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Background: Induced abortion can seriously harm the physical and mental health of adolescent women. long-acting reversible contraception (LARC) can effectively reduce unplanned pregnancies and prevent repeated abortions among adolescents. This study aimed to analyse the factors affecting the choice of LARC among adolescents in Chongqing of China. Methods: A total of 555 adolescents who underwent induced abortions for unplanned pregnancies between January 2019 and October 2021 were selected as study subjects. Logistic regression analysis was used to determine the factors affecting adolescent LARC choices following induced abortions. Results: The factors that affected adolescent LARC choices included an average monthly income ≥ ¥3000 (OR = 3.432, 95% CI: 1.429~8.244), history of previous abortions (OR = 3.141, 95% CI: 1.632~6.045), worrying about unplanned pregnancy (OR = 0.365, 95% CI: 0.180~0.740), parental support for using LARC (OR = 3.549, 95% CI: 1.607~7.839), sexual partners' support for using LARC (OR = 2.349, 95% CI: 1.068~5.167), concerns about using LARC (OR = 0.362, 95% CI: 0.176~0.745), and willingness to use free IUDs (OR = 13.582, 95% CI: 7.173~25.717). Conclusion: Cost is one of the factors affecting LARC choices. Parents and sexual partners may play important role in the choice of LARC. [ABSTRACT FROM AUTHOR]

Introduction: Unwanted pregnancy constitutes a huge health issue. Long‐acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women. Material and Methods: This is a secondary analysis of women aged 18–25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow‐ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18–25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357). Results: From September 2017 to May 2019, 770 women aged 18–25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25–10.94), initiation (aOR 4.43, 95% CI 2.32–8.46), and use at 12 months (aOR 2.21, 95% CI 1.31–3.73). The odds of LARC choice at pre‐booked visits were higher and more women received information about extended‐use regimen for short‐acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre‐booked compared to drop‐in visits. Conclusions: Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre‐booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimDesign and settingMethodsResultsConclusion\nSHORT CONDENSATIONIn the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited.The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation.Retrospective cohort study utilising data from a Dutch primary care research network.We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions.We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation.The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.Despite their effectiveness premature discontiunuation rates of LARC are high, especially for subdermal implants. The most mentioned reason for discontinuation is alternation in bleeding partern. Better couneling by general practitioners and research into the underlying disturbed endometrial mechanism have to be done. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions This study aimed to describe the use of etonogestrel (ENG) implants for menstrual management (i.e., management of bleeding and symptoms associated with menstruation) in individuals with intellectual disabilities.This study retrospectively analyzed a cohort of individuals with intellectual disabilities who began using ENG implants between 2003 and 2018, in Joinville, Brazil. We collected sociodemographic, clinical, and reproductive data from the medical records, along with information related to ENG implant use.In total, 369 implants were placed in 130 individuals with intellectual disabilities. The median age at the first implant was 20 (interquartile range [IQR], 17–26) years, and 43.8% of the patients were adolescents. By December 2018, 90 patients had received two or more subsequent implants. The median duration of current ENG implant use was 19 (IQR, 12.8–22) months. More than 40% of the patients had comorbidities, with epilepsy being the most common. During the use of the current implant, 80% of the patients had a favorable bleeding profile (no bleeding or ≤1 bleeding episode per month), and 53.8% (70/130) had no bleeding within 3 months before their last medical visit. Among patients experiencing dysmenorrhea and premenstrual syndrome (PMS), 79% (64/81) and 82% (54/66) reported complete improvement, respectively. The premature implant removal rate was 8.9% (33/369). Unfavorable bleeding was the main reason for premature implant removal (20 out 33 removals).ENG implants might be a suitable option for individuals with intellectual disabilities who require management of menstrual bleeding and symptoms associated with menstruation. Most patients had a favorable bleeding profile and experienced significant improvements in dysmenorrhea and PMS, contributing to the high continuation rates of ENG implants. [ABSTRACT FROM AUTHOR]

Objective This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV). Study Design A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020. Results Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan. Conclusion Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV. Key Points Contraceptive use among PWHIV is poorly understood. Having insurance and increased parity are associated with long-acting reversible contraception use. Earlier GA at first prenatal care visit is associated with increased PPBC uptake. [ABSTRACT FROM AUTHOR]

Multiparous teens, compared to primiparous teens, are at increased risk for adverse neonatal and maternal outcomes. Long-acting reversible contraception (LARC) is infrequently used among postpartum teens. This study identifies predictors of teens' intentions to use LARC postpartum when it is widely available. Colorado teens who were patients during their pregnancy in an adolescent-centered clinic where all common methods of contraception were easily accessible were surveyed in clinic during their third trimester and following delivery regarding life circumstances (relationships, stress, and family function) and intended method of postpartum contraception. Multinomial logistic regression analyses were used to examine predictors of intended postpartum contraceptive method: LARC, non-LARC effective (condoms, birth control pills, shot, patch, or ring), or low-effective method or no contraception (abstinence, no method, or undecided). A total of 1203 patients were enrolled. Greater life stress was associated with greater likelihood of intending to use low-effective contraception versus LARC postpartum. Teens in a longer relationship with their baby's father (versus those never in a relationship with the baby's father) were less likely to intend to use low-effective contraception or non-LARC effective methods and more likely to intend to use LARC postpartum. When structural barriers are minimized, non-clinical factors such as relationship context and life stress are most associated with postpartum LARC use intentions. Health care providers can help teen patients obtain the postpartum contraception the patients believe is best by employing developmentally appropriate, person-centered care that is sensitive to life stressors and relationship context. [ABSTRACT FROM AUTHOR]

