UNASSIGNED: To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity.
UNASSIGNED: Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units.
UNASSIGNED: Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women.
UNASSIGNED: The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies.
UNASSIGNED: The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

Individuals with lupus nephritis (LN) are at high risk of adverse maternal and fetal outcomes in pregnancy. Outside of pregnancy, proliferative lesions on kidney biopsies are associated with disease progression, but these have not been consistently associated with increased risk in pregnancy. This retrospective, single-center study examines how histologic findings, the timing from kidney biopsy to pregnancy, and the clinical features in the first trimester are associated with preterm birth among individuals with LN. Among 35 deliveries in 31 women, the mean gestational age at delivery was 33.8 weeks. The presence of a urine protein-to-creatinine ratio >0.5 g/g in the first trimester was associated with preterm delivery (81% vs. 36%, p = 0.04). Preterm birth was more common in individuals with glomerular crescents on biopsy (89% in those with >20% crescents vs. 50% in those with <20%, p = 0.06). A pregnancy occurring within 2 years after a kidney biopsy was more likely to result in preterm birth than if the biopsy was performed more than 2 years prior to conception (82% vs. 23%, p = 0.01). The time from diagnostic biopsy may be a surrogate for disease activity, and a 2-year delay from biopsy might allow sufficient time to achieve disease remission. Overall, these data could aid family planning discussions and promote preconception disease optimization for patients and their providers.

暂无摘要。

The Centering Equality, Race, and Cultural Literacy in Family Planning (CERCL-FP) program aims to break racial silence and dismantle structural racism in the field of family planning, by providing racial equity workshops and trainings.
OBJECTIVE: The objective of this study was to begin a multi-phased, rigorous evaluation to determine the impact and outcomes of the work of CERCL-FP.
METHODS: A needs assessment with former graduates and current directors of fellowships in family planning was conducted using qualitative interviews. The focus of these interviews was to determine the ability, readiness, and willingness of the field of family planning to retrofit new curricula grounded in equity, race, and cultural literacy.
RESULTS: Nine (N=9) interviews were completed with seven board certified obstetrician-gynecologists and two board certified family medicine physicians. Three themes were identified: 1) Establishing the Distribution of Work; 2) The Push/Pull of Change from Inside and Outside: Curricula and Faculty Responsibilities; and 3) Reproductive Justice and Fellowships in Family Planning. Despite acknowledging the need to retrofit the field of family planning with content grounded in equity, race, and cultural literacy, there are structural, institutional, and individual level barriers that have limited the adoption of CERCL-FP curricula within family planning curriculum nationwide.
CONCLUSIONS: Findings from this study illuminate multiple barriers that should be considered when expanding foundational knowledge of clinicians and researchers.

Background: Lack of credible sexual partner dialog and support regarding family planning (FP) and other sexual reproductive health issues is a major impediment to contraception service uptake and utilization. This study examined the feasibility and acceptability of attitudes toward using telehealth for remote education of couples through behavioral, motivational, and informational messaging on FP methods and its eventual impact on partner conversations around FP. Methods: The study was conducted in Kampala, Uganda, and involved recruiting 450 men from diverse settings. These men received regular SMS content on FP and sexual and reproductive health for a duration of 6 months. The content aimed to provide information and motivation while serving as a resource for discussions with their spouses. Following the main quantitative study, a qualitative follow-up study was conducted with a subset of 15 randomly selected men. In-depth interviews were conducted with these men to gain deeper insights into their experiences and perspectives. Results: The study revealed positive outcomes where men reported improved knowledge of FP methods such as child spacing, and types of contraception. The messaging prompted discussions with spouses on family size and spousal support. Couples reported a shift toward viewing FP as a joint responsibility, with some couples even taking concrete actions. The findings suggested that telehealth interventions can promote social and behavioral change and can improve couple communication and male involvement in FP decisions in Uganda. Conclusion: The study found that using telehealth messaging to educate men about FP in Uganda successfully improved communication between couples on the topic.

Planned oocyte cryopreservation (OC) has the potential to address the burden of the biological clock, giving women and individuals with ovaries more autonomy in choosing when to have children and with whom. In the United States, the annual number of OC cycles has grown significantly, yet many questions remain regarding planned OC. The field is starting to gather data on the clinical practice and social perspectives around planned oocyte cryopreservation, including the optimal age range at which to offer planned OC, what factors are most predictive of a successful outcome, and the optimal number of oocytes and ovarian stimulation cycles to achieve a live birth. There is a clear need for setting realistic expectations about the chance of success with OC; however, most patients have yet to return to thaw their oocytes, and outcomes data are limited. Clinical models have been developed to predict OC success based on surrogate markers such as age, number of oocytes retrieved, and anti-Müllerian hormone level. Patient education should emphasize the age-related decline in fertility, that eggs do not equal embryos, and that more than one cycle may be needed to obtain sufficient oocytes to have a reasonable chance of future success. While planned OC is not quite an insurance policy against future reproductive challenges, it provides the best option to date for expanding the reproductive window and maximizing reproductive options while navigating individual life circumstances in the context of family building.

