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PubMed1978

More research on the pill and alternative methods (of contraception).

More research on the pill and alternative methods of contraception was urged by Ralph Nader's Health Research Group (HRG), which also recommended that the Food and Drug Administration develop a new patient package insert for all forms of contraceptives, including nonprescription methods. The group also said the government and drug companies should share the cost of long-term follow-up studies of the effects on health of the pill and other birth control methods. The recommendations followed presentations at an HRG forum from NIH scientists and S. Ramcharan, principal investigator of the Walnut Creek (California) Contraceptive Study supported by the National Institute of Child Health and Human Development. Ramcharan studied 15,000 women over 10 years and found cervical cancer incidence of 173/100,000 person years for women who used the pill for more than 4 years, compared with a rate of 32/100,000 for women who never used the pill. Ramcharan declined to draw any cause-effect conclusions based on these results, stating they were "confounded" by possible differences in sexual activity between the 2 groups. She said a preliminary case comparison study to adjust for these differences "suggests sexual behavior may account for some, but not all," of the 5-fold increase in cervical cancer incidence among pill users. HRG director S. Wolfe said enough data exists to state a relationship between the pill and cervical cancer. "There's no other explanation for the increase," he said, adding that Ramcharan had controlled for the effects of age, education, marital status, number of Papanicolaou smears, religion, number of pregnancies, a history of genital infections, and smoking. Forum participants urged more research on contraceptive devices and drugs now in use, long-term effects of sterilization, value of condoms and spermicides in preventing VD, and development of a patient package insert for all forms of contraception stating the relative effectiveness and risks of each. The group discussed the need for long-term funding of follow-up studies, and suggested that drug companies be required to pay for at least some of the pre- and postmarketing research.

Contraception↗
PubMed1978

Observations on family planning acceptors in Papua New Guinea.

The continuation contraceptive practise of 3,293 I.U.D., 1985 pill and 749 depo-provera acceptors was analysed by a survey of family planning records. The proportions of grand multiporae were 40.3%, 24.2% and 40.4% in the three groups. Pap smears were taken in from 12 to 38.5% of acceptors and the proportions of pathological smears varied from 8.9 to 13.3%. The percentages of acceptors who attended only once more were 11% (I.U.D.), 18.1% (pill) and 25.1% (d-p.), Pregnancy rates were for the I.U.D., 1.7 per Hundred Woman Years, for the 2.1 per H.W.Y. and for d-p, 0.4, per H.W.Y. Temporary interruptions of the contraceptive methods were common with the pill and d-p. In the long run the I.U.D. is superior to the other temporary methods of contraceptives. Continuation rates with the I.U.D. were 89.9% after one year and 70.9% after five years (similar rates for the pill were 55% and 16.5% and for d-p 50.5% and 10.3%). The importance of a proper pelvic examination and the need to have all methods available for any individual receiving contraceptives are emphasized in the discussion. Tubal ligations should always be considered as an alternative to the temporary methods of contraceptives in ground multiporae and others at special risk from further pregnancies.

Adult↗
PubMed1985

The progestagen releasing vaginal ring.

The results of the Manchester study and its reinforcement from data from the multicenter study indicate that the ring is a well-tolerated delivery system for low-dose progestagens. The expulsion rate is low and vaginal tolerance satisfactory. The pregnancy rate and bleeding pattern is of the same order as oral low-dose progestagens. Indeed, there is an indication that the pregnancy rate and abnormal bleeding rate may be even lower. Data from other more extensive phase 3 studies will be required to confirm this impression. The subjective assessment is that the majority of patients are enthusiastic about this method of contraception, bearing in mind that many of them had become disenchanted with existing marketed contraceptive methods. Because of its high level of acceptability, the gap between theoretical and use-effectiveness in narrowed and once inserted, a high degree of motivation is not required since the existing ring only needs to be reinserted after 90 days of use. The acceptability of vaginal methods of contraception as evidenced by the rapid uptake of the vaginal sponge suggests that there is considerable potential for increased use of vaginal methods. In the present state of knowledge, it would appear that the woman for whom the progestagen only conception is particularly appropriate is the one who is lactating or for the older woman whose fertility is on the wane. For the woman who wishes to space her family, the progestagen only contraceptive is also appropriate. With increased refinements and experience of this method, there is a likelihood that the ring may extend the use and application of progestagen only contraception to a wider range of potential patients.

