Measuring Cognitive and Psychosocial Accessibility to Modern Contraception: A Comprehensive Framework

Nowadays, more than ever, the improvement of access to family planning (FP) has become an international goal. What constitutes access to FP? Current human rights-based contraceptive guidelines indicate that access begins as soon as women or couples express a desire to avoid pregnancy and their risk of unintended pregnancy is established. However, few studies have sought to define and measure cognitive and psychosocial access to contraception. To propose a comprehensive framework for the cognitive and psychosocial accessibility of contraception, we critically analyzed the literature on attitudes toward FP. The main dimensions that emerged were knowledge about FP, fear of side effects, approval of contraception, and contraceptive agency. We then identified and adjusted some questions that can capture these dimensions more comprehensively. As a result, we developed a questionnaire module comprising 15 questions, which was integrated into the 6th round of the PMA2020 survey in Burkina Faso in 2019. This research highlighted that previous studies have collected separate dimensions of contraceptive access, and the psychosocial dimension tended to be neglected. Our results demonstrate that it is possible to collect comprehensive data on cognitive and psychosocial dimensions of access to family planning.

Female Contraception: Comparative Study of Biometrics and Vascularization of the Uterus at Sylvanus Olympio University Hospital (Togo)

Female contraception uses both hormonal and non-hormonal methods. The aim of the study is to determine the impact of female contraception on uterine vascularisation and the endometrium. Method: It was a descriptive comparative study with an analytical aim. It took place at the University Clinic of Obstetrics Gynaecology and the Radiology and Medical imaging Department of Sylvanus Olympio University Hospital in Lomé over a two-month period from May 15, 2023 to July 15, 2023. Group 1 included women using a modern contraceptive method and group 2 women not using a modern contraceptive method. Epidata 3.1 and R 4.0.4 software were used to process the data. Results: Each group included 50 women. There were no significant differences in uterine and endometrial biometrics. All women on contraception had their zone 1 vascularized, without vascularisation of zone 2, without significant difference with women without contraception The pulsatility index was greater than 3 in 51% (n = 51) of women, including 62.7% (n = 32) of women without contraception and 37.3% (n = 19) of women on contraception, with a statistically significant difference (p = 0.009). Conclusion: Contraceptive methods do not influence the biometry of the uterus. However, uterine artery Doppler indices can predict abnormal uterine bleeding.

Cognitive and Psychosocial Accessibility to Modern Contraception: Subscales Validation

While studies have examined physical access to services, cognitive and psychosocial barriers to contraceptive use have received less attention, despite their impact on access. Research shows that fours main dimensions exist under the broad concept of cognitive and psychosocial access. This study aims to validate the construction of these dimensions and measure the relation between them and their links with modern contraceptive use. We utilized a questionnaire module to collect 15 questions measuring these dimensions through the 6th round of the Performance monitoring and accountability 2020 (PMA2020) survey in Burkina in 2019. We employed the scale validation technique to choose appropriate measures (observable indicators or items) for constructing each latent dimension (unobservable) in our study. The items consisted of questions that utilized a 5-point Likert scale or dichotomous responses to capture various psychosocial aspects. To assess the validity, reliability, convergence, and divergence of the latent dimensions and items, we utilized the validscale command in Stata. The validation process confirmed the reliability of all the dimensions. Contraceptive approval is more aligned with birth spacing rather than birth limiting, reflecting prevailing social perceptions. Women’s contraceptive agency was found to be more associated with their ability to discuss and negotiate with their partners rather than independent decision-making. Correlations between dimensions were generally weak, but the levels of knowledge, agency, and approval of contraception are positively correlated with contraceptive use and intention to use. Giving women more decision-making power and providing information to address side-effect concerns can enhance contraceptive approval.