UNASSIGNED: Religious leaders are influential and can impact the uptake of family planning (FP). In this study of the Healthy Timing and Spacing of Pregnancies (HTSP) project, led in Siaya County, Kenya, from September 2017 to June 2019, we present findings from the project\'s evaluation, to determine changes in knowledge of the key HTSP messages; changes in the proportion of community members who correctly identify at least three methods of contraception; changes in knowledge of healthy child spacing; and changes in modern contraceptive prevalence rate.
UNASSIGNED: This is a two-staged (baseline and endline) cross-sectional study, designed to assess the knowledge, practice, and coverage of HTSP/FP services. Primary data was collected using a questionnaire adapted from the United States Agency for International Development. Focus group discussion participants included men, women, representatives of community groups, faith leaders, and community heath volunteers. Frequencies were calculated from the ODK platform. Bivariate analytics (paired t test) were performed.
UNASSIGNED: At baseline, women respondents aged 20-29 years constituted 66.3% of the women participants, dropping to 60.9% at endline. Women aged 30-34 years constituted 11.9% and 22% of the entire women respondents, at baseline and endline, respectively. Men aged 20-29 constituted 45.2% of all men respondents at baseline, and 35.4% at endline. There were statistically significant increases in the knowledge of modern contraceptives among women (p = 0.0342), faith leaders (p = 0.0464), and the entire population (p = 0.0097), from baseline to endline.
UNASSIGNED: The HTSP model identifies success factors for FP interventions in Kenya and other low- and middle-income countries where faith leaders and community stakeholders are influential, and that women and faith leaders are much more easily impacted positively with these efforts, as measured by increased knowledge and awareness of modern contraceptive methods, compared with men.

Background: The COVID-19 pandemic affected global access to health services, including contraception. We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users\' desire and ability to obtain removal. Methods: Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results: Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported attempting to access FP since the start of the pandemic, the vast majority of whom were using short-acting methods. Among those who sought services, 95% obtained their preferred method. The proportion of women not using a method before and after pandemic start did not change in Zambia (31%); in South Africa, the proportion increased from 8% to 10%. Less than 7% of implant or IUD users in either country reported wanting removal. Among those who sought removal (n=22), 91% (n=10) in Zambia and 55% (n=6) in South Africa successfully obtained removal. In qualitative interviews, women with challenges accessing FP services mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions: We did not find a substantial impact of COVID-19 on contraceptive access among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people\'s ability to access their preferred contraceptive methods.

Potential associations between periconception dolutegravir (DTG) exposure and neural tube defects (NTDs) reported in 2018 caused shifting international and national antiretroviral treatment (ART) guidelines. They sometimes required women to use contraception prior to initiating DTG. To better understand the tensions between ART and family planning (FP) choices, and explore the decision-making processes of women living with HIV (WLHIV) and their healthcare providers (HCPs) employed, we conducted interviews with WLHIV exposed to DTG and their providers in western Kenya from July 2019 to August 2020. For the interviews with WLHIV, we sampled women at varying ages who either continued using DTG, switched to a different ART, or became pregnant while using DTG. We utilized inductive coding and thematic analysis. We conducted 44 interviews with WLHIV and 10 with providers. We found four dominant themes: (1) a range of attitudes about birth defects, (2) nuanced knowledge of DTG and its potential risk of birth defects, (3) significant tensions at the intersection of DTG and FP use with varying priorities amongst WLHIV and their providers for navigating the tensions, and (4) WLHIV desiring autonomy, and provider support for this, in such decision-making. Variations in beliefs were noted between WLHIV and HCPs. WLHIV highlighted the impact of community and social beliefs when discussing their attitudes while HCPs generally reported more medicalized views towards DTG utilization, potential adverse outcomes, and FP selection. Decisions pertaining to ART and FP selection are complex, and HIV treatment guidelines need to better support women\'s agency and reproductive health justice.