Biology↗
PubMed1984

A comparative trial of the Today contraceptive sponge and diaphragm.

A comparative trial was conducted in the United States to compare the Today contraceptive sponge and the diaphragm used with spermicide. Subjects were randomly assigned to contraceptive methods and were followed up for 1 year. None of the subjects were previous sponge users, but about 30% were previous diaphragm users. The overall cumulative 1-year life-table pregnancy rate was higher for sponge users compared to diaphragm users. No serious side effects occurred with either product. The discontinuation rates for allergic-type reactions and discomfort were higher for sponge users. Similar rates of method-related complaints and discontinuation rates for personal and product-related reasons suggest there were no differences in the acceptability of the two products. In this trial, the allowable use time for the sponge was 2 days. The sponge is now recommended for 1-day use. The overall results of the study indicate the sponge to be a safe and acceptable method of contraception with an effectiveness rate in the range of that for other vaginal contraceptives.

Adolescent↗
PubMed1998

Young women's attitudes toward injectable and implantable contraceptives.

STUDY OBJECTIVE: To assess the potential acceptability of implantable and injectable contraceptive characteristics by young women of diverse ethnic and educational backgrounds. DESIGN: A cross-sectional self-administered survey. SETTINGS: The waiting room of three clinical sites: an elite women's college health service, a coeducational state university health service, and an inner city hospital-based adolescent clinic. PARTICIPANTS: 328 young women awaiting medical care in one of three clinical sites, aged 13 to 21 years (85% 18-21 years); ethnic distribution differed significantly by site. The majority (83%) were sexually active, and of those who were sexually experienced, 25% had been pregnant. OUTCOME MEASURES: A 47-item questionnaire examining attitudes toward characteristics of injectable and implantable contraceptive methods, menstrual, sexual, and gynecologic history. RESULTS: Sixty-two percent of the sample agreed that they would get an injectable method. There was little variation in agreement to get an injectable method by sexual or pregnancy history. Fewer subjects (24%) agreed that they would like to get subdermal implants and agreement to get an implantable method of contraception did not vary by sexual history; however, ever-pregnant young women (33%) were significantly more likely to agree to implants than never-pregnant subjects (21%; chi2, 4.109; p = 0.04). Seventy-four percent of subjects said they would stop using a contraceptive that caused irregular menses, whereas 65% would stop using a method that caused amenorrhea. CONCLUSIONS: An injectable contraceptive method has universal appeal across ethnic, educational, and age categories, whereas implants are less appealing. Irregular bleeding and amenorrhea are poorly perceived side effects of long-acting contraceptives.

Adolescent↗
PubMed1983

Predicting contraceptive behavior from attitudes: a comparison of within- versus across-subjects procedures.

Within- versus across-subjects procedures for predicting behavior from attitudes were contrasted. Each procedure requires a comparison among attitudes in order to generate a prediction; the comparison is either among the same attitudes held by different people (across subjects) or among different attitudes held by the same person (within subject). It was hypothesized that the within-subject model provides a more adequate explanation of behavior from attitudinal constructs and, hence, more accurate prediction of behavior from attitudes than does the across-subjects model. To test this view, a sample of 349 married couples was administered a questionnaire containing measures of three attitudinal components--affect, cognition, and conation--toward each of four contraceptive methods--oral contraceptives, IUD, diaphragm, and condoms. Contraceptive behavior was assessed 1 year later. In support of the hypothesis, the within-subject predictions bore a significantly stronger relation to the behavioral criteria than did the across-subjects predictions. This effect was consistent for each of the three components of attitude, for the prediction of behavior and behavioral intention, for male and female respondents, and for a variety of contraceptive behaviors. In addition, both the within- and the across-subjects analyses demonstrated a clear rank ordering in the predictive validity of the three attitudinal components: Conation was a better predictor of behavior than was affect, which, in turn, was better than cognition.

