Background Guaranteeing the sexual and reproductive health and rights (SRHR) of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations. The migration of Venezuelans, displaced due to current economic circumstances, is one of the largest in Latin America’s history. This study aims to provide an overview of the sexual and reproductive health (SRH) issues affecting migrant Venezuelan women in the state of Roraima, Brazil. Methods Face-to-face interviews were conducted from 24 to 30 November 2019. Data collection covered various issues involving access to and use of SRH services by 405 migrant Venezuelan women aged 18–49 years. The Minimum Initial Service Package readiness assessment tools, available from the Inter-Agency Working Group on Reproductive Health in Crises, were used in the data collection. Results Most commonly, the women reported unmet family planning needs. Of these, a significant proportion reported being unable to obtain contraceptive methods, particularly long-acting reversible contraceptives, either due to the woman’s inability to access them or their unavailability at healthcare centres. Although a significant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, 24.0% of pregnant or postpartum women failed to receive any prenatal or postnatal care. Conclusion Meeting the essential SRHR needs of migrant Venezuelan women in Roraima, Brazil is a challenge that has yet to be fully addressed. Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens. Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Given the current high risks associated with the SARS-CoV-2 pandemic, meeting the SRHR needs of migrant populations has become more critical than ever.

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Objective We evaluated clinical performance when the TCu380A intrauterine device (IUD) and the levonorgestrel (LNG) 52‐mg intrauterine system (IUS) were inserted by different categories of healthcare professionals. Methods A retrospective study was conducted at the University of Campinas, Brazil. The medical records were reviewed of all women in whom an IUD was inserted between January 1980 and December 2018, with data for at least 1 year, and for whom information on the healthcare provider who inserted the device was available. Results Overall, 19 132 (76.9%) IUD and 5733 (23.1%) LNG‐IUS insertions were included, with residents/interns performing 13 853 (55.8%), nurses 7024 (28.2%), and physicians 3988 (16.0%). Removals for pregnancy and infection were significantly higher when physicians inserted the device, while removals for bleeding/pain and other medical reasons were more common when nurses performed the insertion. Expulsion and removals for personal reasons were similar for all three categories. Conclusion Clinical outcomes were similar regardless of whether trained nurses, residents/interns, or physicians inserted the device, and were irrespective of users’ age and parity. These results could stimulate other healthcare services, particularly in regions where there is a shortage of physicians, to invest in training nurses to perform insertions of IUDs.

Introduction Our objectives were to compare the 1‐year follow‐up clinical performance of the TCu380A intrauterine device (TCu380A‐IUD) and levonorgestrel (LNG) 52‐mg intrauterine system (IUS) inserted at post‐placental period. Material and methods We conducted an open‐label, parallel‐group, randomized clinical trial, 1:1 with pregnant women admitted for childbirth independently of the mode of birth. Our primary outcome was expulsion up to 1 year after device placement by type of IUD and mode of delivery. During the follow up (42, 90 and 365 days (±7 days) after device placement), an ultrasound was performed to evaluate the device position. Kaplan–Meier with log‐rank test was used to compare the survival curves of the TCu380A IUD and the LNG IUS. Couple‐Years of Protection after insertion of both devices was calculated. Results One hundred and forty women were randomized to the TCu380A IUD (n = 70) or the LNG IUS (n = 70). By the end of the first year after device placement, 38 women experienced device expulsion (27.1%), most of them (33/38; 86.8%) within the first 42 days after delivery. The expulsions were significantly higher among users of TCu380A IUD (39.4%) than among users of the LNG IUS (22.2%; P = .039), and among those with vaginal delivery (43.8%) than among women with cesarean delivery (15%; P = .003). The 1‐year cumulative continuation rate was 64.2%, significantly higher for LNG IUS (73.1%) than for TCu380A IUD (54.4%; P = .03), and among women with cesarean delivery (77.6%) than for vaginal delivery (52%; P = .00). The post‐placental IUD insertion provided 356.4 Couple‐Years of Protection. Conclusions Two‐thirds of women who accepted a post‐placental IUD placement still used the device 1 year after childbirth. However, expulsion was the most prevalent reason for discontinuation, mainly within 42 days after device placement. The expulsion rate was significantly higher among TCu380A IUD users and among women with vaginal delivery.

Highly effective long-acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and implants, can be an excellent contraceptive choice for women wishing to avoid unplanned pregnancies. However, the method mix of IUDs, including the copper IUD (Cu-IUD) and the 52-mg levonorgestrel intrauterine system (LNG-IUS), is reported to be pitifully small (less than 5%) in 63 countries and only 5%-9% in a further 32 countries. 1 Compared with other contraceptives, LARC methods have lower contraceptive failure, are safe, and have fewer adverse effects. 2 The reported contraceptive failure rate of the TCu380A IUD is 1 per 100 women-years, with up to 12 years of effective protection. 3 For the LNG-IUS, failure is between 0.1 and 0.2 per 100 women-years and 0.3 per 100 womenyears up to the sixth year of use, 4 providing effective contraception for up to 6 years. 5,6