BACKGROUND: Digital technology has proliferated rapidly in low- and middle-income countries in recent decades. This trend will likely persist as costs decrease, dramatically expanding access to reproductive health and family planning (FP) information. As many digital tools aim to support informed choice among individuals with unmet contraceptive need, it is essential that high-quality information is provided. We set out to assess the accuracy and comprehensiveness of FP content in select user-facing digital self-care platforms.
METHODS: We identified 29 digital tools in circulation between 2018-2021 and selected 11 that met our eligibility criteria for analysis. Referencing global guidance documents such as the Family Planning Handbook, Medical Eligibility Criteria for Contraceptive Use, and the Digital Health for Social and Behavior Change High Impact Practice Brief, we developed an original rubric outlining 12 key content areas necessary to support informed, person-centered counseling. We applied this to each tool, enabling assignment of a numerical score that represents content accuracy and comprehensiveness across the 12 key areas.
RESULTS: FP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 identified key content areas, 5 were included in all 11 tools, while 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use.
CONCLUSIONS: Complete, accurate, and evidence-based FP content is a foundational element of quality digital self-care. Inaccuracies and omissions can impact individual user experiences and decision-making in critical ways. FP content quality should be verified before digital tools are scaled or researched at the programmatic level. From this exercise, we developed a checklist for use in conjunction with global guidance documents to improve future FP content of user-facing digital tools.
RéSUMé: CONTEXTE: La technologie numérique a proliféré rapidement dans les pays à revenu faible et intermédiaire au cours des dernières décennies, une tendance qui devrait se poursuivre à mesure que les coûts diminuent, élargissant considérablement l’accès aux informations sur la santé reproductive, y compris la planification familiale (PF). Étant donné que de nombreux outils numériques permettent de faire des choix éclairés, il est essentiel que les informations fournies soient de grande qualité. Nous avons entrepris d’évaluer l’exactitude et l’exhaustivité du contenu sur la PF dans certains outils numériques destinés aux utilisateurs. MéTHODES: Nous avons identifié 29 outils numériques utilisés entre 2018–2021 et en avons sélectionné 11 pour l’analyse en fonction de nos critères d’éligibilité. Nous avons élaboré une rubrique basée sur des documents d’orientation mondiaux, notamment le Manuel de planification familiale, les Critères d’admissibilité médicale pour l’utilisation de contraceptifs et l’aperçu du pratique a haut impact Sante Numérique pour un changement social et comportemental, reflétant 12 domaines de contenu clés du conseil éclairé et centré sur la personne. Nous avons appliqué cette méthode à chacun des outils, ce qui nous a permis d’attribuer une note quantitatif représentant l’exactitude et l’exhaustivité du contenu de chaque outil en matière de PF dans les 12 domaines de contenu. RéSULTATS: Le contenu des outils numériques en matière de planification familiale varie considérablement en termes de précision et d’exhaustivité. Sur les 12 domaines clés que nous avons identifiés, 5 ont été inclus dans les 11 outils; 6 domaines ont été traités de manière incohérente ou pas du tout. Quatre domaines ont été les plus précis et les plus complets: la liste complète des méthodes modernes, la durée de la protection, l’utilisation d’une double méthode et le retour à la fertilité. Les domaines les moins bien notés étaient la gestion des effets secondaires, les avantages non contraceptifs, l’efficacité, les effets secondaires et le mode d’emploi. CONCLUSIONS: Un contenu complet, précis et fondé sur des données probantes est un élément fondamental de la qualité des soins. Les inexactitudes et les omissions peuvent avoir un impact critique sur l’expérience et la prise de décision des utilisateurs. La qualité du contenu de la PF doit être contrôlée et vérifiée avant que les outils numériques ne soient mis à l’échelle ou que des ressources ne soient utilisées pour leur recherche. Sur la base de cet exercice, nous avons élaboré une liste de contrôle à utiliser en conjonction avec les documents d’orientation mondiaux pour améliorer le contenu PF des outils numériques destinés aux utilisateurs.
Digital tools are increasingly used to reach people in low- and middle-income countries with reproductive health information and links to services. We set out to understand the quality of the information available in digital tools relating to family planning. To do this, we searched for a set of tools and applied eligibility criteria, ultimately identifying 11 tools for assessment. To assess their content, we developed a rubric based on cornerstone documents in family planning. This rubric contains 12 FP content areas (such as method effectiveness, duration of protection, etc.) and was applied to assess accuracy and comprehensiveness of all FP content. The FP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 key content areas we identified, 5 were included in all 11 tools; 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use. Digital tool users have the right to accurate, comprehensive FP information, and gaps in quality can impact users of digital tools in various ways. Quality of FP content should be checked and verified before digital tools are scaled or resources are used to research them. Based on this exercise, we developed a checklist for use in conjunction with global guidance documents to improve the FP content of user-facing digital tools.