Oral contraceptive use and protective behavior after missed pills

A three-month prospective study of 103 women initiating oral contraceptive use examined how consistently the women took their pills and whether those who missed pills employed other means to avoid pregnancy. The results showed that 52% took each active pill or never missed more than one pill at a time after the first week of the initial cycle, according to electronic devices that recorded the date and time each pill was removed from the blister pack. Another 21% were protected by behaviors that reduce the risk of pregnancy when two or more consecutive pills have been missed: avoiding coitus for the next seven days (18%) or using backup contraception during that period (3%). The remaining 27% were at increased risk of pregnancy. Predictors of increased risk were receiving low partner support for effective pill use, being unmarried and not considering it especially important to avoid pregnancy. Increased risk was most likely during the first seven days and during the third cycle of pill use.     

Contraceptive behavior in the population of the Czech Republic: results of a national survey

Using an anonymous questionnaire the authors investigated in a representative group of the Czech population above 15 years of age (862 men and 857 women) the use of the main contraceptive methods. During the first intercourse more than half the respondents did not use any contraception, a condom was used only by 19% men and 14% women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby experience with hormonal contraception was reported by cca one third and with a condom by two thirds of respondents. Among younger men and women there are more users of hormonal contraception and condoms. Only 5% of the examined men and 4% of the women opposed any type of contraception, almost one quarter of respondents use only so-called "natural methods" and almost three quarters of the respondents consider them an essential part of sex life. The attitudes of atheists and junior and more educated women are more liberal.     

Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

OBJECTIVES: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy. DESIGN: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents. SETTING: Postnatal wards of Harare Maternity Hospital. SUBJECTS: 923 mothers following delivery. MAIN OUTCOME MEASURES: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge. RESULTS: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy. CONCLUSION: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.     

The history of family planning among women who opt for surgical sterilization in the Social Security Fund of Panama

In this study, the previous history of family planning and prior usage of contraceptive methods are analyzed, in a sample of 175 women who voluntarily opted for surgical sterilization as a permanent method of fertility regulation, in the Panamanian Social Security System. A questionnaire was applied during the second trimester of pregnancy, by which information would be gathered in regard to knowledge, usage and adverse effects of the contraceptive methods used prior to the intervention. Results showed that 99% of the sample had heard, on some occasion about oral contraceptives (OC) and, in lesser proportion to intrauterine devices (IUD), barrier methods and hormonal inyectables. The first contraceptive method used, and the one of longest usage, was the combined OC, of which 43% begun between 17 and 25 years of age. In contrast, 7.4% initiated contraception with IUD, from the age of 26 years. The health personnel constituted the major source of recommendation for contraceptive usage and, despite the fact that 37% of the sample did not use contraception prior to the last pregnancy, over half of the subjects responded that combined OC were considered as the most secure method.     

Socioeconomic development, status of women, family planning, and fertility in Bangladesh: a district level analysis

In this paper we examine the effects of socioeconomic development, the status of women, and family planning on fertility and the extent to which these effects vary among the nineteen districts of Bangladesh. The 1983 and 1991 Bangladesh Contraceptive Prevalence Survey data are used to examine the effects of these factors on differences in contraceptive use among currently married women aged 15-49. The proportion of currently married women aged 15-49 using contraception was 46.3 per cent in 1991, a considerable increase from 26.5 per cent in 1983. Contraceptive use rates for all the districts increased substantially over the period between 1983 and 1991 and the gap between Dhaka's rate and those of other districts was narrower in 1991 than in 1983. An analytical model composed of socioeconomic development, status of women, and family planning variables is tested using logistic regression. The logit model is used to evaluate the effects of a selected group of variables on the probability of using contraceptive methods. The analysis demonstrates clearly that socioeconomic development and women's status significantly impact the use of contraceptive methods in Bangladesh. The results also suggest that better-educated, employed women are more likely to use contraception than those who have little or no formal education and who are not employed. In 1983, rural-urban differences in contraceptive use were significant, but in 1991 area of residence was not significant, which suggests that family planning programs may have played an important role in providing contraceptive information and technology to rural areas. Our analysis also suggests that family planning programs operated more efficiently in some districts than in others, and regional differences remained important in 1991 as they were in 1983. Decomposition analysis suggests that shifts in population structure favored increased contraceptive use in Bangladesh. This analysis also indicates that change in rate is also important, contributing about 21 per cent of the overall increase in contraceptive use.     

