While there is a large literature on the prevalence of unmet need for family planning, there is no matching quantitative evidence on the prevalence of unwanted family planning; all contraceptive use is assumed to represent a "met need." This lack of evidence raises concerns that some observed contraceptive use may be undesired and coercive. We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low- and middle-income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception. We find that 12.2 percent of women have an unmet need for family planning, while 2.1 percent have unwanted family planning, with estimated prevalence rates ranging from 0.4 percent in Gambia to 7.1 percent in Jordan. About half of unwanted family planning use can be attributed to condoms, withdrawal, and abstinence. Estimating the prevalence of unwanted family planning is difficult given current data collection efforts, which are not designed for this purpose. We recommend that future surveys probe the reasons for the use of family planning.

Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one's partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of "failure" to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied "ABC" HIV prevention approach, a public health messaging strategy that described A-abstinence, B-be faithful, and C-use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).

Men continue to have a strong interest and commitment to effective family planning. Traditional methods of male contraception have long included periodic abstinence, non-vaginal ejaculation, condoms and vasectomy, the latter two representing physical methods to prevent sperm from reaching the site of fertilization. However, for male contraception the reversible methods are not reliable, and the only reliable method is not intended as reversible. During the 20th century, a wide array of reversible and highly reliable female hormonal contraceptive methods was marketed; however, no new methods for male fertility regulation have been introduced for centuries. For men to share more equally the burdens as well as the benefits of family planning, more effective reversible male contraceptive methods need to be available. Most studies into male contraception have been conducted with hormonal methods, analogous to well-known female hormonal contraceptives, making them the closest to introducing a reliable, reversible male contraceptive method. The most promising hormonal approach is the combination of an androgen (usually testosterone) with a progestin and multiple studies have shown such combinations of depot steroids displays high contraceptive efficacy, based on reliable and reversible suppression of sperm output, with few side-effects. While research into novel methods for male fertility regulation has continued in the public sector, private sector research into male contraception, essential for effective commercial product development, has stalled in recent decades. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

Male contraception plays a small role in global contraception. However, safe and effective means exist and are available with a low failure rate, such as vasectomy or to a lesser extent, condoms. Other so-called natural methods are used despite being less effective, such as periodic abstinence or withdrawal. Finally, new methods are currently being evaluated or developed, such as thermal contraception, hormonal and non-hormonal contraception. Although preliminary results are encouraging, the effectiveness of these methods remains variable and sometimes difficult to reproduce, and still requires controls and validation regarding their safety over long-term use.

Information about state and local education policies regarding sexually transmitted infections, including human immunodeficiency virus, and unintended pregnancy prevention is available, yet less is known about school-level implementation of such policies. We examine trends in the percentage of US secondary schools teaching sexual and reproductive health (SRH) topics in a required course in Grades 6-8 and 9-12, including healthy relationships, sexual abstinence, condoms and condoms with other contraceptive methods. We analyze representative data from 38 states across six cycles of School Health Profiles (2008-18) assessed through self-administered questionnaires completed by lead health teachers. Logistic regression models examined linear trends in the percentages of schools teaching topics for Grades 6-8 and 9-12, separately. Trends were calculated for states having representative data for at least three cycles, including 2018. During 2008-18, it was more common to have increases in teaching how to obtain condoms, correct condom use and use condoms with other contraceptive methods in Grades 6-12 than decreases. More states showed decreases in teaching abstinence in Grades 6-12 than increases. Most states had no change in teaching SRH topics across grades. Findings suggest some improvement in school-based SRH education, yet efforts are needed to improve comprehensive, developmentally appropriate content.

New data based on retrospective interviews with older informants enable us to review the history of contraceptive use among Spanish women over much of the twentieth century. This source is unique because it includes cohorts of women whose reproductive lives took place before, during, and after the baby boom. Traditional contraceptive methods (withdrawal and periodic abstinence) were central to the experience of the first set of women, while the last set made full use of modern as well as some traditional methods. For the first cohorts, traditional methods spearheaded the historic decline in fertility, while among the last set of women modern methods led to a precipitous decline towards the below-replacement fertility that continues in Spain today. There is no evidence that the modest increases in fertility during the baby boom in Spain were the result of a decline in the use of contraception among married women.

