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Introduction Despite evidence that the unintended pregnancy rate is higher among U.S. servicewomen than the general population and that servicewomen may face barriers to contraceptive use, there is little research about contraceptive access and use experiences of non-deployed active duty servicewomen. This qualitative study aimed to explore the experiences of accessing contraception while in the U.S. military among active duty servicewomen who had an abortion. Materials and methods From January 2015 to July 2016, we conducted qualitative in-depth interviews with 21 servicewomen who had obtained an abortion within the prior two years while active duty. The interviews included questions about participants' experiences accessing and using contraception while in the military. Interviews were transcribed and analyzed thematically using inductive and deductive coding. Ethical approval was obtained from the Allendale Investigational Review Board. Results Over half of the respondents had ever obtained contraception from the military and had positive feelings about the military's contraceptive services; however, the vast majority of participants described barriers to contraceptive access in the military. Many identified barriers that were related to the military health care system, including inadequate counseling, challenges getting a preferred contraceptive method, and the structure and functioning of the military health system, or were a result of the demands of military service. In addition to these factors that were directly related to being in the military, respondents identified barriers not directly related to service, including contraceptive adherence, product concerns, and side effects; although not directly related to their service, in some cases, these barriers were exacerbated by their career. Conclusions Active duty servicewomen who had an abortion experienced many barriers to accessing contraception while in the military. These findings highlight the need to improve contraceptive counseling and access in the U.S. military. Results support the need to implement mandatory yearly and pre-deployment contraceptive counseling as required by the 2016 National Defense Authorization Act, offer contraceptive counseling in multiple settings, ensure military providers receive training to avoid contraceptive coercion, expand military clinic and pharmacy hours, increase the number of female military health care providers and providers able to administer all forms of contraception, and expand the contraceptive methods included under the Basic Core Formulary. Limitations to this study include that participants were self-selected and were asked to recall experiences up to several years in the past. Future studies should evaluate representative samples to understand the proportion of servicewomen with unmet contraceptive need.

Objective The objective was to investigate public funding policies for abortion in countries with liberal or liberally interpreted laws (defined as permitting abortion for economic or social reasons or upon request). Study design In May 2011–February 2012 and June 2013–December 2014, we researched online resources and conducted an email-based survey among reproductive health experts to determine countries' public funding policies for abortion. We categorized countries as follows: full funding for abortion (provided for free at government facilities, covered under state-funded health insurance); partial funding (partially covered by the government, covered for certain populations based on income or nonincome criteria, or less expensive in public facilities); funding for exceptional cases (rape/incest/fetal impairment, health/life of the woman or other limited cases) and no public funding. Results We obtained data for all 80 countries meeting inclusion criteria. Among the world's female population aged 15–49 in countries with liberal/liberally interpreted abortion laws, 46% lived in countries with full funding for abortion (34 countries), 41% lived in countries with partial funding (25 countries), and 13% lived in countries with no funding or funding for exceptional cases only (21 countries). Thirty-one of 40 high-income countries provided full funding for abortion ( n =20) or partial funding ( n =11); 28 of 40 low- to middle-income countries provided full ( n =14) or partial funding for abortion ( n =14). Of those countries that did not provide public funding for abortion, most provided full coverage of maternity care. Conclusion Nearly half of countries with liberal/liberally interpreted abortion laws had public funding for abortion, including most countries that liberalized their abortion law in the past 20 years. Outliers remain, however, including among developed countries where access to abortion may be limited due to affordability. Implications Since cost of services affects access, country policies regarding public funding for services should be monitored, and advocacy should prioritize ensuring the affordability of care for low-income women.

