Margareta Larsson

Sexual and reproductive health

Summary In many ways our sexual and reproductive health reflects our way of life and living conditions. In a long-term perspective, advances in welfare combined with a well-developed health and medical care system, have meant that by international standards it is now rare for mothers to die during delivery and infant mortality continues to decline to new record lows. Pregnancy and childbirth, however, continue to be a time in a woman’s life associated with many health problems, and absence from work due to illness is common. The age of parents at the birth of their first child is

Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination

Background. More than 30 000 legal abortions are performed every year in Sweden despite sexual education in schools, widespread youth‐clinics and family planning services that are free of charge. The aim of this study was to investigate reasons for induced abortion, contraceptive habits and reasons for contraceptive failure among women presenting for induced abortion.

Internet use by Chinese women seeking pregnancy-related information

OBJECTIVE to investigate whether and how Chinese pregnant women used the Internet to retrieve pregnancy-related information. DESIGN AND SETTING a descriptive, cross-sectional design using a waiting-room questionnaire was employed to obtain information from Chinese pregnant women attending the antenatal clinic of a general hospital in Guangzhou, mainland China from September to October in 2011. PARTICIPANTS a total of 335 Chinese women pregnant at least 32 weeks participated in the study with the response rate 85%. FINDINGS the great majority of the women (91.9%) had access to the Internet. Most of them (88.7%) used it to retrieve health information and began from the beginning of the pregnancy. Fetal development and nutrition in pregnancy were the two most often mentioned topics of interest. More than half of the women regarded the information as reliable. The first most important criterion for judging the trustworthiness of web-based information was if the facts were consistent with information from other sources; the second most important criterion was if references were provided. Most (75.1%) of the women did not discuss the information they retrieved from the Internet with their health professionals. CONCLUSION the Internet was a common source for pregnancy related information among Chinese pregnant women, the same as that in the western countries. Health professionals should be able to guide Chinese pregnant women to high-quality, web-based information and then take the opportunity to discuss this information with them during antenatal visits, consultations and childbirth education classes.

Knowledge, use and attitudes towards emergency contraceptive pills among Swedish women presenting for induced abortion

Objective To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion.

High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students

Objective To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. Methods Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. Results Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). Conclusion Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.

Bringing emergency contraception over the counter: experiences of nonprescription users in France, Norway, Sweden and Portugal.

Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about womens experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills.

Knowledge of human papillomavirus and attitudes to vaccination among swedish high school students

The aim of the study was to investigate knowledge of and attitudes to sexually transmitted infection (STI) and STI prevention with special focus on human papillomavirus (HPV) and the new vaccine against HPV, among 16-year-old high school students in a Swedish context. A study-specific questionnaire was distributed to 572 first year high school students from five different high schools in a medium-sized town in Sweden. The students lacked knowledge of HPV and its association with cervical cancer. Similarly, their knowledge of the new vaccine was limited. Their attitude to condom use when having sex with a new partner was positive, but decreased if oral contraceptives were used and if they were vaccinated against an STI. The main source of information was the school, followed by youth clinics and the media. The results highlight the clinical importance for school nurses and personnel at youth clinics to inform adolescents about HPV and its association with cancer.

Introducing reproductive life plan-based information in contraceptive counselling: an RCT.

STUDY QUESTION Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase womens knowledge of reproduction, and of the importance of folic acid intake in particular? SUMMARY ANSWER The RLP-based information increased womens knowledge of reproduction including knowledge of folic acid intake. WHAT IS KNOWN ALREADY Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease. STUDY DESIGN, SIZE, DURATION The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate). MAIN RESULTS AND THE ROLE OF CHANCE There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1. LIMITATIONS, REASONS FOR CAUTION As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution. WIDER IMPLICATIONS OF THE FINDINGS The provision of RLP-based information seems to be a feasible tool for promoting reproductive health. STUDY FUNDING/COMPETING INTEREST(S) Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest. TRIAL REGISTRATION NUMBER ClinicalTrial.gov Identifier NCT01739101.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom

Abstract Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population. Chinese Abstract 摘要 目的 孕前保健对于那些影响妊娠结局的风险因素的筛查、预防和管理是非常重要的。我们旨在调查六个欧洲国家的孕前保健政策、指南、推荐规范和服务项目 方法 2013年，一项服务于医疗专家和公众的电子搜索和调查项目在六个欧洲国家：比利时（弗兰德斯）、丹麦、意大利、荷兰、瑞典和英国展开。其结果从以下五个方面进行比较：政府政策和立法；专业团队和机构；医务人员；慈善组织；基于网络的公共信息和互联网站。 结果 所有国家对于患有慢性病的女性（如糖尿病和癫痫）均有相应的孕前推荐规范。而对于健康男女的推荐规范则比较分散且不一致。孕前指南常包括在产前和妊娠指南中。各个国家关于营养和生活方式的建议，尤其涉及鱼类、咖啡因、饮酒和维生素补充方面是不同的。 结论 现行的指南多种多样，需要整个欧洲进行合作研究，从而为孕前卫生保健制定循证指南。因此有必要为促进建议和指南在欧洲生育年龄人群中的实施建立清晰的方法。

Advance provision of emergency contraceptive pills reduces treatment delay: a randomised controlled trial among Swedish teenage girls

Objective. To evaluate an intervention involving advance provision of emergency contraceptive pills (ECP) to Swedish teenage girls. Material and methods. Some 420 girls aged 15–19, requesting ECP at a local youth clinic were randomly assigned to intervention group (IG) (n = 214) or control group (CG) (n = 206). Both groups received ECP on request. The IG received one extra dose of ECP, condoms and an information leaflet regarding ECP and condom use. Main outcome measures were differences between IG and CG regarding ECP use, time span between unprotected intercourse and ECP intake, contraceptive use, and sexual risk taking. Questionnaires were completed at the initial visit, and the girls were followed up by structured telephone interviews 3 and 6 months later. Results. At the 3‐month follow‐up, girls in the IG were almost twice as likely to have used ECP compared to girls in the CG (IG: 24.0%, CG: 13%, p = 0.02), and they used it sooner after unprotected intercourse (mean time IG: 13.61 h, CG: 25.47 h, p = 0.007). Significant differences persisted 6 months after the intervention (ECP use IG: 31%, CG: 19%, p = 0.01; and mean time IG: 15.59 h, CG: 26.38 h, p = 0.006). No significant differences were found in the use of regular hormonal contraceptives or condoms at either follow‐up. About 40% of the girls in both groups had risked pregnancy during the follow‐up period, but only half of these had used ECP. Conclusions. This intervention shortened the time interval from unprotected intercourse to pill intake without jeopardising contraceptive use and without increasing sexual risk taking.