In the United Kingdom (UK) there is easy access to a wide range of contraceptive methods, available at no cost. In addition, oral emergency contraception (EC) (1.5 mg levonorgestrel) is now widely available from the community pharmacy. In spite of this, unintended pregnancy is common. In 2014 in England and Wales, 184,571 induced abortions were performed, and in Scotland, the corresponding figure was 11,475. Long acting reversible methods such as contraceptive implants and intrauterine contraception, are amongst the most effective methods available and National Institute for Health and Care Excellence (NICE) recommends that increased uptake can lead to fewer unintended pregnancies. However, uptake of long acting reversible contraceptive (LARC) methods remains low. The majority of women who require to use EC do so following unprotected sex or an accident with a condom. Increasingly women in Great Britain prefer to attend a pharmacy for EC rather than a sexual and reproductive health (SRH) service or general practitioner (GP). Starting an effective on-going method of contraception after EC use is clearly important if women are to avoid unintended pregnancy. Community pharmacists in the UK and most other high income countries are usually unable to provide any on-going contraception except condoms. So we have created a situation where EC is provided almost solely from settings where other more effective methods of contraception cannot be immediately provided. Novel strategies are therefore required to facilitate both uptake and continuation of the most effective methods of contraception, in order to prevent unintended pregnancy for more women. This thesis presents a mixture of biomedical, clinical and health services research to evaluate a series of strategies aimed at improving uptake of the most effective methods of contraception. Two studies investigated patient knowledge and information provision relating to contraceptive methods. The first sought to determine if women held misconceptions about intrauterine methods of contraception, and revealed that although myths persist in a small number of women, a lack of knowledge about these methods was also evident. The second study aimed to determine if the use of a digital video disc (DVD) to provide contraceptive information was acceptable and informative to women, and identified that it is, and could possibly enhance patient consultations. Studies three, four and five investigated strategies aimed at increasing the uptake of effective on-going contraception, following emergency contraception provided from a community pharmacy, and patient and health care provider attitudes to such approaches. They showed that simple interventions such as supplying one month of a progestogen only pill (POP), or offering rapid access to a family planning clinic (FPC), hold promise as strategies to increase the uptake of effective contraception after EC and that both women and clinicians were positive about such measures. Additionally, the problems encountered in conducting these studies provided valuable feedback to inform further development of research methods in the community pharmacy setting, and larger scale studies of such interventions. Community SRH services may be well placed to deliver more abortion care in the UK, and consequently this may result in greater uptake of contraception post abortion. Study six aimed to determine the views of health professionals working in SRH regarding their attitudes towards providing more abortion services and also the views of staff within one community SRH centre in Scotland where a service providing early medical abortion was due to commence. It showed there is clear support amongst health professionals in community SRH in the UK towards greater participation in provision of abortion care services.

Philosophiae Doctor - PhD / This thesis extends the literature on the trends and magnitude of health inequalities in the area of maternal and reproductive health services in Sierra Leone, and particular across sub-Saharan Africa. It attempted to provide a good understanding of, not only the determinants of maternal and reproductive healthcare use, but also factors that enable health inequalities to exist in Sierra Leone. This is an appropriate topic in population health studies as it aims to address important questions on the research agenda in the context of sub-Saharan Africa, particularly in a country with poor health outcomes such as Sierra Leone. A proper understanding of not only the coverage rates of population health outcomes but also the extent of health inequalities as well as the factors that contribute to these inequalities is crucial for any government. The thesis applied various techniques in the analysis of DHS data (from 2008 and 2013 rounds) in an attempt to answer the research questions.

