Family planning is hailed as one of the great public health achievements of the last century, and worldwide acceptance has risen to three-fifths of exposed couples. In many countries, however, uptake of modern contraception is constrained by limited access and weak service delivery, and the burden of unintended pregnancy is still large. This review focuses on family planning's efficacy in preventing unintended pregnancies and their health burden. The authors first describe an epidemiologic framework for reproductive behavior and pregnancy intendedness and use it to guide the review of 21 recent, individual-level studies of pregnancy intentions, health outcomes, and contraception. They then review population-level studies of family planning's relation to reproductive, maternal, and newborn health benefits. Family planning is documented to prevent mother-child transmission of human immunodeficiency virus, contribute to birth spacing, lower infant mortality risk, and reduce the number of abortions, especially unsafe ones. It is also shown to significantly lower maternal mortality and maternal morbidity associated with unintended pregnancy. Still, a new generation of research is needed to investigate the modest correlation between unintended pregnancy and contraceptive use rates to derive the full health benefits of a proven and cost-effective reproductive technology.

Objectives The vaginal microbiota help protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota between pre-, peri- and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA). Methods 87 women (age 35–60) were classified as premenopausal (n=30), perimenopausal (n=29) or postmenopausal (n=28) according to STRAW guidelines. Mid-vagina bacterial community composition was characterized by 16S rRNA gene analysis. Results Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, L. gasseri, L. iners, or L. jensenii; and two (CST-IV-A and IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B by Atopobium. There was a significant association between menopause stage and CST (p-value=0.004) and VVA and CST (p-value=0.002). Perimenopausal women were more likely to be classified as CST IV-A or the L. gasseri CST, whereas postmenopausal women were mostly CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared to women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A vs. L. crispatus CST (aOR: 25.89, 95% Credible Interval:2.98-406.79). Conclusions A distinct bacterial community state (CST IV-A) with low relative abundance of Lactobacillus was associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate and restore vaginal microbiota homeostasis which would provide stronger evidence for a causal relationship with VVA and ultimately improve treatment and prevention of atrophic vaginitis in menopause.

Objectives-The vaginal microbiota help protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota between pre-, peri-and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA). Methods-87 women (age 35-60) were classified as premenopausal (n=30), perimenopausal (n=29) or postmenopausal (n=28) according to STRAW guidelines. Mid-vagina bacterial community composition was characterized by 16S rRNA gene analysis. Results-Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, L. gasseri, L. iners, or L. jensenii; and two (CST-IV-A and IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B by Atopobium. There was a significant association between menopause stage and CST (p-value=0.004) and VVA and CST (p-value=0.002). Perimenopausal women were more likely to be classified as CST IV-A or the L. gasseri CST, whereas postmenopausal women were mostly CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had

Understanding the fraction of newly detected human papillomavirus (HPV) infections due to acquisition and reactivation has important implications on screening strategies and prevention of HPV-associated neoplasia. Information on sexual activity and cervical samples for HPV DNA detection using Roche Linear Array were collected semi-annually for two years from 700 women age 35–60 years. Incidence and potential fraction of HPV infections associated with new and lifetime sexual partnerships were estimated using Poisson models. Cox frailty models were used to estimate hazard ratios (HR) for potential risk factors of incident HPV detection. Recent and lifetime numbers of sexual partners were both strongly associated with incident HPV detection. However, only 13% of incident detections were attributed to new sexual partners whereas 72% were attributed to ≥5 lifetime sexual partners. Furthermore, 155 out of 183 (85%) incident HPV detections occurred during periods of sexual abstinence or monogamy, and were strongly associated with cumulative lifetime sexual exposure (HR: 4.1, 95% CI: 2.0, 8.4). This association increased with increasing age. These data challenge the 20 paradigm that incident HPV detection is driven by current sexual behavior and new viral acquisition in older women. Our observation that most incident HPV infection was attributable to past, not current, sexual behavior at older ages supports a natural history model of viral latency and reactivation. As the highly exposed baby-boomer generation of women with sexual debut after the sexual revolution transition to menopause, the implications of HPV reactivation at older ages on cervical cancer risk and screening recommendations should be carefully evaluated.

Objective To explore attitudes towards new cervical cancer screening options and understand factors associated with those beliefs among women in routine gynecologic care. Methods We used an interviewer-administered survey of 551 women aged 36–62 years enrolled in the HPV in Perimenopause Study. Poisson regression with robust error variance was used to estimate prevalence ratios and 95% confidence intervals to compare women’s preferences for cervical cancer screening methods and frequency. Results A majority of women (55.6%, 95%CI: 51.4–59.8%) were aware that screening recommendations had changed, yet 74.1% (95%CI: 70.3–77.7%) still believed women should be screened annually. If recommended by their doctor, 68.4% (95% CI: 64.4–72.2%) were willing to extend screening to every three years, but only 25.2% (95%CI: 21.9–29.2%) would extend screening to five years. Most women (60.7%, 95%CI: 56.5–65.7%) expressed a strong preference for Pap testing, and 41.4% (95%CI: 37.4–45.6%) expressed at least moderate concern over having an HPV test without a Pap test. A desire for more frequent care, higher degree of worry and perceived risk, and abnormal screening history were all associated with reduced willingness to accept HPV testing and longer screening intervals. Conclusion A majority of routinely screened women indicated a willingness to adopt a cervical cancer screening strategy of cytology alone or Pap-HPV co-testing every 3 years if recommended by their physician. However, they remain concerned about HPV testing and extension of screening intervals to once every 5 years. Our results suggest continued reticence to accepting newer HPV-based screening algorithms among routinely screened women over age 35 years.

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A lower cumulative probability of HPV infection among women with a sexual debut before the sexual revolution may be masking an age-related increase in HPV reactivation in the United States.

ObjectivesTo assess knowledge, pregnancy attitudes and contraceptive practices in relation to the Zika virus outbreak in Brazil. MethodsWe interviewed 526 women 18 to 49 years old in primary health services in a Northeastern capital of Brazil, in 2016. They provided information about their knowledge of Zika transmission and health consequences, their receipt of counseling related to sexual and perinatal transmission of Zika, their pregnancy intentions and reassessment of contraceptive options in the context of the Zika virus outbreak.