Affect↗
PubMed1989

Contraceptive practice of Irish married and single first-time mothers.

This study surveys 100 married and 100 unmarried primiparous mothers, attending the National Maternity Hospital, Dublin, with regard to their contraceptive practice, their planning of their pregnancy and the timing of their first antenatal visit. Nineteen per cent of the married women, but 64% of the unmarried women, had never used any contraceptive method. The contraceptive pill was the most popular method for both groups, but while three in five of the married women had at some time used the pill, only a little more than one in five of the unmarried women had ever used it. One quarter of the women who had used contraception reported that their pregnancy was the result of a failure in their contraceptive method. Eighty-nine per cent of the single group and 20% of the married had not planned their pregnancy. None of the married women, but almost a quarter of the single, delayed their first antenatal visit until after they were 20 weeks pregnant.

Contraception Behavior↗
PubMed2006

Contraceptive intentions among adolescents after abortion.

Changes between choice of contraceptive methods before abortion and contraceptive intentions after abortion were assessed among 482 adolescents with regards to efficacy to prevent pregnancy or sexually transmitted diseases (STD) and human immunodeficiency virus (HIV). Adolescents substantially increased their intention to use oral contraceptives (214 of 452 who did not use before intended to after; p < .001) and depot-medroxyprogesterone acetate (DMPA) (121 of 469 who did not use before chose to after; p < .001). None of the 134 adolescents who used condoms as their primary contraceptive method before abortion intended to continue afterwards (p < .001). There was no difference in intention to use condoms after abortion among adolescents who received voluntary HIV counseling and testing compared to those who did not. Twenty-two percent of adolescents intended to use condoms together with spermicidal foam as their primary contraceptive method after abortion, thereby combining contraceptive efficacy with STD prevention. The intention to preferentially adopt hormonal methods as the primary contraceptive, especially among adolescents counseled and tested for HIV, is discouraging for STD and HIV prevention efforts in this adolescent population.

Abortion, Induced↗
PubMed1999

Effect of price and access on contraceptive use.

The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its financial sustainability. Options to increase financial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the effect that these additional prices would have on the use of contraception. The effect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that influence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two field sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No effect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to fixed clinics was greater than 30 min.

Adult↗
PubMed2000

Efficacy and acceptability of depo-medroxyprogesterone acetate injection. As a method of contraception in Saudi Arabia.

OBJECTIVE: To determine the efficacy and acceptability of Depo-Medroxyprogesterone acetate (depo-provera) among the women using that method of contraception at King Faisal Military Hospital in the south-west region of Saudi Arabia. METHODS: A preliminary retrospective and questionnaire analysis of 165 Saudi women who had depo-provera as a method of contraception at the contraception clinic of King Faisal Military Hospital over a period of 2 months. RESULTS: The mean age of the women was 31.21 years and the mean parity 6.77. There was no pregnancy reported during the period of use of the contraceptive method which ranged from 3 months to 7.25 years. The side effects were mainly irregular spotting (69%), continuous bleeding per vaginam (7%), amenorrhoea (8%) and menorrhagia (1%). The rest reported normal menstrual pattern. Irregular spotting was common in women who had used the method for less than 2 years while amenorrhoea was the most common menstrual abnormality after 3 years of use. The other complaints included weight gain, loss of hair, abdominal pain and backache. The side effects were not acceptable to 4% of the women and they tried other methods of contraception. Thirteen percent of the women became pregnant after stopping the injections within intervals varying between 6 months to 2 years. Seventeen percent were using the method for the 2nd time. CONCLUSION: Depo-provera is a very effective form of contraception in our community. While a few of the patients (4%) in our series would try other methods if not happy with the side effects, the majority were prepared to cope with the side effects as long as the desired prevention of pregnancy was guaranteed. Further studies are needed to validate these findings.

