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PubMed1998

New developments in contraception: what's happening.

Research is ongoing to develop improved birth control methods and additional contraceptive methods to increase reproductive choices for both men and women. To date, limited male contraceptive choices are available. Immunocontraceptives, injectables, implants, and pills are in developmental stages to become future male contraceptive options. Researchers are pursuing several new birth control ideas for women such as new intrauterine devices, improved barrier methods, biodegradable and non-biodegradable implants with fewer rods, new injectables, vaginal rings, and vaccines. To meet this challenge of developing new, safer, more effective birth control products, support from the private and public sectors is going to be essential.

Choice Behavior↗

PubMedDate not supplied

Development of methods for skin barrier peeling tests.

OBJECTIVE: We sought to develop a more effective method to evaluate the adhesive properties of skin barriers. DESIGN: The experimental design used was based on 3 principles: partial control, randomization, and repetition. Using these principles, the 180-degree peeling tests were conducted as specified in a standardized methodology (JIS Z0297) to the extent possible. However, the use of a stainless steel plate as a proxy for skin barrier application may result in the stretching and breaking of the skin barrier, making it impossible to obtain suitable measurements. INSTRUMENTS: Tests were conducted in constant temperature/ humidity chambers using a Tensilon Automatic Elongation Tester, where a sample was fixed on the side of a sample immobilization device, a sturdy metal (aluminum) box from which the air in the box was drawn off with a vacuum pump. METHODS: A fluorocarbon polymer film was applied to the adhesive surface of a sample skin barrier. The film was peeled off in the volte-face (180-degree) direction in order to measure adhesive strengths. RESULTS: The films exhibit such properties as (a) ease of removal from the adhesive surface, (b) no resistance to a 180-degree fold back due to the thinness and flexibility of the material, and (c) tolerance of elongation. The adhesive properties of skin barriers were measured by peeling the fluorocarbon polymers in a 180-degree direction. Twelve specimen skin barrier products were selected for measurement, providing results with satisfactory reproducibility. Results based on the conventional stainless steel plate-based testing method acted as a control. CONCLUSION: The newly developed testing method enables chronological measurement results for skin barriers applied to fluorocarbon polymer films after 24 hours, 48 hours, and longer period.

Adhesiveness↗

PubMed1994

Effect of bis (tributyl tin) oxide on permeability of the blood-brain barrier: a transient increase.

OBJECTIVES: To study the effect of bis (tributyl tin) oxide (TBTO) on permeability of the blood-brain barrier. METHODS: Electron microscopy and an x ray microanalyser with lanthanum chloride as a tracer were used, and blood tin concentrations were determined with an atomic absorption spectrophotometer. Adult male wistar rats received 0.05 ml/kg body weight of TBTO orally. RESULTS: A transient increase in paracellular permeability at the blood-brain barrier was found 2 h after the dose of TBTO. Electron dense lanthanum deposits penetrated tight junctions of the endothelia and permeated the subendothelial space. The x ray microprobe data showed an accumulation of TBTO at the tight junctions at 2 h. Leakage of tracer did not occur at 4 h, but oedematous changes in the surrounding glial cells were prominent between 4 and 8 h and had almost returned to normal by 24 h. By atomic absorption analysis, it was seen that blood tin concentrations rapidly increased at 1 h and rose to a maximum peak at 8 h, then gradually decreased to reach zero at 24 h. CONCLUSIONS: Accumulated TBTO at tight junctions could have caused the temporary replacement of calcium ion by tin, which induces a transient increase in paracellular permeability throughout the blood-brain barrier.

Animals↗

PubMed1995

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES: The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS: Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS: All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS: Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

Contraception↗

PubMed1994

Methods of contraception and rates of genital infections.