Background: Consistent use of effective contraceptives is directly associated with a lower risk of unintended pregnancies, a significant public health burden in the U.S. The Asian American population is heterogeneous and fast-growing. However, patterns and disparities in contraceptive use among Asian American women, particularly within racial/ethnic subgroups, have been understudied, hindering effective family planning. Objectives: This study aimed to identify the prevalence of contraceptive use and its pattern in Asian American women using the 2015–2016 California Health and Interview Survey (CHIS) data, with a focus on different Asian ethnic subgroups. Study Design: A composite score of acculturation level (0–5) was created based on place of birth, years in the U.S., and language spoken at home. Data on demographics, self-rated health, contraceptive use, and related information were collected from women aged 18–44 years who were at risk of unintended pregnancy. Adjusted multivariable logistic regressions were conducted to examine contraceptive use and patterns in relation to race/ethnicity and other factors. Results: Over 18.20% of the overall sample (pop estimated N = 16,177,759) were Asian Americans, and among them, 24.62% were Chinese, followed by other Asian subgroups (28.83%), Filipina (25.49%), Korean (11.25%), and Vietnamese (9.80%). Overall, Filipina, Korean, and Vietnamese women were less likely to use contraception compared to their non-Hispanic White (NHW) peers, whereas acculturation level was positively associated with contraceptive use. Among different types of contraceptives, Filipina, Korean, and Vietnamese women were less likely to use long-acting reversible contraceptives compared to NHW. Such racial/ethnic disparities were not observed with less or moderately effective contraceptives. Conclusions: Patterns of contraceptive use and associated disparities varied among Asian American subgroups. Providers working with Asian American women should be aware of these racial disparities in contraceptive use and seek ways to address barriers to effective contraception use in this diverse population in order to provide culturally competent family planning services.

Objective Methods Results Conclusion To assess the impact of an educational video on immediate postpartum contraceptive implant utilization.This was a randomized controlled study conducted in a university hospital. Postpartum women aged over 18 years were recruited and divided into two groups: the intervention group, which viewed a 7‐min educational video about contraceptive implants; and the control group, which did not. We evaluated the uptake of contraceptive implants immediately and during a 12‐week period postpartum, in addition to the reasons for not selecting this method.A total of 202 participants were included in the study, 101 in each group. Viewing the educational video was associated with higher immediate postpartum contraceptive implant usage (22.77% vs 10.89%; relative risk [RR] 2.09, 95% confidence interval [CI] 1.08–4.06). However, no significant difference was observed at the postpartum follow‐up visit (29.9% vs 25.74%; RR 1.61, 95% CI 0.74–1.82). The primary reasons for not selecting contraceptive implants were concerns about potential side effects and discomfort associated with the insertion procedure.The inclusion of an animated educational video significantly improved immediate postpartum contraceptive implant uptake, making it a potentially viable strategy in settings with high rates of loss to follow‐up. However, further research into how to address patients' fears regarding the implant is required. [ABSTRACT FROM AUTHOR]

Background: Consistent use of effective contraceptives is directly associated with a lower risk of unintended pregnancies, a significant public health burden in the U.S. The Asian American population is heterogeneous and fast-growing. However, patterns and disparities in contraceptive use among Asian American women, particularly within racial/ethnic subgroups, have been understudied, hindering effective family planning. Objectives: This study aimed to identify the prevalence of contraceptive use and its pattern in Asian American women using the 2015–2016 California Health and Interview Survey (CHIS) data, with a focus on different Asian ethnic subgroups. Study Design: A composite score of acculturation level (0–5) was created based on place of birth, years in the U.S., and language spoken at home. Data on demographics, self-rated health, contraceptive use, and related information were collected from women aged 18–44 years who were at risk of unintended pregnancy. Adjusted multivariable logistic regressions were conducted to examine contraceptive use and patterns in relation to race/ethnicity and other factors. Results: Over 18.20% of the overall sample (pop estimated N = 16,177,759) were Asian Americans, and among them, 24.62% were Chinese, followed by other Asian subgroups (28.83%), Filipina (25.49%), Korean (11.25%), and Vietnamese (9.80%). Overall, Filipina, Korean, and Vietnamese women were less likely to use contraception compared to their non-Hispanic White (NHW) peers, whereas acculturation level was positively associated with contraceptive use. Among different types of contraceptives, Filipina, Korean, and Vietnamese women were less likely to use long-acting reversible contraceptives compared to NHW. Such racial/ethnic disparities were not observed with less or moderately effective contraceptives. Conclusions: Patterns of contraceptive use and associated disparities varied among Asian American subgroups. Providers working with Asian American women should be aware of these racial disparities in contraceptive use and seek ways to address barriers to effective contraception use in this diverse population in order to provide culturally competent family planning services. [ABSTRACT FROM AUTHOR]

