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[Use of the pill by adolescents for contraception or as therapy].

OBJECTIVE: To describe frequency of oral contraceptive (OAC) use, indications for OAC use and influence of calender age, gynaecological age (age minus age at menarche) and level of education on OAC use among ninth grade secondary school girls. SETTING: Secondary schools in Amstelland-de Meerlanden, a combined urban and rural region to the south of Amsterdam. METHOD: By questionnaire and individual interview on menstrual cycle pattern and OAC use, school girls were asked about duration and reasons for OAC use and what preparation they used. RESULTS: The response to the questionnaire was 92%, that to the interview 83%. Of the 2248 responders 248 (11%; mean age 15.3 years (SD: 0.6)) used OAC: 74% used low dose 'sub 50' preparations, 3% pills with 50 micrograms oestrogen, 3% 3-phase preparations and 17% pills with antiandrogens. Of girls aged 14, 15 and 16 years 4%, 12% and 28%, respectively, used OAC. Of the 15-year-olds 36% mentioned contraception as most important reason, 20% menstrual cycle irregularity, 28% dysmenorrhoea, 12% acne and 5% other reasons. With multiple logistic regression analysis age, gynaecological age and level of education were independent variables for OAC use in general and for OAC use for contraception or dysmenorrhoea, but less so for OAC use for menstrual cycle irregularity or acne. CONCLUSION: During adolescence low dose OACs are frequently used. Of adolescent OAC users 36% mentioned contraception as most important reason. OAC use in the Netherlands among girls aged 15 and 16 years doubled in comparison with 1982. Gynaecological age and calender age (determinants of biological maturation), and level of education (a determinant of life style) were associated with OAC use.

Acne Vulgaris↗

Contraception.

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Abortion, Induced↗

Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.

CONTEXT: Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. METHODS: Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. RESULTS: When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. CONCLUSIONS: Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.

Abortion, Induced↗