Participants randomized to MICA will receive all core MI elements in the MICA sessions. A key component of any MI-based intervention is for the counselor to support au- tonomy by explicitly stating that it is the participant, not the counselor, who will make decisions regarding behavior change. Counselors will lead the participant in a directed, empathic discussion that includes a review of the Timeline Followback (TLFB) calendar, pregnancy intentions, the pregnancy and STI risk assessment printouts, and Stages of Readiness to Change. The behaviors targeted vary de- pending on the needs of the participant with the overall goal of decreasing the risk for unplanned pregnancies and STIs. For example, some want to focus on decreasing the number of sex partners, some using birth control consist- ently, and others want to see a medical provider to initiate a birth control method. The counselor will support the participant’s decision to make, or consider the possibility of, change. All MICA participants will receive: (1) feedback on personal risks for pregnancy and STIs; (2) clear advice to avoid pregnancy (until it is desired) and STIs that might impact future fertility by either using highly effective con- traceptives and condoms consistently and correctly or staying abstinent; and (3) a review of the menu of options by which to prevent pregnancy and STIs. Detailed educa- tion about contraceptive choices is offered according to the participant’s needs and requests. The session will end with the development of a ‘CARE plan’ in which the par- ticipant lists her goals and methods for reaching her STI and pregnancy prevention goals. A second MICA session will be conducted 3 months after release and include a re- view of the’CARE plan’ as well as elements provided in session one. If a woman chooses no method or decides she wants to become pregnant then preconception coun- seling is offered.
There is a large theoretical literature on the relationships between female education, fertility, and contraceptive use. Generally, the results are consistent with predictions of utility theory, showing that women with more schooling behaved rationally when considering their family sizes by having fewer children. However, there is little empirical study tying together women’s schooling, fertility, and contraceptive use. While advancing the understanding of the determinants of fertility and contraceptive use, previous studies have focused on only a few variables. For example, they have neglected to examine the role of other important factors such as cultural traits in fertility and contraceptive use decisions. According to a study by Castro and Juarez (1994), education can influence women’s reproduction in several ways: by increasing knowledge of fertility, increasing socioeconomic status, and changing attitudes about fertility control. Education may also affect the distribution of authority within households, whereby women may increase their authority with husbands, and affect fertility and use of family planning (Bertrand et al., 1993). This may lead to a demand for fewer children, and consequently, the use of contraceptives to prevent or to space childbirth. Education is closely linked to the use of contraception: more educated women are more likely to use family planning (Kasarda et al., 1986, Robey et al., 1992). Data from the countries where the Demographic and Health Surveys (DHS) have been conducted demonstrate the relationship between education and the use of family planning (Robey et al., 1992).
With this poor contraceptive patronage in Nigeria, we at the Niger Delta University Teaching Hospital, Okolobiri decided to use our antenatal patients to see the degree of contraceptive patronage in the past. To determine the pattern of contraceptive choice before the current pregnancy. We also decided to use our antenatal mothers for this study because the antenatal period offers a great opportunity where women of the reproductive age who at one point in time would likely require a modern contraceptive method are gathered. Information, messages and programmes on family planning can easily be passed on to this group of women during antenatal education programmes.
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All the new clients were women and majority of them (94.4%) were married; this is similar to the findings in other studies [17,18]. The median parity was 3, with majority of the new clients (73.4%) being multiparous (Para 2-4) women. This is also similar to the findings of the above studies, although these studies specifically targeted grand-multiparous women. There was no significant difference on comparism of mean age and median parity of clients by choice of contraceptive method.
