Master of Public Health - MPH / The problem of the unmet need for contraception continues to affect contraceptive uptake particularly the use of long-acting reversible contraceptives. Globally, Sub-Saharan Africa is reported to have the highest unmet contraceptive need. For example, nearly 50 % of married women of reproductive age, wanting to avoid pregnancy or plan when to have children, are reportedly not using contraception. More specifically, the prevalence of contraceptive use, in the Midlands Province of Zimbabwe where the Gweru District is situated, is estimated to be only 11%. This study examined the uptake of and reasons for use of different types of modern contraceptives; the factors influencing contraceptive use; discontinuation of use and non-use and reasons thereof for contraception and for long-acting reversible contraception in particular, amongst women in the Gweru district attending contraceptive services.

Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure. Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period. Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion. Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion. In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’. Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.

Introduction and Background: Between 1999 and 2014 the number of patients in the labor and delivery that were on medication for opioid use disorder (MOUD) quadrupled. The rate of unintended pregnancies in pregnant patients of mOUD is at a tremendous high due to inconsistencies in the use of reliable contraception in this population. Purpose Statement: To reduce the number of unintended pregnancies and infants born with neonatal abstinence syndrome there is a need for prevention and required education for men and women in medication-assisted facilities. Literature Review: Twenty research studies were reviewed and evaluated. These articles were found by utilizing PubMed, CINAHL, One Search, and Google Scholar. Most articles were discovered in the following Journals: Medical, Contraceptive, Preventative Medicine, Women's Health, Addiction, and Neonatal Nursing Journals. Findings: Through this research, we found there is a need for prevention services and required education onsite at the facility where patients are receiving medication for opioid addiction (mOUD). The following articles show the lack of contraceptive education, and misinformation about reproduction while on methadone or other medication-assisted drugs. Conclusion: The accessibility of having contraceptives onsite with required education for patients who are in treatment has been proven to be more effective and can decrease the number of unintended pregnancies or infants born with Neonatal Abstinence Syndrome. To be able to give better patient care for this specific demographic it is crucial that nurses are allowed to educate clients.