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Contraception Journal
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Contraception Highlights July 2016

Thinking (Re)Productively
Expert analysis on pressing issues from the Association of Reproductive Health Professionals

In support of community-based emergency contraception
Dawn S. Chin-Quee, John Stanback, Victoria Graham
Community-based family planning is a proven, high-impact practice for extending reproductive health services to women, particularly those in hard-to-reach places. Accordingly, many community-based family planning programs facilitate and support the provision of condoms, oral contraceptive pills and even injectable contraceptives by community health workers (CHWs). Emergency contraceptive pills (ECPs)—a method for which there are no contraindications and the user herself can determine need—are not routinely included among the contraceptive methods provided by community health workers.
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Commentary

The Research Consortium on Religious Healthcare Institutions: studying the impact of religious restrictions on women's reproductive health
Lori R. Freedman, Debra B. Stulberg
Catholic hospitals and other religious institutions are a large and growing part of the US health care system. They have specific policies restricting reproductive health care. Despite increased public attention in the media to women denied necessary pregnancy-related care at Catholic hospitals, research on the effects of religious restrictions remains limited. This article summarizes research priorities as generated by 80 attendees at the inaugural meeting of the Research Consortium on Religious Healthcare Institutions. Such research is need to understand the impact of religious health system ownership on women's health.
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Original Research Articles

Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report
Chelsea B. Polis, Sarah E.K. Bradley, Akinrinola Bankole, Tsuyoshi Onda, Trevor Croft, Susheela Singh
Background: While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries and to 12-month failure rate estimates.
Conclusions: Our findings help us to highlight those methods, subregions and population groups that may be in need of particular attention for improvements in policies and programs to address higher contraceptive failure rates.
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Correlates of unmet need for contraception in Bangladesh: does couples' concordance in household decision making matter?
Jalal Uddin, Mohammad Habibullah Pulok, Md Nasim-Us Sabah
Introduction: A large body of literature has highlighted that women's household decision-making power is associated with better reproductive health outcomes, while most of the studies tend to measure such power from only women's point of view. Using both husband's and wife's matched responses to decision-making questions, this study examined the association between couples' concordant and discordant decision makings, and wife's unmet need for contraception in Bangladesh.
Conclusion: Couple's concordant joint decision making, reflecting the concept of equalitarian power structure, appeared to be a significant analytic category. Policy makers in the field of family planning may promote community-based outreach programs and communication campaigns for family planning focusing on egalitarian gender roles in the household.
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An evaluation of a family planning mobile job aid for community health workers in Tanzania
Rebecca Braun, Christine Lasway, Smisha Agarwal, Kelly L'Engle, Erica Layer, Lucy Silas, Anna Mwakibete, Mustafa Kudrati
Objectives: The global rapid growth in mobile technology provides unique opportunities to support community health workers (CHWs) in providing family planning (FP) services. FHI 360, Pathfinder International and D-tree International developed an evidence-based mobile job aid to support CHW counseling, screening, service provision and referrals, with mobile forms for client and service data, and text-message reporting and reminders. The purpose of this study is to evaluate the acceptability and potential benefits to service quality from the perspective of CHWs and their clients.
Implications: Mobile job aids can uniquely enhance FP service provision at the community level through adherence to standard protocols, real-time feedback and technical assistance, and provision of confidential care. This study can inform future efforts to support and expand the role of CHWs in increasing FP access and informed contraceptive choice.
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Contraceptive service delivery in Kenya: A qualitative study to identify barriers and preferences among female sex workers and health care providers
Amy Corneli, Ansley Lemons, Rose Otieno-Masaba, John Ndiritu, Catherine Packer, Jesse Lamarre-Vincent, Lisa Dulli
Objective: Female sex workers (FSWs) need access to contraceptive services, yet programs often focus on HIV prevention and less on the broader sexual and reproductive health needs of FSWs. We aimed to identify barriers to accessing contraceptive services among FSWs and preferences for contraceptive service delivery options among FSWs and health care providers (HCPs) in order to inform a service delivery intervention to enhance access to and use of contraceptives for FSWs in Kenya.
Implications statement: An unsupportive clinic infrastructure, discriminatory provider–client interactions and negative partner influences are barriers to FSWs accessing the contraception services they need. Alternative service delivery options, such integrating contraceptive service delivery at drop-in centers designed for FSWs and information delivery through peer educators, might provide improved access and better service quality to FSWs seeking contraception.
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Medroxyprogesterone acetate levels among Kenyan women using depot medroxyprogesterone acetate in the FEM-PrEP trial
Kavita Nanda, Rebecca Callahan, Douglas Taylor, Meng Wang, Kawango Agot, David Jenkins, Lut Van Damme, Laneta Dorflinger, for the FEM-PrEP Study Group
Objective: To describe medroxyprogesterone acetate (MPA) levels among Kenyan depot medroxyprogesterone acetate (DMPA) users in the FEM-PrEP HIV prevention trial, and to compare MPA levels between ARV for HIV prevention (treatment) and placebo groups.
Implications: This study presents some of the few available data on MPA levels among DMPA users in Africa. The low levels among users described here, together with a number of pregnancies among DMPA users, are potentially concerning and require further investigation.
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EC4U: results from a pilot project integrating the copper IUC into emergency contraceptive care
Julia E. Kohn, Deborah L. Nucatola
Objective: The copper intrauterine contraceptive (IUC) is the most effective method of emergency contraception (EC), yet it is underutilized. The objective was to evaluate a pilot project integrating the copper IUC into EC care.
Implications: Copper IUCs are a viable option for women in need of EC. All women should be offered the most effective EC option.
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Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing
Alison B. Edelman, Ganesh Cherala, Steven W. Blue, David W. Erikson, Jeffrey T. Jensen
Objective: To determine if differences exist in the pharmacokinetics (PK) of levonorgestrel-based emergency contraception (LNG-EC) in obese and normal body mass index (BMI) users and test whether doubling the dose of LNG-EC in obese women increases total and free (active) LNG serum concentrations.
Implications: This study demonstrates that obesity interferes with the pharmacokinetics of LNG EC, and that doubling the dose may be an effective strategy to improve its efficacy in obese women.
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A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial
Elizabeth Miller, Daniel J. Tancredi, Michele R. Decker, Heather L. McCauley, Kelley A. Jones, Heather Anderson, Lisa James, Jay G. Silverman
Objective: We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy.
Conclusion: This brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.
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Effects of relationship context on contraceptive use among young women Ushma D. Upadhyay, Sarah Raifman, Tina Raine-Bennett
Objectives: To understand how relationship status influences contraceptive use among young people.
Implications: Family planning providers should discuss women's relationship context and association with contraceptive use in order to help women think of contraception as a long-term personal strategy. Since relationship status affects contraceptive use, providers and programs that aim to reduce unintended pregnancy can consider strategies to create a paradigm shift around contraceptive use that focuses on the woman's reproductive goals, current life stage, and life goals.
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Assessment of contraceptive needs in women undergoing bariatric surgery Biftu Mengesha, Leanne Griffin, Alexander Nagle, Jessica Kiley
Objective: To evaluate documentation of contraception and counseling in women planning to undergo bariatric surgery.
Implications: Pregnancy planning and documentation of perioperative contraceptive use in women undergoing bariatric surgery are suboptimal, placing these women at risk of unintended pregnancies. Future research should delineate the best practices in contraceptive provision in this high-risk population of women.
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Pregnancy following hysteroscopic sterilization at an Urban Abortion Clinic- A case series: Are We looking in the wrong places?
Luis R. Hoyos, Jocelyn Leon-Peters, Jay M. Berman, Michael Hertz
Objective: Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. However, recent evidence suggests that the failure rate may be higher than previously reported. We describe women with a history of HS presenting for abortion at a 3-site urban abortion clinic.
Implications: We identified a number of hysteroscopic sterilization failures at termination of pregnancy at a 3-site urban abortion clinic. We hypothesize that the HS failure rate underestimates the true method failure because previous analysis have excluded cases such as these.
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Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting
Elise Berlan, Kelly Mizraji, Andrea E. Bonny
Objective: The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation.
Conclusion: The vast majority of adolescents continued the ENG implant at 12 months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers.
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Postpartum contraception: An exploratory study of lactation consultants' knowledge and practices
Kathleen Dunn, Lisa L. Bayer, Sheila K. Mody
Objective: Lactation consultants interact with women during the postpartum period; however, they may not have comprehensive education on postpartum contraception and the impact on breastfeeding. The aims of this study were to assess lactation consultants' knowledge and practices about postpartum contraception and assess whether lactation consultants are interested in more education on postpartum contraception.
Implications: This study explores lactation consultants' knowledge and practices about postpartum contraception, demonstrating that more evidence-based education is needed on this topic.
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Correspondence

The challenge to solve the expulsion problem of immediate postplacental insertion of IUD
Dirk A. Wildemeersch, Norman D. Goldstuck
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Response to Drs. Wildemeersch and Goldstuck
Rebecca Cohen, Kristina Tocce
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Corrigendum

Corrigendum to “oral and injectable contraceptive use and HIV acquisition risk among women in four African countries: a secondary analysis of data from a microbicide trial” [Contraception 2016; 93 (1): 25–31]
Jennifer E. Balkus, Elizabeth R. Brown, Sharon L. Hillier, Anne Coletti, Gita Ramjee, Nyaradzo Mgodi, Bonus Makanani, Cheri Reid, Francis Martinson, Lydia Soto-Torres, Salim S. Abdool Karim, Zvavahera M. Chirenje
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