Problems of Contraception in Commune IV of the District of Bamako about 109 Cases

In Mali, the low utilization of reproductive health services in general and family planning (FP) in particular contributes strongly to illnesses or deaths of women during and/or after childbirth and of children under the age of one year. This situation is, among other things, the logical consequence of harmful practices, including closely spaced pregnancies, early pregnancies, clandestine abortions, access difficulties and the lack of adequate obstetric and neonatal care. Objective: The objective of our study was to study the difficulties of access to contraception in the health district of commune IV. Methodology: This was a descriptive and multicenter prospective cross-sectional study, carried out in the reference health center of commune IV in the district of Bamako, in the ten (10) CSCOMs and the RENEE CISSE maternity hospital (MRC). Study appalled from June 1 to December 30, 2019. Two subgroups of the study population were involved in the study: Service providers;Users (clients) made up of women of childbearing age (13 - 45 years old). The premises of the FP units, the service providers, the clients who answered our questionnaires constituted our sample;the interviewed providers were also evaluated for their capacity in Counseling with the different methods used. The variables retained for the analysis concerned: the provision of contraceptive products;as well as user files and their characteristics. Results: The result of our survey reveals that the method most used at the time of our survey was Norplant 49.5% and the least used is the pill 1.8;some products, such as the diaphragm, cervical cap, female condom and spermicide, are not available in the various FP units. Side effects were the cause of discontinuation for 17.9% of our clients;50% against the husband;10.7% for no reason;21.4% for desire for children. 87.2% of clients are satisfied with the service delivery compared to 12.8%. 79.8% of clients say that the cost of contraceptive products is affordable compared to 20.2%. Clients who attend the FP unit with their partner’s consent accounted for 21.1% versus 78.9%. All providers were female. They only resort to Doctors in case of tubal ligation and resection. The preference of the female provider was explained by: Religion: “For Muslims, it is preferable to have one provider”;Personal convenience: “some women don’t want to be examined by a man”;Convenience: “Women feel more comfortable with each other”. Providers who thought that the opposition of the husband prevents women from practicing FP were 50%;33.4% of the providers attribute it to the high cost of the products;8.3% of them attribute it rather to religion.

Hepatic Adenoma Secondary to Long-Term Oral Contraception Use in a Young Female

Hepatic adenomas are a rare byproduct of oral contraceptive pill (OCP) use. Laboratory workup is often inconclusive. Diagnosis can be made via MRI;however, select cases may require further testing such as fine needle aspiration or core needle biopsy. We report a case of a 36-year-old female who was referred to gastroenterology for further evaluation of several liver lesions found incidentally on imaging. Due to risk factors, such as age, long-term oral contraceptive use and obesity, adenoma was high on the differential. Although infrequent, this case emphasizes the importance of a detailed history, including medication review, and physical examination.

Effect of emotion management and nursing on patients with painless induced abortion after operation

BACKGROUND With an estimated 121 million abortions following unwanted pregnancies occurring worldwide each year,many countries are now committed to protecting women’s reproductive rights.AIM To analyze the impact of emotional management and care on anxiety and contraceptive knowledge mastery in painless induced abortion(IA)patients.METHODS This study was retrospective analysis of 84 patients with IA at our hospital.According to different nursing methods,the patients were divided into a control group and an observation group,with 42 cases in each group.Degree of pain,rate of postoperative uterine relaxation,surgical bleeding volume,and postoperative bleeding volume at 1 h between the two groups of patients;nursing satisfaction;and mastery of contraceptive knowledge were analyzed.RESULTS After nursing,Self-Assessment Scale,Depression Self-Assessment Scale,and Hamilton Anxiety Scale scores were 39.18±2.18,30.27±2.64,6.69±2.15,respectively,vs 45.63±2.66,38.61±2.17,13.45±2.12,respectively,with the observation group being lower than the control group(P<0.05).Comparing visual analog scales,the observation group was lower than the control group(4.55±0.22 vs 3.23±0.41;P<0.05).The relaxation rate of the cervix after nursing,surgical bleeding volume,and 1-h postoperative bleeding volumes were 25(59.5),31.72±2.23,and 22.41±1.23,respectively,vs 36(85.7),42.39±3.53,28.51±3.34,respec tively,for the observation group compared to the control group.The observation group had a better nursing situation(P<0.05),and higher nursing satisfaction and contraceptive knowledge mastery scores compared to the control group(P<0.05).CONCLUSION The application of emotional management in postoperative care of IA has an ideal effect.

