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Abstract Task-shifting the provision of pregnancy tests to community health workers (CHWs) in low-resource settings has the potential to reach significantly more underserved women at risk of pregnancy with essential reproductive health services. This study assessed whether an intervention to supply CHWs with home pregnancy tests brought more clients for antenatal care (ANC) counselling. We implemented a randomized controlled trial among CHWs providing reproductive health services to women in Eastern Madagascar. We used ordinary least squares regressions to estimate the effect of the intervention, with district- and month-fixed effects and CHW baseline characteristics as control variables. Our outcomes of interest included whether the intervention increased: (1) the number of women at risk of pregnancy who sought services from CHWs; (2) the number of these women who knew they were pregnant by the end of visit; and (3) the number of these women who received ANC counselling during visit. We found that providing pregnancy tests to CHWs to distribute to their clients for free significantly increased the number of women at risk of pregnancy who sought services from CHWs. At follow-up, treatment-group CHWs provided services to 6.3 clients compared with 4.2 clients among control-group CHWs, which represents a 50% relative increase from the control-group mean. A significantly higher number of these clients knew they were pregnant by the end of the visit, with a mean of 0.95 in treatment compared with 0.10 in control (Coeff. 0.86; 95% CI 0.59–1.13). A significantly higher number of these clients received antenatal counselling at the visit (Coeff. 0.4; 95% CI 0.14–0.64). Introducing free home pregnancy tests as part of community-based health services can improve pregnancy care by attracting more clients at risk of pregnancy to services at the community level, enabling more women to confirm they are pregnant and receive antenatal counselling.

Reliance upon patient assessment in excluding pregnancy is questionable. Physicians are encouraged to obtain pregnancy tests in all women of childbearing age. We affirmed the accuracy of women and their physicians in predicting pregnancy. This was a prospective, observational study performed in a suburban academic emergency department on adult women with an ordered pregnancy test. A standardized gynecologic history was obtained by trained research assistants. Subjects estimated their likelihood of pregnancy as impossible, possible, or definite. Emergency department physicians estimated the likelihood of pregnancy as high, moderate, or low. All women had either a serum or urine β-human chorionic antigen. The diagnostic characteristics of patient and physician predictions of pregnancy were calculated with 95% confidence intervals (CIs). We enrolled 377 subjects. Median age was 29 (interquartile range, 22-37) years. Twelve percent of the women were pregnant. Women's estimates of pregnancy were as follows: impossible, 64.7%; possible, 22.5%; and definite, 12.7%. The pregnancy rates among women with estimates of impossible, possible, and definite were 0% (95% CI, 0%-1.5%), 4.7% (95% CI, 1.9%-11.5%), and 89.6% (95% CI, 77.8%-95.5%) ( P < .001). Physicians' suspicions of pregnancy were high (13.7%), moderate (11.3%), and low (75.1%). The rate of pregnancy among low, moderate, and high physician suspicion groups were 0% (95% CI, 0%-1.4%), 9.5% (95% CI, 3.8%-22%), and 84.3% (95% CI, 72%-92%) ( P < .001). There were no pregnancies among women who estimated pregnancy as impossible or whose physicians thought that the likelihood of pregnancy was low. Routine pregnancy testing before radiological imaging and medication administration may not be required in adult women of childbearing age.

This study describes a project to determine the incidence of negative pregnancy tests performed in an urban community for teens 18-years old and younger. Pregnancy test logs were kept at a variety of clinical agencies for a three-month period. Five hundred and fifty urine pregnancy tests were performed; 77% were negative. In our community a large number of teens are accessing health care services for pregnancy tests, the vast majority of which are negative and represent an important opportunity to prevent unintended pregnancies in a population of adolescent girls.

OBJECTIVES: This study estimated the prevalence of home pregnancy testing among adolescents. METHODS: A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years. RESULTS: The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant. CONCLUSIONS: Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

ISSUES AND PURPOSE To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community. DESIGN AND METHODS Clinicans focus groups were conducted to identify the needs of adolescents at the time of a NPT result. RESULTS Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinical dependent, and strategies for follow‐up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints. CONCLUSION Adolescents need comprehensive, teen‐friendly reproductive care at the time of a NPT results.

Profiles and related sexual histories of 2,029 women who sought pregnancy tests at a university health center over a 5-year period were examined. Rates of pregnancy (30%) were consistent over the 5 years. The highest rates of testing were among seniors and juniors, with graduate students reporting the highest levels of unintended pregnancy. More than 37% of the women indicated they had not used any method of contraception at the time of risk; 29% of the women who had used condoms reported that the device had either torn or slipped off. The women with previous pregnancies were more likely to test positive and to terminate the pregnancy than were the women who had never been pregnant. The findings are discussed with reference to sexually education programs and pregnancy counseling.

Pearson discusses the avoidance of anesthetizing and performing a procedure on a patient with an undiagnosed pregnancy. The risk of general anesthesia to both a pregnant patient and fetus in early pregnancy is discussed, and an algorithm that allows clinicians to make appropriate clinical decisions when ordering pregnancy tests is offered.

Context: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives. Methods: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race. Results: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item-worry over the potential side effects of the hormonal injectable contraceptive-did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues. Conclusion: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

In both 1975 and 1977, the Committee on Safety of Medicines reported an association between hormonal pregnancy tests (HPTs) and subsequent congenital abnormalities and stated that such tests should no longer be used. Despite these findings, the Secretary of State declined to ban the proprietary drug involved (Primodos). Following the 1977 warning, 600 consecutive abortion patients at 6 branches of the British Pregnancy Advisory Service (BPAS) were asked whether they had been given HPTs. 12 patients (2%) indicated they had received such tests. Since most women had not consulted a general practitioner before coming to BPAS, this figure is probably an underestimate of actual use. Although a few doctors may have prescribed an HPT in the belief that the pregnancy would be terminated anyway, some HPTs were administered by doctors who subsequently refused to refer the patient for an abortion. If banning Primodos is considered an unacceptable infringement of professional freedom, the Department of Health and Social Security should consider making it a controlled drug, with the requirement that physicians ascertain through an immunological test that the recipient is not pregnant.