A sexualidade se estabelece por um conjunto de possibilidades que necessitam de serem exploradas, haja vista que a adolescência que corresponde ao período de 10 a 19 anos, é marcada pela transição da infância para a fase adulta e por uma série de transformações, tanto anatômicas, fisiológicas, psicológicas como também sociais. Nesse contexto associa-se a este ciclo da vida a necessidade de compreender e refletir o conhecimento que os adolescentes possuem tanto sobre as infecções sexualmente transmissíveis quanto a gravidez na adolescência, já que, é nesse momento da vida que os mesmos têm um maior risco tanto quanto as infecções advindas do sexo inseguro como também a uma gravidez não planejada, sendo essencial nessa conjuntura que estes temas sejam interiorizados de forma cotidiana, atual e preventiva tanto na escola quanto na família. Parte-se do pressuposto das perspectivas de ação das práticas de educação em saúde, além dos conteúdos se são, explícita e implicitamente, veiculados acerca do tema sexualidade e seus desdobramentos, além do acometimento psicossocial de uma gravidez precoce. Nessa perspectiva, este trabalho objetiva avaliar o conhecimento dos adolescentes de uma escola pública sobre as práticas, percepções necessidades de diálogo sobre as IST e de uma gravidez durante o período da adolescência. A metodologia consistiu em um estudo transversal, de natureza quantitativa, sendo escolhida de forma intencional uma escola pública da cidade de Pouso Alegre-MG; o número de participantes desta pesquisa foi de 499, de ambos os sexos do 8º ano do ensino fundamental II ao ensino médio. Esse processo somente se deu a partir da aprovação do Comitê de Ética da EERP, e da assinatura do Termo de Consentimento Livre e Esclarecido e do Termo de Assentimento Livre e Esclarecido; o instrumento utilizado para a coleta de dados foi um questionário semiestruturado. Quanto aos resultados, o estudo mostrou que os adolescentes participantes pertenciam ao grupo de idade entre 12 - 17 anos (99,8%), sendo que adolescentes com 12 anos representam a menor parte (9,6%) e os de 17 a maior (37,7%). O sexo feminino representou 58,5% da amostra e o sexo masculino 41,5%. A iniciação sexual ocorreu em média aos 13,8 anos com os meninos e 14,4 anos em relação as meninas. Além disso, demonstrou-se que 90,18% dos participantes valorizam e concordam com a ocorrência de oficinas e projetos de sexualidade no interior do ambiente escolar. Dessa forma, é pertinente a necessidade de programas e políticas públicas voltadas a informar, conscientizar e estimular esses indivíduos a se prevenirem e entenderem as modificações dessa fase da vida. Além disso, é pertinente discutir entre os adolescentes as emoções e valores que impedem o uso das informações que os mesmos possuem em suas práticas sexuais. Nota-se também a necessidade de a escola assumir um trabalho cotidiano de abordagem da sexualidade como intrínseca a saúde, como prática sexual saudável e segura através do uso de métodos anticoncepcionais e preventivos contra a IST / Sexuality is established by a set of possibilities that need to be explored, since the adolescence that corresponds to the period from 10 to 19 years is marked by the transition from childhood to adulthood and by a series of transformations, both anatomical, physiological, psychological as well as social. In this context, it is associated with this cycle of life the need to understand and reflect the knowledge that adolescents have as much about sexually transmitted infections as teenage pregnancy, since it is at that moment of life that they have a greater risk both as well as the infections due to unsafe sex, as well as to an unplanned pregnancy, and it is essential at this juncture that these themes are internalized in a daily, current and preventive manner, both at school and in the family. It is based on the assumption of the perspectives of action of health education practices, in addition to the contents if they are explicitly and implicitly conveyed about the theme sexuality and its unfolding, in addition to the psychosocial involvement of an early pregnancy. In this perspective, this study aims to evaluate the knowledge of the adolescents of a public school about the practices, perceptions, needs for dialogue about STIs and a pregnancy during adolescence. The methodology consisted of a transversal study, of quantitative nature, being chosen intentionally a public school in the city of Pouso Alegre-MG; the number of participants in this research was 499, of both sexes from the 8th year of elementary school II to high school. This process only occurred after the approval of the Ethics Committee of the EERP, and the signing of the Term of Free and Informed Consent and the Term of Free and Informed Assent; the instrument used for data collection was a semi-structured questionnaire. Regarding the results, the study showed that the adolescents belonged to the age group between 12 - 17 years (99.8%), with 12 year olds representing the smallest part (9.6%) and those 17 years old (37.7%). The female sex represented 58.5% of the sample and the male sex 41.5%. Sexual initiation occurred on average at 13.8 years for boys and 14.4 years for girls. In addition, 90.18% of the participants have been shown to value and agree with the occurrence of sexuality workshops and projects within the school environment. In this way, the need for public policies and programs to inform, raise awareness and stimulate these individuals to prevent and understand the modifications of this phase of life is pertinent. In addition, it is pertinent to discuss among adolescents the emotions and values that prevent the use of the information they have in their sexual practices. It is also noted the need for the school to take on a daily work of approaching sexuality as intrinsic to health, as a safe and healthy sexual practice through the use of contraceptive and preventive methods against STI