Abstinence-only education taught predominately via formal classroom instruction has continuously been emphasized throughout history and in classrooms today. Although abstinence-only methods are often stressed, contraceptive education is occasionally but not consistently implemented in school curricula. A variety of other instructional delivery methods include student-peer education, education outside of the formal classroom setting, community youth service programs, education via telehealth, educational videos, self-study websites and social media. Providing comprehensive sexual education utilizing multiple instructional delivery methods could close the gap in sexual education for adolescents. The age at which sexual education instruction is introduced has remained relatively unchanged throughout history. Adolescents are being formally educated within classrooms as early as grade five, although they are often exposed to informal and potentially misleading information regarding sexual education much earlier than this. In part, this is due to the relatively recent emergence and subsequent influence of technology such as social media. Thus, given the influence of technology such as social media in recent history we need to reevaluate the age of formal sexual education and increase comprehensive sexual education resources. Additionally, it is important to note that sexual education instruction provided solely in formal classroom settings may not provide sufficient information for youth to make informed decisions. Thus, sexual education information including abstinence and contraceptive methods should be provided through additional means via utilizing differing instructional delivery methods in conjunction with formal classroom instruction. For example, comprehensive sexual education should also be provided in healthcare offices including pediatric and obstetrics and gynecology (OBGYN) offices. Sexual education could include discussing/providing external resources such as pamphlets that incorporate social media and other links to online resources that provide a more inclusive, accurate educational experience within a safe environment. This would allow healthcare professionals to provide a better targeted and engaging educational experience to adolescents as well as proactively allow for exposure of younger adolescents to helpful educational resources.

Tubal Sterilization is performed at the request of women who have completed childbearing and desire an effective and irreversible form of birth control.[1] It can be performed at any time during a woman's cycle and in the immediate postpartum or postabortal period.[2] It may be performed via laparoscopy, mini-laparotomy, or hysteroscopy.[2] Apart from contraceptive benefits, there are some studies that show that tubal ligation procedures are associated with decreased risk of epithelial ovarian cancers as well as an observed reduced risk of pelvic inflammatory disease.[3] Informed consent is very important.[4] It should be stressed that this procedure is permanent and not meant for reversal.[5] The risk of regret and risk factors for regret including young age at sterilization (less than 30 years), lower parity, sterilization performed in the immediate postpartum period, divorce or remarriage following sterilization, being poor or being of Hispanic origin should be discussed.[6] Young age at the time of sterilization seems to be the strongest predictor of regret.[7] It is important to discuss that it does not provide 100% protection.[8] According to the CREST study, the 10-year failure rate is 18.5 per 1000 procedures (all procedures aggregated).[9] The pregnancy rates were highest following laparoscopic Hulka clip sterilization and lowest following monopolar coagulation and postpartum salpingectomy.[10] Even bilateral salpingectomy is associated with a risk of failure.[11] If tubal sterilization does fail, there is an increased risk of ectopic pregnancy with a ten-year probability of 7.3 ectopic pregnancies per 1000 procedures.[12] The rates of ectopic pregnancies also vary by procedure, with the highest rates following laparoscopic sterilization using bipolar coagulation.[13] Patients should, therefore, be counseled to present early if they suspect pregnancy. Serious complications following tubal sterilization are rare, which demonstrates its safety.[1] As with any procedure, informed consent should be obtained.[14] Therefore the risks associated with the procedure such as bleeding, infection, injury to nearby organs, wound complications, among others, should be discussed.[14] The alternatives such as vasectomy, long-acting reversible contraceptives (Long-acting reversible contraceptives [LARCs] like intrauterine devices [IUD]), injection, ring, patch, pills, barrier methods, and abstinence should also be reviewed with the patient.[15]

For patients with acne treated with the teratogen isotretinoin, emergency contraception (EC) is the only recourse when abstinence fails or effective contraception is not properly used. The purpose of this study was to evaluate the current understanding and provision of EC among pediatric dermatology providers. The survey found that 37% (21/57) of providers indicated they were at least somewhat confident in their understanding of EC. 7% (4/57) of providers agreed/strongly agreed that they provided EC counseling to all patients of reproductive potential at their initial visit and 3.5% (2/57) agreed/strongly agreed that they provide EC counseling at follow-up visits. Our survey results suggest the need for improved EC education for pediatric dermatology providers and subsequent counseling for patients of reproductive potential on isotretinoin therapy.

