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, Anna Glasier, Helen Dewart, Anne Johnstone
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 213-216; https://doi.org/10.1783/147118910793048719

Abstract:
Background and methodology Research has shown that many women choosing an early medical abortion would prefer to be at home rather than in hospital to expel the pregnancy. A service was commenced at a hospital abortion service in Edinburgh, Scotland, UK that allowed women at up to 56 days' gestation to be discharged home soon after misoprostol administration. During a 3-month period, an anonymous questionnaire of women's experiences was conducted 1—2 weeks after the procedure. Results During the 3 months of the survey a total of 145 women chose to go home to abort. A total of 100 women completed questionnaires out of 145 (69%) distributed. The commonest reasons given for choosing to go home were: to get home sooner (53%) and to be in the privacy of one's own home (47%). Most (81%) of the women stated that bleeding was either “as expected” (55%) or “not as bad as expected” (26%), and 58% of the women stated that the pain was “as expected” (40%) or “not as bad as expected” (18%). The majority (84%) of the women said that they would recommend this method to a friend. Discussion and conclusions Discharge home for the final stage of a medical abortion was highly acceptable to women. Since availability is not limited by hospital bed space, more women can be treated by medical methods.
Comment
Maggie Gormley, Ann Eady
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 254-254; https://doi.org/10.1783/147118910793048476

Journal of Family Planning and Reproductive Health Care, Volume 36, pp 218-218; https://doi.org/10.1783/147118910793048647

Henrietta Hughes
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 248-248; https://doi.org/10.1783/147118910793048674

María Dolores Tomás-Tello, Gill Hodgson
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 255-255; https://doi.org/10.1783/147118910793048692

Journal of Family Planning and Reproductive Health Care, Volume 36, pp 216-216; https://doi.org/10.1783/147118910793048728

Comment
Hannat Akintomide
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 255-255; https://doi.org/10.1783/147118910793048737

Comment
Kate Davies
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 254-254; https://doi.org/10.1783/147118910793048520

Journal of Family Planning and Reproductive Health Care, Volume 36, pp 189-189; https://doi.org/10.1783/147118910793048584

, , Matthew Cooke
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 191-195; https://doi.org/10.1783/147118910793048593

Abstract:
This article assesses the risks associated with the insertion and removal of contraceptive implants. Risks to patient safety relate to the way the insertion device is designed and used, rather than to the pharmacological properties of the implant itself. Risks associated with removal are not amenable to thoughtful design. A systems approach is taken, the assumption being that human errors are symptoms of underlying systems deficiencies rather than causes of adverse events. The insertion procedure is broken down into five key steps. Errors in these steps contribute to non-insertion and deep insertion of implants. The design of the Implanon® applicator is critically examined and suggestions made as to how it could be improved in such a way as to reduce errors in its use. The exercise undertaken has coincided with the imminent launch of the redesigned applicator of the new contraceptive implant, Nexplanon®. Preliminary comments are made about the new features of Nexplanon.
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 228-230; https://doi.org/10.1783/147118910793048638

, Diana Mansour, Lee P Shulman
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 231-238; https://doi.org/10.1783/147118910793048665

Abstract:
The past 50 years have seen great advances in combined oral contraceptives (COCs) that have resulted in reduced risks of adverse events and improved cycle control. The most important changes in COCs over time include repeated lowering of the estrogen dose, development of new progestogens, and the reduction or elimination of the pill-free interval. Most recently, formulations that deliver estradiol in lieu of ethinylestradiol have been introduced. The advantages of COCs generally far outweigh the disadvantages. Current options in oral contraception include a wide spectrum of products that enable clinicians to choose the most appropriate formulation for individual women. This article summarises the advances in oral contraceptives over time and describes the most current clinical data regarding the use of COCs.
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 256-256; https://doi.org/10.1783/147118910793048683

, Latifat Ibisomi, , Mairo Mandara
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 219-224; https://doi.org/10.1783/147118910793048494

Abstract:
Relying on focus group discussions and in-depth individual interviews with men and women in Jigawa and Kano states in northern Nigeria, we investigated barriers to spousal contraceptive communication. While attitudes toward spousal contraceptive communication were generally positive, there was very little evidence that respondents engaged in it. Poor spousal contraceptive communication in northern Nigeria is, in many ways, driven by the ample incentives that husbands and wives have to keep having children. For wives, having many children stabilises their marriage. It prevents husbands from marrying additional wives and sustains their attention and investments even if they ultimately do. For husbands, having many children helps them to keep their wives from objecting to their taking other wives and to mollify them by showing their continued commitment to that relationship should they take other wives. Our findings clearly challenge conventional population, family planning and reproductive health programmes that view high fertility as disempowering for women, and contraceptive use as capable of redressing gender inequality. New norms of gender relations are key to promoting contraceptive uptake and smaller families in northern Nigeria.
, Ramona Schmid, Sharon Cameron
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 197-201; https://doi.org/10.1783/147118910793048656

