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On the basis of the present investigations concerning the employment of contraceptive methods in Denmark and the knowledge of the efficacies of these methods, the annual number of legal terminations of pregnancy performed in Denmark are assessed. A considerable proportions of the unwanted pregnancies may be explained by defective high efficacy of the contraceptive methods employed.
SELF (systeme en logique floue = system in soft discware), developed by the Computer Sciences Laboratory of the Faculté de Médecine in Nancy, is, by comparison to many systems of assistance in medical decisions already existing, a comprehensive and simple unit enabling the construction and modification of basic knowledge as well as its questioning. The first application of SELF concerned the field of gynecology, by producing a system of assistance applied to the prescription of a contraceptive method. The systematic use of this computer program along with the traditional prescription of a contraceptive method, was tested for three months in the Regional Maternity Hospital by several physicians in the Gynecology Clinic. The system was extremely well accepted and the responses have generated numerous discussions between physicians leading to an improvement of SELF and a better rationalization of the prescription. The medical and paramedical personnel in training at the hospital found SELF to be a teaching tool which, on the basis of simulated cases, permits an easier and more concrete explanation of the practical management in advising or prescribing a contraceptive method.
This article analyzes determinants of contraceptive method choices among adolescent women in the United States. By using data from the 1982 National Survey of Family Growth, we examined factors that differentiate users of various methods early in the sexual careers of teenaged women. We find that patterns of method choice not only vary by race and region within the United States but also change over the teenager's life course. In addition, among teenagers who did not use a method at first sex, the likelihood of adopting a method soon thereafter was low for both whites and blacks and was unaffected by social structural characteristics.
Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic, determinants of method switching in four areas were investigated. Method switchers, those who switched from an unprepared to a prepared method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.
We describe the case of a woman with McCune-Albright syndrome who had a pathological bone fracture while being treated with an oral contraceptive. In this syndrome the bone lesions contain estrogen and progesterone receptors. The possibility of progression of the bone lesions during pregnancy is well-known. We judge the use of oral contraceptives to be dangerous in this syndrome; the affected women must be orientated towards alternative contraceptive methods.
Contraceptive use and method mix were analysed using Philippines national survey data of 1973, 1978, and 1983. The analyses suggest that the reported decline in contraceptive prevalence between 1978 and 1983 was due to under-reporting of use in 1973 and 1983. The shifts in contraceptive method mix were also partly from under-reporting of rhythm and other methods in 1973 and 1983. Nevertheless, the determinants of method choice were similar in all three sets of data. Filipino couples were making rational choices in terms of their contraceptive goals, access, evaluation, and competence. Modifications in the directions and magnitude of the relationships in determining method choice also occurred, partly reflecting the increased use of sterilization by older, higher parity women.
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An APL computer program has been developed to perform life table analysis without the tedium and error associated with manual computation. Life table analysis is proposed as the standard method of reporting and analysing the effectiveness of contraceptive methods of all types.
A potential male contraceptive approach was evaluated in clinical trials involving monthly injections of depot medroxyprogesterone acetate and either subdermal implants of testosterone propionate or monthly injections of testosterone enanthate. Pregnancies occurred in partners of 9 men with recent sperm counts of 10 million/ml or below. In 5 of the 9 instances, the sperm counts were less than 1 million/ml. It appears that male contraceptive methods involving spermatogenic suppression may require attainment and maintenance of azoospermia. The pregnancy rate cannot be calculated, because the extent of other contraceptive use is uncertain. There were no spontaneous abortions. 6 pregnancies were carried to term, and all progeny were normal, based on physical examination at birth or 3 months after birth.
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Trends in contraceptive method of use by California family planning clients, 1976-84, are reviewed. Although use of foam and condoms doubled from 1976 to 1980 and was sustained, interest peaked but markedly declined for the diaphragm. Oral contraceptive (OC) use declined overall and most notably for older women, but there are indications in 1983 and 1984 of a slight OC "come back". Older women were more likely to choose methods free from medical side effects than were younger women.
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Better knowledge about contraceptive use in adolescents is needed if pregnancy prevention is to be improved. Data from the 1979 National Survey of Young Women were used to examine method switching once contraceptive use had begun among 449 never-pregnant young women who reported premarital intercourse more than once. Bivariate chi2 tests and multivariate logit regression were used to examine factors related to switching in four analyses: overall switching; switching among those with one intercourse partner; and switching from nonmedical and medical methods separately. Frequency of intercourse and type of first method had an interactive effect on switching; length of exposure to switching, type of relationship, and reason for choosing the first method were also significant. These results suggest that providers and educators should consider the circumstances under which contraceptive methods are chosen and used by young women when counseling them as to what method may be best for them.
To elucidate further the etiology of toxic shock syndrome, we assessed the effects of certain contraceptive methods and recent history of vaginal infection on the incidence of toxic shock syndrome, with confounding effects of other risk factors controlled. We found a strong but imprecise positive association between toxic shock syndrome and tubal ligation (rate ratio = 7.9, 90% confidence interval 1.4 to 42.7). We also observed a negative association with oral contraceptives (rate ratio = 0.49, 90% confidence interval 0.22 to 1.1) and a positive association with a recent history of vaginitis (rate ratio = 2.1, 90% confidence interval 1.2 to 3.9).
A study was undertaken at the main PROFAMILIA clinic in Bogota, Colombia to compare the effectiveness of nurses and physicians in the delivery of family planning services. Contraceptive method continuation was the major outcome variable in this analysis. Clients were randomly assigned to physicians or nurses on their first visit and for the duration of care. On all revisits, data were collected pertaining to method prescribed, side effects, pregnancy, and method changes. There was a field survey at eight months to locate clinic drop-outs and determine their contraceptive use status. There were no significant differences in method continuation between clients who received services from physicians and those who received services from nurses. At nine months, the overall continuation of the first method prescribed was 79.1 per cent in the physicians' group and 75.8 per cent in the nurses' group (t = 1.057, p greater than .20). When controlling for first method used, the IUD users in the physicians' group had a continuation rate of 86.1 per cent and in the nurses' group 84.0 per cent (t = 0.556, p greater than .50). Of the pill users who received services from physicians, 78.1 per cent were continuing at nine months and 74.3 per cent of the pill clients in the nurses' group were continuing at nine months (t = 0.573, p greater than .50). There were no differences in pregnancy rates, side effects rates, and method change rates between the two groups. It may be concluded that these nurses were as effective as physicians in the delivery of family planning services.
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