Objective: To study midwives management, practice and reasoning regarding contraceptive counseling for women who are experiencing "mild" side effects of the pill Methods: Four focus groups, made up of three to five midwives per group, participated in focus group discussions. Qualitative design with the method “Think-Aloud” has been used to collect data and the material was analyzed using content analysis. Results: The study identified three categories, the first "How midwives practice regarding the side effects of the pill," shows that midwives have a systematic approach when meeting with women who are experiencing side effects of the pill. The next category "Using a holistic and professional approach for women" highlights that the midwives take women's side effects seriously and that midwives respect individual woman’s autonomy. Finally in the third category "Lack of evidence about side effects becomes a women's dilemma" here midwives describe varying ways of interpreting side effects as well as attitudes and socio-economic conditions in society that affect women's choice of contraception. Conclusion: The midwives express that side effects such as loss of libido, depression and weight gain are complex and often difficult to attribute solely to the pill. The midwives' work is characterized by a holistic approach. We see the benefits of sharing information in groups, therefor we suggest that midwives create mediums where they can learn from each other by sharing their valuable experience and knowledge.

Bakgrund: Barnmorskans arbetsfält omfattar idag sexuell-, reproduktiv- och perinatal hälsa och det centrala i yrkesutövningen är att främja hälsa. Barnmorskan ska ha kunskaper om, kunna ge information och undervisa om sexualitet och samlevnad utifrån ett genus- och livscykelperspektiv. Uppdraget på ungdomsmottagning är att arbeta med sexualitet och hälsa samt att förebygga oönskade graviditeter och STI. Syfte: Syftet var att beskriva barnmorskors erfarenheter av preventivmedelsrådgivning på ungdomsmottagning. Metod: Individuella intervjuer genomfordes med nio barnmorskor på ungdomsmottagningar. Vid intervjutillfället användes en frågeguide och semistrukturerade frågor ställdes. Som analysmetod användes kvalitativ innehållsanalys. Resultat: Fyra kategorier och 15 subkategorier identifierades. Kategorierna var enligt följande: Erfarenheten och kunskapens betydelse, Det kliniska arbetssättet, Modererande faktorer och Utmaningar. Slutsats: Barnmorskor uppgav god kunskap och goda erfarenheter av ungdomar och preventivmedelsrådgivning på ungdomsmottagning men menade att det är ett dynamiskt arbete som bidrar till ständig utveckling. Vid möten med preventivmedelssökande ungdomar på ungdomsmottagning fanns önskan att mötet skulle ske på individnivå. Erfarenheter av modererande faktorer för barnmorskan, utmaningar för preventivmedelsrådgivningen och följsamheten fanns vilket innebar att preventivmedelsrådgivning för ungdomar på ungdomsmottagning är komplext. Klinisk tillämpbarhet: Studiens resultat skulle kunna innebära ökad förståelse för arbetet på ungdomsmottagning och skapa underlag för att möta utmaningarna som barnmorskorna möter i det dagliga arbetet. / Background: The midwife’s field of work today includes sexual,- reproductive,- and perinatal health and the core of the profession is to promote health. The midwife should have the knowledge, to provide information and teach about sexuality and relationships from a gender and lifecycle approach. The mission of the youth center is to work with sexuality and health and the prevention of unwanted pregnancies and STI’s. Aim: The aim was to describe midwives' experiences of contraceptive counseling at youth clinics. Method: Interviews were conducted with nine midwives in youth clinics. In time of the interview a questionnaire was used and semistructured questions were asked. Qualitative content analysis was used as analyze method. Results: Four categories and 15 subcategories were identified. The categories were as follows: Importance of experience and knowledge, the Clinical approach, Moderating factors and Challenges. Conclusion: Midwives feel they have good knowledge and experience of young people and contraceptive counseling at the youth clinic and has experience that it is a dynamic work that contributes to constant development. When they meet contraception seeking young people they wish to meet them at an individual level. The midwives had experiences in that there are moderating factors and challenges for the contraception counselling and compliance in contraceptive use, this means that contraceptive counselling for young people is complex. Clinical application: The result of the study could mean greater understanding for the work in youth clinics and create a basis for meeting the challenges that midwives face in their daily work.

No description available.