Introduction: The Norwegian Government introduced in 2002 a reimbursement scheme for hormonal contraceptives to adolescents at the same time as public health nurses and midwives received authorization to prescribe hormonal contraceptives. This study examines the impact of increased accessibility and public funding on hormonal contraceptive use among adolescents. Material and Methods: The Norwegian Prescription Database, Statistics Norway, and Norwegian Institute of Public Health served as data sources for this cohort study. The study population comprised 174 653 Norwegian women born 1989–1990, 1994–1995, and 1999–2000. We examined use of hormonal contraceptives through dispensed prescriptions from age 12 through age 19 with duration of first continuous use as primary outcome. The statistical analyses were done in SPSS using chi‐squared test, survival analysis, and Joinpoint regression analysis with p‐values < 0.05. Results: By age 19, ~75% of the cohorts had used at least one hormonal method. The main providers of the first prescription were general practitioners and public health nurses. Starters of progestogen‐only pills (POPs) have increased across the cohorts, while starters of combined oral contraceptives (COCs) have decreased. The use of long‐acting reversible contraceptives (LARCs) has increased since its inclusion in the reimbursement scheme (2015). Most switchers shifted from COCs or POPs as a start method to implants after LARCs became part of the reimbursement scheme. There has been a significant increase across the cohorts in the number of women who continuously used hormonal contraceptives from start to the end of the calendar year they became 19 years with the same method and after switching methods. We could not correlate changes in decreasing trends for teenage births or induced abortions (Joinpoint analysis) to time for implementation or changes in the reimbursement of hormonal contraceptives from 2002. Conclusions: Primarily public health nurses and to a lesser extent midwives became soon after they received authorization to prescribe COCs important providers. The expansion of the reimbursement scheme to cover POPs, patches, vaginal ring, and depot medroxyprogesterone acetate in 2006 had minor impact on increasing the proportion of long‐term first‐time users. However, the inclusion of LARCs in 2015 significantly increased the proportion of long‐term first‐time hormonal contraceptive users. [ABSTRACT FROM AUTHOR]

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Telemedicine for long-acting reversible contraception (LARC) care is understudied given the rapid implementation of these services in response to the COVID-19 pandemic. We compared outcomes over 1 year of adolescents and young adults (AYAs) attending a LARC post-insertion visit via telemedicine vs in person. Longitudinal cohort study. Four academic adolescent medicine clinics in the United States. AYAs (ages 13-26 years) who received LARC between 4/1/20 and 3/1/21 and attended a post-insertion visit within 12 weeks. none. Outcomes over 1 year were compared between AYAs who completed this visit via telemedicine vs in person. We analyzed the data using descriptive statistics, bivariate analyses, and regression models. Of 194 AYAs (ages 13.9-25.7 years) attending a post-insertion visit, 40.2% utilized telemedicine. Menstrual management (odds ratio (OR) = 1.02; confidence interval (CI): 0.40-2.60), acne management (P =.28), number of visits attended (relative risk (RR) = 1.08; CI: 0.99-1.19), and LARC removal (P =.95) were similar between groups. AYAs attending via telemedicine were less likely than those attending in person to have STI testing (P =.001). Intrauterine device expulsion or malposition and arm symptoms with implant in situ were rare outcomes in both groups. Roughly 40% of AYAs attended a post-insertion visit via telemedicine during the first year of the COVID-19 pandemic and had similar 1-year outcomes as those attending in person. The decreased likelihood of STI testing for those using telemedicine highlights the need to provide alternative options, when indicated, such as asynchronous or home testing. Our results support the use of telemedicine for AYA LARC post-insertion care and identify potential gaps in telemedicine care which can help improve clinic protocols. [ABSTRACT FROM AUTHOR]

To assess the relationship between knowledge of long-acting reversible contraception (LARC) and intention to use LARC among female students. Participants consisted of a convenience sample of 292 female undergraduate and graduate students at a large midwestern university. We conducted a cross-sectional in-person survey and multivariate analysis of LARC knowledge and intention to use LARC. Total response rate was 84.9%. Among contraceptive users, 13.3% were using a LARC method. On average, respondents scored 4.8/10 (SD 2.5) on a 10-item LARC knowledge assessment. Higher levels of LARC knowledge were associated with the intent to use LARC in the future in our multivariate analysis (RR 1.7, 95% CI 1.14–2.54: p =.01). Common reasons for LARC hesitancy were a need for more information, safety concerns, and risk of undesirable side effects. Low LARC knowledge and students' self-identified need for further LARC information represent an opportunity for campus contraceptive interventions which empower students to make informed reproductive decisions. [ABSTRACT FROM AUTHOR]

Issue Addressed: The internet is an important source of health information, however, the quality of information about long‐acting reversible contraception (LARC, including intrauterine devices (IUDs) and contraceptive implants) found online is largely unknown. Methods: A scoping review of webpages returned in a Google search was conducted. The first three pages of results were included if they were written in English and contained information about LARC. Results were critically reviewed and assessed using the DISCERN quality of health information tool. Results: Of 778 results, 306 pages met the eligibility criteria. While most webpages provided key information about LARC, including location in the body, benefits, side effects and risks, the information provided varied considerably. Only half mentioned efficacy and many webpages did not provide information about the cost of insertion and removal, how and where to access the devices or how they work. Despite side effects being mentioned in more than three‐quarters of webpages, the depth and specificity of these varied considerably and were often contradictory across different webpages. Conclusions: Most webpages provided medically accurate information to consumers; however, many did not include key information such as cost or how they work. Descriptions of side effects varied between webpages, and this may inhibit informed decision‐making. So What?: Most people make decisions about what contraceptive method they might like to use before visiting a health care provider, and most will get this information from the internet. Providing comprehensive, medically accurate and consistent information about both IUDs and contraceptive implants is vital to support informed decision‐making. [ABSTRACT FROM AUTHOR]

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice. [ABSTRACT FROM AUTHOR]