Determinants of Modern Contraceptive Uptake among the Youth in Akuse Township in the Lower Manya Krobo Municipality, Ghana

Background: Access to safe and effective contraception is crucial for sexual and reproductive health to be at its best. This allows improved pregnancy results and the avoidance of unintended births. Teenagers’ views on using contraceptives are influenced by the information available at their disposal. The study assessed the influential factors affecting the utilization of modern contraceptives among the youth in Akuse in the Eastern Region of Ghana. Methods: The data for the study were gathered from 378 consented youth aged 15 - 24 years using a quantitative cross-sectional study design and a well-structured questionnaire. Person’s Chi-Square test was adopted to measure the association between the outcome variable and selected independent variables. Logistic regression models were utilized to measure the odds of the factors influencing modern contraceptive use among the respondents. Results: The results of the study suggested a high knowledge level of contraceptives;however, the prevalence of utilization was low. The level of education and age were factors found to influence the uptake of contraceptives. A bivariate analysis to examine the association between selected socio-demographic variables revealed that educational level (p = 0.044), religious affiliation (p = 0.002), and ethnicity (p = 0.016) were statistically associated with modern contraceptive use among the respondents. All other tested demographic variables including the age groups, gender, marital status, and residential status proved otherwise at the observed p-values greater than the 0.05 threshold. Respondents who indicated staying with partners were 6.79 times more likely to use contraceptives compared to their counterparts staying with a parent, after controlling for all other covariates. Conclusions: Based on the findings of this study, it was concluded that high contraceptive knowledge influences the choice of contraceptive preferred by the youth, and contraceptive use is also influenced by the advancement in age and educational level of the youth. It is however recommended that parents, guidance, and teachers be entreated to offer relevant and timely sexual information or education as these will most likely improve the uptake of modern contraceptives among the targeted population.

Correlates of Mistimed Pregnancy and Unmet Need for Family Planning among Women of Reproductive Age in Sandema, Ghana

Background: Globally, an estimated 80 million unintended pregnancies comprising both mistimed and unwanted pregnancies are recorded yearly. Yet only half of the women at risk of mistimed pregnancy use contraceptives. In developing countries, over 100 million females have unmet need, and national surveys in Ghana indicate 23% unmet need rate. Methods: Using a cross-sectional community-based approach, a sample size of 300 women of reproductive age were selected using multi-step cluster sampling techniques. The study was quantitative, using structured interviewer-administered questionnaires. Results: Two-third (66%) of the women in reproductive age still had unmet need, 71% were currently pregnant, and more than a third (36%) confirmed ever having a mistimed pregnancy. Fifty-three percent (53%) of the women confirmed never communicating with their partners on family planning issues, a little below half (45%) took their own health care decisions. Seventy nine percent (79%) ever received family planning services from a health professional. Factors related to unmet needs included mistimed pregnancy, level of education, preferred birth/pregnancy interval, communication between partners and the autonomy to spend self-earnings. Conclusion: Considering that high rates of unmet need results in mistimed pregnancy, improved policies around the influence of unmet need on mistimed pregnancies are needed.

Successful Laparoscopic Management of a Migrated Intrauterine Contraceptive Device in the Pelvic Cavity: A Case Report

Background: An Intrauterine device (IUD) is a long-acting reversible contraceptive commonly used in clinical practice. Its insertion in the uterus is simple and safe. But sometimes, complications can occur. Case Report: Herein, we report a case of successful laparoscopic removal of a missing IUD Copper-T, mis-inserted in a 32-year-old woman, 4 months after she delivered by caesarian section, and presented persistent lower abdominal pain lasting 6 months. Uterine ultrasound was unremarkable, but a plain abdominopelvic X-ray confirmed the presence of the Copper-T inside the abdominal cavity. Conclusion: Insertion of IUD is simple and safe. When the diagnosis of uterine perforation following its insertion is clinically suspected and radiologically confirmed, laparoscopy, when available, remains one of the best options for removal.

