Puri Mahesh, Henderson Jillian T, Harper Cynthia C, Blum Maya, Joshi Deepak, Rocca Corinne H
Center for Research on Environment Health & Population Activities (CREHPA), Kusunti, Lalitpur, PO Box 9626, Kathmandu, Nepal.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA; Kaiser Permanente Center for Health Research, Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
Contraception. 2015 Apr;91(4):301-7. doi: 10.1016/j.contraception.2014.12.011. Epub 2014 Dec 30.
OBJECTIVE: To examine postabortion contraceptive discontinuation and pregnancy in Nepal, where abortion was decriminalized in 2002. STUDY DESIGN: We conducted an observational cohort study of 654 women obtaining abortions from four public and nongovernmental facilities in 2011. Patients completed questionnaires at their abortion visit and 6 and 12 months later. We used Cox proportional hazards models to assess contraceptive discontinuation and pregnancy by method initiated postabortion and other sociodemographic and reproductive factors. RESULTS: Among the 78% (508/654) of women who initiated a modern contraceptive method within 3 months postabortion, the 1-year contraceptive discontinuation rate was 62 per 100 person-years. Discontinuation was far lower among the 5% of women using long-acting reversible methods (21/100 person-years) than among those using condoms (74/100 person-years), pills (61/100 person-years) and the injectable [64/100 person-years; adjusted hazard ratio (aHR)=0.32 (0.15-0.68)]. Unmarried women and those not living with their husband experienced higher contraceptive discontinuation [aHR=2.16 (1.47-3.17)]. The 1-year pregnancy rate for all women was 9/100 person-years. Pregnancy was highest among those who initiated no modern method postabortion (13/100 person-years) and condoms (12/100 person-years), and pregnancy was lowest among users of long-acting reversible methods (3/100 person-years). The poorest women were at increased pregnancy risk [aHR=2.31 (1.32-4.10)]. CONCLUSION: Women using intrauterine devices and implants experienced greatly reduced contraceptive discontinuation and pregnancy within a year postabortion, although initiation of these long-acting methods was low. Increased availability of long-acting methods in Nepal and similar settings may help to prevent unwanted pregnancy and attendant maternal mortality and morbidities. IMPLICATIONS: Initiation of modern contraception was high postabortion; however, 1-year discontinuation was high for the condom, pill and injectable, the methods most commonly used. Rates for intrauterine devices and implants were low. Results support efforts to facilitate patient knowledge and access to the full range of contraceptives, including long-acting reversible methods.
目的：研究2002年堕胎合法化后的尼泊尔堕胎后避孕措施停用及再次怀孕情况。 研究设计：我们对2011年从四个公共及非政府机构接受堕胎的654名女性进行了一项观察性队列研究。患者在堕胎就诊时以及6个月和12个月后完成问卷调查。我们使用Cox比例风险模型，根据堕胎后开始采用的避孕方法以及其他社会人口统计学和生殖因素，评估避孕措施停用及再次怀孕情况。 结果：在堕胎后3个月内开始采用现代避孕方法的女性中，78%（508/654）的1年避孕措施停用率为每100人年62例。采用长效可逆方法的5%女性中，停用率（每100人年21例）远低于使用避孕套（每100人年74例）、口服避孕药（每100人年61例）和注射剂（每100人年64例）的女性[调整风险比（aHR）=0.32（0.15 - 0.68）]。未婚女性及未与丈夫同住的女性避孕措施停用率更高[aHR = 2.16（1.47 - 3.17）]。所有女性的1年怀孕率为每100人年9例。堕胎后未采用任何现代避孕方法的女性（每100人年13例）和使用避孕套的女性（每100人年12例）怀孕率最高，长效可逆方法使用者怀孕率最低（每100人年3例）。最贫困女性怀孕风险增加[aHR = 2.31（1.32 - 4.10）]。 结论：使用宫内节育器和植入剂的女性在堕胎后一年内避孕措施停用及再次怀孕情况大幅减少，尽管这些长效方法的采用率较低。在尼泊尔及类似环境中增加长效避孕方法的可及性，可能有助于预防意外怀孕及随之而来的孕产妇死亡和发病情况。 启示：堕胎后现代避孕方法的采用率较高；然而，避孕套、口服避孕药和注射剂等最常用方法的1年停用率较高。宫内节育器和植入剂的使用率较低。研究结果支持努力提高患者对包括长效可逆方法在内的各类避孕措施的了解并增加其可及性。
Am J Obstet Gynecol. 2018-1
Am J Obstet Gynecol. 2017-7
Int J Gynaecol Obstet. 2014-11
Int J Gynaecol Obstet. 2014-8
Reprod Health. 2024-12-24
Contracept Reprod Med. 2021-5-3
Zotero 插件