- Email: [email protected]
Reproductive autonomy and contraceptive use among adolescent and young adult women in Ghana
416
Abstracts / Contraception 94 (2016) 387–434
P81 THE EFFECT OF BMI ON UNINTENDED PREGNANCY RATES AMONG USERS OF COMBINED ORAL CONTRACEPTIVES Bauerfeind A Berlin Center for Epidemiology and Health Research (ZEG), Berlin, Germany Barnett C, Thai M, Heinemann K Objectives: We aimed to determine if the Pearl Index of combined oral contraceptives differs by BMI. Methods: We conducted a meta-analysis of five prospective, observational cohort studies with primary endpoints of venous thromboembolism (VTE) among women using combined oral contraceptives. Studies were conducted between 2007 and 2016 using a similar methodology. In sum, 246,209 women and 382,789 women– years were included. Women were followed for 3–5 years. The inclusion criterion was prescription of a new combined oral contraceptive. Studies were conducted across Europe and the United States. Results were analyzed within four age groups: younger than 25, 25–29, 30–39 and 40 or older. BMI was defined dichotomously as less than 35 kg/m2 and 35 kg/m2 or higher (US studies) and less than 30 kg/m2 and 30 kg/m2 or higher (Europe). The Pearl Index was calculated within each age and BMI category stratified by region. Significance of factors was tested in a stratified Cox regression model; age and BMI were included as continuous variables. Results: In the United States, the Pearl Index ranged from 0.15 (age 40 +, BMIb35) to 4.12 (age b25, BMI ≥ 35) with higher values observed among women with BMI 35 kg/m2 or higher within each age group. Significance (pb.0001) was obtained for both factors when simultaneously included in a Cox regression model. In the European sample, the Pearl Index ranged from 0.06 (age 40+, BMIb30) to 0.80 (age b25, BMI ≥30). Cox regression showed independent effects of age (pb.0001) and BMI (p=.0003) on the occurrence of an unintended pregnancy. Conclusions: BMI has a significant effect on the Pearl Index of combined oral contraceptives. Increasing BMI decreases the efficacy of combined oral contraceptives in Europe and the United States. http://dx.doi.org/10.1016/j.contraception.2016.07.122
P82 UNWANTED PREGNANCIES AMONG WOMEN USING INTRAUTERINE DEVICES: FINAL RESULTS FROM THE EURAS-IUD 5-YEAR STUDY Hagemann C Berlin Center of Epidemiology Health Research (ZEG), Berlin, Germany Heinemann K, Moehner S, Reed S Objectives: Intrauterine devices (IUDs) are a widely used method and have shown high contraceptive efficacy in clinical trials. The primary objective of the analysis is to determine the rate of unwanted pregnancies among women using IUDs and to describe associated complications. Methods: We conducted a large, comparative, multinational, prospective, noninterventional cohort study with new users of LNG-IUDs and copper IUDs. The combined cohort included more than 60,000 women in six European countries. The study was conducted from 2006 to 2015. The women received a follow-up questionnaire 12 months and 5 years after enrollment. All patientreported outcomes of interest were validated with the treating physicians. The analysis was based on Cox regression models comparing the cohorts. Results: As of September 2015, a total of 58,324 women (70% used LNGIUDs, 30% copper IUDs) had provided 133,015 women–years of exposure. A total of 175 contraceptive failures have been reported (41 LNG-IUD, 134 copper IUD), giving a Pearl Index of 0.04 for LNG-IUD and 0.4 for copper
IUD. The hazard ratio adjusted for age, BMI and parity for LNG-IUD versus copper IUD was 0.16 (95% CI, 0.11–0.23). Some 33 pregnancies (13 LNGIUD, 20 copper IUD) were ectopic pregnancies, giving an adjusted hazard ratio of 0.28 (95% CI, 0.14–0.58). Conclusions: The contraceptive failure rate for both cohorts was low, and LNG-IUD had a significantly lower contraceptive failure rate than copper IUD. Physicians should consider the possibility of extrauterine gravida if they suspect a pregnancy during IUD use.
