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The dynamics of contraceptive use in Peru.

In 1986, the Demographic and Health Surveys project administered the first six-year calendar history of events that included women's contraceptive use and their reasons for discontinuation in experimental surveys in Peru and the Dominican Republic. In this report the experimental survey from Peru is examined to demonstrate how the calendar data can be used to calculate multiple increment-decrement life table rates of contraceptive discontinuation--including contraceptive failure, method switching, and abandonment of use--and of resumption of method use following discontinuation. These analyses reveal that nearly half of all Peruvian women who begin to use a method will stop using it within one year; 29 percent of women discontinue method use for nonpregnancy-related reasons within one year of initiating use. Women who switch methods do so frequently, and many will return to a method used previously, or move on to a third method. Women who become pregnant after abandoning contraceptive use have similar contraceptive-use patterns to women who experience a contraceptive failure.

Adult↗

Attitudes toward the rhythm method in the Philippines.

Two sets of focus group discussions on the advantages and disadvantages of the rhythm method were carried out in the Philippines in 1980 and 1981. The first discussions were held among 30 women and nine men 21-40 years of age, and the second among eight women 25-35 years of age who had voluntary pregnancy terminations after the method had failed. Among the perceived advantages of rhythm were that it permits spontaneous intercourse on the safe days and has no bad side effects. Among the perceived disadvantages were that it is ineffective, especially for women with irregular periods, and it requires abstinence. The women who had had voluntary pregnancy terminations discussed their motivations and rationales and the methods that they had used. The information obtained from the discussions formed the basis for support materials that are now used throughout the country.

Abortion, Spontaneous↗

Incidence of irregular cycles among Mayan women who reported having regular cycles: implications for fertility awareness methods.

Despite the low contraceptive prevalence among the Mayan population of Guatemala, past research has found interest in natural methods. A calendar rhythm method with a simple blanket rule would appear to be preferable to more complicated methods. Under a blanket rule, the number of days of abstinence is predetermined and all couples are instructed to abstain during the same interval of the menstrual cycle. However, regular menstrual cycles may be key to successful practice of a calendar method. A database of 880 cycles of 301 women of the Guatemalan highlands was analyzed to determine the length and regularity of menstrual cycles in this population.

Adolescent↗

The Billings method of family planning: an assessment.

The Billings/ovulation method is a periodic abstinence method of regulating births based on the client's interpretation of changing patterns in secretions of cervical mucus monitored by external self-examination. It was developed in Australia and is now widely promoted overseas. This paper outlines the method's recent history and goes on to discuss its physiological basis, its use-effectiveness as measured in a number of major trials, and some evidence concerning its general acceptability and applicability in family planning programs.

Body Temperature Regulation↗

Birth control practice in Khartoum.

The results presented here are based on a fertility survey carried out in Khartoum in 1978. It was shown that the knowledge of family planning is widespread in the city and that the level of ever-use of birth control is becoming significant. The popularity of the different methods of birth control is investigated, revealing that the pill is used by nearly all ever-users. IUDs, rhythm, and withdrawal are also relatively popular. A great degree of consistency was found to exist between reports given by husbands and their wives in this respect. The purpose of using birth control is not yet clear. The significant ever-use, noted before the 3rd live birth, indicates that these methods are used for the purpose of spacing births rather than limiting the number of children.

Africa↗

Acceptability of the modified mucus method: study of the psychosocial factors affecting acceptance.

A three-phase study designed to study the acceptability and use-effectiveness of the modified mucus method covered a sample of 2,601 poor rural migrant women living in eight low-income areas--villages and resettlement slum colonies. In phase I, the women were exposed to NFP awareness, i.e., the modified mucus method, and 61.6% of the women accepted the method, and agreed to learn and use it. The learning phase is three cycles. Of these acceptors, 83.7% were fertile. A large percentage of the acceptors are Hindus. The low acceptance by the Sikhs was who were non pregnant, menstruating cohabiting. 15.3% were nonmenstruating owing to pregnancy or breast feeding; 0.9% were menstruating, but not cohabitating; 35.4% of the women were not interested in learning or using the method. A comparative study of the acceptance and nonacceptance for the selected sociodemographic and family planning variables is analysed. The acceptors of NFP differed significantly from the acceptors of sterilization and IUD in their occupation, educational levels, duration of marriage, number of living children, number of living sons, knowledge of family planning, and previous use of family planning.

Cervix Mucus↗

Sterilization and contraceptive services in Catholic hospitals.

Sterilization and contraceptive practices in United States Catholic hospitals were surveyed by anonymous mail questionnaires, obtaining a 57% response rate (340 of 598). Twenty per cent of the hospitals permitted medically indicated sterilization operations. Forty-seven per cent of those hospitals not allowing sterilization procedures reported that their medical staffs were interested in performing medically indicated sterilizations. The types of contraceptive services offered varied widely. The rhythm method was most frequently available, with oral contraceptives in second place; many hospitals did not provide any family-planning services; 13% utilized all types of contraception. The thesis is advanced that improvement in availability of sterilization and contraceptive services is a duty of hospital medical staffs.

Catholicism↗

Further analysis of the theoretical effectiveness of the TwoDay method of family planning.

This article validates the theoretical effectiveness of a simple approach to identify the fertile window of the menstrual cycle. The TwoDay method identifies all days in the cycle in which the woman notices cervical secretions, and the days immediately following these days, as the period in which the woman should consider herself fertile. Women who use this method are counseled to avoid unprotected intercourse on these days. The theoretical effectiveness of the TwoDay method was tested previously by applying the method rules to the menstrual cycles of women from a large data set from the World Health Organization (WHO). For the current study, we administered the same analysis to a data set from an Italian Ovulation Method center. These data are better suited for the analysis than were the WHO data because they identify all days with secretions. Results suggest that the method can be highly effective in helping women to identify correctly the days on which they should avoid unprotected intercourse if they do not wish to become pregnant, although some users may identify a few days as fertile that actually are not.