Background: The use of progestin‐only long‐acting reversible contraception (LARC) may be a risk factor for acne. Few studies have focused primarily on the effects of hormonal LARC on the development or exacerbation of acne in adolescents and young adults. We sought to understand the incidence and management of acne following hormonal LARC insertion in this adolescent/young adult population. Methods: A secondary data analysis was conducted of prospectively collected quality improvement (QI) data from the Adolescent Medicine LARC Collaborative. Subjects were evaluated by clinicians in adolescent medicine clinics at participating study sites, and acne severity was documented using a standardized recording instrument and scale. Descriptive statistics were reported as frequencies and percentages for categorical variables or mean and standard deviation (SD) for continuous variables. We compared demographic and clinical characteristics by those who had worsening acne, accounting for site inter‐correlation using Cochran–Mantel–Haenszel chi‐square tests for categorical variables and linear generalized estimating equation (GEE) regression for continuous variables. Results: Of 1319 subjects who completed LARC insertion, 28.5% (376/1319) experienced worsening acne following use of progestin‐only LARC. Acne was a contributing factor to LARC removal in only 3% (40/1319), and the sole reason for removal in 0.4% (5/1319) of all subjects. As this was a secondary analysis of prospectively collected QI data, limitations of this study include incomplete or inaccurate documentation of acne severity. Moreover, LARC insertions without follow‐up/removal visits or with only follow‐up/removal within 8 weeks of insertion were excluded from our study, which may also bias results. Conclusions: Adolescents and young adults seeking progestin‐only LARC should be counseled about the potential for developing acne or experiencing a worsening of existing acne during LARC use. However, acne was not a common reason for LARC discontinuation. [ABSTRACT FROM AUTHOR]

Abstract Background The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant. Methods Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively. Results We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators. Conclusions There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years.

Background: The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant. Methods: Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively. Results: We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators. Conclusions: There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years. [ABSTRACT FROM AUTHOR]

Objective: In Italy the percentage of repeated abortions is about 24%. Long-acting reversible contraceptive (LARC) methods are currently considered the most effective mode worldwide and are associated with the highest rate of 12-months continuation, with a potential reported reduction of recurrent abortions. The aim of this study was evaluating LARC continuation and the patients' satisfaction at two and twelve months in use. Materials and methods: A longitudinal observational study collected women who underwent surgical abortion and placed a LARC method at the time of abortion in our hospital. Results: Totally 828 women underwent surgical abortion during the study period from which 434 choose a LARC method. After two months the rate of continuation of 52mg LNG IUD was 100% in women presenting for follow-up. Continuation rate at one year was approximately 70% for all LARC methods. More than 70% of women declared themselves satisfied or very satisfied with all LARC methods. Conclusion: Despite a high rate of patient loss at follow-up, LARC methods showed a high rate of continuation at two and twelve months, with a high degree of patients' satisfaction. [ABSTRACT FROM AUTHOR]

Background: Due to high rates of unintended pregnancies in Delaware, the state launched a public health initiative in 2014 to increase access to contraceptive services. Objectives: This study was designed to assess the practice-level barriers and facilitators to providing contraceptive care, particularly long-acting reversible contraceptives (LARCs), to adolescents in primary care settings. Design: This qualitative study was part of a larger process evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. Methods: In-depth, semi-structured qualitative interviews were conducted with 16 practice administrators at 13 adolescent-serving primary care sites across the state of Delaware. A process of open, axial, and selective coding was used to analyze the data. Results: Despite the interest in LARC among their adolescent patients, administrators described numerous barriers to providing LARC for adolescents including confidentiality in patient visits and billing, preceptorship, and provider discomfort and assumptions about the need for contraception among adolescent patients. Conclusion: Findings from this study reveal substantial barriers to providing contraception to adolescents, even in primary care practices that were committed to comprehensive contraceptive access for their adolescent patients. This study supports the need for contraceptive care to be integrated into training of pediatricians at every stage of their education. Such training must go beyond education about contraceptive options and the clinical skills necessary for LARC insertion and removal, to include counseling skills based in a reproductive justice framework. Additional changes in policies and practices for adolescent patients would further increase access to contraceptive care. [ABSTRACT FROM AUTHOR]

Introduction: Highly effective long‐acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long‐term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC. Material and methods: In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self‐reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results. Results: Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31–2.76) and less likely to be using a short‐acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46–0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36–6.75) and youth clinics (aOR 1.81, 95% CI: 1.08–3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96–3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes. Conclusions: The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated. [ABSTRACT FROM AUTHOR]

Aim: To identify components of an online education intervention to improve preference for, and uptake of, long‐acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD). Issue Addressed: Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long‐acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high‐risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long‐acting reversible contraception. Methods: This qualitative study involved semi‐structured interviews with six Australian English‐speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis. Results: A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision‐makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders. Conclusions: There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. So What?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds. [ABSTRACT FROM AUTHOR]

To determine the metabolic effects of the subcutaneous etonogestrel implant compared with an oral contraceptive in adolescents and young adults (AYAs) with type 1 diabetes (T1D) on body weight, body composition, glucose, lipids, and C-reactive protein levels. This was a non-randomized, interventional, prospective study. Thirty-nine AYAs with T1D participated; 20 used the implant (Implant-T1D), and 19 used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring, lipids, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated. All participants were followed for at least 12 months, and 26 completed the 24-month follow-up. No women discontinued the intervention due to adverse effects. Body weight increased by 0.8 ± 3.5 and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (P <.001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. Glucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception. [ABSTRACT FROM AUTHOR]