The scanning electronmicroscopy of human cervical mucus in the non-pregnant and pregnant states

With a standard questionnaire 7356 lying-in patients at the Department of Obstetrics and Gynecology, University Erlangen-Nürnberg, were asked about their social background and their sexual habits. First of all some statistical facts concerning the frequency of distribution: 20% of all women questioned had their first cohabitation before the age of seventeen. 53% had sexual intercourse with one man, 23% with two, the remainder with more than two men. Quite a number of social characteristics influenced the sexual behavior of women. Thus it was shown that women have their first cohabitation before the age of eighteen the sooner the lower their social status is and the more partners they had. Insufficient contraceptive precautions or the neglect of any contraception were mainly met with women of lower social status. The same correlation could be found between contraceptive behavior on the one hand and the parameters education and strong religious commitment on the other hand. In rural aereas contraceptive measures were used insufficiently or less often then in urban communities.     

Contraception in Spain

This report analyzes various aspects of contraception in Spain. One notable finding is the wide socioeconomic, cultural and health variation among regions. Since 1975 a significant drop in the birth rate has been observed overall. Twenty per cent of the women studied at risk of pregnancy are using oral contraceptives. The most widespread contraceptive method is still coitus interruptus, followed by oral contraception and the condom, as well as the rhythm method. The highest use of oral contraceptive and IUDs is seen in Catalonia (20% and 26% respectively) followed by Andalusia, Madrid and Valencia. Although contraception has only recently become legal in Spain, it is widely available either without charge or very inexpensively; all methods including abortion are available. At present, priority is given to special interest groups such as women in special circumstances, teenagers, etc. and to special programs like "Integrated Care for Women" which includes contraception, STD, pregnancy monitoring, early diagnosis of gynaecologic cancer and menopause.     

Contraceptive practice after clinic discontinuation

A follow-up study was conducted of clients who stopped attending 4 family planning clinics in Washington County, Oregon, a predominantly white, middle-class suburban community. Clients had enrolled in the program between 1971-74, and dropped out by April 1975. 29% of the women (746) who were overdue for a return visit by more than 3 months (i.e. inactive clients) were contacted by phone and mail. No significant social or demographic differences were found between active and inactive clients or between dropouts who were contacted and those who were not. 71% of all program enrollees dropped out by the end of 3 years. However, 90% of the sample were either using contraception or not at risk of an unwanted pregnancy for a variety of reasons. The remaining 10% were either unprotected or already pregnant with an unplanned pregnancy (2%). The women at risk and not using contraception were more likely to be young, poorly educated, single, and recent enrollees in the family planning program. No other social or economic differences affected the comparison of the 2 groups. Most users continued to use the same method of contraception they had used before. However, a significantly smaller proportion of women were using the pill, a slightly larger proportion were using IUD and 6% more clients were sterilized. The most common reasons for leaving the program were the decision to use a private physician and relocation. Among women at risk, the most common reason was worry about the contraceptive method, especially the pill. New sources of care included private physicians (71%, but 1/3 of these women were disatisfied with their doctors' care or fees), public health clinic not part of the family planning program (21%) and drugstores. A very few women reported no alternate source of care.     

Levonorgestrel subdermal implants. A review of contraceptive efficacy and acceptability

Levonorgestrel 6-capsule subdermal implants (Norplant) are an effective form of reversible contraception. When implanted under the skin of the upper arm, they release drug into the circulation at a relatively constant rate over 5 years. Generally, the cumulative pregnancy rate at the end of 5 years' levonorgestrel implant use is less than 2 per 100 users. The implants provide contraceptive efficacy equivalent to, or better than, that provided by other reversible methods (including oral contraceptives). Younger women are more likely than older women to become pregnant while using levonorgestrel implants. Bodyweight was positively correlated with risk of pregnancy in a number of studies, but may not be a factor with the currently available 6-capsule implant formulation. Limited data suggest that a new 2-rod levonorgestrel subdermal system (Jadelle) is as effective as the more extensively studied 6-capsule system and has a similar tolerability profile. Fertility returns rapidly after the implants are removed. Use of levonorgestrel subdermal implants is compatible with breast-feeding. In several studies, discontinuation rates were 2 to 15% during the first year of use; cumulative 5-year discontinuation rates ranged from 22 to 64 per 100 women. Despite a substantial incidence of adverse events during therapy, levels of user satisfaction are generally high. Menstrual abnormalities (increased or decreased menstrual flow, spotting, irregularity and amenorrhoea) affect most women at some time during therapy and are the most frequent reason for discontinuing levonorgestrel implants before the end of 5 years' treatment (incidence of 4.2 to 30.7 per 100 users). Mood changes and headache also may lead to discontinuation. Other reported adverse events include skin reactions (including acne), dizziness and weight gain. Serious adverse events (such as stroke, thrombotic thrombocytopenia and idiopathic intracranial hypertension) have been reported during levonorgestrel implants therapy, but the population incidence is difficult to calculate and causality is unclear. According to 3 pharmacoeconomic analyses from an institutional or managedcare perspective, all contraceptive interventions result in net cost savings. It is not clear whether levonorgestrel implants provide greater or smaller economic benefits than combined oral contraceptives. CONCLUSION: Levonorgestrel subdermal implants provide effective long term contraception. Despite a high incidence of menstrual adverse events, overall levels of user satisfaction are high, and 1-year continuation rates are better than those for combined oral contraceptives. Levonorgestrel subdermal implants are a good choice of contraceptive method in women who desire effective contraception, but who are unable to, or prefer not to, comply with an oral regimen.     

