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PubMed2005

Emergency contraception and prevention of induced abortion in India.

OBJECTIVE: Induced abortion is associated with high morbidity and mortality in India. Use of regular contraception with emergency contraception (EC) as backup can reduce the incidence of induced abortion. The study aimed to assess women's knowledge, practice, preference and acceptance of different contraceptive methods with special reference to the causes of induced abortion, and their willingness to use hormonal EC. METHODS: The study comprised a structured questionnaire survey conducted in the family planning clinic of a tertiary teaching hospital in New Delhi, India. A total of 623 women and three men seeking contraceptive advice and/or termination of pregnancy were interviewed. The main outcome measures were knowledge of different contraceptive methods including EC and the reasons for unintended pregnancy. RESULTS: More than 99% of the respondents knew about most of the modern methods of contraception whereas only 37 (5.9%; 95% CI 4.0-7.8) of the respondents knew about EC and none of them had ever used it. Contraceptive method failure led to unintended pregnancy in 39.1% (95% CI 33.7-44.5) of abortion seekers. Correct use of EC could have prevented nearly 65.5% (95% CI 57.0-74.0) of induced abortions due to contraceptive method failure and 25.6% (95% CI 20.7-30.5) of all induced abortions. CONCLUSIONS: More efforts are required to generate awareness about the safety, efficacy and availability of EC, regular use of effective contraception and the health hazards of induced abortion.

Abortion, Induced↗
PubMed1975

Prevalence of gonorrhoea among women using various methods of contraception.

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

Adult↗
PubMed1989

A survey of contraception in five west European countries.

In 1984 and 1985, a survey was conducted of 7696 women aged 15-44 living in Italy, France, Great Britain, Spain and the Federal Republic of Germany. The aim of the study was to examine the use of contraceptive methods, the differences in contraceptive use, knowledge of fertility, communication about contraception, motives for choice and the perceptions held by women regarding contraceptive methods, particularly oral contraception. The results show important differences between the countries studied.

Adolescent↗
PubMed1991

Can combined oral contraceptives be made more effective by means of a nursing care model?

This manuscript is a theoretical attempt to show how the Neuman Systems Model can be practically used in combined oral contraceptive counselling by Swedish midwives. Counselling regarding combined oral contraceptives is not solely of a medical nature. There are many dimensions of care, namely sociological, developmental and philosophical. In 1980, the midwife in Sweden was responsible for between 70-80% of counselling in contraceptive methods. To facilitate the contraceptive counselling by the midwives, the Neuman Systems Model can be used as a theoretical aid. In the present report, the midwife's oral contraceptive counselling is described at an individual level with primary prevention. It is concluded that, from a theoretical standpoint, it is not possible to predict how the Neuman Systems Model, as a theoretical aid for the midwife, can increase the effectiveness of the birth control pill in preventing pregnancy. Research about the use of the nursing care model in oral contraceptive counselling should be carried out.

Adult↗
PubMed2006

Patient satisfaction with 3 methods of postpartum contraceptive counseling: a randomized, prospective trial.

OBJECTIVE: To compare patient satisfaction with 3 different postpartum contraceptive counseling methods. STUDY DESIGN: Randomized, prospective trial in an urban medical center. Patients were randomized to receive physician-patient counseling, written literature or an educational video. The main outcome variable was patient satisfaction with the contraceptive teaching method. Patient satisfaction was analyzed as a categorical variable and compared with chi2 tests. Secondary outcomes were compared with chi2 tests and ANOVA. RESULTS: Greater than 90% of patients in each arm were satisfied with the contraceptive counseling that they received. Patients receiving physician-patient counseling expressed a 99% satisfaction rate (p = 0.044). African American (98.2%) and Hispanic (93.5%) patients were more satisfied than Caucasian (83.3%) patients (p = 0.026). Satisfaction with contraceptive counseling decreased with age. CONCLUSION: An organized program of contraceptive counseling provides adequate information for patients to be comfortable with their decision about their postpartum contraceptive method. Patients were most satisfied with physician counseling.

Adolescent↗
PubMed1984

Mortality among young black women using contraceptives.

