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.

The Use of Modern Contraception after Childbirth in an Urban Health Center in Bangui, CAR

Introduction: The use of modern postpartum contraception not only reduces unplanned pregnancies but also improves the well-being of mother and child. The present study aims to identify the determinants of postpartum contraceptive use in a first level health facility. Methodology: This was a 6-month cross-sectional study conducted at the Urban Health Center of Castors. Postpartum women who presented within 42 days of delivery and who had a live child were included after informed consent. Results: Of 318 women enrolled during the study period, 106 were currently using a modern contraceptive method, for a prevalence of 33.3%. The mean age of the women was 25.3 years (±3.6), with extremes of 14 and 49 years. The age group [20 to 29] was the most represented with 52.8%. More than half of the women were in couples (54.7%) and had completed secondary education (53.8%). These women were mostly students (42.5%) and primiparous or pauciparous (70.7%). The most used contraceptive method was injectables (depot medroxyprogesterone acetate) (43.4%), followed by male condoms (23.6%) and oral contraceptives (17.9%). The unmet need for contraception was 40.6%. The main reasons for non-use were the desire to have more children (41.5%), fear of side effects (34.9%) and spousal opposition (12.3%). Factors associated with contraceptive non-use were educational level, occupation and parity. Conclusions: The rate of modern contraceptive use in the postpartum period is low in the study population. Interventions to increase the use of effective contraceptive methods are needed, especially among young women.

《生殖与避孕》、Journal of Reproduction and Contraception征稿简则

一、系计划生育科学技术的综合性学术刊物,国内、外发行。读者对象主要是国内外从事生殖医学和计划生育科研、避孕药具研制、遗传优生和生殖生物学、生殖健康等方面的科技人员、医务人员和广大计划生育工作人员。二。

Determinants of Long Acting Reversible Contraception Method Use among Mothers in Extended Postpartum Period, Durame Town, Southern Ethiopia: A Cross Sectional Community Based Survey

Background: After a live birth, there is much unsatisfied interest in, and unmet family planning need for contraception. Waiting at least for 24 months before attempting the next pregnancy was recommended to reduce the risk of adverse maternal, perinatal and infant outcomes. The purpose of this study was to assess the determinants of long acting reversible contraception method use among mothers in extended postpartum period in Durame Town, Southern Ethiopia. Methods: A community based cross sectional study was conducted in Durame Town, Southern Ethiopia in December, 2014. Systematic random sampling technique was employed to recruit a total 460 study participants. Structured and pretested questioner was used to collect the data. Descriptive statistics was employed to characterize the study population using frequencies and proportions. Bivariate logistic regression analysis was conducted to identify all possible factors affecting utilization of LARC method. Multivariable logistic regression model was developed to control the confounding variables. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed in identifying the real factors associated with use of LARC methods. Results: In this study we found that the prevalence of LARC method use among mothers during their extended postpartum period was 36.7% (95%CI: 32.2, 41.0). The unmet family planning need of mothers in the extended postpartum period was 123 (27.9%). The odds of using LARC by literate mother were four fold higher than their counterpart illiterate mothers (AOR 4.09 95%CI: 1.68, 9.58, P value < 0.001). The odds of mother who had pervious experiences of using LARC were up to eight folds higher than mother never used LARC methods (AOR 7.84 95% CI: 3.78, 16.23, P value< 0.001). Mother who received counseling service on LARC methods during delivery was up to three times more likely to utilize the services than not counseled (AOR 3.29 95% CI: 1.53, 7.03, P value < 0.001). And odds of mothers who received counseling service on LARC during immediate postpartum period were up to five fold more likely to opt method than never got the counseling service (AOR 4.55 95 % CI: 1.94, 10.66, P value < 0.001). Conclusions: In the study area, about one third of mothers utilized LARC methods during their extended postpartum period. Another one third of mother had unmet need for family planning. Participant’s education, previous history of using LARC methods, receiving counseling services on LARC during delivery and immediate postpartum periods were found major determinant for LARC use. Educating women, providing counseling service on LARC methods during antenatal, delivery and postnatal were recommended.

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.

Postpartum intrauterine device contraception: A review

AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.

Making emergency contraception more widely known and available──theConsortiumforEmergencyContracepti

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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.

