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Contraception Journal
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Contraception Highlights June 2016

Original Research Articles

Contraception in Japan: Current trends
Honami Yoshida, Haruka Sakamoto, Asuka Leslie, Osamu Takahashi, Satoshi Tsuboi, Kunio Kitamura
Objectives: High proportion of Japanese uses condoms; lower proportion uses oral contraceptive pills (OCPs). We examined the longitudinal patterns for contraceptive usage in Japan and evaluated differences before and after OCP government approval.
Implications: Through a wide gap in OCP use between Japan and other countries, we revealed how choices of contraceptive methods and their benefits could be openly available for women of reproductive age, and how health care professionals disseminate appropriate knowledge about contraception for women in need.
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The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study
Blair G. Darney, Sandra G. Sosa-Rubi, Edson Servan-Mori, Maria I. Rodriguez, Dilys Walker, Rafael Lozano
Objectives: To test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.
Implications: Adolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.
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Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia
Ndola Prata, Janelle Downing, Suzanne Bell, Karen Weidert, Hagos Godefay, Amanuel Gessessew
Objective: To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia.
Conclusion: With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP.
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Does the evidence support global promotion of the calendar-based Standard Days Method® of contraception?
Cicely A. Marston, Kathryn Church
Objectives: To scrutinise claims about the effectiveness of the Standard Days Method® (SDM). The SDM is a calendar method with similarities to the rhythm method that has now been reclassified and is marketed as a modern contraceptive method. As promoted, it requires users to avoid unprotected intercourse on days 819 of the menstrual cycle. It is used in at least 100 countries. SDM has been researched, developed, and is marketed by the Institute of Reproductive Health (IRH) at Georgetown University, USA, and a for-profit company Cycle Technologies. SDM proponents say it is a major advance on traditional periodic abstinence, claiming that it is 95% effective when used correctly rivalling pills and condoms. The effectiveness claim is repeated in recent documents from the World Health Organization.
Implications: Use, delivery and promotion of SDM should be reevaluated. Meanwhile, SDM should only be offered to family planning clients as an adaptation of traditional periodic abstinence methods, requiring total abstinence in fertile days reflecting correct use" in the efficacy study to achieve high effectiveness. Delivery of any form of SDM should include presentation of the full range of other contraceptive methods, including the most effective options.
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Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A
Patrick Rowe, Tim Farley, Alexandre Peregoudov, Gilda Piaggio, Simone Boccard, Sihem Landoulsi, Olav Meirik, for the IUD Research Group of the UNDP/UNFPA/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction
Objectives: To compare rates of unintended pregnancy, method continuation and reasons for removal among women using the 52-mg levonorgestrel (daily release 20 microg) levonorgestrel IUD (LNG-IUD) or the copper T 380 A (TCu380A) intrauterine device.
Implications: The 52-mg LNG-IUD and the TCu380A have very high contraceptive efficacy through 7 years. As an IUD, the unique side effects of the LNG-IUD are reduced bleeding, amenorrhea and symptoms compatible with hormonal contraceptives.
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A Phase III, single-arm study of LNG-IUS 8, a low-dose levonorgestrel intrauterine contraceptive system (total content 13.5mg) in postmenarcheal adolescents
Kristina Gemzell-Danielsson, Kai J. Buhling, Sylvia M. Dermout, Eeva Lukkari-Lax, Elaine Montegriffo, Dan Apter
Objective: To assess the safety profile of the low-dose levonorgestrel intrauterine system (LNG-IUS) total content 13.5 mg (average approximate release rate 8 g/24 h over the first year; LNG-IUS 8; Jaydess®) in adolescents.
Implications: This study is the first to assess the low-dose levonorgestrel intrauterine system LNG-IUS 8 (average approximate release rate 8 g/24 h over the first year and total content 13.5 mg) specifically in females<18 years of age and confirms the safety and efficacy of LNG-IUS 8 in an adolescent population.
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Diclofenac plus lidocaine gel for pain relief during intrauterine device insertion. A randomized, double-blinded, placebo-controlled study
Usama M. Fouda, Noha M. Salah Eldin, Khaled A. Elsetohy, Hoda A. Tolba, Mona M. Shaban, Sherin M. Sobh
Objective: To determine the effectiveness of diclofenac potassium combined with 2% lidocaine gel in reducing the pain of intrauterine device (IUD) insertion.
Implications: Although we found a statistically significant lowering of pain scores with pretreatment with diclofenac potassium and lidocaine gel in parous women having copper IUD placement, the reduction is not clinically relevant. These findings may be more relevant for nulliparous women who experience more pain than parous women with IUD insertion and support studies of diclofenac potassium and lidocaine gel in this population.