Abstract:
Background and methodology Emergency hormonal contraception (EHC) can reduce unintended pregnancy and the associated costs and consequences for the individual and National Health Service (NHS). Levonorgestrel (LNG 1.5 mg) is currently the standard of care in the UK; however, it is not licensed for use >72 hours after unprotected sexual intercourse (UPSI). This cost-effectiveness analysis compares LNG 1.5 mg with ulipristal acetate (UPA) (ellaOne®), a new emergency hormonal contraceptive that is licensed for use up to 120 hours post-UPSI. The costs of both drugs and the costs of the consequences of unintended pregnancy — namely miscarriage, induced abortion and birth — are compared in a decision model from the perspective of the UK NHS. Results The incremental cost-effectiveness ratio (ICER) is the cost of preventing one additional unintended pregnancy with UPA and is calculated to be £311 compared to LNG 1.5 mg when taken up to 120 hours post-UPSI. In sensitivity analysis, looking at different time frames and costs, the ICER ranges from £183 to £500. All these costs are less than the estimated cost of an unintended pregnancy (£948) regardless of the outcome or the cost of an induced abortion (£672). Discussion and conclusions Even when considering only the direct costs of an unintended pregnancy, UPA represents value for money as a method of EHC when taken up to 120 hours post-UPSI. UPA is a cost-effective alternative to LNG 1.5 mg for all women presenting for EHC.
, Soe Nyunt Aung, Kate Guthrie
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 225-227; https://doi.org/10.1783/147118910793048467

Abstract:
Background An e-contraceptive advice line ([email protected]) was set up by our unit to support contraceptive provision in primary care. This advice line was for general practitioners (GPs) initially and was then extended to certain pharmacists. All queries were to be answered within 24 hours. A similar e-advice line on emergency contraception for patients seeking advice had been successful in the USA and South Africa. Methods Our aim was to evaluate the contraceptive advice line using standards developed at its inception. A retrospective audit of the queries received by the contraceptive advice line between January and September 2009 was conducted. Results Sixty-seven queries were received from 30 GPs, nine from practice nurses and none from pharmacists. Some 61% of the queries were answered within 24 hours and 85% were answered within 72 hours; 90% were within the advice line guidelines. Conclusions The e-mail advice line is a useful, low-cost, well-received support service for GPs. This model could be adopted by other areas wishing to increase contraceptive access in primary care.
, , Angela J Robinson, Makeda Gerressu, Karen E Rogstad, One-Stop Shop Evaluation Team
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 202-209; https://doi.org/10.1783/147118910793048502

Abstract:
Background and methodology Little evidence is available on the extent to which one-stop shops address users' sexual health needs and the extent to which they identify additional needs users may not have identified. As part of the One-Stop Shop Evaluation, a questionnaire was designed to compare the reasons for users' visits and the reported outcomes of visits at a one-stop shop with the experiences of users in separate genitourinary medicine (GUM) and contraceptive clinics. Results The difference in the proportions of those attending the one-stop shop and those attending the control sites services for a sexually transmitted infection (STI)-related reason who were diagnosed with an STI was minimal, but those attending for an STI-related reason in the one-stop shop were more likely to receive an additional contraceptive outcome. Women attending for a contraceptive-related reason at the one-stop shop were more likely to have an STI screen than those attending the control sites for the same reason, but there was little difference in the proportions amongst this group receiving an STI diagnosis or receiving treatment. When focusing on women attending for a pregnancy-related reason, one-stop shop users were more likely to have received contraceptive advice or supplies. Discussion and conclusions It was not possible in our evaluation to determine the relative effectiveness of the one-stop shop in comparison to the traditional GUM and contraceptive clinics in improving sexual health status, however the one-stop shop was more likely to address additional sexual health needs that service users may not have previously identified.
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 238-238; https://doi.org/10.1783/147118910793048557

Jackie Maybin
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 250-250; https://doi.org/10.1783/147118910793048575

Ben Thair-O'reidy
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 256-256; https://doi.org/10.1783/147118910793048755

, John Guillebaud
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 239-242; https://doi.org/10.1783/147118910793048764

Abstract:
Antiepileptic drugs (AEDs) that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. There is also the potential for the hormonal method to affect the AED. Women may also be prescribed AEDs to treat conditions other than epilepsy, such as chronic pain and migraine. These effects should be considered in the choice of both the treatment of the epilepsy and the choice of contraceptive method. This review considers these interactions and offers advice about their management.
Gill Wakley
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 129-129; https://doi.org/10.1783/147118910791749227

, Helen Sweeting,
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 141-146; https://doi.org/10.1783/147118910791749506

