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Examining pregnancy intendedness among pregnancies ending in spontaneous abortion
Abstracts / Contraception 94 (2016) 387–434
Objectives: A package of interventions to introduce emergency contraception (EC) to Mexico was implemented, resulting in the addition of EC to the national family planning guidelines in 2004. We describe EC knowledge and use among women in Mexico over time. Methods: We used the 2006, 2009 and 2014 waves of a nationally representative demographic survey (ENADID). We assessed EC knowledge and usage among women aged 15–29 who were not using permanent methods and tested whether EC knowledge and use changed over time after controlling for social and demographic characteristics using logistic regression. Results: Our sample included n= 99,223 (population N= 40,234,355) women. Overall, knowledge of EC increased over time: 62% of respondents in 2006 to 79% in 2009 to 83% in 2014 (pb.001). Among young women who had used contraceptives (n= 42,883, population N= 16,816,701), the proportion that reported EC use increased from 3% to 11% to 29% (pb.001). Women who had ever used EC were more likely than nonusers to be using no contraceptive method (44% vs. 35%) or barrier method (22% vs. 17%). Demographic factors including lower wealth, less education, indigenous status and rural residency were significantly associated with decreased EC knowledge and use. Stratified multivariate analysis found that demographic disadvantages magnify lower EC use among rural residents compared with nonrural residents. Conclusions: Knowledge and use of EC are growing rapidly in Mexico, but disparities persist among demographically disadvantaged women, particularly those living in rural areas. Women who use EC appear to be at higher risk of unintended pregnancy based on levels of current contraceptive use. http://dx.doi.org/10.1016/j.contraception.2016.07.132
P92 GROUP VERSUS INDIVIDUAL CONTRACEPTIVE COUNSELING FOR RESETTLED AFRICAN REFUGEE WOMEN: A PILOT RANDOMIZED CONTROLLED TRIAL Royer P University of Utah, Salt Lake City, UT, USA Jenkins A, Weber L, Jackson B, Sanders J, Turok D
Objectives: We aimed to evaluate the feasibility of group contraceptive counseling and its associations with family planning knowledge acquisition, service satisfaction, method uptake and continuation among a group of resettled African refugee women. Methods: We adapted materials for group contraceptive counseling from USAID resources. Individual contraceptive counseling using shared decision making was standard of care. Participants were recruited via community leaders and snowball referral methods. Following informed consent, participants completed a demographics survey and baseline contraceptive knowledge assessment (adapted from the Fog Zone study). Participants were then randomized to receive either group or individual counseling. Postcounseling, women were privately offered their choice of contraceptive method at no cost. Exit surveys reassessing knowledge and service satisfaction were administered. Knowledge acquisition was based on mean number of correct answers (range, 0–27). Service satisfaction was assessed with a 5-point Likert scale. Results: We conducted three sessions to recruit 17 participants who were randomized to receive group (n= 8) or individual (n= 9) counseling. Baseline knowledge was similar between groups (p=.12), while knowledge acquisition differed significantly between groups (p=.006); the mean number of correct answers increased from 11 to 19 among those who received group counseling and from 14 to 16 among the individual counseling group. Counseling satisfaction did not differ between groups. Modern contraceptive method uptake was greater in the individual counseling group: Five women initiated a method versus two women who received group counseling. Data collection on method continuation is ongoing.