Adolescent pregnancy is a major public health issue with profound implications for health and socioeconomic factors. The use of long-acting reversible contraception (LARC) could be an interesting strategy to reduce the unintended pregnancy rate. However, the cost of LARC is still a barrier to widespread adoption. This study aimed to analyze the effectiveness and economic impact of LARC compared with non-LARC methods in preventing unintended pregnancy among adolescent girls. This systematic review was registered in PROSPERO (CRD42023387735) and conducted following the PRISMA guidelines. We included articles covering adolescents aged 10-19 years without language restrictions that evaluated the use of LARC compared with non-LARC in terms of effectiveness and the public health costs of unintended pregnancy. The search for articles included the databases MEDLINE/PubMed, Cochrane Library, Embase, and Lilacs, using the entry terms "Adolescent" and "Long-Acting Reversible Contraception." We evaluated the risk of bias and the certainty of the evidence for each outcome of interest. The search retrieved a total of 1,169 articles and, after the title and abstract, we identified 40 articles for full-text analysis. Out of the 40 studies evaluated, 4 articles met the eligibility criteria for cost evaluation, and 1 met the eligibility criteria for effectiveness as an outcome. In conclusion, LARC emerges as the most effective and cost-effective contraceptive method. The cost of utilizing LARC, especially the copper IUD, is significantly lower than the costs attributable to unintended pregnancies in adolescence. [ABSTRACT FROM AUTHOR]

In Australia, 20% of pregnancies occur within the first year after birth and most are unintended. Both unintended pregnancies and short interpregnancy intervals (<12–18 months) can have adverse effects on maternal, infant, and child health. Access to postpartum contraception reduces the risk of unintended pregnancies and short interpregnancy intervals, and supports women in pregnancy planning and birth spacing. In this forum article, we describe how postpartum contraception is currently provided in Australia and highlight opportunities for improving access in the primary care setting. Unintended pregnancy in the first year after birth is common. Unintended pregnancies and short interpregnancy intervals can have adverse effects on maternal, infant and child health. Contraception can support pregnancy planning. Opportunities to increase access to postpartum contraception in primary care include antenatal counselling, contraception provision during routine postnatal home visits, contraception provision during other postnatal appointments (e.g. well-baby checks), and pharmacist-led contraception provision. Improving access to postpartum contraception can support women in pregnancy planning and improve health outcomes. [ABSTRACT FROM AUTHOR]

Single-visit long-acting reversible contraception (LARC) is cost-effective and convenient. Our objective was to compare incidence of single-visit LARC placement and associated factors during the year before the COVID-19 pandemic (March 15, 2020) and the first year of the pandemic. This retrospective cohort study analyzed electronic health records from a large healthcare system. Eligible adolescents were aged 10–19 years and received outpatient LARC from March 15, 2019 to March 14, 2021. Logistic regression models determined the relationship of patient and provider characteristics on single-visit LARC before and during COVID-19. One thousand six adolescents initiated LARC during the study period. Fewer adolescents received single-visit LARC during COVID-19 (289/506, 57.1%) compared to before (315/500, 63.0%), although changes in odds of single-visit LARC were not statistically significant. Concordance between county of patient residence and the location of the LARC placement facility was associated with single-visit LARC before (adjusted odds ratio [aOR] = 2.75) and during (aOR = 1.74) the pandemic (both p <.05). During the pandemic, a few factors were associated with reduced odds of single-visit LARC: (1) public insurance (aOR = 0.49, p <.01), (2) nonobstetricians/nongynecologists providers (pediatrics [aOR = 0.35, p <.01], family medicine [aOR = 0.53, p <.01], or internal medicine [aOR = 0.14, p <.05]), and (3) advanced practice practitioners (aOR = 0.49, p <.01). Incidence of single-visit LARC was similar before and during the pandemic. Certain factors were associated with lower odds of single-visit LARC insertion, suggesting differential access during the pandemic for subgroups of adolescents. Our findings may guide policy and programmatic interventions to improve access to single-visit LARC for all adolescent populations. [ABSTRACT FROM AUTHOR]

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Widespread use of telemedicine for contraceptive care, including long-acting reversible contraception (LARC), was adopted in the United States in response to the COVID-19 pandemic. Given the rapid implementation of these services, little is known about the use of telemedicine for adolescent and young adult (AYA) contraceptive care. This study examined the routine use of telemedicine for LARC post-insertion care by comparing visit attendance between AYAs receiving LARC before and after the COVID-19 pandemic onset. This analysis included LARC insertions 3/1/19–11/30/19 (pre-pandemic onset cohort) and 4/1/20–12/31/20 (post-pandemic onset cohort) from three Adolescent Medicine subspecialty clinics in the United States. De-identified data were collected via review of the electronic health record. Descriptive statistics, χ2 tests, and t-tests described and compared groups. Adjusted logistic regression models examined factors associated with attending a post-insertion visit and attending this visit via telemedicine. This analysis included 525 LARC insertions (279 pre- and 246 post-pandemic onset). The proportion of AYAs attending a post-insertion visit increased after the COVID-19 pandemic onset (pre 30 % vs. post 46 %; p≤0.001). Adjusted models revealed that the post-pandemic onset cohort was nearly twice as likely to attend a post-insertion visit as the pre-pandemic onset cohort (OR=1.90; 95 % CI=1.68–2.15). Of those attending this visit in the post-pandemic onset cohort (n=112), 42 % utilized telemedicine. AYAs were more likely to attend post-insertion visits after the COVID-19 pandemic onset than before. Telemedicine may have influenced this change in visit attendance. [ABSTRACT FROM AUTHOR]

