J Fam Plann Reprod Health Care
· 2017 Jan · PMID 28007820
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OBJECTIVE: In response to a persistent low fertility rate in the country, the Supreme Leader of Iran in 2012 called for the shift to pronatalist population policies. Consequently, Iran's Parliament proposed a bill to cur...OBJECTIVE: In response to a persistent low fertility rate in the country, the Supreme Leader of Iran in 2012 called for the shift to pronatalist population policies. Consequently, Iran's Parliament proposed a bill to curb the provision of contraceptive knowledge and services as a solution to raising the country's low fertility rate. This study aimed to investigate which groups of women will be adversely affected if the provision of subsidised contraceptive methods [i.e. sterilisation, intrauterine device (IUD) and injections] is curbed. METHODS: This study used recent data from the 2014 Tehran Survey of Fertility (n=3012) conducted among a representative sample of 3012 married women of reproductive age, and used multinomial logistic regression analysis to identify women with a higher likelihood of using government-funded contraceptive methods. RESULTS: Currently 82% of married women living in Tehran use a contraceptive method. The use of long-acting contraception, namely sterilisation and IUDs, declined from 34% in 2000 to 20% in 2014, and the prevalence of male methods (withdrawal and condoms) increased from 33% to 55% in the same period. Multivariate results showed that women who have a large number of children, want no more children, live in poor districts, and have low education are more likely to use long-acting contraceptive methods than withdrawal and condoms. CONCLUSIONS: Women of low socioeconomic status who want to stop childbearing are the most vulnerable subgroups of the population if the publicly-funded family planning services are curbed.
Keogh LA, Newton D, Bayly C
… +4 more, McNamee K, Hardiman A, Webster A, Bismark M
J Fam Plann Reprod Health Care
· 2017 Jan · PMID 27913574
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INTRODUCTION: In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived...INTRODUCTION: In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. METHODS: Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. RESULTS: Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. CONCLUSION: Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.
Iltemir Duvan C, Onaran Y, Aktepe Keskin E
… +4 more, Yüce E, Yanık B, Kafali H, Ozturk Turhan N
J Fam Plann Reprod Health Care
· 2017 Apr · PMID 27908964
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AIM: To evaluate the effects of the etonogestrel contraceptive implant (Implanon) on bone metabolism in lactating women using markers for bone formation and resorption. STUDY DESIGN: This single-centre, prospective cohor...AIM: To evaluate the effects of the etonogestrel contraceptive implant (Implanon) on bone metabolism in lactating women using markers for bone formation and resorption. STUDY DESIGN: This single-centre, prospective cohort study was conducted in Turgut Ozal University Medical Faculty Obstetrics and Gynecology Department with healthy lactating women aged between 24 and 38 years to compare the effect on bone metabolism of 6 months' use of either the implant or a non-hormonal contraceptive method. The study group (=25) used an implant and the control group (=25) used a non-hormonal contraceptive intrauterine device inserted 40 days' postpartum. Bone metabolism differences at the time of insertion and after 6 months were assessed quantitatively by biochemical analysis of serum and urine samples. RESULTS: At baseline, serum levels of bone metabolism parameters were similar for the two groups. In the implant group, serum alkaline phosphatase (ALP) levels decreased (=0.004) and total protein levels increased (=0.045) at 6 months. In the control group, serum levels of bone metabolism parameters did not change at 6 months compared to baseline. However, serum levels of phosphorus (=0.013) and ALP (=0.003) decreased at 6 months compared to baseline. CONCLUSION: Six months' postpartum use of Implanon was found to have no deleterious impact on bone turnover in healthy lactating women.
J Fam Plann Reprod Health Care
· 2017 Jan · PMID 27899410
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BACKGROUND: In recent years there has been growing international interest in identifying risk factors associated with 'repeat abortion', and developing public health initiatives that might reduce the rate. This article d...BACKGROUND: In recent years there has been growing international interest in identifying risk factors associated with 'repeat abortion', and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. STUDY DESIGN: Mixed-methods research study: a quantitative survey of 430 women aged 16-24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). RESULTS: The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. CONCLUSIONS: This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion.