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PubMed2005

Nonprescription availability of emergency contraception in the United States: current status, controversies, and impact on emergency medicine practice.

In October 2004, the American College of Emergency Physicians Council joined more than 60 other health professional organizations in supporting the nonprescription availability of emergency contraception. This article reviews the history, efficacy, and safety of emergency contraception; the efforts toward making emergency contraception available without a prescription in the United States; the arguments for and against nonprescription availability of emergency contraception; and the potential impact nonprescription availability could have on the practice of emergency medicine in the United States.

Adolescent↗
PubMed1993

[Ignorance and misconceptions in the use of contraceptive methods].

Good knowledge of the available contraceptive methods ensures better acceptability, continuity and satisfaction, and lower failure rates of these methods. This paper describes an inquiry on the contraceptive knowledge in 114 women attending three Brussels family planning clinics. Misconceptions, beliefs in false rumors, and considerable insufficiencies in knowledge were detected. In order to increase patient's ability to correctly use birth control methods, so as to lower unwanted pregnancy rate, efforts should be made by health practitioners as well as by mass media and teaching institutions.

Adolescent↗
PubMed2002

Availability of emergency contraceptive pills at university and college student health centers.

The author used the stages of change model to determine how ready student health centers at surveyed universities and colleges were to make emergency contraceptive pills (ECPs) available to students. Of the 358 centers that responded, 52.2% offered ECPs and 47.8% did not. The benefits of offering ECPs were listed as pregnancy prevention, the opportunity to introduce students to traditional contraception methods, and students' appreciation. Barriers to offering ECPs included institutions' religious affiliations, clinic and administrative staff objections, inability to prescribe or dispense medications, fear of liability, concern that ECPs would undermine students' use of traditional contraception methods, and no expressed need. Whether ECPs were available was associated with demographic characteristics of the institutions that responded, including geographic region, type of institution, size of student population, and students' status as commuter or on-campus residents.

Adolescent↗
PubMed1995

Safety implications of transferring the oral contraceptive from prescription-only to over-the-counter status.

The idea of making oral contraceptives available without prescription has a long history, and has been recently revived in the US and the UK. High dose oral contraceptives have generally been replaced by low dose formulations and, subsequently, most cardiovascular risks have been reduced and a protection against ovarian and uterine cancers has been consistently demonstrated. Oral contraceptive compliance, however, continues to be a problem, but there is no reason to assume that wise practice would be any more or less if oral contraceptives were available over-the-counter (OTC). Some countries have introduced alternatives to prescription-only oral contraceptives, whereby nurses, midwives, social workers and/or pharmacists are incorporated into the distribution process. This article concludes that the balance of risks and benefits is in favour of OTC access for oral contraceptives.

Contraceptives, Oral↗
PubMed2000

Rheological properties of contraceptive gels.

The rheological properties of 4 commercially available contraceptive drug delivery gels and their dilutions with a vaginal fluid simulant were measured. These properties govern the critical functions of spreading and retention of these gels over the vaginal surfaces. Measurements made on Conceptrol, KY Plus, Gynol II, and Advantage-S included stress growth, stress relaxation and residual stress, and the shear rate dependence of viscosity. All gels exhibited non-Newtonian behavior including shear thinning and viscoelasticity. Conceptrol and Gynol II had no residual stress, while both KY Plus and Advantage-S did. The gels differed in their response to dilution with vaginal fluid simulant.

Acrylic Resins↗
PubMed1999

Knowledge and use of birth control methods in active duty Army enlisted medical trainees.

This study was designed to determine the familiarity of medical advanced individual training (AIT) students with current methods of birth control and to evaluate the accessibility of these methods. A survey was distributed to 578 medical specialist AIT students assigned to Fort Sam Houston, Texas, for training. Results obtained show a lack of knowledge concerning the newer forms of contraceptives available. This study also indicates that barriers may exist that limit a soldier's ability to acquire prescription forms of contraception while in training.

Adult↗
PubMed1972

Sexual behaviour and contraceptive practice of unmarried female undergraduates at Aberdeen University.

After the sixth week of the spring term of 1971 the unmarried female undergraduates at Aberdeen University were sent a postal questionnaire about their sexual behaviour and contraceptive practice and 1,552 (90%) replied. Of these, 684 (44%) had experienced intercourse, 486 in the six-week period preceding the study, of whom 46% had had it more than six times in this period. It was found that 86% of the relationships were with fiancés or steady partners.Only half of the experienced and a quarter of the inexperienced girls thought that contraceptive advice and materials were adequately available. Contraceptives had not been used by 53% of the students on the first occasion that they had intercourse. In the previous six-week period 192 girls had intercourse without using a contraceptive -39% of those having sexual relations. The use of contraceptives increased with the frequency of intercourse and the stability of the relationship. During the previous six weeks 30% of those having intercourse were on the pill, 38% used the sheath, and 26% relied on the safe period or withdrawal as their most frequent method of contraception.Sixty-five girls had been pregnant in the past, six were pregnant at the time of the survey, and 49 thought that they might be.The uncertainty and difficulty that are experienced in obtaining contraceptives and the large number of occasions on which they are not used are discussed. Moral and pragmatic aspects of promoting a more effective use are examined and better publicity for the family planning clinics that already exist is urged.