Abstract:
Background Attempts to address the 'problem' of teenage pregnancy need to further explore contraceptive use among young people at potentially greatest risk. We examine contraceptive use among a particularly vulnerable subgroup: girls who reported having had sex with more than one partner by age 16 years. Methods Females (n = 435) completed questionnaires as part of the Scottish SHARE school-based sex education trial, reporting on contraceptive use at three episodes of sexual intercourse: first, first with most recent partner, and most recent. Results Most used some form of contraception at each episode but a quarter reported withdrawal, putting on a condom before ejaculation or non-use. Some 57% of the girls reported using methods that suggested lower levels of pregnancy risk-taking behaviour at all three episodes, but 20% reported method use suggestive of greater risk-taking behaviour at one episode, 12% at two, and 11% at all three. In multivariate analysis, the factors associated with greater pregnancy risk-taking behaviour were living in social or rented accommodation, not knowing where to get prescription contraceptives, having pressurised or unexpected or spur of the moment sex, and not having talked to their partner about protection prior to sex. Conclusions Most girls used an effective method of contraception at each episode of intercourse but a sizeable minority reported use of no contraception, or an ineffective method, which suggested greater pregnancy risk-taking behaviour; one in ten at all three episodes. Particular efforts are required to further understand and better target those girls who are putting themselves at repeated risk of pregnancy.
Hilary Critchley, Julia Wilkens
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 179-179; https://doi.org/10.1783/147118910791749209

Journal of Family Planning and Reproductive Health Care, Volume 36, pp 178-178; https://doi.org/10.1783/147118910791749263

Shelley Mehigan
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 180-180; https://doi.org/10.1783/147118910791749308

Comment
Ruzva Bhathena
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 179-179; https://doi.org/10.1783/147118910791749399

Journal of Family Planning and Reproductive Health Care, Volume 36, pp 168-168; https://doi.org/10.1783/147118910791749452

Comment
Louise Melvin
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 182-182; https://doi.org/10.1783/147118910791749362

Louise Melvin
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 181-181; https://doi.org/10.1783/147118910791749407

, Barbara Mawn
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 150-158; https://doi.org/10.1783/147118910791749380

Abstract:
Background and methodology Unintended pregnancy is a concern in the USA due to its association with adverse physical, mental, social and economic outcomes. Few studies have examined this issue among married women from a social and contextual perspective. This study targeted married women to examine factors associated with unintended pregnancy using the ecological model of health promotion that focuses attention on both individual and social environmental factors. Data from the National Survey of Family Growth (NSFG) were merged with NSFG contextual files to examine the major predictive factors. Results Multilevel logistic regression modelling revealed that married women of lower socioeconomic status, higher parity, who lived in communities with a high rate of marital dissolution had a higher probability of an unintended pregnancy. Women reported that their husbands were likely to concur with the unintended designation of the pregnancy. Discussion and conclusions This study utilised a unique perspective to examine contextual factors related to unintended pregnancy among married women. The results support the need to focus on the couple as a unit for prevention efforts. Social policies to enhance access to family planning services are necessary to improve outcomes and prevent unintended pregnancies.
, Anita Assmann, Sabine Möhner, Thai Do Minh
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 123-129; https://doi.org/10.1783/147118910791749416

Abstract:
Objective The primary objective of the study was to clarify whether the use of the oral contraceptive 2 mg dienogest/30 μg ethinylestradiol (DNG/EE) is associated with a higher risk of venous thromboembolism (VTE) than the use of other combined oral low-dose contraceptives (i.e. containing ≤30 μg EE), particularly oral contraceptives containing levonorgestrel (LNG). The secondary objective was to investigate the VTE risk associated with drospirenone/ethinylestradiol (DRSP/EE) in comparison to low-dose LNG/EE. Methods This German community-based, case-control study recruited VTE cases from the primary care sector. Eligible cases were women aged 15–49 years with a VTE between January 2002 and February 2008. Four controls (women without a confirmed or potential VTE before the index date) were matched by age and region to each case. Medical information relevant for the assessment of VTE was abstracted from patient charts. Data on personal characteristics of the patients were collected via self-administered questionnaires. At the end of the study a blinded adjudication of the reported VTE was conducted. Conditional logistic regression techniques were used, adjusting for nine potential confounders, including personal history of VTE, family history of VTE, body mass index, duration of current combined oral contraceptive (COC) use and smoking. Results A total of 680 VTE cases and 2720 corresponding controls were analysed. The mean age of cases and controls was – as a result of matching – almost identical (36.1 years). A total of 35, 25, and 60 of the cases had used DNG-, DRSP- and LNG-containing low-dose COCs, respectively, at the time of the VTE diagnosis. The crude odds ratio (OR) for VTE associated with current COC use in comparison to women who had never used a COC before the index date was 1.9 (95% CI 1.5–2.5), the adjusted OR was 2.3 (95% CI 1.7–3.0). The point estimate of the crude OR of DNG/EE vs any other low-dose COCs was 0.9 (95% CI 0.6–1.3), the adjusted OR was 0.9 (95% CI 0.6–1.4). The crude ORs for DNG/EE and DRSP/EE vs low-dose LNG/EE were 1.1 (95% CI 0.7–1.8) and 1.0 (95% CI 0.6–1.6), respectively; the adjusted ORs were 1.1 (95% CI 0.7–1.9) and 1.0 (95% CI 0.6–1.8). Conclusions The study confirms that COC use is associated with an increased risk of VTE. The VTE ORs (adjusted and crude) that compared DNG/EE and DRSP/EE with other low-dose COCs (including LNG/EE) were close to unity and do not indicate a higher risk for users of DNG/EE or DRSP/EE.
Comment
Susan Young
Journal of Family Planning and Reproductive Health Care, Volume 36, pp 180-180; https://doi.org/10.1783/147118910791749281

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