This study investigated the perceptions of college student health center administrators concerning the availability of contraceptive services to college students. The major purposes of the study were (1) to determine the extent to which specific contraceptive services were available to college students from various sources, (2) to determine the extent and effectiveness of any opposition or support from various pressure groups concerning the provision of contraceptive services by student health centers, and (3) to describe the trend, as .perceived by student health center directors, of student access to contraceptive services from 1970 to 1975 and to project the trend to 1980. The findings indicated that pressure activity supporting the provision of contraceptive services by student health centers arose mostly from institutionally related student groups and was considered to be "effective" (i.e., influenced administrative decision making). Pressure which arose from other groups was found to be slight and of little effectiveness.

Este estudo teve como objetivo analisar o conhecimento sobre métodos anticoncepcionais (MAC) e identificar as variáveis associados ao conhecimento adequado sobre o tema, em adolescentes de escolas públicas municipais de Ribeirão Preto-SP. Consiste em um estudo do tipo transversal, desenvolvido segundo uma abordagem quantitativa. Foram escolhidas, intencionalmente, duas escolas municipais. A amostra foi constituída por cento e vinte (120) adolescentes, de ambos os sexos, com idade de 13 a 16 anos. A coleta de dados ocorreu no período de 05/03/2007 a 16/03/2007, sendo que o instrumento para a coleta foi um questionário semi-estruturado. Os resultados mostraram que os adolescentes deste estudo pertenciam ao grupo de idade entre 13 - 14 anos (81,7%), sendo que adolescen tes com 15-16 anos represen taram a menor parte (18,3%). O sexo masculino representou 51,6% da amostra e, o feminino, 48,4%. A iniciação sexual ocorreu com 13 anos para ambos ,no sexo feminino com (71,43%)e no sexo masculino (41,18%). Com relação ao uso da camisinha masculina 57,5% dos adolescentes entrevistados não utilizaram a camisinha e 28,3% a utilizaram em suas relações sexuais. Quanto ao uso de métodos anticoncepci onais, para a primeira relação, os resultados mostraram que 36,7% não fizeram uso de nenhum tipo de método e 54,2% não responderam. Em relação segundo o local de obtenção dos MAC os resultados mostraram que 75,8% obtinham no posto de saúde através do médico e 50,7% em farmácias. Sobre a diversidade de métodos anticoncepcionais, o trabalho mostrou que 45% não conheciam nenhum método, seguido de 20,8% que conheciam apenas um; 5,8% conheciam dois tipos e 10,8% conheciam três. Os métodos anticoncepcionais mais conhe cidos foram os de barreira, como o preservativo masculino (45,8%) e o feminino (30,8%), seguidos os anticon cepcionais orais (28,3%). No que diz respeito às fontes de informações e orientações desses métodos, a escola foi a mais citada pelos alunos, com 51,7% e, logo em seguida, surge a família, com 40,8% e a televisão, também com cerca de 40%. O estudo evidenciou que as estratégias mais utilizadas pela escola para informar sobre sexualidade, gravidez na adolescência e os métodos anticoncepcionais foram: no decorrer das aulas (40,8%),e em seguida com a palestra (32,5%). Entre os temas discu tidos em sala de aula com o professor, o mais citado foi sexualidade, com 57,4%. Sobre o diálogo em família, os entrevis tados consideraram a mãe o elo de comunicação mais importante sendo avaliado como bom por 79,2% dos entrevistados. Dos diversos tipos de atendimento à saúde, recebido na Unidade Básica pelo adolescente, a consulta médica foi o mais citado pelos entrevistados, com 48,2%. O estudo mostrou ainda que o conhecimento sobre os métodos anticoncepcionais não garante o seu uso. Entretanto, a disponibilidade de maior número de serviços e orientações sistematizadas sobre tais métodos podem favorecer a mudança de atitudes dos adolescentes em relação a uma prática de uso eficiente e preventivo em relação aos MAC. / The present study aimed to assess knowledge on contraceptive methods and identify variable associated with appropriate knowledge among students in the municipal school system of Ribeirão Preto -SP. This transversal study was developed through a quantitative approach. Two schools belonging to the Health District of Vila Virgínia were purposely selected and the sample size was a fixed number of 120 adolescent students of both genders, aged between 13 and 16. Data collection was conducted from 03/05/2007 to 03/16/2007 and a semi-structured questionnaire was used as data collection instrument. The research showed that the subjects consisted of a group of adolescents between13 and14 years old (81,7%) and a smaller group of adolescents between 15 and 16 years old (18,3%), with males representing 51.6% and females 48.4%. The sexual initiation occurred around the age of 13 for both genders(71,43%) of females and (41,18%) male sex . The use condom was reported by (57,5%) of subjets group did not using, while among the group within the same, 28.3% reported using it. The findings also showed that 36,7% of the subjects did not use any kind of contraceptive method in their first sexual intercourse, and 54,2% did not answer this question. Regarding ways to obtain contraceptive methods, the results showed that 75,8% of the subjects received them from a Health Unit and a doctor of them prescription, 50,7% bought them at a drugstore. The study showed that 45% of the students did not know any kind of contraceptive method, followed by 20.8% that knew only one kind, 5.8% knew two methods, and 10.8% knew three kinds of methods. The most widely known method was the male condom (45,8%) and the female kind (30.8%), followed by the oral contraceptive (28.3%). As for sources of information and advice on contraceptive methods, the most common source was the school (51.7%), followed by the family (40.8%), and TV (40%). The study showed that the advice and information on sexuality, pregnancy in adolescence, and contraceptive methods received at school were delivered through lectures (32.5%) and during lessons (40.8%). According to the data, among the topics associated with health in adolescence discussed in class with the teacher, sexuality was the most common one (57.4%). In terms of conversations with the family, the mother was shown to be the most important bond. In addition, the level of communication with the mother was considered good by 79.2% of the students. Health attention received at the Health Unit and consultation with a doctor was the most common option mentioned by adolescents (48.2%). The research showed that knowing contraceptive methods does not guarantee their use. However, availability of more services and extensive advice on contraceptive methods can assist in changing adolescents\' behavior as regards the efficient and preventive use of contra ceptive methods.