Data on the risk of death associated with various contraceptive methods are incomplete. Therefore, we analyzed the mortality rates for young, black inner-city women who used one of four methods of contraception--oral contraceptives, depomedroxyprogesterone acetate, intrauterine (contraceptive) devices, and barrier methods. The subjects were 30,580 15- to 44-year-old women who enrolled at a family planning clinic between 1967 and 1972 and who were observed by monitoring death certificates through the end of 1977. Forty percent of the 218 deaths observed were from accidents and violence. Use of this family planning clinic greatly reduced the risk of death from childbearing; only two deaths were associated with pregnancy and childbirth, compared with the 24 deaths expected. Overall, users of the four methods died at similar, low rates. Given that this study involves considerable loss to follow-up, possible acute effects of contraceptives (eg, infections or thrombosis) are more accurately estimated than possible long-term effects (eg, cancer).

Adolescent↗
PubMed2001

Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception.

OBJECTIVE: To clarify the effect of the using the intrauterine device on fertility in nulliparous women. DESIGN: Prospective cohort study of two groups of nulliparous women, one recruited while using an intrauterine device and the other while using an oral contraceptive. SETTING: Seventeen family planning clinics in England and Scotland. SAMPLE: 1,071 nulliparous, married women, aged 18-40 years, 558 of whom contributed information to the main objective of the study. METHODS: The women were recruited between 1982 and 1985 and followed up annually to 1994. Dates and reasons for any contraceptive method changes (which were most frequently to barrier methods) were recorded, together with the outcome of any pregnancies, at each follow up. MAIN OUTCOME MEASURES: The number of nulliparous women giving birth at term after stopping contraception (oral contraceptive, intrauterine device or barrier method) in order to conceive. RESULTS: Women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% were delivered after one year vs 39% of intrauterine device and 32% of oral contraceptive users (log rank P = 0.002). There was no association between fertility and duration of oral contraceptive use: However, short term intrauterine device users (< 42 months) showed a fertility pattern more favourable than seen in those discontinuing oral contraceptives, with increasing duration of intrauterine device use being associated with decreasing fertility (linear trend P = 0.005); the fertility of women who had used the intrauterine device for 78 + months was the most impaired (28% were delivered by 12 months vs 46% of short term users; at 36 months the corresponding figures were 79% vs 91%). This association remained after adjusting for potential confounding factors, including maternal age, husband's social class, and history of gynaecological illnesses, factors which themselves had independent associations with fertility. CONCLUSIONS: Long term intrauterine device use in nulliparous women appears to be associated with an increased risk of fertility impairment.

Adolescent↗
PubMed1995

Differential effects on bone density of progestogen-only methods for contraception in premenopausal women.

The question of differential effects on bone density by two different types of progestogen-only methods for contraception in premenopausal women was addressed. Data from a prospective randomized clinical trial among 22 premenopausal women, age 32.6 (range 20-45 years), who were randomly assigned to either of two treatments with continuous progestogens for contraception were analyzed; depot-medroxyprogesterone acetate (DMPA) or continuous levonorgestrel treatment with subdermal implants (Norplant), respectively. Forearm bone density (BMDprox) increased with 2.94% (p = 0.006) in women who were prescribed levonorgestrel, which was in contrast to stable values in those prescribed depot-medroxy-progesterone acetate; group difference at 6 months for BMDprox 3.4% (95% CI 1.3, 5.5; p = 0.025) and BMDdist 4.1% (95% CI - 1.3, 9.6; p = 0.077). The changes in bone density were consistent with the changes in biochemical indices for bone metabolism; DMPA users showed signs of increased bone turnover and users of levonorgestrel showed increased bone formation with increased levels of both alkaline phosphatase (p = 0.004) and osteocalcin (p = 0.007). The findings suggest an increase in bone density during treatment with levonorgestrel and stable values during short-term administration of DMPA, in standard clinical doses for contraception.

Adult↗
PubMed1996

[Induced abortions in relation to the use of contraceptive agents].

The aim of the study was to investigate the use of contraceptive methods among women referred to an induced abortion. The design was a prospective study of women seeking abortion, 854 were included consecutively. All were asked about the contraceptive methods used preceding their actual pregnancy. Was the contraceptive method used in a regular way, and what was the motive for her voluntary abortion? Of the 854 women, 831 chose to participate and answered the questions (97.3%). We found that 35% had used their contraceptive method in a regular way but became pregnant nevertheless. Another group of 33% had forgotten to use their contraceptives for a few days and became pregnant by accident. In the last group of 32% the women had not used any contraceptive methods. It is concluded that more information is necessary to get women and men to use contraceptive methods regularly with better precision and more seriousness.

Abortion Applicants↗
PubMed2001

[Men participation in contraception according to women's perspective].