Abdominal Pain↗
PubMed2001

Contraception in the adolescent: an update.

Contraception remains an important part of national efforts to reduce adolescent pregnancy in the United States. A number of safe and effective contraceptive methods are available for our youth, including abstinence, barrier methods, oral contraceptives, Depo-Provera, and Norplant. Research over the past few decades has resulted in a variety of oral contraceptives with reduced amounts of hormones and reduced side-effects. A number of methods have received approval by the Food and Drug Administration since the last review in 1980, including emergency contraceptives, depomedroxyprogesterone acetate, and the cervical cap. The use of condoms and vaginal spermicides continues to be recommended for all sexually active adolescents to reduce (not eliminate) the risk for acquiring sexually transmitted diseases. A polyurethane condom is now available, in addition to the latex condom and other barrier contraceptives, including the following: diaphragm, cervical cap, vaginal sponge, female condom and vaginal spermicides. Because of continuing concerns about pelvic inflammatory disease related to intrauterine devices, currently available intrauterine devices are not recommended for most adolescents. Abortion is not considered as a contraceptive method.

Adolescent↗
PubMed2003

Changes in contraceptive use in Vietnam.

This analysis used data, primarily from the 1997 Vietnamese Demographic and Health Survey (VN-DHS 1997), to determine the changes in contraceptive use in Vietnam. A descriptive analysis of individual, household and community characteristics was made to obtain a general description of contraceptive use. Multinomial logistic regression analyses were also performed on the currently married in (a) a sample of all women and (b) only those women who live in rural areas, to identify the strength of association that each variable has with the use of modern contraceptives. The use of any contraceptive method and the use of modern methods increased from 1988 to 1997. The primary contraceptive method utilized is the IUD and its use has increased substantially from 1988 to 1997. Younger women (aged 15-24) were less likely to use any contraceptive method. Women not desiring additional children were significantly more likely to use contraceptive methods than those desiring more children. Education has a clear impact on both contraceptive knowledge and use by women, with higher educated women being more likely to use a contraceptive method. Illiterate women with no formal education were significantly less likely to use modern methods of contraception. Differentials in contraceptive use exist regarding place of residence. Urban women are more likely than rural women to use contraception, but the difference is not large. Women living in mountainous areas are less likely to use contraception, compared with women living in the lowlands. Living standards, especially the availability of electricity in the community, have a large effect on the methods of contraception adopted by women. Religion is not strongly related to the contraceptive behaviour of women. There were significant differences in the use of contraceptives in communities with good quality of care, with increased contraceptive use corresponding to the increase in availability of family planning workers at communes, provision of counselling services at health facilities, and the volume of mass media family planning messages.

Adolescent↗
PubMedDate not supplied

Barrier methods of contraception: a reappraisal.

In the last two years, there has been a gradual reawakening of interest in barrier methods and an increase in their usage by both men and women. This is in large part due to concern about the sometimes serious side effects reported for other contraceptive methods. The return to these techniques is particularly important, given the current epidemics of teenage pregnancy and veneral disease. One of the major problems in relation to barrier methods today is the accurate determination of their efficacy. There are very limited data with statistical validity available to judge the exact rate of effectiveness one might obtain using one of these techniques. The National Survey of Family Growth, conducted by the National Center for Health Statistics, showed a failure rate per 100 women of 16.7 for foam, cream or jelly and 15.9 for diaphragms (22). There is a great need for new and improved barrier methods of contraception. Numerous clinical studies are being set up to test spermicidal agents and vaginal sponges for the female, as well as such things as disposable condoms for males.

Adolescent↗
PubMed1972

A study of contraception as related to unwanted pregnancy.