Bacterial vaginosis, trichomoniasis and candidiasis are the most common genital infection. The aim of this study was to evaluate the various methods of contraception with regard to the prevalence of bacterial vaginosis and vulvo-vaginitis over a period of four years. We also evaluated in the same period the rates of trichomoniasis, candidiasis, bacterial vaginosis and vulvo-vaginitis between users and non users of contraceptional methods and the relationship between ages of patients and types of contraceptives. Finally we considered the change of contraceptive use with regard to age among two different periods. The IUD users showed a significant increase of B.V., T.v. and other bacteria and a decrease of the negatives compared to OC users. Barrier contraceptive users had a reduction (0.01 > p > 0.001) of B.V. and an increase (p < 0.001) of the negatives compared to IUD users. OC users had a significant (p < 0.05) increase in candidiasis, B.V. together with a reduction of the negatives compared to non users group. IUD users had a significant (p < 0.001) increase of B.V. and vulvo-vaginitis from other bacteria, and the reduction of the negatives. Teenagers use OC much more than adults, but less IUD (p < 0.001). The use of OC has increased and the use of IUD decreased among adults (p < 0.001). The barrier methods were seen to be statistically reduced.

Adult↗

PubMed2004

As often as needed: appropriate use of emergency contraceptive pills.

Previous research has established that emergency contraceptive pills are safe and have the potential to reduce unintended pregnancy; however, policy makers, providers and even women themselves have expressed concern about repeat use of the method. Evidence regarding the safety, efficacy and frequency of repeat use show that the method is safe and effective, even when used multiple times. Reported rates of repeat use are actually lower than would be expected, and needed, based on the frequency of unprotected intercourse and contraceptive failure reported in most countries. Healthcare providers should encourage use of emergency contraceptive pills as a backup after recognizable failure of barrier methods or other hormonal contraceptive methods, and should expect that women may need emergency contraceptive pills multiple times during their reproductive years.

Contraceptives, Oral, Combined↗

PubMed1988

Infectious diseases and the anaesthetist.

The methods of dealing with various items of anaesthetic equipment in order to assure a fresh supply for each patient have been discussed. These consist of using disposable items, steam sterilization, disinfection by both chemical methods and pasteurization and the use of ethylene oxide sterilization. The use of disposable bacterial and viral filtres to protect ventilators and soda lime cannisters is discussed. These can then be sterilized by ethylene oxide at less frequent intervals, i.e., weekly. Protection of the anaesthetists' skin from contact with body fluids by the use of barrier methods are stressed. Methods to avoid penetration of the skin by needlestick and sharp objects are discussed. The increasing number of persons being treated for opportunistic infections makes it likely that anaesthetists will encounter increasing numbers of patients infected with HIV. The more common infections encountered in the operating room in North America have been included, with methods of avoiding possible infection from them. Constant vigilance and the use of universal precautions when caring for all patients is therefore required by the anaesthetist in the operating room in order to avoid contacting infection from patients.

Acquired Immunodeficiency Syndrome↗

PubMed1994

The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers.

BACKGROUND: Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. METHODS: We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum. RESULTS: Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use. CONCLUSIONS: The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.

Adolescent↗

PubMed1998

Barriers to health care access for Latino children: a review.

BACKGROUND AND OBJECTIVES: More than 9 million Latino children currently live in the United States. Latinos will soon be the largest minority group in the country, but little is known about access barriers to health care faced by Latino children. We reviewed the literature to define specific barriers to care for Latino children, identify methodologic problems, and highlight the clinical and research implications of the identified barriers. METHODS: We did a MEDLINE search, using combinations of the key words Hispanic, children, and access. Study exclusion criteria included "not an original research article," "enrolled only adult subjects," "no separate data analysis for children," and "dental care focus." RESULTS: The search yielded 497 citations, of which 27 met the inclusion criteria. Of the 32 potential barriers identified, 21 had good supportive evidence. Lack of health insurance was a consistent barrier; recent data revealed that 26% of Latino children are uninsured, compared with 10% of white children and 14% of African-American children. Latino children also are at greater risk for episodic insurance coverage, low rates of private insurance, and loss of employee-based coverage. Parent beliefs about the etiology and treatment of their child's illness, use of home remedies, choice of sources of advice, and folk medicine practices may also influence how health care is obtained. Few data are available on differences in access among major Latino subpopulations, and no studies focused primarily on barriers as perceived by Latino parents. Evidence is equivocal or lacking that the following are barriers for Latino children: immigration status, duration of parent residency in the United States, and acculturation. Several barriers were identified that originate with practices and behaviors of health care providers, including reduced screening, missed vaccination opportunities, decreased likelihood of receiving prescriptions, and poor communication. CONCLUSIONS: Lack of health insurance and lack of a regular source of care are major access barriers for Latino children, but many other barriers were identified that also can have a substantial effect on health care. In addition, the behaviors and practices of both health care providers and parents can affect access to care. Too little is known about what parents perceive to be the major barriers, access differences among Latino subpopulations, the roles of language and culture, and the causes of obstacles resulting from the actions of providers.