Adult↗

Contraceptive practice and unplanned pregnancy among single university students.

The sexual behaviour and contraceptive practices of a random sample of unmarried university students were compared with those of a group attending the student health service with an unplanned pregnancy. The immediate cause of most pregnancies in this series was incorrect use of a rhythm method. Irregularity of the menstrual cycle may have been a contributing factor in many cases. Psychological factors influencing the desire for pregnancy, while present, were not major contributing causes in many pregnancies.

Adolescent↗

The secularization of U.S. Catholic birth control practices.

Except for sterilization, Catholic and non-Catholic contraceptive practices are now quite similar. Within several years, even sterilization will probably be adopted by the same proportions of Catholics as non-Catholics, and the rhythm method is destined to be of historical interest only. The wide gulf between official Catholic doctrine and the birth control behavior of Catholics can only deepen in the next few years.

Adolescent↗

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.

Abortion, Induced↗

Use of periodic abstinence in Bangladesh: do they really understand?

Data from a nationally representative study in Bangladesh (BDHS 1996-97) were analysed to identify significant predictors of use of periodic abstinence, in comparison with other modern contraceptive methods. The study found that women in Bangladesh mostly use modern methods during their peak reproductive years, after which some of them switch to periodic abstinence. These women tend to be more from educated and from higher socioeconomic backgrounds and with at least one living son. Another set of data from the Matlab DSS was analysed and the results were in the same direction. Focus group discussions found that women were using the periodic abstinence method incorrectly, abstaining for more days than is necessary. For Bangladeshi contraceptive users to reach a higher degree of use-effectiveness for period abstinence, more IEC materials need to be developed.

Adult↗

Contraceptive discontinuation among married women in the United States.

Using data from the 1982 National Survey of Family Growth (NSFG), this analysis reports differentials in contraceptive discontinuation among married women aged 15-44 years in the United States. The total discontinuation rate is broken down into change to no method (termination) or to a different method (a method switch), and rates are obtained for specific methods. In addition, sociodemographic differences in risks associated with each type of discontinuation are shown. Discontinuation rates are compared to use-failure rates to provide a more comprehensive understanding of the implications of discontinuation for contraceptive efficacy.

Actuarial Analysis↗

Factors related to ovulation method efficacy in three programs: Bangladesh, Kenya, and Korea.

Sociodemographic and reproductive health data were gathered on approximately 200 acceptors in each of three programs offering the Ovulation Method of Natural Family Planning. The programs were located in Bangladesh, Kenya, and Korea. In addition, a one year follow-up was attempted to assess continuation and efficacy. Descriptive data show a variety of religious, educational, income, family, and family planning backgrounds among acceptors. Life table analyses of reported unplanned pregnancy occurrence among spacers and limiters combined was 15% at 12 months in Bangladesh, 11% in Kenya and 13% in Korea. The pregnancy rate at 12 months for all pregnancies, planned and unplanned, was 27.0, 26.0, and 23.7, respectively. In Bangladesh 37 of the 48 unplanned pregnancies were user-related as were all of the 14 unplanned pregnancies in Kenya and 17 of the 20 in Korea. Method failure was the reported cause of pregnancy in only 2 of the 83 unplanned pregnancies. A major aspect of this study was the assessment of higher risk population subgroups; increasing age, education, previous pill use and previous family planning are significantly associated with fewer unplanned pregnancies while religion, attendance as a couple, family planning intention, size and source of referral do not have a demonstrated impact on pregnancy occurrence. The time of entry into the data set in relation to time of initial NFP acceptance may be an important variable in assessing OM effectiveness.

Adolescent↗

Barrier contraception in the teenager: a comparison of four methods in adolescent girls.

The use-effectiveness and continuation rates of 4 methods of contraception were studied during a 2 year follow-up period in a group of 405 teenage girls. Results were compared in 2 groups of adolescents, 1 of highly motivated, high socioeconomic status girls (A) and 1 of poorly motivated, low socioeconomic status adolescent clinic patients (B). The method of contraception was selected by the girls, who were instructed in their proper use. Results showed good rates of continuation among girls of the 1st group as compared to those of the 2nd group. Pregnancy rates after 24 months of use, as calculated by Pearl's formula, was 3.6 and 5.4 respectively with the use of a condom, and 5.8 and 10.8 when the diaphragm was used. When using vaginal foam alone, the rates were 4.2 and 12.3 and with the rhythm method, 8.5 and 13.1. The foam-alone method was unpopular in both groups. No serious side effects or complications were recorded. The study demostrated a reasonable acceptability and use-effectiveness for barrier contraceptives. It is suggested that these harmless and complication-free methods, especially the condom and diaphragm, may be reasonable alternatives for the more modern methods in teens of all socioeconomic strata; an effort must be made to educate and instruct the poorly motivated and encourage them to present themselves for regular follow-up.

Adolescent↗

Calendar methods of fertility regulation: a rule of thumb.

"[Many] illiterate women, particularly in the third world, find [it] difficult to apply usual calendar methods for the regulation of fertility. Some of them are even unable to make simple subtractions. In this paper we are therefore trying to evaluate the applicability and the efficiency of an extremely simple rule which entails only [the ability to count] a number of days, and always the same way." (SUMMARY IN ITA)

Contraception↗