The purpose of this research project is to develop a clinical practice guideline for contraceptive counseling to include long acting reversible contraceptive (LARC) recommendations for the adolescent population. LARCs, which include intrauterine devices and implants, are the top-tier contraceptive for nulliparous women yet they are only used in less than 6% of women under 19 years old. There is no LARC clinical practice guideline that addresses the adolescent’s unique developmental and psychosocial needs that arise. A clinical practice guideline with adolescent-specific recommendations will strengthen counseling especially for long-acting reversible contraceptives. The review of literature searched PubMed, CINHAL, National Guideline Clearinghouse, Google Scholar and the Cochrane Library using search terms "LARCs," and "contraceptive counseling." The search yielded over 35,000 results; titles and abstracts were reviewed using pre-determined inclusion and exclusion criteria. The final source documents included forty-eight applicable manuscripts, which were graded using the United States Preventative Task Force (USPSTF) scale. The evidence was then sorted by similar findings and practice recommendations. The findings were used to formulate practice statements, which were then input into the Bridge-wiz software. The program generated recommendations and assigned a strength rating, and the clinical practice guideline was written from these recommendations. Finally, four clinical experts were identified using snowball sampling; they each participated in the final appraisal using the AGREE II tool. Based on the analysis of the review of literature, fifteen evidenced-based recommendations emerged. The recommendation topics included: best-practices for recommending LARCs, using developmentally appropriate teaching, providing youth-friendly services, and eliminating potential barriers to LARC uptake in adolescents. There are fifteen practice recommendations that increase adolescent uptake of LARCs. Limitations for the project included the absence of an internal review committee to grade the evidence and assign a strength to each recommendation. The use of Bridge-wiz software and the USPSTF evidence scale minimized bias. Providers can facilitate use of LARCs among adolescents by using developmentally appropriate and comprehensive contraceptive counseling. If more adolescents chose a LARC as their primary form of contraception, then overall teenage pregnancies may decrease. Further research is needed to understand other barriers and possible interventions.

Objective Safety-net clinics such as health department family planning (HD) and federally qualified health centers (FQHCs) provide free or low-cost contraceptive care to low-income and uninsured populations. Integration of contraceptive focused training within safety-net clinics is essential to deliver comprehensive, patient-centered contraceptive care. In SC, HDs receive Title X funding, which requires providing training to staff. However, due to different funding policies, trainings may be less available to FQHC staff which creates gap in care. This study examined perceptions of impact of trainings on overall performance and patient care among safety-net clinics in South Carolina (SC) that received externally funded contraceptive trainings for healthcare providers and clinic staff. The key focus of this study was to identify the perceptions of training among clinical staff and providers in HDs and FQHCs in SC. Our study showed that when equal funding opportunities were provided, it expanded the opportunity of positive impact. Method Key informant interviews were conducted among 58 individuals, 31 HD and 27 FQHC clinic staff and system leaders in 2019. Interview questions assessed the respondent’s perception of trainings on overall performance and patient care. Formal informed consent was obtained before the interview and participation was voluntary. Interviews were conducted privately via phone by study staff at East Tennessee State University. The interview recordings were transcribed and coded with QSR International’s NVivo 12 qualitative data analysis software. A codebook was developed, and inter-rater reliability and consensus coding methodologies were utilized to ensure consistency of coding. Results The majority of HD and FQHC respondents identified improved quality of services and infrastructure as positive impacts of provided trainings (N=14 and N=12, respectively). Additionally, four respondents from FQHC sectors mentioned that training increased capacity for contraceptive provision. Challenges with staffing capacity such as not having time for training were mentioned as a negative perception among both sectors. Perception of impact of training on patient care were positive among most respondents (N=44). Most respondents from both sectors indicated improved capacity for patient counseling as a positive impact of training (N=26). Two FQHC respondents mentioned that training led to implementing best practices. Conclusion Positive perception of contraceptive training on overall performance and patient care have been identified throughout this study. Federal funding provides support for training implementation but restrictions in funding due to policy changes and different funding mechanisms limit some clinics. Although external funding provides support; this does not ensure the sustainability of trainings after completion of the funding period which can create gaps in care and contraceptive provision. Future research should focus on training sustainability models such as Train-the-Trainer to ensure continuity of positive impact in local and state levels.