Postpartum Family Planning at the Timbuktu Hospital in Mali

Introduction: Postpartum family planning is the prevention of pregnancies during the 12 months following childbirth. Few studies have been devoted to postpartum family planning in Mali. Our work will contribute to reducing unmet need for family planning. Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics and gynecology unit of Timbuktu hospital. Materials and Methods: This was a descriptive and analytical cross-sectional study with prospective collection of data from January 1, 2022 to December 31, 2023. All women who gave birth having chosen and benefited from a contraceptive method were included. The statistical test used was the Fisher test with a significance threshold fixed at 5%. Results: The frequency of contraception in the postpartum period was 17.03%. The average age of clients was 26.14% with extremes of 14 and 45 years. They were paupiparous at 56.4% with an inter-birth interval of less than 12 months at 12.3%. More than half of the counseling (58.5%) was done during postnatal visits. The methods chosen were implants at 48.1%, injectable progestins at 21.3%, intrauterine device at 14.7%, miro-progestin pills at 13.5%, tubal ligation at 1 .4% and condoms at 1%. The regular follow-up rate was 51.1% of cases and 25.6% had no follow-up. Conclusion: The overall rate of postpartum family planning of 17.08% remains low. Improving FP staff skills will reduce unmet needs and contribute to increasing contraceptive prevalence in Timbuktu.

Vas deferens, a site of male contraception: an overview

The vas deferens is a site which can be exploited for male contraception without undue side effects. The only ef-fective technique available for male contraception is vasectomy, being practiced world wide, despite that it is a perma-nent surgical procedure and its successful reversal is not assured. Although no-scalpel vasectomy minimizes surgicalprocedures, the fate of its reversal is akin to that of vasectomy. Several occlusive and non-occlusive vasal procedureswhich claim to be reversible without surgical intervention, possess more disadvantages than advantages. Vas occlusionwith plug, ' Shug' or medical grade silicone rubber, although claimed to produce reversible azoospermia without affect-ing spermatogenesis, requires skilled microsurgery for their implantation and later removal. RISUG^R, a non-scleroticpolymer styrene maleic anhydride (SMA), could be more advantageous than vasectomy and other vas occlusive proce-dures in that it could be a totally non-invasive procedure by 'no-scalpel injection' and 'non-invasive reversal'. It isclaimed to offer long-term contraception without adverse side effects and also to be possible as a male spacing methodby repeated vas occlusion and non-invasive reversal. The drug is currently under multicentre Phase Ⅲ clinical trial.

Development of methods of male contraception: impact of the World Health Organization Task Force

Objective: To give an historical record of the research of the World Health Organization (WHO) Task Force to develop methods of male contraception; to examine the social, political, medical, pharmaceutical, funding, and other factors that influenced progress; and to suggest reasons why such methods are only now becoming available. Design: Review of basic and clinical research over 30 years. Setting: Task force of a multinational agency and collaborating agencies. Conclusion(s): Through the involvement of many international scientists, the WHO Task Force has uniquely contributed to the exploratory phases of the research in male contraception and by its multicenter contraceptive efficacy studies has accelerated progress towards the ideal hormonal method. Despite an adverse climate involving social and political attitudes, funding constraints, and pharmaceutical industry hesitations, WHO formed coalitions with governments and international agencies to sustain research with results that apply to men in culturally diverse populations and thereby to influence activities across the whole range of global reproductive health and family planning.

Low dose gossypol for male contraception

Aim: To ascertain whether the side effects of gossypol, hypokalemia and irreversibility, could be avoided on dose re-duction. Methods: Seventy-seven male volunteers were divided into 3 groups: control (22 cases), 10 mg gossypol(29 cases) and 12.5 mg (26 cases). Serum levels of testosterone, FSH and LH were measured by RIA and potassiumby flame photometry. Spema counts and motility were examined before and regularly after treatment for the evaluationof contraceptive efficacy. Results: The average sperm density and motility started to decrease significantly by theend of month 2 of medication and gradually reached the infertility levels ( < 4 million /mL) in both treated groups. Af-ter that the 10 mg group was asked to take the same dose every other day for up to a total observation period of 16-18months for the maintenance of infertility. Subjects in the 12.5 mg group did not take gossypol any more so as to ob-serve the length of the loading dose required, but in a few, a maintenance dose of 12.5 mg every other day was insti-tuted for a few more months. In both treated groups, none of the spouses was pregnant during the maintenance dose pe-riod. Serum levels of potassium, FSH, LH and testosterone were not significantly changed and not a single volunteercomplained of myoasthenia. After cessation of drug administratioin, the semen data returned to pretreatment levels.Conclusion: A regimen with 10 or 12.5 mg of gossypol as the daily loading dose and 35 or 43.75 mg as the week-ly maintenance dose could induce infertility in male volunteers without developing hypokalemia or irreversibility.(Asian J Androl 2000 Dec; 2: 283-287)