Background: Approximately 70% of US adults currently receiving opioid agonist treatment (OAT) for opioid use disorder are of reproductive age. Among women receiving OAT at risk of having an unintended pregnancy, typically less than half report any current contraceptive use compared to 90% in the general population. In addition, the rate of unintended pregnancy among women receiving OAT is disproportionately higher than the general population (~80% vs. 45%, respectively). Lack of knowledge about family planning may be contributing to decreased rates of contraceptive use and increased rates of unintended pregnancy among women receiving OAT. Method: Participants were a convenience sample of women and men receiving OAT or a comparison group receiving primary care (PC) services. Family planning knowledge was assessed with the recently validated Contraceptive Knowledge Assessment (CKA), a self-administered 25-question multiple-choice survey. A two-way ANOVA, with fixed factors (i.e. patient sample and sex), compared the total number of correct responses for all questions and five more specific content areas (p<.05). Results: Overall, 332 participants completed this survey. The mean percent of total correct responses was significantly lower in the OAT sample (n=167) compared to the PC sample (n=165), 47% vs. 53% correct, respectively (p<.001) or approximately 1.5 questions less. The mean percent of correct responses in four of the five content areas was also lower among the OAT sample compared to the PC sample (ps<.01). The mean percent of total correct responses was significantly higher among women (n=169) than men (n=163), 56% vs. 44% correct, respectively (p<.0001) or approximately 3 questions more. The percent of correct responses in four of the five content areas was also higher among women than men (ps<.01). Conclusion: Given the substantial discrepancy in rates of contraceptive use and unintended pregnancy between individuals receiving OAT and the general population, it is somewhat unexpected that individuals receiving OAT did not have lower levels of family planning knowledge, although patients in both samples only answered approximately 50% of the questions correctly. Results from the present study suggest deficits in family planning knowledge, while statistically significant, may be less clinically so. Overall, lack of family planning knowledge is likely only playing a small role in population differences in contraceptive use and unintended pregnancy and interventions aimed at decreasing these differences will need to address other barriers to accessing family planning services and utilizing contraception in this population.

