BACKGROUND: Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for the study of specific population subgroups such as people with low income. Health administrative data could be an innovative and less costly source to study contraceptive use.
OBJECTIVE: We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data.
METHODS: We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population-based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age.
RESULTS: There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women.
CONCLUSIONS: Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person\'s reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one\'s entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Teen pregnancy is often considered an adverse health outcome that accentuates gender inequities, diminishes opportunities, and jeopardizes the safety of adolescent and young adult birthing people. Long-Acting Reversible Contraceptives (LARC) have been hailed as a panacea for teen pregnancy. However, adolescents and emerging adults intersect with multiple assaults on their health and well-being due to gender inequity and racism. To establish equitable care, it is imperative to discern all barriers that influence their reproductive autonomy. This study evaluates the measurement, operationalization, and quality of research conducted on adolescents and emerging adults that analyzed the use of LARC within the social determinant of health framework (SDOH) in the US. SDOH were assessed using the Dahlgren and Whitehead model, and reports were analyzed using a modified version of the Joanna Briggs Institute (JBI) Critical Appraisal tools. Nineteen articles were included in this study. Researchers found the insufficient measurement of race, ethnicity, sexuality, and gender among studies on LARC and SDOH in adolescents and emerging adults. Future studies must measure a full range of identities in data collection to generate knowledge on the impact of SDOH and LARC use among diverse populations.

OBJECTIVE: Since 2020, the Food and Drug Administration has approved multiple extensions to the use of the levonorgestrel (LNG) 52-mg intrauterine device (IUD) for pregnancy prevention beyond 5 years. The accessibility of this information to patients calling a reproductive health clinic to schedule replacement remains unknown. We assess the patient experience in accessing information via phone call on the duration of pregnancy prevention for LNG 52-mg IUD.
METHODS: We utilized a mystery client study design to inquire about LNG 52-mg IUD use beyond 5 years. Purposeful sampling ensured clinic diversity.
RESULTS: In June 2022, 18 (32%) clinics offered extended use beyond 5 years, 25 (44%) recommended replacement at 5 years, and 14 (25%) could not provide information. The number of clinics offering extended LNG 52-mg IUD use did not significantly increase in August 2023 (n = 22, 39%, p = 0.27).
CONCLUSIONS: Patients scheduling a replacement of the LNG 52-mg IUD may not receive information about use beyond 5 years.
CONCLUSIONS: Reproductive health clinics scheduling staff need further training on updated guidelines.

Background Modern contraception plays a vital role in family planning and preventing unintended pregnancies. However, its uptake remains limited in many developing countries, including Pakistan. This study aimed to evaluate the barriers to modern contraception and identify strategies to enhance its adoption in the urban slums of Karachi. Methods A multi-site, cross-sectional study was conducted in 38 slum areas of Karachi, Pakistan. Women aged 15-49 years were interviewed using a comprehensive questionnaire. The questionnaire covered socio-ethnic and economic demographics, knowledge and perceptions of modern contraception, accessibility, affordability, attitudes, and usage. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24 (IBM SPSS Statistics, Armonk, NY). Results The majority of the respondents identified as Pathan ethnicity (49%), and the age range was predominantly from 23 to 34 years (45.5%). A high proportion of participants demonstrated satisfactory knowledge of contraceptives (87.6%). However, a significant portion perceived contraception or family planning to be in conflict with religious beliefs (84%). Many women expressed a desire for more children (56%) and had concerns about contraceptive side effects (78%). A notable proportion of women reported that their spouses forbade the use of contraceptives (12%). Among the surveyed population, the most widely used contraceptives were injections among women (15.5%) and condoms among their male partners (12%). Conclusion Despite sufficient knowledge and accessibility, considerable barriers exist in the uptake of modern contraception in the urban slums of Karachi, Pakistan. These barriers include religious conflicts, cultural norms, concerns about side effects, spousal disapproval, and desires for larger families.

We report a case of intrauterine device (IUD) migration in order to describe the contribution of imaging in its diagnosis. It was a 35-year-old woman received on 06/01/2018 for pelvic ultrasound for pelvic pain. Ultrasound examination revealed a hyperechoic right para-uterine tubular image. A hysterosalpingography revealed an IUD in the pelvis in extra-urine position. Surgical extraction was done without complications. Intrauterine device migration is rare in our context. The radiological means make it possible to specify its topography.
Nous rapportons un cas de migration de dispositif intra-utérin (DIU) dans le but de décrire l\'apport de l\'imagerie dans son diagnostic. Il s\'agissait d\'une dame de 35 ans reçue le 01/06/2018 pour une échographie pelvienne dans le bilan d\'une douleur pelvienne. L\'exploration échographique a objectivé une image hyperéchogène tubulaire para-utérine droite. Une hystérosalpingographie avait objectivé un DIU dans le bassin en position extra-urine. Uneextraction chirurgicale a été faite avec des suites simples. La migration de dispositif intra-utérin est rare dans notre contexte. Les moyens radiologiques permettent de préciser sa topographie.

UNASSIGNED: Although IUD has become more popular in recent years, its migration through uterine perforation is a rare but serious complication.
METHODS: We present the case of a young otherwise healthy woman with a missing IUD that had penetrated terminal ileum.
UNASSIGNED: The incidence of uterine perforation after IUD insertion has been reported 1.3 to 1.6 per 1000 insertions. Although a rare complication, it can cause serious problems requiring major surgery.
CONCLUSIONS: Uterine perforation and migration of IUD is a rare but serious complication that should be considered in all missing IUD threads.

BACKGROUND: Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients.
OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history.
METHODS: We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications.
RESULTS: We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P > .999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%).
CONCLUSIONS: IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD.

UNASSIGNED: Uterocolon fistula is one of the complications of intrauterine device (IUD) insertion. Not only may IUD materials cause perforation, but some other risk factors may contribute to its development including uterine abnormalities, thus IUD is contraindicated in patients with anatomical anomaly.
UNASSIGNED: P3A1 woman, 50 years old with a history of IUD use for 16 years presented with complaints of fecal discharge from the vagina 8 months ago which worsened after IUD extraction. Physical examination revealed no abdominal tenderness. Speculum examination found feces in the cervical canal. CT scan examination showed multiple uterocolon fistulas and uterine didelphys. Diagnostic laparoscopy and hysteroscopy were carried out and found a recto-uterine fistula, then the patient was scheduled for colostomy and reanastomosis with the stapler method.
UNASSIGNED: Diagnosis was very difficult to establish despite proper imaging modalities. The use of direct visual diagnostics (hysteroscopy and laparoscopy) can be a good alternative for the diagnosis of uterocolon fistula. To the best of our knowledge, this is the first case report on recto-uterine fistula in a patient with long-term use of IUD and uterine didelphys.

OBJECTIVE: To explore the evidence on the impact of extended use of intrauterine devices (IUDs) use among women of reproductive age.
METHODS: Electronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2012 to 2022 were considered.
METHODS: Ten articles met the criteria and included data for a total of 7,420 women.
METHODS: Data were extracted from each study using the subheadings \"Author/Date,\" \"Participants,\" \"Methods,\" \"Interventions,\" and \"Outcomes.\" Additionally, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to guide data extraction.
RESULTS: Common themes were identified among each of the articles that supported the purpose of this integrative review, such as adverse effects, perceived effectiveness, pregnancy prevention, and cost effectiveness of extended use of IUDs.
CONCLUSIONS: The available evidence supports the notion that extending IUD use beyond the original time frame approved by the U.S. Food and Drug Administration is safe and effective with minimal side effects. However, there remains a paucity of evidence examining this topic.