419
Conclusions: Group contraceptive counseling provides a novel approach to family planning provision, has a demonstrated ability to improve knowledge acquisition and is worthy of further investigation. http://dx.doi.org/10.1016/j.contraception.2016.07.133
P93 EXAMINING PREGNANCY INTENDEDNESS AMONG PREGNANCIES ENDING IN SPONTANEOUS ABORTION Flink-Bochacki R University of Pittsburgh, Pittsburgh, PA, USA Meyn LA, Chen BA, Achilles SL, Borrero S Objectives: Spontaneous abortion affects more than one million US women each year, yet little is known about the intendedness of these pregnancies. We examined prevalence and correlates of unintended and unwanted pregnancies ending in spontaneous abortion, using nationally representative data. Methods: We used cross-sectional data from a sample of US women aged 15–44 with a history of pregnancy ending in spontaneous abortion, who participated in the 2011–2013 National Survey of Family Growth. Multivariable logistic regression models were used to evaluate associations of demographic and pregnancy characteristics with unintended and unwanted pregnancy. Results: Among 1365 pregnancies ending in spontaneous abortion, 44.8% were unintended (unwanted or occurring sooner than desired). Younger women were more likely to report unintended pregnancies than women aged 30 or older, with the highest odds among women aged 19 or younger [adjusted odds ratio (aOR),12.6; 95% CI, 6.0–26.4]. Unintended pregnancy was significantly more likely among unmarried than among married women (never married: aOR, 5.0; 95% CI, 2.9–8.7; previously married: aOR, 4.5; 95% CI, 2.2–9.2). Other factors associated with unintended pregnancy were interpregnancy interval of 12 months or less compared with an interval of more than 12 months (aOR,1.6; 95% CI, 1.1–2.4) and gravidity of four or more compared with gravidity of one (aOR, 2.5; 95% CI,1.3–5.1). In a secondary analysis examining unwanted pregnancies alone (15.5% of pregnancies in our sample), similar associations were found, with the exception of short interpregnancy interval. Race/Ethnicity was not associated with either unintended or unwanted pregnancy. Conclusions: A substantial proportion of pregnancies that end in spontaneous abortion are unintended or unwanted. Further research is needed to better understand the reproductive goals of women experiencing spontaneous abortion. http://dx.doi.org/10.1016/j.contraception.2016.07.134
P94 SEXUAL PARTNERS AMONG SEXUAL MINORITY YOUNG WOMEN: FEMALE, MALE AND NONE Lindberg L Guttmacher Institute, New York, NY, USA Jerman J Objectives: We aimed to explore sexual partnership patterns among a nationally representative sample of sexual minority young women. Methods: We use data from the 2006–2010 and 2011–2013 National Survey of Family Growth from self-identified females aged 15–24. We combine measures of sexual orientation, attraction and behavior to identify sexual minority young women and examine sexual partnership patterns among this group. Results: Overall, 27% of females aged 15–24 identified as a sexual minority; 8% of young women identified as bisexual and 2% as lesbian; 20% reported at least some sexual attraction to women and 16% reported ever having had a female sexual partner. Same-sex behavior and attraction did not fully overlap. Female partners were reported
Objectives: A package of interventions to introduce emergency contraception (EC) to Mexico was implemented, resulting in the addition of EC to the national family planning guidelines in 2004. We describe EC knowledge and use among women in Mexico over time. Methods: We used the 2006, 2009 and 2014 waves of a nationally representative demographic survey (ENADID). We assessed EC knowledge and usage among women aged 15–29 who were not using permanent methods and tested whether EC knowledge and use changed over time after controlling for social and demographic characteristics using logistic regression. Results: Our sample included n= 99,223 (population N= 40,234,355) women. Overall, knowledge of EC increased over time: 62% of respondents in 2006 to 79% in 2009 to 83% in 2014 (pb.001). Among young women who had used contraceptives (n= 42,883, population N= 16,816,701), the proportion that reported EC use increased from 3% to 11% to 29% (pb.001). Women who had ever used EC were more likely than nonusers to be using no contraceptive method (44% vs. 35%) or barrier method (22% vs. 17%). Demographic factors including lower wealth, less education, indigenous status and rural residency were significantly associated with decreased EC knowledge and use. Stratified multivariate analysis found that demographic disadvantages magnify lower EC use among rural residents compared with nonrural residents. Conclusions: Knowledge and use of EC are growing rapidly in Mexico, but disparities persist among demographically disadvantaged women, particularly those living in rural areas. Women who use EC appear to be at higher risk of unintended pregnancy based on levels of current contraceptive use. http://dx.doi.org/10.1016/j.contraception.2016.07.132
P92 GROUP VERSUS INDIVIDUAL CONTRACEPTIVE COUNSELING FOR RESETTLED AFRICAN REFUGEE WOMEN: A PILOT RANDOMIZED CONTROLLED TRIAL Royer P University of Utah, Salt Lake City, UT, USA Jenkins A, Weber L, Jackson B, Sanders J, Turok D
Objectives: We aimed to evaluate the feasibility of group contraceptive counseling and its associations with family planning knowledge acquisition, service satisfaction, method uptake and continuation among a group of resettled African refugee women. Methods: We adapted materials for group contraceptive counseling from USAID resources. Individual contraceptive counseling using shared decision making was standard of care. Participants were recruited via community leaders and snowball referral methods. Following informed consent, participants completed a demographics survey and baseline contraceptive knowledge assessment (adapted from the Fog Zone study). Participants were then randomized to receive either group or individual counseling. Postcounseling, women were privately offered their choice of contraceptive method at no cost. Exit surveys reassessing knowledge and service satisfaction were administered. Knowledge acquisition was based on mean number of correct answers (range, 0–27). Service satisfaction was assessed with a 5-point Likert scale. Results: We conducted three sessions to recruit 17 participants who were randomized to receive group (n= 8) or individual (n= 9) counseling. Baseline knowledge was similar between groups (p=.12), while knowledge acquisition differed significantly between groups (p=.006); the mean number of correct answers increased from 11 to 19 among those who received group counseling and from 14 to 16 among the individual counseling group. Counseling satisfaction did not differ between groups. Modern contraceptive method uptake was greater in the individual counseling group: Five women initiated a method versus two women who received group counseling. Data collection on method continuation is ongoing.