<p>Contraception is said to be one of the vital determinants of fertility (Bongaarts, 1978). African nations, especially those in sub-Saharan Africa have a history of high fertility levels and low contraceptive use. However, contraceptive methods have been used one way or another throughout human history, although, due to improvements, these methods have evolved over the years. In Namibia, there tend to be a huge gap between women&rsquo / s knowledge of methods of contraception and usage thereof. For instance as per NDHS survey of 2000, 97 percent of married women knew of a contraceptive method, while 38 percent utilised them. This study aims at investigating knowledge and usage of contraceptives among women in union of reproductive age in an independent Namibia, 10 years after independence between 1992 and 2000. Socio-economic and demographic factors affecting contraceptive usage are examined in this study to determine their significance.</p>

<p>The present study was conceived to examine the trend and factors affecting fertility in Nigeria and Guinea. Fertility has declined by about nineteen percent in Nigeria between 1982 and 1999. In the same period it has declined by five percent in Guinea. The decline is observed in data from censuses and surveys. Studies have reported that fertility transition is in progress in most Sub-Sahara African countries (Bongaarts 2008 / Guttmacher 2008), Nigeria (Feyisetan and Bankole 2002) and Guinea (measuredhs 2007). Studies and surveys done in some regions and among ethnic groups suggest that fertility is declining in Nigeria (Caldwell et al. 1992) and Guinea (measuredhs 2007). However, these studies and surveys are devoid of national representativeness as they are localized in specific regions or selected ethnic groups. Thus, they cannot be used as a national reference. The trend of the total fertility rate (TFR) from the three consecutive Demographic and Health Surveys in Nigeria did not show any meaningful decrease over time. In the same vein, no evidence of fertility decline was observed in Guinea from the Demographic and Health Surveys. The claim that fertility is declining in these two countries which assures the funding organizations that Family Planning programs are successful is beyond the scope of the present study. Based on Demographic and Health Surveys the claim that fertility is decreasing in Nigeria may be misleading, whereas in Guinea fertility has shown stability. This suggests that while the factors affecting fertility may be similar, their impacts differ from country to country.</p>

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

The aim of this research was to study the correlation between tissue tumor marker expression and HR-HPV infection, smoking, hormonal contraceptive use and sex steroids in women with cervical intraepithelial neoplasia or normal epithelium. The study investigated the expression of 11 tumor markers in cervical biopsies obtained from 228 women with different diagnoses ranging from normal cervical epithelium to various stages of CIN. 188 women were recruited at our colposcopy clinic (out-patient surgery, Department of Obstetrics and Gynecology, Falun Hospital) for laser cervical conization or a directed punch biopsy, either because of a vaginal smear (Pap smear) that showed cytological findings suggesting CIN, or because of repeated findings showing atypical squamous cells of undetermined significance (ASCUS). For 40 volunteers, punch biopsies were taken from the normal cervical epithelium. The time period for this study was 2005-2007. Study I :  228 women, of whom 116 were tested, 64 were positive to HR-HPV. The results showed that Ki67 tumor cell proliferation index was the only marker that independently correlated to both the presence of HR-HPV and the severity of cervical lesions. Study II:  228 women, of whom 83 were smokers (36, 9%). Smokers showed lower expression of p53, FHIT (tumor suppressor markers) and interleukin-10 .Higher expression of Cox-2 and Ki-67 (tumor proliferation markers). Study III:  195 women who were premenopausal. There was increased p53 expression (tumor suppressor) in the progestin-IUD users compared to non-users. Decreased IL-10 expression (immunological marker) was observed in both COC users and any progestin-only users. Study IV: Serum from 80 premenopausal women was available. The main finding was that the increased levels of serum progesterone and estradiol were associated with increased Cox-2 expression (proliferation marker). Serum progesterone and estradiol levels influence cellular and extracellular proteins which have been associated with neoplastic development in normal epithelium and CIN. Conclusion: The results of these studies support previous epidemiological findings on the role of smoking, contraceptive use and sex steroids as co-factors in development of CIN and that tumor marker expression varies in different grades of CIN.