Adolescent↗
PubMed2000

Economic analysis of long-term reversible contraceptives. Focus on Implanon.

OBJECTIVE: To examine the economic impact of a new implantable contraceptive, Implanon, in comparison with other available contraceptive methods. DESIGN: This was a modelling study using cost data derived from national published sources and effectiveness data from either controlled clinical trials (Implanon) or reports in the literature (other contraceptives). In the baseline analysis, Implanon was compared with 2 long term reversible contraceptives, Norplant and Mirena. Further analyses were then carried out comparing Implanon with Depo-Provera and with combined oral contraceptives. SETTING: The study concentrated on the UK, but also made reference to several other European countries. MAIN OUTCOME MEASURES AND RESULTS: The baseline analysis showed that all 3 long term reversible contraceptives produce very good rates of return, with Implanon providing the best rate of return (both average and internal) of the 3 methods. The payback period for Implanon was calculated as 146 days, compared with 339 and 368 days for Norplant and Mirena, respectively. In terms of cost effectiveness, the cost per protected year for Implanon was 95 Pounds, compared with 146 Pounds and 168 Pounds for Norplant and Mirena, respectively. In comparison with Depo-Provera (an injectable contraceptive), Implanon was both less costly and more effective, the cost per protected year for Depo-Provera being 131 Pounds. The threshold beyond which Implanon delivers cost savings compared with combined oral contraceptives was at a failure rate of 4.9% for the combined pill. CONCLUSIONS: Reversible long term approaches to contraception provide an effective and efficient use of healthcare resources and generate an excellent return on public investment. Implanon produces better rates of return than both Norplant and Mirena, and is also more cost effective in terms of cost per pregnancy avoided and cost per protected year than Norplant, Mirena, Depo-Provera and oral contraceptives.

Adult↗
PubMedDate not supplied

Contraceptive choices--turning back the clock.

Contraceptive choices are being reduced rather than being expanded in many parts of the world, particularly in Western countries. Although this paper presents an Australian perspective, the concerns are shared by family planners in other countries. The reasons for this are multiple and complex and often interrelated but ultimately depend on commercial considerations. The community expectation is that an ideal contraceptive can and does exist, but the media sensationalization of contraceptive problems has given many contraceptive methods a poor image. Contraceptive availability is also affected by liability issues, which have increased the cost of product liability insurance, and medical liability insurance of health professionals, increasing both the cost of contraceptives to the individual and the availability of services such as IUD insertions and sterilization, as practitioners withdraw their services, due to cost of insurance. The cost of marketing a new contraceptive from the time the idea is first developed until it is approved for marketing also deters manufacturers from developing new contraceptives. Delays in drug evaluation procedures in many countries deters companies with already well established contraceptives from marketing them in such countries. The effect of political stands by radical feminists or consumer groups, also effect both the image and the availability of contraceptives, as can be seen with the saga of Depo-Provera, RU486 and intrauterine devices. Similarly, the moral perceptions of anti-abortion groups and health care providers is also a threat to fertility control services. Possible solutions to some of these problems are offered in the paper.

Contraception↗
PubMedDate not supplied

Origins and elements of the population policies of Cameroon Republic.

The author discusses the pro-natalist policies of Cameroon, measures that are not explicit population policies but are instead implied in other government policies and pronouncements. It is argued that "this pronatalist policy partly has its roots in the inherent cultures of the people which have been forged from several years of ravages from epidemic and endemic diseases, inter-tribal conflicts and slave trade. These have been further authenticated, constitutionalised and perpetuated by official policy which bears the stamp of its French colonial masters...." These policies include "legislation against contraception and abortions, discriminatory taxation in favour of married persons, family allowances and other travel, leave, transfer, retirement, housing and educational benefits and concessions for persons with large families as well as an elaborate network of mother and child health care centers." Attention is also given to the establishment of family planning and family care clinics, contraceptive availability, and illegal abortions. (SUMMARY IN FRE)

Abortion, Illegal↗
PubMed1991

New female intravaginal barrier contraceptive device. Preliminary clinical trial.

The Fem Cap, a silicone rubber cervical cap, is shaped like a sailor's hat. While its dome covers the cervix, its rim fits snugly into the vaginal fornices, and its brim adheres and conforms to the vaginal walls. A spermicidal material is applied to the cap, then it is positioned over the cervix by hand or with a special applicator. The device is removed by hand up to 48 hours after insertion, but no sooner than eight hours after intercourse. Women chosen for the trial had contraindications to or were dissatisfied with the currently available contraceptive methods. Each woman was fitted with a cap of suitable size and instructed in its use. She was then asked to note any side effects and the dates of her menses in a diary. One-hundred-twenty-one women were enrolled in the study. Five became pregnant. Of those, two reported dislodgment of the cap during intercourse; the other three admitted to non-use of the cap on several occasions. This device has proven so far to be safe, effective and acceptable to women and men. It has several advantages over the currently available barrier contraceptive devices. The silicone rubber material from which it is made is non-allergenic, durable and easy to clean. Its design fits the anatomy and accommodates physiological changes. The Fem Cap is easy to insert and remove; an applicator facilitates insertion for some women. Instruction for use of the device requires short time from the health care provider.