Acculturation↗

PubMed1995

Contraception in the adolescent patient.

Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). If the adolescent plans to be sexually active, however, she is encouraged to select some form of hormonal contraception, namely Norplant, Depo-Provera, or oral contraceptives, in conjunction with condoms. The authors have had little success recommending barrier methods alone. Condoms are used sporadically and the diaphragm is very awkward for adolescents who are still uncomfortable with their bodies and with touching themselves. Of the three hormonal methods, Depo-Provera seems to be well-accepted by our patients. It offers several advantages that we believe make it attractive. First, it does not require any forethought by the patient other than coming in for the injection every 3 months. There is an effective grace period, so the patient is afforded good contraception even if she is up to a month late for her injection. The frequent visits for injections actually can be looked upon as positive, frequent contacts with the patient and can provide opportunities for counseling. In addition, some patients become amenorrheic, which teens view as an advantage, increasing compliance. If it is not likely that a patient will be compliant with every-3-month injections, Norplant is recommended. Studies have shown good acceptance of Norplant by adolescents and that has been the experience of the authors. With appropriate counseling prior to insertion and a counseling session with patients who request removal, the number of actual Norplant removals has been limited. If Depo-Provera and Norplant are not acceptable to the patient, then oral contraceptives are recommended. Of the three methods, more opportunities for failure exist with oral contraceptives. Pills are missed for a variety of reasons, including going away for the weekend; not having a regular schedule, which can interrupt pill-taking; and even ambivalence about becoming pregnant. One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2000

Healing following GTR treatment of intrabony defects distal to mandibular 2nd molars using resorbable and non-resorbable barriers.

AIMS: The objectives of the present, randomised clinical trial were (i) to evaluate the healing of periodontal intrabony defects at the distal aspect of mandibular 2nd molars using a resorbable polylactic acid (PLA) barrier and a non-resorbable polytetrafluoroethylene (e-PTFE) barrier and (ii) to compare the therapeutic effect of the bioresorbable versus the non-resorbable barrier. METHOD: 19 patients with intrabony defects distal to mandibular 2nd molars > or = 4 mm (on radiographs) were included in the study. The defects all remained 5 years after surgical removal of impacted 3rd molars. Following flap elevation and defect debridement, the defects were randomly covered with, either a resorbable PLA or a non-resorbable e-PTFE barrier. Flaps were repositioned and sutured to completely cover the barriers. Treatment was evaluated clinically after 1 year by measurements of probing depth (PD), probing attachment level (PAL), and probing bone level (PBL) and radiographically by measurements of bone levels on computer digitised images of radiographs taken immediately before and 1 year postsurgery. RESULTS: Both treatments resulted in significant PD reduction, PAL gain, and bone fill. The total PD reduction was 5.3 +/- 1.9 mm for the PLA treated sites and 3.7 +/- 1.7 mm for the e-PTFE treated sites (p<0.05). The corresponding values for PAL gain were 4.7 +/- 0.7 mm and 3.6 +/- 1.7 mm (p<0.05) and for PBL gain 5.1 +/- 1.2 and 3.3 +/- 2.0 mm (p<0.05). Radiographic bone fill averaged 3.4 +/- 1.2 for the PLA and 2.0 +/- 1.6 mm for the e-PTFE barriers (p<0.05). Radiographic bone level measurements were significantly smaller than the corresponding clinical measurements, indicating that radiographs tend to underestimate bone fill. CONCLUSIONS: GTR treatment of deep intrabony defects distal to mandibular second molars using resorbable PLA barriers resulted in significant PD reduction, PAL gain and bone fill at least equivalent to the results obtained using non-resorbable e-PTFE barriers.