Objective(s): To identify barriers and facilitators related to reimbursement processes, device acquisition costs, stocking, and supply of long-acting reversible contraception (LARC) from 27 jurisdictions (26 states/1 territory) participating in the Increasing Access to Contraception Learning Community from 2016 to 2018. Materials and Methods: A descriptive study using qualitative data collected through 27 semistructured key informant interviews was conducted during the final year of the learning community among all jurisdictional teams. Excerpts were extracted and coded by theme, then summarized as barriers or facilitators using implementation science methods. Results: Most jurisdictions (89%) identified barriers to reimbursement processes, device acquisition, stocking, and supply of LARC devices, and 85% of jurisdictions identified facilitators for these domains. Payment methodology challenges and lack of billing and coding processes were identified as the most common barriers to reimbursement processes. Device acquisition cost challenges and lack of delivery facility protocols for billing were the most common barriers to device acquisition, stocking, and supply of LARC. The most common facilitator of reimbursement processes was expanded payment methodology options, whereas supplemental funding for acquisition costs and protocol development were identified as the most common facilitators of device acquisition, stocking, and supply. Conclusion: Revised payment methodologies and broader health systems changes including additional funding sources and protocols for billing, stocking, and supply were used by learning community jurisdictions to address identified barriers. The learning community framework offers a forum for information exchange, peer-to-peer learning, and sharing of best practices to support jurisdictions in addressing identified barriers and facilitators affecting contraception access. [ABSTRACT FROM AUTHOR]

The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin‐only pill postpartum in non‐breastfeeding women (category 1). Differences are found in women who breastfeed. In non‐breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high‐income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing. Synopsis: Guidelines do not entirely agree on the prescription of combined or progestin‐only pill, implants, and intrauterine contraceptives, depending on the postpartum interval and breastfeeding state. [ABSTRACT FROM AUTHOR]

Objective: In Italy the percentage of repeated abortions is about 24%. Long-acting reversible contraceptive (LARC) methods are currently considered the most effective mode worldwide and are associated with the highest rate of 12-months continuation, with a potential reported reduction of recurrent abortions. The aim of this study was evaluating LARC continuation and the patients’ satisfaction at two and twelve months in use. Materials and methods: A longitudinal observational study collected women who underwent surgical abortion and placed a LARC method at the time of abortion in our hospital. Results: Totally 828 women underwent surgical abortion during the study period from which 434 choose a LARC method. After two months the rate of continuation of 52mg LNG IUD was 100% in women presenting for follow-up. Continuation rate at one year was approximately 70% for all LARC methods. More than 70% of women declared themselves satisfied or very satisfied with all LARC methods. Conclusion: Despite a high rate of patient loss at follow-up, LARC methods showed a high rate of continuation at two and twelve months, with a high degree of patients' satisfaction.

Abstract Objective: To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period. Methods: A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation. Results: Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question. Conclusion: Professionals’ communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion.

ABSTRACT Objectives: to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care. Methods: an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022. Results: 141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses’ competency to insert an intrauterine device; and Women’s access to intrauterine devices. Conclusions: nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.

International guidelines recommend placement of intrauterine devices immediately after second-trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. This study aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at 2 to 4 weeks after second-trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at 2 to 4 weeks after the abortion, in terms of the proportion of intrauterine device use after 6 months, with maintained safety and acceptability. In this open-label, randomized, controlled, superiority trial, we recruited participants at 8 abortion clinics in Sweden. Eligible participants were aged ≥18 years, requesting medical abortion with gestation ≥85 days, and opting for use of a postabortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in nonnormal continuous variables were analyzed with the Mann–Whitney U test, and differences in dichotomous variables with the chi-square or Fisher exact tests. A P value <.05 was considered statistically significant. Group differences are presented by modified intention-to-treat and per-protocol analyses. Between January 2019 and June 2022, we enrolled 179 participants, of whom 90 were assigned to the intervention and 89 to the control arm. Enrollment was prematurely stopped after an interim analysis exceeded a predefined intrauterine device expulsion rate of 20%. According to modified intention-to-treat analysis, use of intrauterine device after 6 months was 50.7% (34/67) in the intervention group vs 71.6% (48/67) in the control group (proportion difference, 20.9%; 95% confidence interval, 4.4%–35.9%; P =.02). The intrauterine device expulsion rate was 30.1% (22/73) in the intervention group vs 2.9% (2/70; P <.001) in the control group. Other adverse events were rare and patient acceptability was high in both groups. Intrauterine device placement within 48 hours after second-trimester medical abortion was nonsuperior in terms of the proportion of intrauterine device use after 6 months when compared with placement after 2 to 4 weeks. Placement within 48 hours after second-trimester abortion can be used in selected individuals after counseling on expulsion risk. [ABSTRACT FROM AUTHOR]

