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Background Nearly 20% of women presenting with breast cancer in the UK are of reproductive age. The aim of our study was to assess fertility outcome in relation to intent to conceive in patients who had completed breast cancer treatment. Methods Between July 2011 and December 2013, women, aged less than 43 years at the time of diagnosis, were asked during their follow-up in breast cancer clinic, to complete a questionnaire on intentions to conceive and pregnancy outcome. Results A total of 175 women completed the questionnaire at a median time of 6 years from time of diagnosis. Their median age at the time of diagnosis was 37 years and at the time of the survey was 43 years. At the time of the survey, 42% (72/175) had completed their family, 41% (72/175) reported that they would like to have children and 4% (7/175) did not wish to have children. Twenty-seven respondents had actively tried to conceive, and of those 13 (48%) had a live birth. There were 12 unintended pregnancies; the majority of which were terminated (58% (7/12)) with only 3 live births. Among those who did not wish to conceive, only 32% (36/111) reported using contraception. Conclusion This is a retrospective study investigating menstrual function, contraceptive methods and fertility outcomes of young breast cancer survivors. This study highlights the need for healthcare professionals to provide long-term contraceptive advice to women who do not wish to conceive.

Introduction Pregnancies affected with neural tube defects (NTDs) are mostly associated to maternal deficiency of folic acid (FA). Although supplementation is recommended for all women of childbearing age, the incidence of NTDs in Puerto Rico has not shown a significant decrease. Objective The goal of this study was to assess the awareness and level of knowledge of FA supplementation among women attending prenatal clinics, and correlate this knowledge with the source ofinformation and the actual use of FA. A secondary objective was to corroborate or abrogatethe association of the lack of FA supplementation with the occurrence of unplanned pregnancies. Methods This descriptive study was conducted at the High-Risk Prenatal Care Clinicsof the Adults University Hospital from August 2015 to November 2015. The answers to a non-validated self-administered questionnaire were assessed and then analyzed with Epi Info 7. Results From a total of 200 Hispanic female participants, 87.0% were Puerto Rican, most (69.0%) had an education above high school level and 54.5% had a low-income status. Overall, 66.5% were taking FA at the time of the interview, 77% understood that the best time to start FA supplementation was prior to conception, but only 23% of the participants actually began preconceptional FA intake. Unplanned pregnancies were reported in 70.5%. Most referred to have received information about FA benefits from a healthcare professional, yet many could not identify all of FA benefits. Conclusion Although most participants were aware of the best time to begin FA supplementation, the majority began intake once pregnancy was discovered; timing related to the 70.5% unplanned pregnancies. Information received is not sufficient sincemost women are not entirely clear about the benefits of FA supplementation, despite their source of information. In caring for women of childbearing age, further investigation is required to optimize educational strategies and methodologies.

This study examines the prevalence, reasons, and predictors of unwanted pregnancies and induced abortions among ever married HIV-infected women attending a care facility in Maharashtra, Western India, and discusses its programmatic and policy implications. Retrospectively collected data of pregnancies conceived after the diagnosis of HIV were analyzed using descriptive and logistic regression techniques. Among the 622 women interviewed, 113 women had 158 pregnancies with known outcomes after HIV diagnosis. Among these pregnancies, 80 (51%) were unwanted and 79 (50%) were voluntarily terminated. Fear of transmitting HIV to the child was a frequently mentioned reason for an unwanted pregnancy (71.8%) and induced abortion (59.5%). Women from urban areas [OR 2.43 (95% CI 1.23-4.79)] and with two or more live births before HIV diagnosis [OR 3.33 (95% CI 1.36-8.20)] were significantly more likely to report an unwanted pregnancy. Women with two or more live births before HIV diagnosis [OR 3.16 (95% CI 1.20-8.35)], who did not know that HIV transmission to the baby can be prevented [OR 3.29 (95% CI 1.48-7.34)] and with an unwanted pregnancy [OR 4.82 (95% CI 2.33-10.00)], were significantly more likely to terminate the pregnancy. Despite increased coverage of antiretroviral treatment, effective provision of reproductive healthcare services to HIV-infected women remains challenging. A high prevalence of unwanted pregnancies and induced abortions and a low level of knowledge about prevention of mother to child transmission (PMTCT) underscore the need for preconception counseling and provision of comprehensive family planning services to HIV-infected women. Enrolling all HIV-infected pregnant women, irrespective of their decision to continue with their pregnancy, in the PMTCT program and discussing with HIV-infected women and their partners at HIV diagnosis a full array of contraceptive methods and not just consistent use of condoms might be helpful in reducing unwanted pregnancies.

Nicaragua, a largely urban country (56 percent of the population lives in urban areas), is one of the least populous (5.53 million) and poorest countries in CentralAmerica. Following reforms in the 1980s, Nicaragua made remarkable progress in gender equity in education and the labor force, while the wide availability of primary health care initiated in the 1970's, including family planning services, led to improvements in infant and child mortality rates. Several lessons emerge from Nicaragua's success at reducing fertility. The government was committed to gender equity and female empowerment through educating girls and women and recruiting women into the labor force. Family planning services were provided within a well functioning primary health care system, including an extensive, efficient contraceptive distribution network that works with international donors, and international and national Non-Governmental Organizations (NGOs) to offer women a good mix of options. Demand must be created through a timely public education campaign. Success requires civic engagement with stakeholders, which may initially mean avoiding unnecessary confrontation and publicity of services for addressing the concerns of more conservative stakeholders.

The World Bank has produced this policy Toolkit in response to a growing demand from our government clients and partners for advice on how to create and implement effective policies for at-risk youth. The author has highlighted 22 policies (six core policies, nine promising policies, and seven general policies) that have been effective in addressing the following five key risk areas for young people around the world: (i) youth unemployment, underemployment, and lack of formal sector employment; (ii) early school leaving; (iii) risky sexual behavior leading to early childbearing and HIV/AIDS; (iv) crime and violence; and (v) substance abuse. The objective of this Toolkit is to serve as a practical guide for policy makers in middle-income countries as well as professionals working within the area of youth development on how to develop and implement an effective policy portfolio to foster healthy and positive youth development.