It is expected that contraceptive use or uptake would depend on the knowledge of available methods and the will- ingness to use them. Accurate knowledge of use – different from mere awareness of the names of methods – should permit appropriate use of methods. When students were asked to describe how they would use any two methods of contraception, their answers showed a low level of knowledge and understanding of the use modern (artificial) methods. A similar finding has also been documented in previous stud- ies, most of which evaluated knowledge of the timing for the use of emergency contraception among university students. In this study, approximately 34% could correctly describe two modern methods of contraception; however, Aziken et al in Benin, Nigeria found that only 18% of female students understood correctly how to use emergency contraception. 13
A study in Uganda found that integration of family planning into HIV and AIDS services appears to offer a lot of benefits. The benefits reported included an increase in family planning uptake by HIV positive women and reduction of stigma among HIV clients as opposed to free standing contraceptive services (African J Reprod Health. 2010). It also led to improved discussion of sex and fertility desires among between HIV positive women and health care workers who already had an ongoing relationship with clients unlike unfamiliar health facilities where women might fear discrimination (African J Reprod Health. 2010). However integration may also be associated with several challenges like problems of space for storage of additional supplies associated with integration, increased workload which may affect quality of services and stock out of supplies (African J Reprod Health. 2010).
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In present study awareness regarding modern methods of family planning was found to be 85.2%. According to NFHS -4 99% couples know about atleast one modern method of contraception. 5 Ramaiah et al reported it as 81%. 16 Study done by Veena at al stated that 70.1%, 9 while Prateek et al found it 52.2%. 17 More awareness in our study may be due to more involvement of ASHA/AWW/ANM in health education over the years. In our study overall contraceptive use was found to be 70.9% and among them 65% were used modern methods while 5.9% still believed in conventional methods. Among all contraceptive choices tubectomy was the most preferred choice (60.8%) followed by male condom and OCP i.e. 17.8% and 13.5% respectively. According to NFHS-4 similar pattern of preference was seen. 4 The findings are at par with the study of Sulthana et al which stated tubectomy 42.3% and condom 10.5% were most preferred choices. 13 In present study vasectomy was not adopted at all. It shows poor acceptance for vasectomy in rural India. Sulthana et al also reported similar results. 13 According to NFHS-4 vasectomy was the least preferred method. 4
Abstract: Oral contraceptives remain a popular method of contraception over 50 years after their introduction. While safe and effective for many women, the failure rate of oral contraception is about 8%. Concerns about the risk of venous thromboembolism continue to drive the search for the safest oral contraceptive formulations. The oral contraceptive NOMAC-E2 contains nomegestrol acetate (NOMAC) 2.5 mg + 17b-estradiol (E2) 1.5 mg. The approved dosing regi- men is 24 days of active hormone, followed by a 4-day hormone-free interval. NOMAC is a progestin derived from testosterone, which has high bioavailability, rapid absorption, and a long half-life. Estradiol, though it has a lower bioavailability, has been successfully combined with NOMAC in a monophasic oral contraceptive. Two recently published randomized controlled trials demonstrate that NOMAC-E2 is an effective contraceptive, with a Pearl Index less than one pregnancy per 100 woman-years. The bleeding pattern on NOMAC-E2 is characterized by fewer bleeding/spotting days, shorter withdrawal bleeds, and a higher incidence of amenor- rhea than the comparator oral contraceptive containing drospirenone and ethinyl estradiol. The adverse event profile appears to be acceptable. Few severe adverse events were reported in the randomized controlled trials. The most common adverse events were irregular bleeding, acne, and weight gain. Preliminary studies suggest that NOMAC-E2 does not seem to have negative effects on hemostatic and metabolic parameters. While no one oral contraceptive formulation is likely to be the optimum choice for all women, NOMAC-E2 is a formulation with effectiveness comparable with that of other oral contraceptives, and a reassuring safety profile.
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Abstract: The contraceptive vaginal ring (CVR) is a combined hormonal contraceptive method, containing ethinyl estradiol and etonogestrel, that works by inhibiting ovulation. It differs from combined oral contraceptives (COCs) in the route of administration, which is vaginal, and the frequency of administration, which is monthly. The efficacy of the CVR is similar to that of COCs but compliance appears to be better in typical users. The CVR enables appropriate control of the menstrual cycle, with a similar side effect profile to COCs, while achieving good user acceptance. Different studies have established noncontraceptive beneficial effects of the CVR; for example, it can be useful for treating dysmenorrhea or excess menstrual bleeding. Recent epidemiological studies have confirmed that the risk of venous thromboembolism with the CVR is similar to that of COCs, including COCs that contain levonorgestrel.
