non-use and discontinuation of modern methods, although little opportunity exists for counselling on side effects, since few health workers are trained. An obstacle to use is legislation that only allows contraception to be prescribed by gynaecologists, who are mostly concentrated in the hospitals of urban centres. However, the main handicap to increased use of modern contraception, is insufficient contraceptive supply. Not only is there a lack of method choice nationally, but few of the facilities we surveyed had any contraceptives available. This situation threatens to worsen as the United Nations Population Fund (UNFPA) retracts commodities' funding.

Conclusions?The lack of knowledge of modern contraception, lack of trained staff and poor commodity availability signals that much remains to be done for the people of Azerbaijan to achieve their fertility control goals.     

Contraceptive use,fertility, and unsafe abortion in developing countries

Objectives Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive prevalence and unsafe abortion in developing regions with different levels of fertility. These relationships manifest the extent to which the desire to regulate fertility is addressed by contraception or by unsafe abortion, where access to safe abortion is legally restricted.

Methods Secondary analysis of estimates of unsafe abortion, total fertility rate and contraceptive prevalence, by geographical regions.

Results High levels of unsafe abortion persist even where contraceptive prevalence is increasing and fertility is declining. It appears that a high dependence on sterilization for limiting family size may by be preceded by reliance on unsafe abortion, where abortion is restricted, for birth spacing.

Conclusions The reliance on unsafe abortion could be reduced during fertility transition by improving women's access to reversible contraceptives for spacing births as well as to sterilization for terminating childbearing. Expanding contraceptive choices and a balanced method mix can serve as an effective strategy to prevent unsafe abortion where reliance on sterilization to limit childbearing is not preceded by the use of reversible modern methods for spacing and where access to safe abortion is restricted by law. The intriguing association between contraceptive method choice and the incidence of unsafe abortion deserves further exploration.     

Determinants of choosing withdrawal over modern contraceptive methods in Turkey

Objectives The determinants of the use of withdrawal in Turkey are examined using a multinomial logistic model.

Methods Data were drawn from a nation-wide population-based cross-sectional study, the Turkish Demographic Health Surveys that took place in 1998 and 2003. Detailed interviews were conducted with 8576 women aged 15–49 and analysed using SPSS.

Results Contextual, cultural and demographic characteristics define women's choice of withdrawal over modern methods. Socio-economic status, education, employment status, and past fertility behaviour are among key determinants. First-ever used contraception method has a very strong impact on later choices. Urban women, the more educated, those with better socioeconomic status, and those living in less crowded households resort less to withdrawal. Experience and empowerment positively linked to modern contraceptive use among women in Turkey.

Conclusions The use of contraceptive methods in Turkey differs greatly. Empowerment of women in terms of better socioeconomic status, better education, modern and liberal attitudes towards women and family planning seem to reduce withdrawal use as the main method of contraception. The results suggest the need for education (particularly targeting young women and couples), information and provision of modern contraceptive services particularly for disadvantaged groups.     

Contraceptive behaviour of Czech and Romanian women: comparison of representative national samples

ObjectiveTo investigate the contraceptive behaviour of Czech and Romanian women and their attitudes towards different forms of contraception.Study designAnonymous questionnaire research among 1011 Czech and 1001 Romanian women between 15 and 50 years of age. The samples were representative of both the Czech and Romanian female populations with respect to age, education and the size of their place of residence.ResultsThe majority of women use contraception when in a stable sexual relationship. We found a higher percentage of women using contraception among Czech women. Romanian women more often use less reliable methods in a stable relationship, and condoms. Czech women use hormonal contraception much more. Women in the Czech Republic would more often agree to use a condom and, in particular, to use hormonal and intrauterine contraception. More Romanian women than Czech women prefer the method of infertile days. The use of contraception is influenced by the factors of age, education and size of the place of residence.ConclusionThe majority of Czech and Romanian women protect themselves against unwanted pregnancy. Czech women are more frequent users of contraceptives in general and, in particular, of hormonal contraception. Romanian women tend to use less reliable methods of contraception but on the other hand, they more often use condoms as a means of protection.     

Risk factors for unwanted pregnancy and subsequent abortion among women aged 16 to 25 years in Latvia

Objective?To explore key factors influencing young women when choosing between two methods of emergency contraception (EC).

Methods?We interviewed 26 young women who accessed community sexual and reproductive health services for emergency contraception after they had chosen an EC.

Results?Most women had an unrealistically high expectation about efficacy of the emergency contraceptive pill (ECP) and lacked knowledge of the intrauterine device (IUD) as an alternative method of EC. Previous use, easy accessibility, ease of use, and advice from peers, influenced women to choose the ECP, whereas past experience of abortion, firm motivation to avoid pregnancy, presentation after 72 hours, and considering that an IUD may provide long-term contraception as well, inclined women to choose the IUD. When participants were shown the IUD, many found it to be smaller and less frightening than they had imagined.