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Impact evaluation of the Urban Health Initiative in urban Uttar Pradesh, India
Pranita Achyut, Aimee Benson, Lisa M. Calhoun, Meghan Corroon, David K. Guilkey, Essete Kebede, Peter M. Lance, Anurag Mishra, Priya Nanda, Rick O'Hara, Ranajit Sengupta, Ilene S. Speizer, John F. Stewart, Jennifer Winston
Objective: The Urban Health Initiative (UHI) was initiated in 2009 with the goal of increasing family planning (FP) use among the poor in urban areas of Uttar Pradesh, India. The Measurement, Learning & Evaluation project (MLE) was tasked with rigorous impact evaluation of the UHI. This paper presents the impact evaluation findings of the UHI program.
Implications Statement: Findings from this study are important for designing sustainable and scalable FP strategies for urban India where increases in FP use will be relevant for meeting international FP targets.
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Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study
David K. Turok, Jessica N. Sanders, Ivana S. Thompson, Pamela A. Royer, Jennifer Eggebroten, Lori M. Gawron
Objectives: We assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users.
Implications: Consideration should be given to LNG IUD insertion with concomitant use of oral LNG 1.5 mg for EC. Use of this combination may increase the number of women initiating highly effective contraception at the time of their EC visit.
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Evaluation of an intervention designed to improve the management of difficult IUD insertions by advanced practice clinicians
Amna Dermish, David K. Turok, Janet Jacobson, Patricia A. Murphy, Hanna M. Saltzman, Jessica N. Sanders
Objectives: To assess whether clinical skills training in cervical dilation and paracervical anesthesia, as well as the introduction of a clinical protocol for difficult insertions, increased intrauterine device (IUD) insertion success rates among advanced practice clinicians (APCs) including women's health and family practice nurse practitioners, physician assistants and certified nurse midwives.
Implications: Clinics with high rates of IUD insertion failure can improve care with a simple intervention, which may yield significant benefits in IUD service delivery.
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An evaluation of contraception mobile applications for providers of family planning services
Rachel Perry, Britt Lunde, Katherine T. Chen
Objective: We aimed to identify mobile applications (apps) about contraception and to evaluate those targeted toward providers of family planning services in order to assess their quality and comprehensiveness.
Implications: There is potential for further mobile resource development in the area of contraception, given the limited number and inconsistent quality of available apps.
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Implementation and evaluation of a dilation and evacuation simulation training curriculum
Sloane L. York, William C. McGaghie, Jessica Kiley, Cassing Hammond
Objectives: To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures.
Implications: Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision.
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If I know I am on the pill and I get pregnant, it's an act of God: women's views on fatalism, agency and pregnancy
Rachel K. Jones, Lori F. Frohwirth, Nakeisha M. Blades
Objectives: Fatalism is the idea that outside forces have control over events. Pregnancy and pregnancy prevention play a prominent role in many women's lives, and we sought to understand if and how fatalism informed their thinking about these issues.
Implications: Given that women do not have total control over attainment of a wanted pregnancy or even prevention of pregnancy, some amount of fatalism about fertility is a logical and pragmatic response. Both research and clinical practice need to recognize that fatalism and contraceptive use are often not in conflict.
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I don't know enough to feel comfortable using them: Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus
Kelli Stidham Hall, Elizabeth Ela, Melissa K. Zochowski, Amy Caldwell, Michelle Moniz, Laura McAndrew, Monique Steel, Sneha Challa, Vanessa K. Dalton, Susan Ernst
Objective: To assess multiple dimensions of long-acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women.
Implications: Lack of knowledge of IUDs and implants served as a primary barrier to highly effective contraceptive use among these college women. Comprehensive, patient-centered and multi-level educational public health strategies are needed to promote positive campus climates around LARC and improve family planning outcomes among this substantial reproductive-aged population.
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Letters to the Editor

Obesity's effect on contraceptive failure is diluted by grouping of progestins
Ganesh Cherala, Alison Edelmanp
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Modern contraceptive methods: a new misleading definition
Cristina Lopez-del Burgo, Jokin de Iralap
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Response to letter
David Hubacher, James Trussell
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Thanks to Reviewers
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