Contraceptive use and attitudes in Great Britain

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.     

Durable effects of implementation intentions: Reduced rates of confirmed pregnancy at 2 years.

Objective: To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Design: Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Main outcome measures: Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Results: Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). Conclusion: The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dual-method use among an ethnically diverse group of women at risk of HIV infection

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.     

Haiti: unions, fertility and the quest for survival

This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.     

Differentiation of Veillonella atypica, Veillonella dispar and Veillonella parvula using restricted fragment-length polymorphism analysis of 16S rDNA amplified by polymerase chain reaction

OBJECTIVE: To investigate the effect of pre-treatment counseling on discontinuation rates of 150 mg depo-medroxyprogesterone acetate (DMPA), given for contraception. METHODS: A total of 421 women participated, 204 receiving intensive structured pre-treatment and on going counseling on the hormonal effects and probable side effects of DMPA and 217 receiving only routine counseling. All participants were followed up at every 3 months for 1 year. The primary endpoint was termination rate, secondary endpoints were frequency of medical events and reasons for termination. RESULTS: The most common reasons for terminating DMPA were menstrual changes. Although women in the intensive structured counseling group reported more menstrual irregularity (39.7%) than did women in the routine counseling group (26.3%), study termination rates were significantly lower in the intensively structured counseling group than in the routine counseling group. At one year, the total cumulative termination rates were 11.3% (23/204) and 42.4% (92/217), respectively (P < 0.0001). No pregnancy and serious medical events were reported. CONCLUSION: Pre-treatment counseling on expected side effects increases the acceptability of DMPA.     

Contraception and voluntary termination of pregnancy. Survey of a sample of 500 women

In order to better evaluate the link between contraceptive attitudes and induced abortion, 500 women who underwent voluntary termination of pregnancy (VTP) at the First Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza" were interviewed. They were young (median age 28 years), medium to high educated (61%), non married (52.4%), nulliparous (59.2%) women. Forty-two percent of them had the first sexual intercourse before 18 years of age and 72.6% at least five years before. Ninety-five women (19%) admitted a previous voluntary termination of pregnancy. Withdrawal (305 women), oral contraceptives (246 women) and condom (223 women) were the most widely used methods of fertility regulation, but the pill had been taken only for short periods of time, never exceeding one year. Withdrawal resulted to be the most utilized method during the cycle in which conception occurred (49.4%); no method had been employed by 34.8% of the women. The diffusion of modern methods of fertility regulation greatly influences the number of induced abortions in Italy, as clearly indicated by the progressive reduction of VIP starting from 1982 paralleled by a constant increase in OCs diffusion. Our data, although limited in number, confirm that induced abortion is the consequence of an insufficient use of modern methods of fertility regulation.     

Changes of exploratory behaviour and its habituation in rats neonatally treated with monosodium glutamate

BACKGROUND: Because of the ban on oral contraceptive use in Japan, only high-dose combined pills (HDCP), permitted as treatment for menstrual disorders, can be used as a contraceptive. We determined the prevalence of the use of such preparations in a community in Japan and assessed the health characteristics of the users. METHODS: A total of 18,435 female residents age 35 years and over in a city of Gifu Prefecture, Japan, responded in 1992 to a health questionnaire that included questions on the use of HDCP, lifestyle, and dietary habits. The response rate was 92%. RESULTS: The rates of current and past HDCP use were 1.3 and 7.1%, respectively, among women ages 35-49 years, and 2.2% of the women had used HDCP for longer than any other method of contraception. Current HDCP users were more likely to be smokers. They had lower intakes of carotene, fiber, and vitamins C and E and a lower polyunsaturated/saturated fat ratio than never-users. CONCLUSIONS: The prevalence of HDCP use was 1.3% among Japanese women ages 35-49 years. Potential risk factors for cardiovascular diseases, such as smoking and a diet with lower intakes of antioxidants, were prevalent among current HDCP users.     

