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Four cases of either unilateral or bilateral irreversible hearing loss are reported in young women following long-term usage of hormonal contraceptives. Two different forms of the hearing disturbance and their causes are described, taking into consideration related neurological, medical and ophthalmologic literature. From this material, guidelines for clinical practise are proposed.
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Globally, men have not shared equally with women the responsibility for fertility regulation. While family planning efforts have been directed almost exclusively toward women, the lack of male involvement may also reflect the limited options available to men. Current methods for men are either coitus-dependent, such as the condom or withdrawal, or permanent, such as vasectomy. The 20-year history of social science research on male contraceptive methods is examined here in terms of the human and method factors related to the acceptability of hypothetical methods and the prevalence of use of existing methods. New male methods, particularly if reversible, may alter men's willingness to accept or share responsibility for the control of fertility. Research opportunities in the areas of gender, decision-making, communication, health education, and service delivery will be enhanced when methods for women and men are comparable.
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A study in Bangladesh showed that couples who lost a child often stopped practising contraception in order to have another child. Logistic regression analysis revealed that contraceptive continuation was related to maternal age, parity, husband's education and the sex of the last child.
Reproductive changes in sub-Saharan Africa are contingent upon women's socioeconomic conditions and informational and cultural resources. This study focuses on socioeconomic and cultural determinants and correlates of the intention to stop childbearing and of contraceptive use among urban women in Mozambique. It uses data from a survey of 1,585 married women conducted in Greater Maputo in 1993, and it employs logistic regression for multivariate analysis. The results of the analysis indicate that although the stopping intention and contraceptive use are interrelated and similarly affected by such factors as education or the area of residence, the intention to stop childbearing is mainly driven by women's perception of their material conditions and socioeconomic security, while contraceptive use is largely a product of social diffusion and the legitimization of innovative, Western-origin information and technologies. The study proposes that these findings may help explain the unique features of the fertility transition in sub-Saharan Africa.
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.
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4 reports published by Demographic and Health Surveys (DHS) include information from husbands of the wives interviewed in the main part of the survey. All are from Africa--Burundi (1987), Ghana (1988), Kenya (1988) and Mali (1987). These surveys of husbands indicate the importance of programs that work to improve communication between spouses about family planning. In particular, they show a positive association between contraceptive prevalence and husband and wife communication about family planning. Husbands and wives were asked how often they discussed family planning in the past year. In Kenya, with a 27% contraceptive prevalence rate--the highest among the 4 countries--about 2/3 of the couples had discussed family planning during the past year. In Ghana, with a rate of 13%, and in Burundi, at 9%, about 1.2 of the couples had discussed family planning during the year. Mali had the lowest contraception prevalence rate of 5% and the least communication among the couples, with only 1.4 discussing family planning during the year. The importance of communication also emerges in data on methods used. In all 4 surveys, the wives reported lower use of male methods than did their husbands. Estimates of use of female methods were more consistent between husbands and wives. Questions were not exactly the same in all 4 surveys, so summaries for each country vary slightly. In Burundi, about 2 of 5 husbands said they used periodic abstinence, compared to about 1 of 5 wives. Husbands said 0.7% used condoms, with 0.3% of the wives giving that response. Husbands an wives agreed that there was no use of male sterilization. The use of vasectomy in Africa is considerably lower than for other regions of the world (see chart below). Ghana showed a similar pattern. Husbands said 2.1% of couples used condoms, compared to 0.3% according to the wives. Husbands also indicated more widespread use of periodic abstinence than did the wives. In contrast, except for pill use, husbands and wives gave similar responses for use of female methods. In Kenya, 1 of every 2 husbands said they were using family planning, compared to about 1 of every 4 wives. The largest discrepancy was in the data for use of periodic abstinence, where 3 times more husbands than wives said they were using this method--26% compared to 8%. Only in Mali, where total contraceptive use is only 5%, were responses from husbands and wives consistent. Even here, husbands gave higher rates of condom use (0.5%) than did wives (none). When it comes to choosing a method of family planning, women apparently think first of female methods. In general, women assume that their husbands will not be interested in using contraception themselves. Women may, however, underestimate their husbands interest or participation in family planning. Or men could be overstating the use of male methods. These DHS husband surveys suggest that programs aimed at both men and women should encourage more and better communication between spouses about family planning. More data related to communication on family planning will soon become available. Other DHS husbands surveys in various stages of completion are from Pakistan, Cameroon, Tanzania, and Egypt.