Adult↗

PubMed2006

Estimates of pregnancies averted through California's family planning waiver program in 2002.

CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.

Abortion, Induced↗

PubMed1982

Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗

PubMed1999

Comparison of antiadhesive treatments using an objective rat model.

Intraperitoneal adhesions are a significant problem (increased morbidity, mortality, and cost) for patients undergoing abdominal procedures. Although a variety of approaches (e.g., fibrinolytic agents, anti-inflammatory drugs, or barrier/separation methods) have been used with some success in preventing adhesions, a comparison of these different modalities has yet to be performed in a model that objectively measures intraperitoneal adhesion formation. Our objectives were to establish an objective, reproducible model of intraperitoneal adhesion formation and to establish efficacy of different treatment modalities in decreasing the strength and extent of intraperitoneal adhesions. In this two-part study, a rat model establishing an objective measure of both the strength and extent of intraperitoneal adhesions was used to compare different treatment modalities. Fibrinolytic agents [recombinant tissue plasminogen activator (rtPA), streptokinase, and urokinase], anti-inflammatory drugs (dexamethasone and tolmetin sodium), and barrier methods [sodium carboxymethylcellulose (CMC), and sodium hyaluronate] and a control group were compared in the first phase. In the second phase, the two most successful agents (rtPA, CMC) were compared both alone and in combination against a commercially available barrier agent (Seprafilm) and a control group. In the first phase of the study, rtPA was the only agent that had a statistically significant effect in decreasing the strength of adhesions. CMC was the only agent that demonstrated a decrease in the extent of adhesions, and the difference tended toward significance. In the second phase, the combination of rtPA and CMC showed a significant decrease in both the strength and extent of adhesions when compared with those of the control group. This decrease was also observed in the group treated with Seprafilm, which showed no difference from the rtPA + CMC group. We conclude that, in this reproducible adhesion model, only the combination of rtPA + CMC and Seprafilm significantly reduced both the strength and the extent of intraperitoneal adhesions.

Animals↗

PubMed1997

Fertility awareness and natural family planning.

Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the sub-fertility investigations. (2) The information is also useful when helping couples to understand how each method of family planning works--how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective observations of the alterations in cervical mucus and the basal body temperature rise are accurate indicators of the fertile phase. Research on the chances of conception on each day of the menstrual cycle, using hormonal assays to estimate the time of ovulation, was carried out in 1994 by Weinberg and Wilcox. Their results showed that the timing of sexual intercourse, in relation to ovulation, strongly influences the chance of conception. Conception only occurred during a 6-day interval that ended on the estimated day of ovulation. The chances of conception fell to zero 24 hours after ovulation. Several different methods of natural family planning are taught; some methods depend on only using one of the indicators of fertility, others are based on two or more indicators. The main indicators of fertility are: observing the cervical mucus, recording the basal body temperature, palpating the cervix and a calculation based on the cycle length. Research studies performed using a combination of the indicators of fertility show that the failure rate using a combination is less than most of the studies which use a single indicator. In each case the method failure is far lower than the user failure. (ABSTRACT TRUNCATED)

Body Temperature↗

PubMed1997

Sexual behavior and contraceptive use. Changes from 1975 to 1995 in college women.

