Catégorie : Chiffres et études

Source: APHP

Source: ORS idf

L’essentiel de l’étude

L’Île-de-France se situe au 3e rang des régions de métropole pour le recours à l’IVG.À travers ces quatre ans de suivi régional, l’Observatoire régional de santé (ORS) propose un suivi d’indicateurs à l’échelle infra-régionale.

Parmi les résultats marquants :
En 2015, un peu plus de 50 000 recours à l’IVG pour des Franciliennes soit un taux de 17,1‰ femmes en âge de procréer. Ces taux varient selon les départements de 13,5 ‰ dans les Yvelines à 22,4 ‰ en Seine-Saint-Denis,
Près de trois quarts des IVG réalisées dans le département de domicile avec des écarts importants selon les départements, de 86,5 % à Paris à 58,9% pour le Val-de-Marne,
Une offre hospitalière en diminution et une augmentation de l’offre « en ville ».

Pour télécharger la synthèse et le rapport
ORS idf

Auteurs: Marie-Josèphe Saurel-Cubizolles, Marion Opatowski, Philippe David, Françoise Bardy, Annabel Dunbavand

DOI: http://dx.doi.org/10.1016/j.ejogrb.2015.09.025

EJOG: European of Obstetrics and Gynecology and Reproductive Biologie

Source: EJOG

Abstract Objective
To compare the level of pain reported by women by dose of mifepristone, 200 or 600 mg, and describe the main factors related to the pain level in the 5 days after a medical abortion.

Study design
Observational study in 11 medical centers in France between October 2013 and September 2014. The protocols were 200 or 600 mg orally mifepristone on day 1 of the medical abortion and 400, 600 or 800 μg orally misoprostol on day 3. Women returned a questionnaire that they completed during 5 days following the abortion; pain was recorded on a visual analog scale (0–10) daily.

Results
453 women were included; the mean age was 29 years (range 18–49 years). Pain was greater with 200 than 600 mg mifepristone: 33% of women reported a pain level of ≥8 on day 3 with 200 mg as compared with 16% with 600 mg. This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose.

Percentages of symptoms as vomiting or diarrhea were also lower with 600 mg mifépristone than 200 mg.

Conclusion
The mean pain severity experienced by women undergoing medical abortion is high; it is higher with a regimen of 200 mg mifepristone. The findings emphasize the need to improve analgesic strategies and invite to opt for a protocol of 600 mg instead of 200 mg mifepristone.

Keywords:
Pain, Medical abortion, Mifépristone

Source: NCBI
J Sex Med. 2016 Sep;13(9):1359-68.
doi: 10.1016/j.jsxm.2016.06.011.
Epub 2016 Jul 25.

Author: Mark KP, Leistner CE, Garcia JR.

Abstract

INTRODUCTION:
Research investigating the impact of contraceptive use on sexual desire has produced mixed results. This scholarship also has had inconsistent methodology, with some studies not separating contraceptive types and others lacking non-hormonal comparison groups. Relationship context of contraceptive use and sexual behavior also have not been well represented.

AIMS:
To investigate the impact of contraceptive type on sexual desire in women and in men who are partnered to contraceptive-using women.

METHODS:
In two separate studies we examined the impact of contraceptives on the sexual desire of women currently using contraceptives and men partnered to women using contraceptives. The first study examined the impact of contraceptive type on sexual desire in women and in men partnered to contraceptive users in relationships of different lengths. The second study examined this impact in heterosexual couples in long-term relationships.

MAIN OUTCOME MEASURES:
Solitary and dyadic sexual desire as measured by the Sexual Desire Inventory and contraceptive type as categorized into three types: oral hormonal contraceptive, other hormonal contraceptive, and non-hormonal contraceptive.

RESULTS:
Contraceptive type significantly affected solitary and dyadic desire. Women on non-hormonal contraceptives reported higher solitary sexual desire than women on other hormonal contraceptives. Women on oral hormonal contraceptives reported significantly higher dyadic sexual desire than women on non-hormonal contraceptives. In male partners of female contraceptive users, solitary and dyadic sexual desires were not affected by partner contraceptive type. In the multivariate model, relationship length and age were stronger predictors of contraceptive type than was solitary or dyadic sexual desire. At the couple level, contraceptive type also was not related to solitary or dyadic sexual desire in men and women.

CONCLUSION:
Contraceptive type can affect solitary and dyadic sexual desire in women; however, contextual factors seem to be stronger predictors of sexual desire for long-term coupled women and men than contraception type.

Source: ANSIRH

By Sarah C.M. Roberts,
David K. Turok,
Elise Belusa,
Sarah Combellick,
Ushma D. Upadhyay
First published: 24 March 2016
DOI: 10.1363/48e8216

Abstract

Context

In 2012, Utah became the first state to enact a 72-hour waiting period for abortion. Despite debate about the law’s potential effects, research has not examined women’s experiences with it.