A study was made of 150 women requesting therapeutic abortion. Mechanical failure of the contraceptive method used accounted for unwanted pregnancy in 89 (59%) women. In the remainder no method of contraception was used by either partner. Among women requesting abortion, failure to use contraceptives was commoner in the younger and unmarried than in older and married women.The data obtained were analyzed in an attempt to explain the failure and avoidance of contraception. Suggestions are made as to how to discourage the use of abortion as a method of contraception.

Abortion, Legal↗
PubMed1983

Contraceptive use by adolescent females in relation to knowledge, and to time and method of contraceptive counseling.

Contraceptive behavior of adolescent females was examined in relation to their level of knowledge, and time and method of contraceptive counseling. Subjects were 122 subscribers to a prepaid health plan, 13-18 years of age, unmarried, sexually active, and not desiring pregnancy. Contraceptive counseling was offered to 62 adolescents following receipt of a negative pregnancy test and to 60 adolescents following a routine medical visit. The 80 adolescents who chose to participate in the study were randomly assigned to a conventional or developmental method of counseling. The effectiveness of their contraceptive practice was measured 1 year later. Two hypotheses were not upheld: Sexually active adolescents were not more likely to accept contraceptive counseling at the time of a negative pregnancy test than at a time of a routine medical visit, and did not subsequently become more effective users of contraceptives. Two hypotheses were upheld: Effective and ineffective users of contraception did not differ in level of knowledge, and adolescents counseled by a developmental method practiced contraception more effectively than those counseled by a conventional method. Findings are discussed in terms of the theory of adolescent development and the proposition that a pregnancy scare motivates teenagers to control fertility.

Adolescent↗
PubMed1982

[Advantages and risks of hormonal contraception].

Among modern contraceptive methods hormonal contraceptive agents, due to their reliability, are preferred. Nevertheless, it has to be considered that these steroidal hormones and their metabolites do not only possess an ovulation inhibitory effect, but that they also influence other systems, such as carbohydrate and lipid metabolism, blood clotting, fluid balance, plasma proteins as well as the entire hormonal system. These multiple side effects have positive and negative influences. By reducing the doses of estrogens and progestagens occurrence of unpleasant adverse reactions has been decreased. Some years ago, the estrogen content of oral contraceptive preparations was considered to be noxious while a favourable effect was attributed to the progestagen content. The results of biochemical studies yielded a better understanding of the effect of steroidal hormones on lipid metabolism. Fertility problems occurring after discontinuation of oral contraceptive treatment are mainly observed in women who, prior to use of oral contraceptive agents have already been suffering from functional cycle disturbances. Ovulation inhibitory preparations may also be given to adolescent girls with immature cycles. As the juvenile endocrine system is adaptable, after cessation of the ovulation inhibitory effect, the cycle returns to pretreatment patterns. It may now even be possible to administer hormonal contraceptive agents to treat endocrine disturbances.

Adult↗
PubMed1999

Audit of condom issuing in eastbourne sexual health clinic.

A perennial question at meetings of family planning practitioners concerns the numbers of condoms to give to patients. If the condom is to act as an effective contraceptive method, then there must be a condom available for every occasion of sexual intercourse. In recent years, the condom has been promoted as a means of protecting against sexually transmitted infections, including HIV. The 'Double Dutch' approach whereby the condom is used alongside other methods of contraception such as the Pill, has been advocated, particularly for younger people. The condom has consequently become a more commonly used method of contraception, particularly amongst the young and single. The family planning clinic in Eastbourne is now part of an integrated Sexual Health Clinic incorporating family planning (FPC), genito-urinary medicine (GUM), HIV and AIDS clinics. At the time of this audit, steps towards integration were already well advanced. We were keen to develop standards for issuing condoms which took account of identified need in target populations. At the same time clinicians were anxious to avoid waste given that the budget for condoms is finite. Often the idea of using a condom is introduced by clinicians rather than by clients, and this may lead to the issuing of condoms which the client is not motivated to use. We were also keen to eliminate any judgements about frequency of requests for supplies of condoms, and to this end the local Health Promotion Department ran training on sexual history taking which included approaches to asking about frequency of sexual intercourse.

Adult↗