http://dx.doi.org/10.1016/j.contraception.2016.07.123
P83 REPRODUCTIVE AUTONOMY AND CONTRACEPTIVE USE AMONG ADOLESCENT AND YOUNG ADULT WOMEN IN GHANA Loll D University of Michigan School of Public Health, Ann Arbor, MI, USA Bauermeister J, Ela E, Manu A, Morhe E, Dozier J, Harris L, Dalton V, Hall K Objectives: Reproductive autonomy, a measure of fertility-specific empowerment, has been associated with family planning outcomes among US women. We examined whether these findings could be replicated among young women in Ghana by assessing the reliability of two reproductive autonomy subscales (decision-making and communication) and their relationships with use of modern contraceptives. Methods: Data were drawn from a survey of 1080 women aged 15–24 recruited from health facilities, high schools and universities in Accra and Kumasi, Ghana. Our analytic sample comprised women who were sexually experienced and in any type of relationship (n=596). We operationalized each reproductive autonomy subscale as a 3-Likert-item additive index reflecting the degree to which respondents had power and communicated with partners about fertility and family planning decisions. Subscale scores ranged from 3 to 12, and higher scores indicated higher autonomy. We tested associations between reproductive autonomy and ever use of a modern contraceptive method using student's t tests and multivariable logistic regressions. Results: The reproductive autonomy decision-making (alpha=0.62) and communication (alpha=0.64) subscales demonstrated acceptable reliability in our Ghanaian sample. In bivariate analyses, contraceptive users had higher decision-making (m=7.86 vs. m=7.41, p=.015) and communication (m=9.68 vs. 9.22, p=.004) scores than nonusers. In multivariable models, higher decision-making scores (but not communication) were associated with increased odds of modern contraceptive use (OR, 1.12; 95% CI, 1.01–1.24; p=.04). Conclusions: Autonomy in reproductive decision making is an important correlate of contraceptive use among young women in Ghana. We are further exploring the impact of reproductive autonomy, partner communication and power dynamics on family planning outcomes in this population and context. http://dx.doi.org/10.1016/j.contraception.2016.07.124
P84 BREASTFEEDING AND INFANT GROWTH PARAMETERS AMONG A PROSPECTIVE COHORT OF MALAWIAN WOMEN WHO UNDERWENT IMMEDIATE POSTPARTUM IMPLANT OR COPPER INTRAUTERINE DEVICE INSERTION Tang J University of North Carolina, Chapel Hill, NC, USA Lemani C, Nkambule J, Talama G, Chanachi S, Chirombo J, Chinula L, Stuebe A
Abstracts / Contraception 94 (2016) 387–434
P81 THE EFFECT OF BMI ON UNINTENDED PREGNANCY RATES AMONG USERS OF COMBINED ORAL CONTRACEPTIVES Bauerfeind A Berlin Center for Epidemiology and Health Research (ZEG), Berlin, Germany Barnett C, Thai M, Heinemann K Objectives: We aimed to determine if the Pearl Index of combined oral contraceptives differs by BMI. Methods: We conducted a meta-analysis of five prospective, observational cohort studies with primary endpoints of venous thromboembolism (VTE) among women using combined oral contraceptives. Studies were conducted between 2007 and 2016 using a similar methodology. In sum, 246,209 women and 382,789 women– years were included. Women were followed for 3–5 years. The inclusion criterion was prescription of a new combined oral contraceptive. Studies were conducted across Europe and the United States. Results were analyzed within four age groups: younger than 25, 25–29, 30–39 and 40 or older. BMI was defined dichotomously as less than 35 kg/m2 and 35 kg/m2 or higher (US studies) and less than 30 kg/m2 and 30 kg/m2 or higher (Europe). The Pearl Index was calculated within each age and BMI category stratified by region. Significance of factors was tested in a stratified Cox regression model; age and BMI were included as continuous variables. Results: In the United States, the Pearl Index ranged from 0.15 (age 40 +, BMIb35) to 4.12 (age b25, BMI ≥ 35) with higher values observed among women with BMI 35 kg/m2 or higher within each age group. Significance (pb.0001) was obtained for both factors when simultaneously included in a Cox regression model. In the European sample, the Pearl Index ranged from 0.06 (age 40+, BMIb30) to 0.80 (age b25, BMI ≥30). Cox regression showed independent effects of age (pb.0001) and BMI (p=.0003) on the occurrence of an unintended pregnancy. Conclusions: BMI has a significant effect on the Pearl Index of combined oral contraceptives. Increasing BMI decreases the efficacy of combined oral contraceptives in Europe and the United States. http://dx.doi.org/10.1016/j.contraception.2016.07.122