Methods

A cohort of 500 women recruited at four family planning facilities in Utah in 2013–2014 completed baseline surveys at the time of an abortion information visit and follow-up telephone interviews three weeks later. Logistic regression and coding of open-ended responses were used to examine which women had abortions and, for those who did not, their reasons.

Results

Among the 309 women completing follow-up, 86% had had an abortion, 8% were no longer seeking abortion, 3% had miscarried or discovered they had not been pregnant, and 2% were still seeking abortion; one woman was still deciding, and the waiting period had pushed one woman beyond her facility’s gestational limit for abortion. At the information visit, women reported little conflict about the abortion decision (mean score on a scale of 0–100 was 13.9 for those who eventually had an abortion and 28.5 for others). Low decisional conflict, but not socioeconomic status, was associated with having an abortion (odds ratio, 1.1). On average, eight days elapsed between the information visit and the abortion.

Conclusion

As most women in this cohort were not conflicted about their decision when they sought care, the 72-hour waiting requirement seems to have been unnecessary. Individualized patient counseling for the small minority who were conflicted when they presented for care may have been more appropriate.

Avortement sécurisé : directives techniques et stratégiques à l’intention des systèmes de santé 2ème édition
Informations sur la publication
Nombre de pages: 135
Date de publication: 2013 – Uniquement en version numérique
Langues: Anglais, français, espagnol
ISBN: 978 92 4 254843 3
Auteurs: Organisation mondiale de la Santé
Source: OMS

l’Organisation mondiale de la Santé (OMS) a mis à jour sa publication de 2004 Avortement médicalisé : directives techniques et stratégiques à l’intention des systèmes de santé. Les directives présentées dans cette nouvelle version s’adressent aux décideurs, aux directeurs de programmes et aux personnels qui dispensent des soins liés à l’avortement. Bien que les contextes juridiques, réglementaires, politiques et de prestation de services puissent varier d’un pays à l’autre, les recommandations et les meilleures pratiques décrites dans le présent document ont pour objectif de permettre une prise de décisions basée sur les faits pour tout ce qui a trait à l’avortement sécurisé.

The safety of intrauterine devices among young women: a systematic review
Tara C. Jatlaoui, Halley E.M. Riley, Kathryn M. Curtis
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
DOI: http://dx.doi.org/10.1016/j.contraception.2016.10.006 |
Contraception, 2017, Volume 95, Issue 1, p1-112
Published online: October 19, 2016

Source: Contraception journal

AbstractObjective
The objective was to determine the association between use of intrauterine devices (IUDs) by young women and risk of adverse outcomes.

Methods
We searched Pubmed, CINAHL, Embase, Popline and the Cochrane Library for articles from inception of database through December 2015. For outcomes specific to IUD use (IUD expulsion and perforation), we examined effect measures for IUD users generally aged 25 years or younger compared with older IUD users. For outcomes of pregnancy, infection, pelvic inflammatory disease (PID), and heavy bleeding or anemia, we examined young IUD users compared with young users of other contraceptive methods or no method.

Results
We identified 3169 articles of which 16 articles from 14 studies met our inclusion criteria. Six studies (Level II-2, good to poor) reported increased risk of expulsion among younger age groups compared with older age groups using copper-bearing (Cu-) IUDs. Two studies (Level II-2, fair) examined risks of expulsion among younger compared with older women using levonorgestrel-releasing (LNG-) IUDs; one reported no difference in expulsion, while the other reported increased odds for younger women. Four studies (Level II-2, good to poor) examined risk of expulsion among Cu- and LNG-IUD users combined and reported no significant differences between younger and older women. For perforation, four studies (Level II-2, fair to poor) found very low perforation rates (range, 0%-0.1%), with no significant differences between younger and older women. Pregnancies were generally rare among young IUD users in nine studies (Level I to II-2, fair to poor), and no differences were reported for young IUD users compared with young combined oral contraceptive (COC) or etonogestrel (ENG) implant users. PID was rare among young IUD users; one study reported no cases among COC or IUD users, and one reported no difference in PID among LNG-IUD users compared with ENG implant users from nationwide insurance claims data (Level I to II-2, fair). One study reported decreased odds of bleeding with LNG-IUD compared with COC use among young women, while one study of young women reported decreased odds of removal for bleeding with LNG-IUD compared with ENG implant (Level I to II-2, fair).

Conclusion
Overall evidence suggests that the risk of adverse outcomes related to pregnancy, perforation, infection, heavy bleeding or removals for bleeding among young IUD users is low and may not be clinically meaningful. However, the risk of expulsion, especially for Cu-IUDs, is higher for younger women compared with older women. If IUD expulsion occurs, a young woman is exposed to an increased risk of unintended pregnancy if replacement contraception is not initiated. IUDs are safe for young women and provide highly effective reversible contraception.