Fear of pain associated with intrauterine device (IUD) placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods. To assess whether instillation of intrauterine mepivacaine before IUD placement alleviates pain more effectively than a placebo. We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing IUD placement. An intrauterine instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to IUD placement. Pain scores were assessed using a 100 mm visual analog scale (VAS) at prespecified time points. Primary outcome measured the difference in VAS pain scores between the intervention group and the placebo group during IUD placement. Secondary outcomes included VAS pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method. We enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% confidence interval (CI) 5.75–20.87; P <.001): the mepivacaine group had a mean of 53.9 mm (standard deviation [SD] 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider's impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85–19.62; P <.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P =.021). The intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during IUD placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy. [ABSTRACT FROM AUTHOR]

This study aimed to describe immediate postpartum long-acting reversible contraception (IPP LARC) insertion rates during delivery hospitalizations at the state level and by payor type. This is a cross-sectional study of 26 states and District of Columbia using 2020 State Inpatient Database. In 2020, IPP LARC insertion rates varied widely by states, ranging from 2.55 to 637.25 per 10,000 deliveries. Rates were higher for deliveries with Medicaid as primary expected payor than with private insurance in all states but District of Columbia. Rates of IPP LARC insertion varied in 2020 by state and were higher for deliveries with Medicaid as primary expected payor. [ABSTRACT FROM AUTHOR]

Background: Induced abortion can seriously harm the physical and mental health of adolescent women. Long-acting reversible contraception (LARC) can effectively reduce unplanned pregnancies and prevent repeated abortions among adolescents. This study aimed to analyse the factors affecting the choice of LARC among adolescents in Chongqing of China., Methods: A total of 555 adolescents who underwent induced abortions for unplanned pregnancies between January 2019 and October 2021 were selected as study subjects. Logistic regression analysis was used to determine the factors affecting adolescent LARC choices following induced abortions., Results: The factors that affected adolescent LARC choices included an average monthly income ≥ ¥3000 (OR = 3.432, 95% CI: 1.429∼8.244), history of previous abortions (OR = 3.141, 95% CI: 1.632∼6.045), worrying about unplanned pregnancy (OR = 0.365, 95% CI: 0.180∼0.740), parental support for using LARC (OR = 3.549, 95% CI: 1.607∼7.839), sexual partners' support for using LARC (OR = 2.349, 95% CI: 1.068∼5.167), concerns about using LARC (OR = 0.362, 95% CI: 0.176∼0.745), and willingness to use free IUDs (OR = 13.582, 95% CI: 7.173∼25.717)., Conclusion: Cost is one of the factors affecting LARC choices. Parents and sexual partners may play important role in the choice of LARC.

Objectives: To assess 3-year efficacy, safety, and tolerability of the Cu 175mm 2 copper intrauterine device (IUD)., Study Design: This single-arm trial recruited participants at risk of pregnancy aged 17-45 years at 42 U.S. centers to receive a Cu 175mm 2 IUD with a flexible nitinol frame. We assessed efficacy in participants ≤35 years old at enrollment and assessed all other outcomes in the entire population. We calculated the Pearl Index (pregnancies/100 person-years) through 3 years as the primary efficacy outcome. Secondary outcomes included pregnancy percentages by life-table analysis, placement success, safety (adverse events), and tolerability., Results: Of 1620 enrollees, 1601 (98.8%) had successful IUD placement, with 1397 ≤35 years at enrollment. We observed a 1-year Pearl Index of 0.94 (95%CI 0.43-1.78) and 1-year and cumulative 3-year life-table pregnancy rates of 1.26% (95%CI 0.57%-1.95%) and 2.47% (95%CI 1.34%-3.60%), respectively. The most common adverse events included bleeding and pain. Over 3 years, 15.4% of participants discontinued due to bleeding or pain. Device expulsions occurred in 36 (2.2%) and 63 (3.9%) participants over 1 and 3 years, respectively. Eight related serious adverse events occurred, including five ectopic pregnancies and one each of uterine perforation, anemia, and uterine hemorrhage. One- and three-year continuation rates were 78.9% and 49.6%, respectively., Conclusion: These data support efficacy, safety, and tolerability of the Cu 175mm 2 IUD during the first 3 years of use., Clinical Trial: NCT03633799., (Copyright © 2024. Published by Elsevier Inc.)