Young people in Ghana, like young people globally, need access to information and services to have safe, healthy sexual and reproductive lives. Young people in Ghana, though, face a number of challenges accessing the sexual and reproductive health information and services they need, as evidenced by high levels of unmet need for family planning, early pregnancy and childbirth, and unsafe abortion. This project aims to explore the internal and external determinants of contraception use and use of services that address early/teen pregnancy, unintended pregnancy, and unsafe abortion among youth in Accra. To do this, we plan to perform a cross-sectional survey with 250 sexually active females and 100 sexually active males aged 18-24 years living in Accra-Tema. If we are able to secure additional funding, we also plan to perform four focus group discussions (8-12 participants each) with sexually active females aged 18-24 years on determinants of reproductive health care utilization so as to get a more nuanced understanding of these issues and the survey findings. Participants of both study components will be recruited from 1-2 low- and middle-income communities in Accra-Tema. The findings of this study will help service providers to tailor programs to better meet the needs of young people in urban Ghana. This project is being conducted by Ibis Reproductive Health, the University of Ghana School of Public Health, and Marie Stopes International/Marie Stopes International Ghana (MSI/MSIG).

Background Since the prescription requirement for oral contraceptives (OCs) can act as a barrier for some women, over-the-counter (OTC) access may improve uptake and continuation. The goal of this study was to ascertain the prescription requirements and informal OTC availability of OCs worldwide. Study Design From April 2011 to September 2012, we researched official documentation and conducted an online survey with government officials and pharmaceutical and reproductive health specialists on OC availability in countries worldwide. Results were compiled in a database and entered into a map for analysis of regional patterns. Results Data were obtained for 147 countries. OCs were informally available without prescription in 38% of countries, legally available without prescription (no screening by a health professional required) in 24% of countries, legally available without prescription (screening required) in 8% of countries and available only by prescription in 31% of countries. Notable regional patterns in OC prescription requirements emerged. Conclusions OCs are available without prescription in the majority of countries. Country experiences with OTC provision may provide evidence about the safety and effectiveness of OTC provision as a strategy to improve access to effective family planning.

Servicewomen's reproductive health experiences during deployment are important given that the majority of women in the U.S. military are of reproductive age and that this population experiences a disproportionately high rate of unintended pregnancy. Few studies have explored women's reproductive health experiences and their perceived barriers and facilitators to health care access during deployment. From May 2011 to January 2012, we conducted 22 in-depth interviews with women in the U.S. military about their reproductive health experiences during deployment, including their access to health services. Participants identified a range of barriers to accessing medical care in deployment settings, including confidentiality concerns, lack of female providers, and health-seeking stigma, which were reported to disproportionately impact reproductive health access. Some participants experienced challenges obtaining contraceptive refills and specific contraceptive methods during deployment, and only a few participants received predeployment counseling on contraception, despite interest in both menstruation suppression and pregnancy prevention. These findings highlight several policy and practice changes that could be implemented to increase contraceptive access and reduce unintended pregnancy during deployment, including mandated screening for servicewomen's contraceptive needs before operational duty and at least annually, and increasing the number of female providers in deployed settings.