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with either tailored reading material or generic reading material. The contraceptive counseling module consisted of 50 questions covering contraceptive history, prefer- ences, priorities, and medical and sexual health. Those who were allocated to receive generic reading material only answered ten sociodemographic questions using a touchscreen interface, similar to the intervention groups. Results of this study indicate that the participants who uti- lized the contraceptive module were more likely to choose an effective form of contraception. Also, module users who received tailored reading material were more likely to adhere to their method of choice and have continued its use at 4 months follow-up.
Changes in the probability of conception occurring outside of marriage explain part of the trend in illegitimacy. Even with absolutely no changes in the choices faced after such a preg- nancy, the probability of having a birth outside of marriage would have risen significantly. Over the sample period being considered, a woman was on average around 0.9 percentage points more likely to be unmarried when she became pregnant for the first time than a woman born the previous year, even after controlling for age at pregnancy and personal characteristics. This trend is accompanied by increases in the rate of modern contraceptive use, which is also higher for later cohorts. Increases in the probability of engaging in premarital sexual intercourse might account for this increase, as well as changes in the relative cost of single motherhood that could have made this choice more attractive for women. Nevertheless, the probability of being single at first birth increased at a significantly faster rate. On average, a woman was 1.4 percentage points more likely to be single when she became a mother than a comparable woman born a year earlier. Therefore, this trend is also driven by changes in the choices taken after the pregnancy occurred.
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nationally in the 2007 Demographic and Health Survey (DHS) ; only half were able to do so in 2010. Modern contraceptive prevalence in 2008 in Kasongo (3.1%) was similar to that found in rural DRC (3.3%) in the 2007 DHS. While contraceptive use remained low overall, prevalence nevertheless doubled from 2008 levels. The contraceptive prevalence of 5.9% found in this study was higher than the 3.6% found in rural areas of DRC in the 2010 MICS survey , as was the LAPM prevalence (1.7% versus 1.0%). We believe that the CARE program was the source of contraceptive method for most respondents who reported current use in 2010 as all except some condom users reported a public health facility as their source. This program supported contraceptive services at all of the public health facilities in the health zone; the 2010 facility assessments con- firmed that contraceptive methods were available at all of these facilities; increasing numbers of clients accepted a method at these facilities during this time period. In addition, interviews with the MOH Health Zone Medical Officer indicated that no private facilities provided contraceptive methods, aside from condoms, in Kasongo at the time. Our results suggest that demand for contra- ception, including long-acting methods, is present even Table 2 Reported knowledge and use of modern contraceptive methods in 2008 and 2010
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Perceptions about contraceptive use are influenced by information adolescents receive from the family, school and the media . However, a lot of sexually-related information has been found to be inaccurate, ambiguous and sometimes misleading; this has a negative impact on sexual behaviour . In addition, there is no clear guidance on the method or language to use when discussing sexuality issues with adolescents, leaving messages passed, to individual interpretations . Sexually explicit content that is without pregnancy prevention messages has also been found to foster negative attitudes and beliefs about unprotected sex among adolescents . Sex decisions among adolescents are derived from insufficient knowledge. For example, in studies carried out in Bangladesh and Nigeria, adolescent females believed that they could not get pregnant if they washed their geni- talia or jumped up and down after intercourse  . To respond to the challenges of the effects of perceptions on contraceptive use, it is important to understand the content of the messages/information on sexual matters and contraception that the adolescents receive while at school and at home through their teachers, fellow students, parents and other family members.
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Background: The extended postpartum period is a one year period after delivery which is critical for women to prevent unintended pregnancy and to reduce the risk of maternal and child mortality by ensuring safe birth intervals. Studies indicate that birth intervals of three to five years reduce maternal mortality and provide health benefits to newborn babies, infants, and children. As a result, assessing postpartum contraceptive use and its determinants are an increasingly important component of global health. The objectives of the study were to determine postpartum contraceptive use and identify the variables which affect postpartum contraceptive use among women of Dabat district.