Background: The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant., Objectives: To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery., Search Strategy: A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011., Selection Criteria: Primary publications of randomised and non-randomised trials, observational studies and case reports were included., Data Collection and Analysis: Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence., Main Results: We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population., Conclusions: Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted., Competing Interests: Competing interests: JB has received honoraria for consultancy and speakers’ fees from Organon, Bayer, Libbs and Gedeon Richter. DG is an employee and shareholder of Organon, and a former employee and shareholder of Merck & Co. VPP is an employee and shareholder of Organon. JWG is an employee and shareholder of Organon. SvS has no conflicts of interest to declare. MK has no conflicts of interest to declare. CB has no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Little is known about the degree to which the COVID-19 pandemic, and associated restrictions and disruptions to health services, impacted the accessibility of hormonal long-acting reversible contraception (LARC) devices within Australia. Here, we explore longitudinal patterns of dispensing of the contraceptive implant and hormonal intrauterine devices (IUDs) within Australia, before and during the COVID-19 pandemic., Methods: Population-based cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data, for females aged 15-49 years dispensed a hormonal LARC device between February 2017 and November 2021., Results: Interrupted time-series analysis demonstrated overall that there were no significant differences in monthly dispensing rates of hormonal LARC following the Australian onset of the pandemic in April 2020, with no subsequent change in the trend. However, when stratified by LARC type, a significant increase was evident during the pandemic period (April 2020-November 2021) in the rate of hormonal IUD dispensing per month (0.20 per 10 000 95% CI 0.01 to 0.38)), compared with a decrease for the implant (-0.08 per 10 000 (95% CI -0.16 to 0.01)). Increases in hormonal IUD dispensing during the pandemic were most pronounced for those aged 20-24 years, new users, those without a Commonwealth concession card, and in the State of Victoria., Conclusions: Within Australia in the defined pandemic period, access to hormonal LARC devices was not negatively impacted. Rather a significant increase in dispensing of hormonal IUDs was evident., Competing Interests: Competing interests: DB and DM have received honoraria, and research and travel funding from pharmaceutical companies marketing long-acting reversible contraception (LARC) products including Bayer and Organon., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: In June 2021, high-profile testimonials in the media about pain during intrauterine device (IUD) procedures in the UK prompted significant discussion across platforms including Twitter (subsequently renamed X). We examined a sample of Twitter postings (tweets) to gain insight into public perspectives and experiences., Methods: We harvested tweets posted or retweeted on 21-22 June 2021 which contained the search terms coil, intrauterine system, IUD or intrauterine. We analysed the dataset thematically and selected illustrative tweets with the authors' consent for publication., Results: Following deduplication and screening, we included 1431 tweets in our analysis. We identified testimonials with descriptions of varied pain experiences. Twitter users reported that clinicians had not warned them that pain could be severe or explained the options for pain relief. Some raised concerns about pain being minimised or dismissed and linked this to the management of women's pain in medicine more broadly. Twitter users described connecting to an online community with shared experiences as validating and used this as a springboard for collective action., Conclusions: While we acknowledge the limitations of our sample, this study highlights important perspectives and accounts relating to pain during IUD procedures. Our findings attest to the need for strategies to improve the patient experience for those opting for IUD as a clinical priority. Further research should explore IUD users' experiences, expectations and wishes around pain management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To explore Australian general practitioners' views and experiences of undertaking postpartum contraception counselling and provision during the 6-8-week postnatal check., Study Design: Qualitative-descriptive study; semi-structured online interviews., Participants, Setting: General practitioners who provide postnatal care in Australian primary health care, recruited using purposive, convenience, and snowball methods, 16 June - 6 July 2023., Main Outcome Measures: Views and experiences of postpartum contraception counselling and provision., Results: Twenty-three general practitioners from six states were interviewed; the mean interview time was 30 minutes (range, 21-47 minutes), twenty-two participants were women, and twenty-one worked in metropolitan areas. All participants provide postnatal checks and had the training and facilities needed for providing contraceptive implant insertions. Twelve participants had training in intrauterine device (IUD) insertion, and twenty-one worked in practices with facilities for IUD insertions. Three themes were constructed: views and preferences regarding postnatal contraception counselling; postpartum provision of long-acting reversible contraception (LARC); and opportunities for improving postpartum contraception care in general practice. While most participants recommended LARC methods at postnatal checks, only twelve were trained to insert IUDs. Time constraints, limited access to training, limited financial support, and the lack of guidelines for postnatal checks and contraception care were seen as impeding postpartum contraception counselling. Participants highlighted the importance of access to education and training, appropriate remuneration for general practitioners, multidisciplinary collaboration among health professionals, the inclusion of practice nurses, and raising awareness among mothers of the importance of postnatal checks and postpartum contraception care., Conclusion: General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth. Postpartum contraception care in general practice could be improved by better access to contraception training, appropriate remuneration for contraception procedures, greater multidisciplinary collaboration, and national postnatal check and postpartum contraception guidelines., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objective: The etonogestrel-releasing implant is a long-acting reversible contraception that is recommended by the Food and Drug Administration for 3 years and has been proven to be highly effective and convenient. Adverse effects including irregular bleeding patterns, weight gain, and acne are reported to be the main reasons for treatment discontinuation. The aim of this study is to learn the association between body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and the incidence of side effects and adherence to treatment., Methods: This is a retrospective cohort study, conducted at a single university-affiliated medical clinic, including all women who underwent etonogestrel-releasing implant (Nexplanon®; New Jersey, USA, Organon USA Inc., Merck and Co) insertion between January 2019 and December 2021. Cases where abnormalities were reported during the insertion procedure or missing data were excluded from the study. Information on patients' demographic, medical history, obstetric and gynecological history, and follow-up was collected from electronic medical files. The primary outcome was defined as the rate of implant removal in the different obesity classes. Data are presented as median and interquartile range. The study was approved by institutional review board., Results: The study population included 1318 women, of whom 466 (35%) requested early removal of the implant. Women's demographic and clinical characteristics were comparable between women who requested early removal and those with full-length treatment. The median time for early removal was 12 (6-20) months from insertion. Irregular bleeding was the most frequent reason for early removal in both groups and was more than twice as prevalent in the early removal group (239 [51.29%] vs 193 [22%], P = 0.001). The early removal group had fewer obese women (BMI ≥30) compared with women who had full-length treatment (163 [31.8%] vs 350 [68.2%], P = 0.03), with comparable rates of class 3 obesity women (BMI ≥40) (P = 0.68). Multi-regression logistic analysis including age, BMI, parity and side effects found that the presence of side effects is the only independent predictor significantly associated with early implant removal (B = 1.74, P = 0.04)., Conclusions: Continuation of etonogestrel-releasing implant contraception treatment was associated with the presence of side effects that were more often reported in non-obese women. BMI was not found to be a significant factor influencing adherence to treatment., (© 2024 International Federation of Gynecology and Obstetrics.)