Assessment of level of knowledge and utilization of emergency contraception among female students of Hawassa University, south Ethiopia

Introduction: Emergency contraception is used as an emergency procedure to prevent unintended pregnancy secondary to an unprotected se xual intercourse and method failure. Hence, this study assessed the level of knowledge and utilization of emergency contraception among undergraduate regular female students of Hawassa University, south Ethiopia. Methods: An institution-based cross-sectional survey was conducted among female students of Hawassa University in December 2012. Seven hundred seventy six of the students were sampled by using multistage sampling technique. Pretested structured questionnaire was used to collect the data. Results: The majority 719 (92.7%) of female university students ever had sexual intercourse and 17 (2.2%) experienced forced sex. Eight (47%) of these 17 students experienced unintended pregnancy all of which resulted in an induced abortion. Three hundred seventy nine (72.2%) of the respondents had knowledge about emergency contraceptives and only 41 (10.8%) of them had ever used emergency contraceptives;oral contraceptive pills were the most widely used form of all emergency contraceptives 41 (10.8%). Age, marital status and age at menarche were associated with knowledge of emergency contraception;moreover, residence, year of study and experience of forced sex were found to be predictors of emergency contraception utilization. Conclusion: Female university students had been experiencing high rate of unintended sexual practice and pregnancy, low knowledge level and utilization of emergency contraceptives;moreover, they had no youth-friendly access to the services. Therefore, there is a need for collaborated effort to improve service access and scale up their utilization level to prevent unwanted pregnancy.

A randomized double-blind multicenter study on comparing levonorgestrel and mifepristone for emergency contraception

Objective: To compare the efficacy and side effects of levonorgestrel and low dose mifepristone in emergency contraception. Method: The study is a randomized double--blind multicenter comparative trial. A total of 1, 276 women with unprotected intercourse within 72 hours were allocated to one of the two study groups. In the levonorgestrel (LNG) group, 0. 75 mg LNG was taken twice, 12 hours apart, whereas in the mifepristone (Mife) group, a single dose of 10 mg mifepristone was taken and a placebo 12 hours after. Follow--up visit was paid on the seventh day of the expected next menstruation to evaluate the contraceptive efficacy and side effects. Contraceptive efficacy was calculated by Dixon’s method. Result:In the LNG group 20 pregnancies occurred among 643 women, while in the Mife group 9 pregnancies occurred among 633 women. The pregnancy rates were 3. 10% and 1. 43% respectively. Contraceptive efficacy rate of preventing pregnancy was 59. 16% and 79. 73%, the difference was statistically significant (P<O. 05). The incidence of various side effects, which were mild, was less than 10%. There was no statistical difference between the two groups. The percentage of subjects who had their next menstruation 3 days earlier or later than their expected menstruation in LNG group and Mife group was 77. 7% and 78. 5% respectively. Conclusion: Use of levonorgestrel or low dose mifepristone for emergency contraception is effective and safe.

Use of Male Condoms among Adolescents with Free Access at Emergency Contraception—Study among Students from the Public Education System of the Sao Paulo, Brazil

The research conducted in public schools in Sao Paulo city, Brazil, studied the awareness and use of emergency contraception (EC) and its possible implications on the condoms use. Among the 4929 students, 55.6% had already had sex, 19.5% had got pregnant and 7.3% had had abortions. Condoms were used by 88.6% and were options for those who did not have a steady relationship. The EC was used by 30.3% after a faulty condom usage, and by the older ones, with a steady partner. It is needed to be given contraceptive alternatives to reduce the risk and provide access to other contraceptives.

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.

紧急避孕药系统评估

目的:评估两种(0.75mg双剂、1.5mg单剂)左炔诺孕酮(LNG)及两种低剂量(10mg、25mg)米非司酮(MFP)紧急避孕方案的有效性和副作用。方法:通过电子及手工检索方式检索相关文献,筛选出其中的随机对照临床试验,提取信息并进行Meta分析。结果:共检索到63篇相关文献,其中28篇纳入本评估。结果显示,两种剂量LNG方案有效性及副反应的发生率均相似。在服用紧急避孕药后无性生活的对象中,25mgMFP与10mgMFP(方法失败率)相似,然而25mgMFP总失败率(在所有对象中计算出的失败率)略低于10mgMFP,但差别没有统计学意义。25mgMFP方案恶心发生率比10mgMFP方案略高。10mgMFP方案与单剂1.5mgLNG方案总失败率相似,而前者方法失败率略低。25mgMFP方案方法失败率与总失败率均略低于单剂及双剂LNG方案,但差别无统计学意义。MFP紧急避孕方案月经延迟的发生率比LNG方案高,而后者点滴出血的发生率比前者高。无保护性生活后越早接受紧急避孕,失败率越低。结论:两种LNG方案和两种MFP方案有效性和副反应发生基本相似,由于LNG为传统避孕药物,其安全性已被证实,并为非处方药,故优先推荐使用LNG方案,单剂1.5mgLNG方案更为方便。

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.