Beyond the use of the most current data, this analysis differs from earlier analyses of Guatemala’s contraceptive dynamics through the use of classification modeling techniques. Classification trees are a non-parametric technique designed to sort data in terms of the dependent variable into mutually exclusive categories based on the effective categorization of the independent variables. Trees have been used in public health research to identify at-risk populations and are valued for their ability to capture conditional relationships (to “describe associations in the data” (Lemon et al. 2003)) rather than to test the significance of variables on the response (see Lemon et al. 2003) for a detailed list of instances where trees have been used). Despite extensive analyses of family planning correlates, however, trees have not been applied in contraceptive use analyses and the utility of these models in family planning research is unexplored. In reference to Guatemala, where there is a long history of family planning research and yet a persistently low rate of contraceptive use, tree models may identify at-risk populations not captured by traditional regression techniques. The results may therefore help to provide researchers and policy makers with more nuanced information on the specific Guatemalan sub-groups at greatest need for the limited family planning resources. Tree models of use versus non-use and intention versus no-intention among Guatemalan women using the most recently collected country-level data will be constructed.
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youth friendly service programs - the prior studies suggest that a lack of community support for adolescents accessing and using contraceptive services may be the biggest factor in preventing adolescents from accessing contracep- tion [24, 25]. Therefore, a multifaceted approach - that targets community-level norms, not just the clinic and providers, will potentially have the most positive effects on adolescents’ unhindered access to contraceptives. Other studies have found effects of training of providers on knowledge, understanding of adolescent barriers to ac- cess, and some health provider attitudes toward provision of contraceptives to adolescents; however, even after ado- lescent targeted training, providers in one study remained reluctant to provide methods to adolescents based on age and parity factors .
This study relies on three reproductive health service provider surveys collected from January 2011- July 2011 in the following six Nigerian cities: Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria. In all public and private health facilities included, a provider survey was undertaken with doctors, nurse/midwives, and community health extension workers (CHEW). CHEWs are health workers with limited, and specific training on basic family planning services. All contraceptive methods are available at most health facilities. A separ- ate provider survey was conducted among pharmacists. Pharmacists can provide condoms, EC, pills, and inject- ables. The third provider survey was with patent med- ical vendors (PMV) – who can only provide over the counter medications: condoms, emergency contracep- tion (EC), and pill refills.
The same pattern is shown by pill use, which had increased sharply from 3 percent in 1984 to almost 10 percent in 1993, but dropped slightly in 1998. Injectables have recorded the most dramatic and consistent increase over the years, from less then 1 percent in 1984 to 12 percent in 1998. The use of barrier methods has shown a general increase over the years but the levels are still relatively low, with just about 1 percent of married women reporting use of these methods. The trend in the use of traditional methods has not been consistent over the years, sho wing the highest level of 9 percent in 1989, and the lowest level of 6 percent in 1993. These method- specific trends mean that the method mix in Kenya has shifted from one in which almost half of all contraceptive use was use of traditional methods and modern method use was fairly evenly divided between sterilization, pills, and IUDs to one in which hormonal methods, particularly injectables, dominate.
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Combined hormonal contraceptive oral pills (CHC) are the combination of oestrogen and progesterone. The oestrogen is essentially ethinyl oestradiol (EE). The first formulation in 1960 has 150 µg de mestranol . The EE strength in the year 1960 was 50 microgram but now it is 35 to 20 microgram. The progesterone had varied from time to time. The first generation was Norethisterone, norethisterone acetate, 2 nd generation was Levonorgestrel, 3 rd generation Desogestrel, gestodene, norgestimate and the 4 th generation is Drospirenone, dienogest, nomegestrol acetate.
In multicentre male hormonal trials, it was noted that Asian men respond to exogenous androgens with or without progestogens with more suppression of spermatogenesis than non-Asians 86 . Postulated explanations for this have been a more sensitive hypothalamo-pituitary axis, lower testis volume or higher basal apoptotic rate of germ cells in Asian men. Therefore, it is likely that an ethnic or geographical variation exists in the testicular responsiveness to gonadotrophin suppression by exogenous androgens and/or progestogens. Androgen alone contraceptive regimens may be feasible and effective in Asian men, but not in non- Asian men.
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