P82 UNWANTED PREGNANCIES AMONG WOMEN USING INTRAUTERINE DEVICES: FINAL RESULTS FROM THE EURAS-IUD 5-YEAR STUDY Hagemann C Berlin Center of Epidemiology Health Research (ZEG), Berlin, Germany Heinemann K, Moehner S, Reed S Objectives: Intrauterine devices (IUDs) are a widely used method and have shown high contraceptive efficacy in clinical trials. The primary objective of the analysis is to determine the rate of unwanted pregnancies among women using IUDs and to describe associated complications. Methods: We conducted a large, comparative, multinational, prospective, noninterventional cohort study with new users of LNG-IUDs and copper IUDs. The combined cohort included more than 60,000 women in six European countries. The study was conducted from 2006 to 2015. The women received a follow-up questionnaire 12 months and 5 years after enrollment. All patientreported outcomes of interest were validated with the treating physicians. The analysis was based on Cox regression models comparing the cohorts. Results: As of September 2015, a total of 58,324 women (70% used LNGIUDs, 30% copper IUDs) had provided 133,015 women–years of exposure. A total of 175 contraceptive failures have been reported (41 LNG-IUD, 134 copper IUD), giving a Pearl Index of 0.04 for LNG-IUD and 0.4 for copper
IUD. The hazard ratio adjusted for age, BMI and parity for LNG-IUD versus copper IUD was 0.16 (95% CI, 0.11–0.23). Some 33 pregnancies (13 LNGIUD, 20 copper IUD) were ectopic pregnancies, giving an adjusted hazard ratio of 0.28 (95% CI, 0.14–0.58). Conclusions: The contraceptive failure rate for both cohorts was low, and LNG-IUD had a significantly lower contraceptive failure rate than copper IUD. Physicians should consider the possibility of extrauterine gravida if they suspect a pregnancy during IUD use.
http://dx.doi.org/10.1016/j.contraception.2016.07.123
P83 REPRODUCTIVE AUTONOMY AND CONTRACEPTIVE USE AMONG ADOLESCENT AND YOUNG ADULT WOMEN IN GHANA Loll D University of Michigan School of Public Health, Ann Arbor, MI, USA Bauermeister J, Ela E, Manu A, Morhe E, Dozier J, Harris L, Dalton V, Hall K Objectives: Reproductive autonomy, a measure of fertility-specific empowerment, has been associated with family planning outcomes among US women. We examined whether these findings could be replicated among young women in Ghana by assessing the reliability of two reproductive autonomy subscales (decision-making and communication) and their relationships with use of modern contraceptives. Methods: Data were drawn from a survey of 1080 women aged 15–24 recruited from health facilities, high schools and universities in Accra and Kumasi, Ghana. Our analytic sample comprised women who were sexually experienced and in any type of relationship (n=596). We operationalized each reproductive autonomy subscale as a 3-Likert-item additive index reflecting the degree to which respondents had power and communicated with partners about fertility and family planning decisions. Subscale scores ranged from 3 to 12, and higher scores indicated higher autonomy. We tested associations between reproductive autonomy and ever use of a modern contraceptive method using student's t tests and multivariable logistic regressions. Results: The reproductive autonomy decision-making (alpha=0.62) and communication (alpha=0.64) subscales demonstrated acceptable reliability in our Ghanaian sample. In bivariate analyses, contraceptive users had higher decision-making (m=7.86 vs. m=7.41, p=.015) and communication (m=9.68 vs. 9.22, p=.004) scores than nonusers. In multivariable models, higher decision-making scores (but not communication) were associated with increased odds of modern contraceptive use (OR, 1.12; 95% CI, 1.01–1.24; p=.04). Conclusions: Autonomy in reproductive decision making is an important correlate of contraceptive use among young women in Ghana. We are further exploring the impact of reproductive autonomy, partner communication and power dynamics on family planning outcomes in this population and context. http://dx.doi.org/10.1016/j.contraception.2016.07.124
P84 BREASTFEEDING AND INFANT GROWTH PARAMETERS AMONG A PROSPECTIVE COHORT OF MALAWIAN WOMEN WHO UNDERWENT IMMEDIATE POSTPARTUM IMPLANT OR COPPER INTRAUTERINE DEVICE INSERTION Tang J University of North Carolina, Chapel Hill, NC, USA Lemani C, Nkambule J, Talama G, Chanachi S, Chirombo J, Chinula L, Stuebe A