Approaches to post-testicular contraception

The induction of infertility in males of several species through epididymal interference is more difficult to achieveby reduction of the mounts of epididymal secretions (eg α-glucosidase, L-carnitine) or immunological interferencewith secreted proteins ( eg D/E, P34H, P26h) than by direct actions of drugs on sperm function (eg inhibition ofglyceraldehyde 3-phosphate dehydrogenase by chloro-compounds). The latter approach holds promise for mankind ashuman sperm are susceptible to glycolytic inhibition. Future contraceptive developments may arise from production oftargeted inhibitors, research on the displacement of sperm proteins in the epididymis and interference with sperm plasmamembrane ion channels.

Hormonal contraception in Chinese men: variations insuppression of spermatogenesis with injectable testosteroneundecanoate and levonorgestrel implants

Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. Methods: The 16 Chinese volunteers treated were divided into two groups in regard to the sperm count during the treatment period, 7 men in the responder group (Group R), including 6 azoospermia and one severe oligozoospermia, and the remaining 9 in the non-responder group (Group N), including 4 oligozoospermia and 5 with sperm counts greater than 20×106/mL. The differences in serum profiles of FSH, LH, T, LNG and T/LH ratio were compared between the two groups and the correlation between the seminal fluid parameters and serum reproductive hormones was analyzed. Results: The serum FSH level was lower in Group R than that in Group N (P<0.05), while the serum LH and LNG levels were higher in Group R than those in Group N (P<0.05). The sperm density (P<0.01, r=0.235), motility (P<0.01, r=0.326) and vitality (P<0.01, r=0.219) showed significantly positive correlation with the serum FSH level. Conclusion: The blood LNG and T levels, the degree of FSH inhibition and/or the sensitivity of the pituitary-testis axis to exogenous steroids, as well as the individual spermatogenetic potential and the functional status of the Leydig cells may be factors bringing about individual differences in spermatogenic suppression in Chinese men treated with LNG and TU.

Three new methods for male contraception

The methods devised for male contraception are meagre. In the crrrent communication, we review 3 recently de-veloped methods applied for male contraception: testicular suspension, polyester-induced azoospermia and prolactin in-jection. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitchand ball. The azoospermic effect of the polyester sling seems to be due to 1) creation of electrostatic field across theintrascrotal structures, and 2) disordered thermoregulation. Prolactin administration, as a contraceptive method is effi-cient and safe and has the potential to be developed as a male contraceptive. The effect of the above mentioned 3methods is reversible. These methods, especially testicular suspension and polyester suspensors, are simple and easilyapplicable and were well acceptable by the subjects. (Asian J Androl 1999 Dec; 1: 161 - 167)

Hormonal contraception for human males:prospects

Development of an ideal hormonal contraceptive for man has been the goal of several research workers during thepast few decades. Suppression of pituitary gonadotropic hormones, which in turn would inhibit spermatogenesis whilemaintaining normal libido and potentia has been the approach for a contraceptive agent. Intramuscularly administeredand orally active testosterone or testosterone in combination with progesterone have been shown to cause inhibition ofspermatogenesis resulting in azoospermia in normal men. Similarly testosterone has been used in combination with go-nadotropin releasing hormone antagonists and agonists to inhibit pituitary gonadotropic hormone release. Immunologicalapproach to neutralize the circulating levels of follicle stimulating hormone has also been shown to cause inhibition ofspermatogenesis. The available literature shows that testosterone causes reversible azoospermia without any significantside effects in Asian population effectively and appears to be a promising chemical for control of fertility in man.