Little is known about the impact of contraceptive stockouts on women and health care providers, or how policymakers perceive and handle such stockouts.In May-July 2015, a qualitative study on experiences of contraceptive stockouts was conducted in two districts of Uganda. It comprised three data collection components: eight focus groups with 50 women, 24 individual in-depth interviews with family planning service providers and facility managers, and 11 in-depth interviews with district-level policymakers and decision makers. Data analysis followed the content analysis approach.Contraceptive stockouts were common, particularly for long-term methods and oral contraceptives. For women, the consequences included stress, increased costs, domestic conflict, and unwanted or unplanned pregnancies. Providers reported emotional distress, blame from clients, deterioration of skills and lower demand for their services as a result of stockouts; they also felt unable to address stockouts under current supply systems. Despite the widespread prevalence and adverse impact of stockouts, policymakers reported being unaware of the scope of the problem.The findings suggest there is a critical need to raise awareness of the issue, reduce stockouts and mitigate their negative consequences. Efforts to eliminate stockouts should include addressing supply chain issues. Raising community awareness and engaging with men on family planning may be ways to deal with the consequences of stockouts.RESUMEN Contexto: Se sabe poco acerca del impacto que los desabastecimientos de anticonceptivos tienen sobre las mujeres y los proveedores de servicios de salud, o sobre cómo los encargados de formular políticas perciben y manejan esos desabastecimientos. Métodos: Entre mayo y junio de 2015, se condujo en dos distritos de Uganda un estudio cualitativo sobre experiencias de desabastecimientos de anticonceptivos. El estudio contó con tres componentes para la recolección de datos: ocho grupos focales con 50 mujeres, 24 entrevistas individuales en profundidad con proveedores de servicios de planificación familiar y gerentes de instituciones de salud, y 11 entrevistas en profundidad con encargados de formular políticas y tomadores de decisiones a nivel distrital. El análisis de los datos se basó en el enfoque de análisis de contenidos. Resultados: Los desabastecimientos de anticonceptivos fueron comunes, especialmente en el caso de métodos de larga duración y anticonceptivos orales. Las consecuencias para las mujeres incluyeron estrés, costos más altos, conflictos domésticos y embarazos no deseados o no planeados. Los proveedores reportaron consternación emocional, reproches por parte de usuarios, deterioro de habilidades y menor demanda de sus servicios como resultado de los desabastecimientos; también sintieron incapacidad para hacer frente a los desabastecimientos bajo los actuales sistemas de suministro. A pesar de la prevalencia generalizada y el impacto adverso de los desabastecimientos, los encargados de formular políticas reportaron no estar al tanto del alcance del problema. Conclusiones: Los hallazgos sugieren que hay una necesidad muy importante de aumentar la conciencia acerca de los desabastecimientos, reducir su ocurrencia y mitigar sus consecuencias negativas. Los esfuerzos para eliminar los desabastecimientos deben incluir el abordaje de problemas relacionados con la cadena de suministros. Aumentar la conciencia de la comunidad e involucrar a los hombres en temas de planificación familiar pueden ser formas de lidiar con las consecuencias de los desabastecimientos.RÉSUMÉ Contexte: L'impact des ruptures de stocks de contraceptifs sur les femmes et les prestataires de soins de santé n'est guère documenté, pas plus que la manière dont les décideurs politiques perçoivent et traitent la situation. Méthodes: En mai-juillet 2015, une étude qualitative de l'expérience de ruptures de stocks de contraceptifs a été menée dans deux districts d'Ouganda. Trois composants de collecte de données ont été considérés: huit groupes de discussion avec 50 femmes, 24 entretiens individuels en profondeur avec des prestataires de services de planification familiale et responsables de structure et 11 entretiens en profondeur avec des responsables politiques et décideurs au niveau du district. L'analyse des données a procédé selon l'approche de l'analyse de contenu. Résultats: Les ruptures de stocks de contraceptifs se sont révélées courantes, en particulier pour les méthodes longue durées et la contraception orale. Pour les femmes, les conséquences en sont le stress, les coûts accrus, le conflit conjugal et les grossesses non désirées ou non planifiées. Les prestataires font état de détresse émotionnelle, reproches des clientes, détérioration des compétences et réduction de la demande de leurs services; ils estiment aussi ne pas pouvoir résoudre la situation dans le cadre des systèmes d'approvisionnement actuels. Malgré la prévalence généralisée et l'impact négatif des ruptures de stocks, les responsables politiques ignorent l'ampleur du problème.Les résultats laissent entendre un besoin critique de sensibilisation à la réalité des ruptures de stocks, de réduction de leur incidence et d'atténuation de leurs conséquences négatives. Les efforts d'élimination des ruptures de stocks doivent prévoir la résolution des problèmes de la chaîne d'approvisionnement. La sensibilisation communautaire et l'engagement des hommes sur les questions de la planification familiale pourraient aider à mieux gérer les conséquences des ruptures de stocks.