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Contraceptive failure in the United States: an update.

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.

Clinical Trials as Topic↗

Adolescent contraception. Review and recommendations.

In the light of the increase in teenage sexual activity over the past decade, the authors review current social, psychological, and educational attitudes. Together with a summary of the legal ramifications, they provide recommendations for treatment of this patient group.

Adolescent↗

An evaluation of teaching cervical mucus symptoms to ovulating infertile women.

Women (n = 113) with ovulatory menstrual cycles but complaining of infertility were instructed in the observation and charting of cervical mucus symptoms. At the completion of 3 teaching cycles, 80 subjects (70.8%) had successfully charted at least one cycle with an ovulatory mucus pattern (10 subjects became pregnant). Sixty-two (54.9%) of the women continued for a further 3 cycles of investigation during which, around the time of ovulation, an assessment was made of the mucus at the cervix. On the basis of this assessment subjects were classified as either Group 1: charting ovulatory mucus symptoms with 'fertile type' mucus observed at the cervix - 48 subjects (10 became pregnant); Group 2A: charting uninterpretable mucus symptoms but 'fertile type' mucus observed at the cervix - 8 subjects; or, Group 2B: charting uninterpretable mucus symptoms and mucus of poor quality observed at the cervix - 6 subjects. The study shows that infertile ovulating women can be taught to observe and chart their mucus symptoms. Such charting is useful in identifying the fertile period of the cycle for timing of intercourse and for timing of postcoital tests and cervical assessment. It is also useful in identifying the small number of women (5.3%) with an apparent deficiency in mucus production. Whether the 20 subjects (17.7%) who became pregnant were assisted in this objective by their charting of symptoms is unclear.

Body Temperature↗

First premarital contraceptive use: United States, 1960-82.

This study shows the first national estimates of trends and differentials in first contraceptive use for a national sample of all women. Only 47 percent of women aged 15-44 in 1982 (or their partners) used a method at first premarital intercourse. The leading method at first intercourse was the condom, followed by the pill and withdrawal. The percentage using a method increased from the early 1960s to the late 1970s, because of increases in use of the pill and withdrawal. However, in the early 1980s, use at first intercourse increased sharply because of an increase in use of the condom. The proportion who used a method at first intercourse varied from 22 percent among Hispanic women to 74 percent among Jewish women; it was higher among white than black women, and higher in higher socioeconomic categories. After first intercourse, contraceptive use did not vary significantly by socioeconomic characteristics. While the condom was the leading method at first intercourse, women who practiced contraception for the first time after first intercourse typically used the pill.

Adolescent↗

The effects of a progestin-only oral contraceptive (levonorgestrel 0.03 mg) on breast-feeding.

This study was a non-randomized clinical trial which compared the breast-feeding experience of 250 Argentine women taking levonorgestrel 0.03 mg daily (begun one week after delivery) with that of 250 women using non-hormonal contraceptives. Weight gain of unsupplemented infants, the most important of the several criteria used to assess breast-feeding performance, was similar for the two contraceptive groups. Levonorgestrel users began supplementary feeding of their infants significantly later than did non-hormonal users; levonorgestrel users were also somewhat less likely to discontinue breast-feeding during the study period. The two contraceptive groups were similar with regard to several other measures of breast-feeding performance: growth of all infants (regardless of supplementation), patterns of contraceptive discontinuation, mothers' subjective impressions of breast-milk sufficiency, and comparison of supplementation initiation with previous experience.

Adult↗

Choosing and using contraception: toward a theory of women's contraceptive self-care.

Thirty women of varying ethnicity and socioeconomic status, who were actively seeking to avoid pregnancy, were interviewed concerning their lifetime experience with contraceptive use. The resulting description, Women's Contraceptive Self-Care, was divided into four processes: the central process, Choosing and Using Contraception, and three contextual processes. Forestalling Pregnancy was defined as using contraceptive methods or behaviors to prevent or delay childbearing. Assigning the Burden of Contraceptive Responsibility was defined as assuming responsibility for contraception or shifting that responsibility to a partner. Negotiating with Those who Control Contraception was defined as maneuvering among individuals and agencies that permit or hinder access to contraceptive methods and behaviors. Each process is comprised of thematic clusters and/or themes that are defined and illustrated.

Adult↗

Frequency of non-hormonal contraception around conception and association with congenital malformations in offspring.

A case-control study using data on deliveries in the mid-1970s at five Connecticut hospitals (cases, n = 1427; controls, n = 3001) found little relationship between delivery of a malformed infant and use by the mother of nonhormonal contraceptive methods at conception. Of particular interest was the lack of an association with use of the rhythm method (odds ratio (OR) = 1.02, 95% confidence limits (CL) = 0.73, 1.42), spermicides (OR = 1.26, 95% CL = 0.85, 1.85) at conception and a modest association for the intrauterine device (IUD) one week before conception (OR = 1.99, 95% CL = 0.98, 4.04). Continued use of the IUD after conception may further increase the risk for malformations but this observation was statistically unreliable in the present study. Mothers of newborns with cleft lip and palate (OR = 2.91) and congenital hydrocele (OR = 4.64) were more frequent rhythm users at conception, and mothers of newborns with multiple anomalies had more recent IUD exposure (OR = 9.87), but these and all other specific congenital malformation groups were not significantly related to any non-hormonal contraceptive after adjustment for multiple observations. Potentially confounding maternal risk factors were controlled.

Adult↗