Predictors for partial suppression of spermatogenesis of hormonal male contraception

Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoospermia or severe oligozoospermia when given monthly injections of 500 mg testosterone undecanoate （TU）, defined as partial suppressors compared with 855 subjects who had suppressed spermatogenesis （complete suppressors）. Sperm density, serum testosterone, luteinizing hormone （LH） and follicle stimulating hormone （FSH） concentrations at the baseline and the suppression phase were compared between partial and complete suppressors. Polymorphisms of androgen receptor （AR） and three single nucleotide variants and their haplotypes of FSH receptor （FSHR） genes determined by polymerase chain reaction （PCR） and DNA sequencing technique were compared between 29 partial and 34 complete suppressors. Results： Baseline serum LH level was higher and serum LH as well as FSH level during the suppression phase was less suppressed in partial suppressors. Additionally, in a logistic regression analysis larger testis volume, higher serum FSH concentrations alone, or interaction of serum LH, FSH, testosterone and sperm concentrations were associated with degree of suppression. The distribution of polymorphisms of AR or FSH receptor genes did not differ between partial and complete suppressors. In cases with incomplete FSH suppression （FSH 〉 0.2 IU/L）, the chances of reaching azoospermia were 1.5 times higher in the subjects with more than 22 CAG triplet repeats. Conclusion： Partial suppression of spermatogenesis induced by 500 mg TU monthly injections is weakly influenced by hormonal and clinical features but not polymorphism in AR and FSHR genes.

Interference with the formation of the epididymal microenvironment——a new strategy for male contraception?

The cystic fibrosis transmembrane conductance regulator (CFIR) or the small conductance cAMP-activated chlo-ride channel encoded by the CFTR gene has been shown to play an important role in the formation of the epididymalfluid microenvironment. Recent work in our laboratory has shown that this protein is also expressed by developing germcells indicating a role of this protein in spermatogenesis. In view of the fact that the CFTR gene has a far reaching andwidespread effect on human reproduction, understanding the role of CFTR in the male reproductive tissues and its inter-vention by pharmacological agents can open a new avenue of research into the development of novel male contracep-tives. (Asian J Androl 2000; 2: 39 - 45 )

Evaluation of intratesticular chlorhexidine gluconate for chemical contraception in dogs

Objective:To investigate the contraceptive effect of intratesticular injection of chlorhexidine gluconate in dogs and compare it with that of zinc gluconate neutralized with arginine.Methods:Twenty-four sexually mature male mongrel dogs were randomly divided by replicate into four groups(n=6 per group).GroupⅡreceived intra-testicular injection of 2 mL zinc gluconate(10 mg/mL)neutralized with arginine.GroupⅡreceived intratesticular injection of 2 mL chlorhexidine gluconate(5%w/v).GroupⅢreceived intratesticular injection of 2 mL chlorhexidine gluconate(4%w/v).GroupⅣdid not receive any treatment and served as the control group.Testicular morphometry was conducted on day 0,7,15 and 30 after treatment.Semen was collected and evaluated on day 0 and 30.Data were analyzed using repeated measures analysis of variance.Results:There was no difference in the mean values of various parameters between dogs treated with zinc gluconate and those treated with chlorhexidine gluconate at any of the time points.In dogs treated with zinc gluconate or chlorhexidine gluconate,there was a significant increase in the testicular morphometric parameters on day 7 followed by a significant reduction thereafter(day 15 and 30).In contrast,there was no change in any of the parameters in the control untreated dogs during the course of the study.Compared to the pre-treatment values,the mean scrotal circumference and the mean paired testicular volume and testicular weight on day 30 were significantly lower in the treated dogs.Semen samples collected on day 30 from treated dogs were found to be azoospermic,whereas no change in semen quality was observed in the control untreated dogs.Conclusions:Intratesticular injection of chlorhexidine gluconate(5%w/v and 4%w/v)is equally as effective as zinc gluconate neutralized with arginine for chemical contraception in dogs.