Biomedical subjects

Nathalie Bajos

Publications and source records attributed to Nathalie Bajos.

9 recordsLinked to original sources

PubMed2006

Sexual behaviour in context: a global perspective.

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.

Adolescent↗

PubMed2006

The determinants and circumstances of use of emergency contraceptive pills in France in the context of direct pharmacy access.

BACKGROUND: In France, the 1999 introduction of a dedicated emergency contraceptive pill (ECP) available without a prescription has resulted in a 72% increase in its use over the past 5 years, especially among younger women. METHODS: We used a population-based health survey conducted in 1999 and in 2004 to examine the changes in the determinants of lifetime ECP use among women aged between 15 and 24 years. We also explored the determinants and circumstances of recent use of ECPs in 2004 among women aged between 15 and 44 years who are at risk for unplanned pregnancy. RESULTS: In 1999, 14.6% of women aged between 15 and 24 years had ever used ECPs; this proportion rose to 31.7% in 2004. Results show consistent patterns of lifetime ECP use in 1999 and in 2004, with greater use among higher-educated women and women living in large cities. In 2004, 22% of women were using no contraceptive at the time they used ECPs and 84% resumed use of a regular contraceptive after ECP use. However, 5.5% had unprotected intercourse after taking ECPs in the same menstrual cycle and in the next. CONCLUSION: Despite direct pharmacy access, differences in ECP use remain by social and residential status. Emergency contraceptive pills were used as a backup method in case of contraceptive failure and did not impede the use of subsequent regular contraception.

Adolescent↗

PubMed2006

Contraception at the time of abortion: high-risk time or high-risk women?

BACKGROUND: Despite the widespread use of highly effective contraception in France, the incidence of abortion is high. A retrospective population-based cohort study was designed to analyse women's contraceptive history. METHOD: We compared the contraceptive use of 163 women, whose last pregnancy ended in abortion, 6 months before, at the time of, 1 month and 6 months after the event with that of 1787 women who had never had an abortion. RESULTS: A total of 46% of women who experienced an abortion used a highly effective form of contraception 6 months before the event (versus 76% among women who had never had an abortion, P < 0.001). This proportion dropped to 33% at the time of the abortion and increased to 71%, 1 month after. In addition, 50% of women who had an abortion had changed their contraceptive method in the 6 months before the event (compared with 16% in the 6 months before the interview in women who had not had an abortion, P < 0.001). Women with socially deprived backgrounds were less likely to use a highly effective contraception after an abortion. CONCLUSIONS: Abortion is a good opportunity for intervention, but especially so for socially disadvantaged women. It is essential to draw the attention of prescribers and women to the higher risk of contraceptive failure at the start of use of a method.

Abortion, Spontaneous↗

PubMed2006

Contraceptive failures and determinants of emergency contraception use.

OBJECTIVES: Two years after emergency contraceptive pills (ECPs) were made available without prescription in France, we investigated the determinants of ECP use in a representative sample of women at risk for unintended pregnancy. STUDY DESIGN: This study is based on data collected from a population-based cohort exploring contraceptive practices and abortion (N=2863). RESULTS: Among the 706 women at risk for unintended pregnancy during the first year of follow-up (2001), only 11.1% used ECPs. Women in stable relationships or using the same contraceptive method during the year were less likely to use ECPs than other women. The study also demonstrates that detailed knowledge of ECPs increases the probability of its subsequent use. CONCLUSIONS: Given the low frequency of ECP use in cases of unintended pregnancy risk, these results suggest that information campaigns should be targeted not only at women with irregular contraceptive practices but also at women who experience errors in the use of their regular contraceptive method.

Adolescent↗

PubMed2006

Social, demographic and situational characteristics associated with inconsistent use of oral contraceptives: evidence from France.

CONTEXT: Oral contraceptives are the most popular form of reversible contraception used in developed countries. Their efficacy depends on how consistently and correctly they are used. METHODS: The incidence of inconsistent pill use was estimated from data from a random sample of 1,234 pill users who participated in a French population-based survey in 2000. Multivariate logistic regressions were used to identify the social, demographic and situational characteristics associated with inconsistent use. RESULTS: Twenty percent of women missed at least one pill during the four weeks prior to the interview, 7% missed two or more pills, and 10% missed at least one pill without using contraceptive backup during subsequent sexual intercourse. Inconsistent pill use was related to situational characteristics that are likely to change over time. The odds of having missed pills were elevated among women whose last intercourse had been with an occasional partner or who had small children. Women who did not have a daily pill-taking routine also had elevated odds of inconsistent use. The likelihood of having missed a pill and not used contraceptive backup was elevated among women who felt they had not been involved in the choice of contraceptive method prescribed by their physician. CONCLUSIONS: Service providers may need to better address women's preferences and needs, to help them choose the contraceptive method that best fits their sexual, emotional.

Adolescent↗

PubMed2005

The remaining barriers to the use of emergency contraception: perception of pregnancy risk by women undergoing induced abortions.

Although access to and knowledge of emergency contraception (EC) have improved, numerous unplanned pregnancies occur each year. We thus assessed the remaining barriers to EC use in a population of women seeking an abortion in four abortion centers in France in 2002. A self-administered questionnaire was completed by 1365 women. Most women have heard of EC (89%), but access to information remained limited in socially disadvantaged populations. Nevertheless, the unperceived risk of pregnancy appeared to be the most limiting factor to EC use. Only 38.5% of women were aware of pregnancy risk at the time of the intercourse that made them pregnant. Of these women, 48% minimized the risk later, resulting in the decision not to use EC. As the perception of risk is commonly reevaluated by women over time, which probably affects EC use, it could be important to promote advance supply of EC so that women could use it immediately after a recognized unprotected intercourse.

Abortion, Induced↗

PubMed2004

Access to health care for induced abortions: analysis by means of a French national survey.

BACKGROUND: With an incidence of 15 per thousand, abortion is a common reproductive event in France. This study describes conditions of access to health care for abortions based on women's reports, taking into account the woman's background and the influence of the first professional contacted. METHODS: A representative sample of 2,863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 480 had an abortion in the last 10 years. MAIN RESULTS: The choice of first professional depended on women's background, as we found differences according to age, educational level or past induced abortion. This choice affected subsequent access conditions, in terms of time delay or complexity of patterns of care to access abortion services. Women who first contacted a private gynaecologist, which is the most frequent situation in France, had more direct and shorter patterns of care. Conversely, general practitioners were associated with longer and more indirect patterns of care, especially when women were less well educated. CONCLUSION: This study reveals the heterogeneous nature of patterns of access to an abortion in France. It also raises questions concerning the training of general practitioners, who seem to be less well prepared to take charge of a request for an abortion than other professionals. Efforts must be made to better inform women and these professionals about the process required for abortions.

Abortion, Induced↗

PubMed2003

Contraceptive practices of non-HIV-seropositive injecting drug users.

AIMS: To study the sociodemographic characteristics and sexual behaviours in contraception choices of injecting drug users (IDUs) and to compare the contraceptive practices of non-HIV-positive IDUs to those of the general population. DESIGN: Two surveys were used: a sample of IDUs attending 10 drug abuse treatment centres in the Paris region (IDU) and the Parisian subsample of the National French Survey of Sexual Behaviour (ACSF). MEASUREMENTS: Percentages of contraception practices were estimated separately for 81 IDU and 130 ACSF women, and for 175 IDU and 168 ACSF men, aged 25-34, not reporting prostitution or HIV seropositivity. FINDINGS: Most IDU (77%) and ACSF (84%) women, and IDU (73%) and ACSF (75%) men currently used a contraceptive method. Male condoms were more widely used by IDUs than by the general population (64 vs. 10% in women, 75 vs. 14% in men), for all subgroups of educational level, marital status, recent multipartnership status and sexual activity. CONCLUSIONS: Contraceptives are used as often by IDUs as by the general population aged 25-34. However, the methods employed differ, with higher condom use by IDUs, which suggest that IDUs take into account the risk of HIV contamination in their contraceptive practices.

Adult↗

PubMed2003

Contraception: from accessibility to efficiency.

BACKGROUND: Despite the widespread use of medical contraception in France, the prevalence of abortion remains stable. A cross-sectional population-based survey was designed to study the characteristics of current contraceptive use in France, the different types of contraceptive failure, and the reasons reported for not using contraception. METHODS: A representative sample of 14 704 French households was randomly selected from the telephone directory. All women who in the last 5 years had had an abortion or whose last pregnancy was unintended were selected (n = 1034), whilst a fraction (n = 1829) of the other women were randomly selected. Altogether, 2863 women answered the questionnaire. RESULTS: Only 2.7% of the women aged 18-44 years who did not wish to conceive and were sexually active did not use any contraception. However, 33% of pregnancies were estimated to be unplanned, of which 50% ended in an abortion. A total of 65% of the reported unplanned pregnancies occurred among women using contraception (21% the pill, 9% IUD, 12% condoms, 23% other method). The main reasons given for these contraceptive failures were the misuse of the methods or the failure of the partner to withdraw. Reasons for not using any contraception go beyond a simple lack of information. CONCLUSIONS: The importance of-and the reasons mentioned for-contraceptive failure show a misadaptation between women's contraceptive needs and the method they use. Improving the training of family planning providers remains a major goal to ensure that women use a contraceptive method that fits their social and sexual lifestyle.

Abortion, Induced↗