OBJECTIVE: The objective of this study was to compare the sexual practices and contraceptive use in a sample of college women in 1995 with women surveyed in 1975, 1986 and 1989. STUDY DESIGN: We surveyed 336 college women seen at a university student health service or on campus and compared their responses to those of women surveyed at the university in 1975, 1986 and 1989. RESULTS: The proportions of women who were sexually experienced, number of life-time male sexual partners, number of male sexual partners in the past year and frequencies of specific sexual practices were similar over the four survey times. Condom use was reported as the usual method of contraception in 7% of sexually experienced women in 1975, 14% in 1986, 25% in 1989 and 46% in 1995 (P < .00001, linear trend). CONCLUSION: We found little change in sexual practices in this college population over the four survey years, with the exception of an increase in the self-reported use of condoms. Increased educational efforts should emphasize safe sexual practices (barrier methods) to prevent sexually transmitted diseases and highly efficacious methods of contraception (hormonal contraception) to avoid unintended pregnancy.

Adult↗

PubMed2001

Quinacrine non-surgical female sterilization in Bangladesh.

This study was undertaken to evaluate the efficacy, safety, and acceptability of transcervical applications of quinacrine along with other adjuvants, such as ampicillin and ibuprofen, for sterilization. The cohort consisted of 750 normal women who requested sterilization and volunteered for this method at the family planning clinic of a tertiary hospital and community clinics in Chittagong, Bangladesh. Several different protocols were followed from October 1989 to April 1999. Each woman received one or two insertions of 180 mg or 252 mg quinacrine with or without adjuvants including 55.5 mg ibuprofen or 125 mg ampicillin. Supplementary contraception was given in the form of combined oral contraceptive pills, barrier methods, or injection of depot medroxyprogesterone acetate for 3 months. Details of each protocol are described in the text. The gross pregnancy failure rate for insertion of 180 mg in 590 women was 3.9% compared to 1.9% for the 160 who received 252 mg. There were no serious complications, and side effects were transient. We conclude that quinacrine non-surgical sterilization is a safe, acceptably effective method when two insertions of 252 mg quinacrine with medroxyprogesterone injection as a supplement is used.

Adult↗

PubMedDate not supplied

Why are US women not using long-acting contraceptives?

CONTEXT: Given the level of unintended pregnancy in the United States, it is somewhat surprising that hormonal implants and injectables-methods that are long-acting, reversible, highly effective and convenient--have not attained the popularity enjoyed by other medical methods. Knowing the reasons why women have so far spurned these methods might lead to the design and implementation of interventions and targeted social marketing to promote their use. METHODS: Data from the 1993 and 1995 rounds of the National Survey of Women are used to examine the reasons women gave for not having used the implant or injectables, whether they intended to use these methods and how their attitudes toward them may influence their decision to use such methods in the future. Logistic regression models were used to identify the social and demographic characteristics that influence women's decisions not to use these methods. RESULTS: Fewer than 2% of women who were at risk of an unintended pregnancy in 1995 were using the implant, and under 3% were using the injectable. Women gave three major reasons for not using either of these methods: lack of knowledge; fear of side effects or health hazards; and satisfaction with the method they were currently using. Age, education, marital status, parity and current contraceptive method strongly predicted fear of side effects, lack of knowledge and satisfaction with the current method as reasons for not using the implant or the injectable. For example, women aged 30 or older and those with a college education were half as likely as younger women and those with no college education to mention fear of side effects as their main reason for not using the implant. Likewise, single women, women with one or more children and those using a barrier method were 2-3 times as likely as married women, childless women and those using a medical method to attribute nonuse to the implant's side effects. Few women said they intended to use these methods in the next 12 months: 5% for the implant and 10% for the injectable. Single women, women with no college education, women with children, women wanting to have a child (or another child) and women with positive attitudes toward the effect of using an injectable were significantly more likely to say they intended to use the injectable. Nevertheless, substantial proportions of women reported quite negative attitudes about these methods. CONCLUSIONS: The low prevalence of use and the low level of use intention for the implant and for injectables raise questions about the promise for the future of these methods. Each method seems to appeal to certain subgroups of women, however. Thus, if proper interventions and social marketing are targeted to such groups, they may be disabused of misperceptions regarding these methods and possibly become more willing to try them.

Adult↗