419
Conclusions: Group contraceptive counseling provides a novel approach to family planning provision, has a demonstrated ability to improve knowledge acquisition and is worthy of further investigation. http://dx.doi.org/10.1016/j.contraception.2016.07.133
P93 EXAMINING PREGNANCY INTENDEDNESS AMONG PREGNANCIES ENDING IN SPONTANEOUS ABORTION Flink-Bochacki R University of Pittsburgh, Pittsburgh, PA, USA Meyn LA, Chen BA, Achilles SL, Borrero S Objectives: Spontaneous abortion affects more than one million US women each year, yet little is known about the intendedness of these pregnancies. We examined prevalence and correlates of unintended and unwanted pregnancies ending in spontaneous abortion, using nationally representative data. Methods: We used cross-sectional data from a sample of US women aged 15–44 with a history of pregnancy ending in spontaneous abortion, who participated in the 2011–2013 National Survey of Family Growth. Multivariable logistic regression models were used to evaluate associations of demographic and pregnancy characteristics with unintended and unwanted pregnancy. Results: Among 1365 pregnancies ending in spontaneous abortion, 44.8% were unintended (unwanted or occurring sooner than desired). Younger women were more likely to report unintended pregnancies than women aged 30 or older, with the highest odds among women aged 19 or younger [adjusted odds ratio (aOR),12.6; 95% CI, 6.0–26.4]. Unintended pregnancy was significantly more likely among unmarried than among married women (never married: aOR, 5.0; 95% CI, 2.9–8.7; previously married: aOR, 4.5; 95% CI, 2.2–9.2). Other factors associated with unintended pregnancy were interpregnancy interval of 12 months or less compared with an interval of more than 12 months (aOR,1.6; 95% CI, 1.1–2.4) and gravidity of four or more compared with gravidity of one (aOR, 2.5; 95% CI,1.3–5.1). In a secondary analysis examining unwanted pregnancies alone (15.5% of pregnancies in our sample), similar associations were found, with the exception of short interpregnancy interval. Race/Ethnicity was not associated with either unintended or unwanted pregnancy. Conclusions: A substantial proportion of pregnancies that end in spontaneous abortion are unintended or unwanted. Further research is needed to better understand the reproductive goals of women experiencing spontaneous abortion. http://dx.doi.org/10.1016/j.contraception.2016.07.134
P94 SEXUAL PARTNERS AMONG SEXUAL MINORITY YOUNG WOMEN: FEMALE, MALE AND NONE Lindberg L Guttmacher Institute, New York, NY, USA Jerman J Objectives: We aimed to explore sexual partnership patterns among a nationally representative sample of sexual minority young women. Methods: We use data from the 2006–2010 and 2011–2013 National Survey of Family Growth from self-identified females aged 15–24. We combine measures of sexual orientation, attraction and behavior to identify sexual minority young women and examine sexual partnership patterns among this group. Results: Overall, 27% of females aged 15–24 identified as a sexual minority; 8% of young women identified as bisexual and 2% as lesbian; 20% reported at least some sexual attraction to women and 16% reported ever having had a female sexual partner. Same-sex behavior and attraction did not fully overlap. Female partners were reported