Conclusions?Women need better information and education about the IUD as a highly effective method of EC. Health professionals must provide such information at every opportunity. Showing the IUD during counselling might help correct misconceptions and would improve acceptability. Wider availability of expertise concerning EC-IUDs is essential to assist more women in making informed decisions when choosing a method for EC.     

The abortion issue in Serbia

Objectives?To investigate the causes of the persistently high abortion rate in Serbia.

Methods?We analysed the legal aspect of abortion, related health care regulations and policies, and social environment, as primary factors, and knowledge, attitudes and practice of health care providers and clients, as secondary determinants of the large number of induced abortions.

Results?A complex array of factors accounted for the high abortion prevalence. The main ones are easy access to induced abortion coupled with substantial obstacles to efficient use of contraception, insufficient relevant knowledge about and a resistance to modern contraceptives among women and men in need and health care providers, a firm social basis for traditional birth control, and limitations in the family planning programme.

Conclusions?The persistence of a high abortion rate in Serbia appears to be due to many underlying causes, which have changed little over time. The future of this issue will depend on the introduction of a modern concept of family planning at the political, educational and health care level.     

Long-acting reversible contraception: Findings from the Understanding Fertility Management in Contemporary Australia survey

Objectives The aim of this research was to investigate awareness, perceived reliability and consideration of use of long-acting reversible contraception (LARC) among Australians of reproductive age.

Methods A sample of 18- to 50-year-old women and men (N = 2235) was randomly recruited from the Australian electoral roll in 2013. Respondents completed a self-administered, anonymous questionnaire. Data were weighted to reduce non-response bias. Factors associated with perceived reliability and consideration of use of LARC were identified in multivariable analyses.

Results Most respondents had heard of implants (76.5%) and intrauterine contraception (63.7%). However, most did not think implants (56.3%) or IUDs (63.9%) were reliable and would not consider using implants (71.6%) or IUDs (77.5%). Those significantly more likely to perceive LARC as reliable were younger, did not regard religion as important in fertility choices, had private health insurance, had been pregnant and had had an abortion; and women who had a partner. Those more likely to consider using LARC were younger and did not regard religion as important in fertility choices; women who had private health insurance, lived in an area of socioeconomic advantage and had had an abortion; and men without a partner, born in Australia and comfortable talking to a health care provider about contraceptive matters.

Conclusions Despite high awareness of LARC among Australian adults, its perceived reliability and willingness to use it remain low in certain groups. Targeted interventions that aim to increase knowledge of the benefits and reliability of LARC and allow informed use are recommended.     

Teenagers' struggles with contraceptive use – What improvements can be made?

Objective?To study the experiences of teenagers using contraceptives at an out-patient abortion clinic and to explore the reasons behind their choices.

Methods?Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

Results?One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

Conclusion?The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was unsatisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to initiate it. Friends and the Internet were the main sources for acquiring information.     

Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries

Objective?The choice of currently available contraceptive methods has increased considerably in recent years, offering women of reproductive age a variety of different methods dependent on their needs and lifestyle. In order to determine the pattern of use of current methods in contraception, a survey was conducted in a large population of women drawn from five European countries (France, Germany, Italy, Spain and the United Kingdom).

Method?More than 12?000 randomly selected women, aged 15–49 years, were interviewed using a standardized questionnaire which addressed the use of current methods of contraception. The responses were analyzed for the total study population, and, where appropriate, by country and age.

Results?An oral contraceptive (OC) was confirmed as the most widely used method of contraception for women in the European study population, with an estimated 22 million users in the five countries. Women using an OC reported very high levels of satisfaction (?>?90%). Male and female sterilization were the main methods of contraception in women aged 40 years and older. One-half of the women had undergone their sterilization before the age of 35 years. More than 50% of the women who had undergone sterilization had not been adequately informed and counselled about alternative reversible contraceptive options. No method of contraception was being used currently by 23% of the European study population, and unreliable methods of contraception (including cap/diaphragm, chemical, and natural and withdrawal methods) were being used by a further 6% of the population. Although valid reasons (e.g. not in a sexual relationship, wish to become pregnant) were given by many women who were not using contraception, there still remains a large number of women who need counselling regarding the importance of using reliable contraceptive methods. The number of women aged 15–49 years in the five European countries who are considered at risk of an unwanted pregnancy is estimated to be 4.7 million (6.5%).

Conclusions?Differences in the use pattern of contraceptive methods were demonstrated that emphasize the social and cultural differences between the countries. The findings in the current study can be used as a baseline from which to monitor trends in contraceptive use and behavior in subsequent studies.     

Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo,Egypt

Abstract

Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt.

Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo.

Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use.

Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.     

Women's contraceptive practices and sexual behaviour in Europe

Objectives To assess current and past contraceptive usage, awareness of and satisfaction with available methods, and sexual and reproductive behaviour of women in 14 European countries (Spain, Italy, UK, France, Germany, Sweden, Denmark, Norway, the Czech Republic, Austria, Estonia, Latvia, Lithuania, and the Russian Federation).

Methods A random sample of women aged 15–49 years underwent web-based or computer-aided face-to-face interviews in June 2006. All data were weighted to correct for differences between the samples surveyed in each country relative to their general population, and further weighted relative to the size of the overall female population across the participating countries.

Results A total of 11,490 women participated in the study. The mean age at first sexual intercourse ranged between 16.5 and 18.5 years. The use of contraception at first intercourse varied significantly across Europe – the rates were the highest in Germany (76%) and France (72%), and the lowest in Russia, the Czech Republic and the Baltic States (29–40%). There was considerable heterogeneity in the general pattern of current contraceptive usage between countries. Oral contraceptives were the most popular current method of contraception, with usage rates highest in France (49%) and the Czech Republic (44%) and lowest in Russia, the Baltic States and Spain (15–18%). The current absence of contraception was fairly consistent across countries, ranging from 21–30%. However, Russia (57%) and the Baltic States (50%) had the highest proportion of women using either no contraception or ‘other methods’ (mostly methods considered unreliable).

Conclusions Oral contraceptives remain a popular method of contraception in Europe; however, great differences exist in contraception acceptance and in the rates of use of the various methods. A sizeable proportion of women do not currently use contraception or use contraceptive methods considered to be unreliable.     

Reconciling religious identity and reproductive practices: The Church and contraception in Poland

Background and objective?After the fall of state socialism in Poland in 1989, a Catholic-nationalist government assumed power. The new political power of the Catholic Church resulted in severe restrictions on family planning (FP) services. Yet, Poland's fertility rate declined sharply, suggesting that women are controlling their fertility despite restrictions. This study examined the Church's influence on women's contraceptive decisions, and how women reconcile religious teachings with their contraceptive use.

Methods?We conducted a mixed-methods study, including a cross-sectional survey and qualitative interviews, in Gdańsk, Poland with sexually active women aged 18–40. The quantitative sample included 418 respondents; the qualitative sample included 49 respondents.

Results?Despite restrictions on FP services, modern contraceptive use among our sample was 56%, up from 19% in 1991. Catholicism played a relatively small role in respondents' contraceptive decisions; though 94.2% of respondents were Catholic, 79% reported that the Church had little or no influence on reproductive decisions. Women's explanations for how they reconcile their reproductive practices with Catholicism included using elements of religion to support contraceptive use, prioritising responsibility for family and financial considerations over the Church's prohibitions, and challenging the Church's credibility in FP matters.

Conclusions?Our findings underscore women's struggles under post-socialist reproductive policies that limit FP access. Despite religious, political, and economic obstacles, contraceptive use has increased dramatically, indicating that FP is a high priority for women in Poland. Policies should respond to women's needs. Comprehensive, state-sponsored FP and sex education are urgently needed and the state should legitimise such services.     

The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium

Introduction?We describe the use of emergency contraception (EC) and its association with sociodemographic, contraceptive and behavioural characteristics in a sample of family practice attendants in Belgium.

Methods?The study was part of a large Chlamydia trachomatis (CT) prevalence study in general practice. Sexually active women under 40 who consulted their general practitioner for routine gynaecological care were enrolled in the study. Participants completed a questionnaire on sociodemographic variables, urogenital symptoms, sexual history and sexual behaviour, and delivered a sample for CT testing. Logistic regression analysis was performed to identify determinants of a history of EC use in women in this sample.

Results?Of 815 questioned women, 23.5% had ever used EC. EC users were a heterogeneous group with respect to educational level, age and ethnicity. The use of emergency contraception was associated with the level of urbanisation, condom use, not having children yet, young age of first sexual intercourse, having had multiple partners in the past year, a history of unintended pregnancy, and current or previous STI.

Discussion?Information on availability and correct use of EC, and on the need for additional testing for STI, are necessary to help primary care attendees to preserve their future reproductive health.     

Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy

Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion.

Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January–May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014.

Results: During the 21 months ([median], IQR 20–22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68–2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06–0.48). When adjusted for LARC initiation status, age?<25 years was a risk factor for subsequent abortion (27 abortions/283 women, 9.5%) compared to women?≥25 years (27/383, 7.0%, HR1.95, 95% CI 1.04–3.67).

Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.     

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia.

Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use.

Results: Most respondents (n?=?1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p?=?.008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p?=?.026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p?p?n?=?534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p?=?.002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p?p?Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.