Sexual communication between adolescent partners is an important component of sexual health and wellbeing. Over 40 years of research on adolescent sexual communication has yielded rich information, yet there remain gaps in our understanding of the communication process. The purpose of this scoping review was to synthesize the body of research on adolescent sexual communication to identify how communication has been conceptualized, how researchers have measured communication, and what theoretical frameworks have been applied across the literature. We identified 198 assessments of sexual communication across 119 quantitative studies. This work included 127,489 adolescents (Mage = 15.97) from 15 countries (81.5% U.S.-based). Most studies relied on self-reports (93.4%) and surveyed only one member of a couple (97.5%). The definition of sexual communication was highly varied across the literature: in half of assessments (52.0%) sexual communication was operationalized as a behavior-the verbal or nonverbal exchange of messages about sex-whereas the remaining half of assessments captured social-cognitive aspects of communication (e.g., communication self-efficacy, fear/anxiety). There was also a tendency for investigators to create their own idiosyncratic instruments: half of studies (48.9%) used instruments created by the research team with limited or no discussion of reliability/validity. Regarding the topic of communication, a third of assessments (33.8%) focused exclusively on condom communication and another quarter (24.0%) focused on other safer-sex issues (e.g., STDs, abstinence). Notably absent were studies focused on communication surrounding consent or sexual pleasure. Also absent was a guiding conceptual model or theory that could unify this body of work. Overall, results highlight gaps and inconsistencies in how partner sexual communication has been conceptualized, measured, and theorized about in previous work. We provide several recommendations for future theory-building efforts as well as rigorous, multimethod empirical investigations of adolescent sexual communication that would further our understanding of this important aspect of adolescent sexual wellbeing.

There are many options to prevent pregnancy; abstinence, withdrawal method, condoms, spermicidal solutions, diaphragms, cervical cups, intrauterine devices, oral contraceptive pills, long-acting hormonal implants, depo injections, lactation amenorrhea method, emergency contraception techniques, vasectomy, and tubal ligation. This activity is an overview of vasectomy, its technique and its role in the prevention of pregnancy. Vasectomy is the only form of permanent male sterilization, a procedure where the vas deferens are transected, ligated, and separated in fascial planes. Urologists perform about 75% of vasectomies while the remainder are performed by general surgeons and family medicine physicians.[1] The success rate for vasectomy is high, 99.7%, with typically low complication rates ranging between 1% to 2%.[2][3]

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex.

In vitro signals indicate that ziritaxestat is a weak cytochrome P450 (CYP) 3A4 inhibitor and inducer. Therefore, potential drug-drug interactions (DDIs) with oral contraceptives were examined at a time when ziritaxestat was under development for treatment of fibrotic diseases. This open-label, crossover (fixed sequence) DDI study enrolled healthy, nonpregnant women aged 18-65 years (n = 15) who were using highly effective contraception, such as a nonhormonal intrauterine device, bilateral tubal occlusion, or sexual abstinence. A single dose of oral contraceptive (0.03 mg ethinyl estradiol (EE) and 3 mg drospirenone (DRSP)) was administered on days 1, 8, and 18, and ziritaxestat 600 mg once daily was administered from days 8 to 23. Co-administration resulted in a 2.8-fold and 2.4-fold increase in EE maximum plasma concentration (Cmax) and area under the plasma drug concentration-time curve from time zero to infinity (AUC0-inf), respectively (day 18 vs. day 1). DRSP Cmax and AUC0-inf increased by 1.1-fold and 1.2-fold, respectively. DRSP is a CYP3A4 substrate, meaning increased EE exposure with ziritaxestat was not due to CYP3A4 inhibition. Ziritaxestat inhibition of EE glucuronidation and sulfation was quantified by liquid chromatography with tandem mass spectrometry in day 1 and day 18 plasma samples after EE conjugate hydrolysis. The ratio of EE AUC from time of administration up to the time of the last quantifiable concentration (AUClast) with/without hydrolysis by arylsulfatase was substantially lower on day 18 vs. day 1, suggesting ziritaxestat is a potent inhibitor of sulfation; EE glucuronidation was largely unaffected by ziritaxestat. In vitro assessment confirmed ziritaxestat is a potent inhibitor of sulfotransferase family 1E member 1 (half-maximal inhibitory concentration < 0.8 μM). These findings highlight the importance of assessing enzymes other than CYP3A4 when investigating potential DDIs with oral contraceptives.