Correlates of contraceptive failure among clients attending an antenatal clinical in Nairobi

This paper presents a study analysing 100 cases of contraceptive failure and an equal number of controls in Nairobi. The study population included all the patients who attended the antenatal clinic at Kenyatta National Hospital, during a ten-week study period and who had conceived while on a contraceptive method. The controls were patients who were carrying a planned pregnancy. The objective of the study was to determine the sociodemographic patterns, level of counselling and attitudes of patients who presented to antenatal clinic after contraceptive failure and to formulate recommendation on how to manage these patients. User failure was more common than method failure. High parity and a high number of living children were associated with increased risk of contraceptive failure (OR 3.7 and 4.6, respectively). Other factors found to be associated with increased risk of contraceptive failure were: inadequate counselling at contraceptive initiation (OR 4.0), poor knowledge of different contraceptive methods (OR 1.9), short duration of contraceptive use (OR 3.3), and non-compliance, with 40% of the cases having been non-compliant. Thirty per cent of the patients who had contraceptive failure were unhappy about the pregnancy. This paper finds that better counselling on contraceptive use and compliance would reduce contraceptive failure and diminish the negative programme effects of failed contraception. Counselling would also enhance acceptance of the pregnancy and minimise the chances of negative psychological sequelae.     

Choice and follow-up of contraception without risk factor

Every young healthy and truly informed woman may use any contraceptive method. Teenagers have to avoid not only pregnancy but also AIDS and other sexually transmitted diseases. Therefore they may use condoms when aware of postcoital contraception or must use both condoms and oral contraceptives. Non smoker women over 40 may choose between combined oral contraceptives, high doses progestogens or IUDs. Whatever the age, newer preparations with desogestrel, norgestimate or gestodene will be preferentially used due to the absence of clinical and metabolic side-effects. Smokers before 35, nonsmoker women over 35 will be preferentially given pills with only 20 micrograms ethinyloestradiol.     

Contraception: traditional and religious attitudes

Humans have tried to control fertility for centuries. Primitive, preliterate societies practiced infanticide and abortion. When primitive women understood the advantages of conception control, they tried, when possible, to use contraception. In the 4th century B.C., Plato and Aristotle advocated a one-child family. Greek medical literature reported a hollow tube inserted through the cervix into the uterus and a potion as contraceptives. Islamic physicians had much knowledge about conception control. The attitudes toward contraception. In the 5th century B.C., Saint Augustine condemned contraception, even among married couples. The condom emerged in the early modern period. Yet, they were usually worn to protect against disease, e.g., bilharzia in Egypt and syphilis in Europe. The cervical cap and the diaphragm are examples of occlusive pessaries. By 1880, contraceptives and spermicides were advertised. In 1928, the IUD joined the existing contraceptives. Today we have combined oral contraceptives. Judaic law requires husbands to fulfill their wives sexual needs, separate from their duty to procreate. It also calls men, not women, to procreate and forbids men from masturbating, thus Judaic law does not forbid women from practicing contraception. The Roman Catholic church forbids contraceptive use because it is a sin against nature. Some Protestant denominations have allowed contraceptive use. Islamic law states that children are gifts from Allah. Some Moslems believe that they must have many children, but Allah and the Prophet state that children have rights to education and future security. These rights allow couples to prevent pregnancy. Neither Hinduism nor Buddhism prohibit contraceptive use. Differences in husband-wife communication, sex roles, access to contraceptives, and traditional family values will have more of an effect on contraceptive use and fertility than theological barriers or the social class of religious groups.     

Trends in contraceptive use in the United States: 1982-1995

CONTEXT: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. METHODS: Information on current contraceptive use was collected from a representative sample of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with similar data from 1982 and 1988 to examine trends in use, both overall and in social and demographic subgroups. RESULTS: The proportion of U.S. women using a contraceptive method rose from 56% in 1982 to 60% in 1988 and 64% in 1995. As in 1982 and 1988, female sterilization, the pill and the male condom were the most widely used methods in 1995. Between 1988 and 1995, the proportion of users relying on the pill decreased from 31% to 27%, while condom use rose from 15% to 20%. The largest decreases in pill use and the largest increases in condom use occurred among never-married women and among black women younger than 25. Reliance on the IUD dropped sharply among Hispanic women, while use of the diaphragm fell among college-educated white women. CONCLUSIONS: The decline in pill and diaphragm use and the increase in reliance on condoms suggest that concerns about HIV and other sexually transmitted diseases are changing patterns of method use among unmarried women.