Male contraception:prospects for the new millennium

Effective regulation of human fertility has global consequences in terms of resource depletion, pollution and pover-ty. Current family planning services predominantly target a female clientele with few significant developments in malefertility regulation for over a century. The last two decades have witnessed a gathering interest, initially from the scien-tific community, and laterally from industry, in the development of safe, reliable, reversible methods of contraceptionfor men. This review summarises the methods of male fertility regulation which are currently available and critically ex-amines the published data on novel developments in male hormonal contraception which offer the potential of improvedcontraceptive choice for all in new millennium. (Asian J Androl 2000; 2: 3 - 12)

Differences in Adolescent Effective Contraception Use between Population Densities

Objective: Studies addressing effective contraceptive use by population density are lacking. We hypothesize that contraception counseling and effective contraception use vary by population density. Study Design: This is a cross-sectional study using the 2006-2010 National Survey of Family Growth data, including female subjects ages 15 to 19. The primary exposure was population density, defined as Principal city of a Metropolitan Statistical Area (MSA) or “city”, Other MSA or “non-city urban”, and Not MSA or “rural.” The primary outcome was effective contraception use and the secondary outcome was contraceptive counseling exposure. Multivariate analysis using logistic regression was performed to estimate the association between population density and effective contraception use, as well as the likelihood of receiving contraceptive counseling. Results: 2284 subjects were studied. Compared to non-city urban dwellers, city adolescents had similar effective contraception use (aOR: 0.99, [0.79, 1.24]), whereas rural adolescents had significantly higher use (aOR: 1.79, [1.35, 2.36]). Among sexually active respondents who were not using contraception, the rate of contraception counseling in non-city urban adolescents was 66.7%. In comparison, the city dwellers had higher rate of counseling (79.1%, aOR: 1.87;95% CI: [1.09, 3.22]). Similarly, rural adolescents also had higher rate of counseling (81.5%, aOR: 2.37;95% CI: [1.08, 5.19]). Conclusions: Rural residents were more likely to use effective contraception methods than their city and non-city urban counterparts. However, higher rates of contraception counseling among sexually active adolescents not using contraception in city and rural densities could suggest ineffective counseling in these groups.

Pattern, Types and Predictors of Contraception among Female In-School and Out-of-School Adolescents in Onitsha, Anambra State, Nigeria

Introduction: The consequences of unsafe sex are suffered mostly by adolescent girls in Nigeria despite efforts to improve accessibility to the reproductive and sexual health of this group. This study elucidates the pattern of contraceptive use, the key socio-demographic factors, sexual beliefs and practices associated with its use amongst adolescent girls in Nnewi, Nigeria. Methods: It was a descriptive cross-sectional comparative study of in-school and out-of-school female adolescents. Data were collected using questionnaires and Focus Group Discussion (FGD), then analyzed by selecting socio-demographic and other variables to assess their interaction with contraceptive use and result compared between the two groups. Data were presented in tables and charts and multivariate and chi-square analyses were performed. Result: Higher proportion of sexually active out-of-school girls than their in-school counterparts had ever used contraception—used it in their first and last sexual exposures, while condom was the commonest contraceptive employed by both groups. Age (older adolescents;F = 0.041), belief in condom use (P = 0.05), willingness to get condom for partner (P = 0.001) and regular sexual practice (P = 0.003) were the most important predictors of contraceptive use among the sexually active adolescents. Generally, the out-of-school girls are more likely to use contraceptives than their in-school counterparts. Some misconceptions about pregnancy prevention and unscientific contraceptive methods were mentioned by the subjects during the FGD. Recommendation: Access to reproductive health services needs to be improved especially among the in-school female adolescents. There is need to incorporate the right contraceptive information in the school curriculum, and the out-of-school adolescents should receive periodic dissemination of appropriate Behavior Change Communication (BCC) on the relevance of contraception.

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)

Urgent need to change clinical practices about postpartum contraception

In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.