OBJECTIVE: To identify women's perceptions on men's participation in contraception. METHODS: Home interviews in the southern region of the city of S. Paulo, SP, Brazil, were carried out. The participant sample was of 254 female users of reversible contraceptive methods, who claimed to have sexual partners at moment of the interview. Statistical analysis of the demographic variables and content analysis techniques of the open questions were performed. RESULTS: In 78.8% of the cases, the contraceptive method of choice was of exclusive female use (pills, injectable, IUD, diaphragm). In spite of the high prevalence of female contraceptive methods, 82.7% of the participants asserted that their male partners were active participants in the contraception, which shows a discrepancy between the method used and their perception on men's participation. The main categories concerning women's perceptions on men's participation in contraception were: men support for the women to use female contraceptive methods and the occasional use by men of male contraceptive method when a woman needs to temporarily interrupt the use of her current contraceptive method. CONCLUSIONS: Women perceive men's participation in contraception as a support for them to use contraceptive methods that are highly efficient. The partner's support may be translated by buying the contraceptive pills, reminding the woman of taking them or expressing their opinion about the desired number of children. Women see contraception as an activity of her responsibility and their partners have an auxiliary role.

Adolescent↗
PubMed1993

Iron status in Danish women aged 35-65 years. Relation to menstruation and method of contraception.

Iron status was assessed by serum (S-) ferritin and hemoglobin (Hb) in a population survey comprising 883 non-gravid Danish women in age cohorts of 35, 45, 55, and 65 years. Premenopausal women (n = 676) had lower S-ferritin, median 42 micrograms/l, than postmenopausal women (n = 207), median 80 micrograms/l (p < 0.0001). Of premenopausal women, 12.1% had S-ferritin < or = 20 micrograms/l (i.e. depleted iron stores), and 35.6% S-ferritin of 21-40 micrograms/l (i.e. small iron stores). Corresponding figures in postmenopausal women were 0.5% and 13.2%. Premenopausal blood donors (n = 88) had lower S-ferritin than non-donors (p < 0.001). In premenopausal women, S-ferritin levels were strongly dependent on the duration of menstrual bleeding (p < 0.0001), which in turn was related to the method of contraception. Women (n = 64) using hormonal contraceptives (the pill) had menstrual bleeding of shorter duration than those (n = 511) not using pills or intrauterine devices (IUD), who in turn had bleeding of shorter duration than those (n = 101) using IUD. Median S-ferritin in pill users was 62 micrograms/l, in those not using pills or IUD 42 micrograms/l, and in IUD users 36 micrograms/l. S-ferritin values < 40 micrograms/l (i.e. small and depleted iron stores) were seen in 25% of pill users, in 48% of those not using pills or IUD, and in 61% of IUD users.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

The intrauterine contraceptive device: an often-forgotten and maligned method of contraception.

Although 90% of women at risk for unintended pregnancy in the United States use contraception, <1% of these women use the intrauterine contraceptive device. The mechanism of action of intrauterine contraceptive devices has been controversial, but several studies suggest that interference with sperm migration or function and with fertilization may be the most likely mechanisms. More important, there is lack of compelling evidence that the intrauterine contraceptive device acts as an abortifacient. The risk for pelvic inflammatory disease among users now appears to be extremely low, primarily as a result of better selection of candidates. A levonorgestrel-releasing intrauterine contraceptive device may offer some new therapeutic approaches for the treatment of certain gynecologic disorders. Although women who are not at risk for pelvic inflammatory disease or sexually transmitted diseases are appropriate candidates for the intrauterine contraceptive device, it appears that use can be expanded to selected nulliparous women and women with certain medical conditions.

Contraceptive Agents, Female↗
PubMed2005

Determinants of spacing contraceptive use among couples in Mumbai: a male perspective.

This study aimed to determine the factors influencing the use of spacing contraceptive methods in India, particularly from men's perspective. Data were obtained through a semi-structured interview schedule from 2,687 married men aged between 18 and 40 years from central Mumbai City, India, during 1999. Chi-squared tests and binary logistic regression analysis was carried out to determine the relationship between various variables and the likelihood of a couple using spacing contraceptive methods. Of the 2,687 couples, 1,395 (51.9%) were using one or other method of spacing contraceptives and 1,292 (48.1%) were not using any method at the time of survey. Male participation in contraceptive use was 23% (condom and withdrawal). The results indicate that the use of spacing contraceptive methods was significantly higher among those couples where the men desired one or two children (OR=4.3), had knowledge of five or more contraceptive methods (OR=1.9) and discussed with their wives obtaining family planning information (OR=3.2), spacing (OR=2.7) and permanent (OR=2) contraceptive methods. Age, income, desired number of children, knowledge of a greater number of contraceptive methods, inter-spouse communication regarding obtaining family planning information, spacing and permanent methods were found to be strong predictors of the use of spacing contraceptive methods. The study underlines the importance of intervention programmes aimed at promoting a small family norm, increasing the number of contraceptive choices available and encouraging inter-spouse communication. Hence, policymakers and programme managers should encourage interventions in this direction, targeting couples to enhance the use of spacing contraceptive methods.