Introduction: Contraceptive decision-making is individual in nature and access to high-quality contraceptive care, including counseling and the full range of contraceptive methods, can help individuals achieve their personal reproductive goals and prevent unintended pregnancy. The COVID-19 pandemic disrupted provision and utilization of contraceptive counseling and contraceptive methods. Long-acting reversible contraception (LARC) methods, such as the contraceptive implant and intrauterine devices (IUDs), were particularly affected by the pandemic because they require placement by a health care provider in a clinical setting. Choose Well (CW), an ongoing statewide contraceptive access initiative in South Carolina, launched in 2017 and continues through 2022. CW aims to implement best practices of contraceptive care via training and funding for IUD and implant methods. This study examined the perceptions of access to contraceptive counseling and implant and IUD methods during the pandemic in 2020 among CW hospital partners. Methods: Data were collected in 2021 via key informant interviews with partners (n=9) at CW implementing hospitals to assess perceptions of CW activities in 2020, the first year of the COVID-19 pandemic. A semi-structured interview guide was used, and interviews were recorded, transcribed, and consensus coded. A codebook was developed based on the interview guide. Data from select questions of interest related to perceived access to contraceptive counseling, access to LARC methods, and the impact of the pandemic on contraceptive care services were analyzed for this study. Coding was conducted with NVivo software version 1.6.1. Results: Findings show that there was continued provision of contraceptive services during COVID-19 at CW partner hospitals, including an increase in access to contraceptive counseling and LARCs in 2020. The most prevalent facilitator for increased access to contraceptive counseling and LARCs at CW partner hospitals was having key personnel available such as physicians and Obstetrics (OB) navigators. Expanded access to outpatient sites was also noted as a facilitator of contraceptive counseling. Advertising and wide-spread patient education, buy-in and engagement from staff were additional facilitators for the increased access to LARCs. Considering the context of the COVID-19 pandemic, patients wanting to quickly leave the hospital and challenges with staffing contributed to an overall decline in access in some hospital locations. Challenges with staffing included not being able to receive training and nurses being overworked and overburdened. Conclusion: While COVID-19 has posed challenges to contraceptive care service provision, most individuals perceived an increase in access to contraceptive counseling and LARCs at CW partner hospitals. Hospital partners have continued to provide contraceptive services during COVID-19. The findings suggest the success of the CW initiative in increasing access to contraceptive services, particularly during COVID-19 through key facilitators. Staffing positions such as OB Navigators should be funded and maintained to increase access to contraceptive care services in hospital inpatient settings. Coordinating care between hospital inpatient and outpatient settings is similarly important for widespread patient education about contraceptive care services.

Objective: Capacity building and training to improve contraceptive care is essential for patient-centered care and reproductive autonomy. This study assessed the feasibility of translating the knowledge and skills gained from contraception trainings into improvements in practice. Study Design: Participants completed surveys following contraceptive care trainings provided to family planning clinic and hospital obstetric providers and staff as a part of the Choose Well contraceptive access initiative in South Carolina. Surveys assessed participants’ intent to change their practice post-training and anticipated barriers to implementing change. A mixed-methods approach was utilized including descriptive analysis of Likert scale responses and thematic content analysis to synthesize open-ended, qualitative responses. Results: Data were collected from 160 contraceptive training sessions provided to 4814 clinical and administrative staff between 2017 and 2019. Post-training surveys were completed by 3464 participants (72%), and of these, 2978 answered questions related to the study outcomes. Most respondents (n = 2390; 80.7%) indicated intent to change their practice and 35.5% (n = 1044) anticipated barriers to implementing intended changes. Across all training categories, organizational factors (time constraints, policies and practices, infrastructure/resources) were the most frequently perceived barrier to improving contraceptive services. Structural factors related to cost for patients were also identified as barriers to IUD and implant provision. Conclusion: The trainings were successful in influencing family planning staff and providers’ intent to improve their contraceptive practices, yet some anticipated barriers in translating training into practice. Improvements in organizational and structural policies are critical to realizing the benefits of trainings in advancing quality contraceptive care. Implications: In addition to training, coordinated efforts to address organizational practices and resources, coupled with system-level policy changes are essential to facilitate the delivery and sustainability of patient-centered contraceptive care.

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

Contraceptives are available free of charge throughout South Africa. Nevertheless the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 47 women who requested TOP services. Gender and financial issues posed challenges for some women to access contraceptives as well as their reported inability to access contraceptives. Most (85,5%) of the respondents used contraceptives. They discontinued using contraceptives because they experienced side-effects, necessitating them to request TOPs. Knowledge about, access to, nor the actual use of contraceptive enabled these women to prevent unwanted pregnancies. More effective counselling about the side-effects of contraceptives and enhanced accessibility of contraceptives during weekends and lunch breaks could enable more women to prevent unwanted pregnancies and reduce the number of requests for TOPs in the Gert Sibande District (Mpumalanga). / Health Studies / M.A. (Health Studies)