This study relies heavily on World Fertility Survey and Demographic and Health Surveys data to examine recent trends and determinants of contraceptive use in five Latin American countries: Colombia, Dominican Republic, Ecuador, Mexico, and Peru. These countries experienced a substantial increase in contraceptive prevalence in the inter-survey period. Within countries, however, the increase was not equally shared by all social and demographic groups. The study found that relatively disadvantaged groups experienced greater gains in contraceptive use. Despite the prevailing tendency towards convergence, wide differentials in contraceptive behavior among social sectors still persist. A decomposition analysis based on logistic regression revealed that certain shifts in the population composition--i.e., increased proportion of urban and better educated women and a growing proportion of mothers who want to discontinue child-bearing--contributed substantially to the aggregate increase in contraceptive prevalence in most countries. Structural changes, understood as changes in the relations between the explanatory variables and the likelihood of using contraception, were also found to play a significant role in contraceptive use trends, particularly in Colombia.
A comprehensive sexuality questionnaire was administered to 37 females, ages 13 through 16 years, who attended clinics for routine health care. Subjects completed standardized scales of self-concept, locus of control, and future orientation. They also were given a short battery of standardized cognitive tests. Three groups were identified: Group 1 was sexually active and using contraception reliably, Group 2 was not using contraception reliably, and Group 3 had not been sexually active. Group 1 adolescents had higher scores on the vocabulary subtest of the WISC-R (F = 3.4, p less than .05) than did Group 2 adolescents, over and above the effect of socioeconomic status (SES). Group 1 subjects had higher scores on knowledge of sex and contraception than did Group 2 (F = 3.3, p less than .05). Group 1 had more internal locus of control (F = 7.0, p less than .005) than did Group 2 over and above the effect of SES. Mean scores for Group 3 adolescents were intermediate and not significantly different. The findings suggest that cognitive factors may influence contraceptive behavior in adolescent females.
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A number of studies have reported data on contraceptive use among white Protestant and white Catholic couples in the United States, but this paper is the first to study a large sample of couples with other or no religious affiliation, as well as black couples by religion, using multivariate controls. Using a nationally representative sample of 14,000 married women aged 15-44, we find convergence among white Protestant, Catholic, and Jewish couples in contraceptive patterns between 1955 and the mid-1970s, but large differences remained at the latter date, even after multivariate controls. Among black couples, differences by religious affiliation are smaller, but differences between white and black couples within religion categories are substantial. We conclude that religious differences are not artifacts of an incomplete demographic transition, and that religious affiliation is an indispensable datum for understanding contraceptive choice in the United States.
An analysis combining individual-level data from the National Survey of Family Growth with aggregate-level information provides evidence that the characteristics of communities influence the contraceptive decisions of currently married white women in the United States. The analysis examined the relationship between the average effectiveness level of the contraceptive methods that a woman used over a three-and-a-half-year period and community characteristics such as employment opportunities, the availability of contraceptive and abortion information and services, and the level of religious adherence in communities. Community characteristics associated with higher levels of contraceptive effectiveness were rapid population growth, high rates of unemployment, elevated levels of religious affiliation, high socioeconomic status, and ready access to family planning information and services. Community liberality was negatively associated with effective contraceptive use. The results support arguments that various community characteristics affect a woman's contraceptive choices by increasing or decreasing the costs of an unintended pregnancy.
OBJECTIVE: To determine the relationship between clinical-epidemiologic findings and microbiologic results in vaginitis. METHODS: A prospective study of 212 women with vaginal symptoms was undertaken. Each patient underwent an evaluation that included standardized history, interview after pelvic examination and vaginal culture. RESULTS: Only 45% of patients received diagnosis. Only two symptoms were more frequently noted with diagnosis. Itching was more frequent in vulvovaginal candidiasis (VCC) whereas odor was more frequent in Bacterial vaginosis (BV). BV was associated with a history of spontaneous and induced abortion, increased number of pregnancy, vaginal douching practice and intrauterine contraceptive device usage. VVC was found to be associated with no contraceptive usage and previous vaginitis history. CONCLUSION: Presenting symptoms alone or with microbiologic studies has limited value, and that of the women with vaginal symptoms may lack a microbiologic diagnosis. Evidence-based approaches that produce highly accurate diagnostic and effective treatment regimens would be expected in the future.