Adolescent↗
PubMedDate not supplied

The quality of family planning services in rural China.

This article provides a preliminary analysis of three aspects of service quality in four rural counties in China--the availability of contraceptive methods, information given to users, and provider knowledge about methods. Contraceptive choice and characteristics of contraceptive use by women in the study areas are also examined. The data are derived from a survey carried out by the authors during 1987, under the auspices of China's State Family Planning Commission. The survey was conducted in four rural counties located in Fujian and Heilongjiang provinces. A total of 318 married women of reproductive age were randomly selected and interviewed. All family planning service sites serving the women were visited and a sample of service providers was interviewed. No shortage of contraceptives existed in any of the counties, but variations in community wealth and local procurement practices have resulted in the acquisition of an IUD with high failure rates. Although providers believe they inform women about method choices and side effects, women were poorly informed about the methods they selected. Not all providers who insert IUDs and distribute pills were knowledgeable about contraindications and side effects of the methods. Ever-use of contraception was nearly 100 percent, but most women, especially in Heilongjiang, have only used one method: the IUD or sterilization. Improvements in quality, especially in method mix, providers' level of knowledge, and the quality and quantity of information provided to users will likely improve contraceptive continuation, client satisfaction, and women's health.

China↗
PubMedDate not supplied

Family planning programs: efforts and results, 1982-89.

According to a set of 30 indices that assess the strength of large-scale family planning programs in developing countries, a strong upward shift in effort scores occurred between 1982 and 1989. During that period, many countries established or augmented their family planning programs, and effort scores improved in all developing regions and in all four dimensions of effort--policies and stage-setting activities, service and service-related activities, record keeping and evaluation, and availability of contraceptive methods. By region, the sharpest improvement was not in East Asia, where levels were already high, but in sub-Saharan Africa, where the movement was clearly upward, from a low base. Earlier associations between program effort and fertility declines are reaffirmed, additive to the contribution of socioeconomic improvements. In order to compute scores ranging from zero to 30 for each of the 30 indices, a detailed questionnaire was sent to 4-6 respondents in each of 103 developing countries having more than one million population. Respondents included program staff, donor agency personnel, local observers, and knowledgeable foreigners. The scores indicate that developing countries are continuing to move toward more favorable policy positions and stronger implementation of action programs, with consequent fertility effects. For the fertility decline to match the medium population projections of the United Nations, however, a substantial enlargement in the number of contraceptive users is necessary, not only to compensate for the enlarging base of couples, but also to increase the proportion who use contraceptives.

Developing Countries↗
PubMed2004

Benefit-risk assessment of the levonorgestrel intrauterine system in contraception.

The levonorgestrel-releasing intrauterine system (IUS) is a long-acting, fully reversible method of contraception. It is one of the most effective forms of contraception available, and combines the advantages of both hormonal and intrauterine contraception. The levonorgestrel-releasing IUS also gives the users many non-contraceptive benefits: the amount of menstrual bleeding and the number of days of menstrual bleeding are reduced, which makes it suitable for the treatment of menorrhagia (heavy menstrual blood loss). Dysmenorrhoea (painful menstruation) and premenstrual symptoms are also relieved. In addition, the levonorgestrel-releasing IUS provides protection for the endometrium during hormone replacement therapy. The local release of levonorgestrel into the uterine cavity results in a strong uniform suppression of the endometrial epithelium as the epithelium becomes insensitive to estradiol released from the ovaries. This accounts for the reduction in menstrual blood loss. All possible patterns of bleeding are seen among users of the levonorgestrel-releasing IUS; however, most of the women who experience total amenorrhoea continue to ovulate. The first months of use are often characterised by irregular, scanty bleeding, which in most cases resolves spontaneously. The menstrual pattern and fertility return to normal soon after the levonorgestrel-releasing IUS is removed. The contraceptive efficacy is high with 5-year failure rates of 0.5-1.1 per 100 users. The absolute number of ectopic pregnancies is low, as is the rate per 1000 users. The levonorgestrel-releasing IUS is equally effective in all age groups and the bodyweight of the user is not associated with failure of the method. In Western cultures continuance rates among users of the levonorgestrel-releasing IUS are comparable with those of other long-term methods of contraception. Premature removal of the device is most often associated with heavy menstrual bleeding and pain, as with other long-term methods of contraception, and is most common in the youngest age group. When adequately counselled about the benign nature of oligo- or amenorrhoea, most women are very willing to accept life without menstruation. The risk of premature removal can be markedly diminished with good pre-insertion counselling, which also markedly increases user satisfaction. User satisfaction is strongly associated with the information given at the time of the levonorgestrel-releasing IUS insertion. Thus, the benefits of the levonorgestrel-releasing IUS make it a very suitable method of contraception for most women.

Administration, Intravaginal↗