Adolescent↗
PubMed1999

Induced abortion: a method for birth control?

Despite the recent improvements in services and an increase in available funds, the expected increase in usage of effective contraceptive methods and decrease in number of induced abortions has not been seen in Turkey. This study investigates the causes of this situation and argues whether induced abortion is being used as a birth control method. Eight-five subjects were involved in the study, all of whom came to a family planning clinic for an induced abortion. Forty-seven (55.29%) of the participants had had at least one induced abortion prior to this. Eight-four (98.8%) had knowledge of at least one contraceptive method, and 80 (94.1%) had knowledge of at least one effective contraceptive method. Eighty (94.1%) participants had used some form of contraception at some time in their lives; 52 (61.17%) had used an effective contraceptive method at some time in their lives. When they became pregnant, 60 (70.6%) were using ineffective methods or were not using any contraceptive method. Both the participant and the spouse wanted the abortion in 68 (80%) cases.

Abortion, Induced↗
PubMedDate not supplied

The presence of endometrial cells in cervical smears in relation to the day of the menstrual cycle and the method of contraception.

The presence of endometrial cells in cervical smears was studied in a large series of women participating in a population screening program for cervical cancer, in relation to different time periods of the menstrual cycle and to the method of contraception practiced. In the total group of women studied, endometrial cells were present in an average of 12% of the cervical smears. In women who were menstruating cyclically, the percentage of cervical smears containing endometrial cells was not age dependent. Only in women over 52 years was a lower number of endometrium-positive cervical smears found: in postmenopausal women, 0.6% of smears were found to contain endometrial cells. In menstruating women, the frequency of endometrial cells in cervical smears was highest during the menses. After day four, through the proliferative phase, the percentages of cervical smears containing endometrial cells markedly decreased. During the secretory phase, an average of 2% of the smears contained endometrial cells; in the premenstrual phase (after day 25), the percentages of endometrial cell-positive smears rose again. When related to the method of contraception practiced, significant differences in the percentages of cervical smears with endometrial cells appeared. In women using oral hormonal contraceptives, the average numbers of smears containing endometrial cells for the whole cycle as well as for each period of the cycle were significantly lower. This phenomenon might be due to endometrial atrophy on the basis of prolonged use of oral hormonal contraceptives. In women wearing an intrauterine device, at any moment the frequencies of smears with endometrial cells present were significantly higher than the values found in women using any other method of contraception or not using contraceptives. The evaluation of cells originating from the endometrium requires considerable experience. The identification of endometrial cells can be made with greater confidence when the cytologist is aware of the exact date of the menstrual cycle and of the impact on the presence of endometrial cells in cervical smears caused by different methods of contraception.

Adult↗
PubMed1999

Contraceptive status and sexual function of climacteric Chinese women.

The objective of the present survey was to assess the contraceptive status and sexual function of climacteric Chinese women. One cross-sectional study randomly recruited 742 premenopausal, perimenopausal, and naturally menopausal women aged 45-55 years from Beijing. Contraceptive methods were used by 75.6% of premenopausal and 54.2% of perimenopausal women. The primary methods were the IUD and barrier method. The women's choices of methods were related to parity and frequency of sexual activities. Sexual activity was related to the satisfaction of contraceptive methods. Perimenopausal and postmenopausal women were about half as likely to enjoy sexual activity and to experience orgasms than premenopausal women. Women of higher socioeconomic status had a lower risk for decreased sexual functioning. The IUD was the most popular and the most appropriate contraceptive method for perimenopausal women. Sexual function was associated with the women's satisfaction with the contraceptive method used, their menopausal status, and their socioeconomic class.

China↗
PubMed2006

Strategies to improve adherence and acceptability of hormonal methods for contraception.

BACKGROUND: Worldwide, hormonal contraceptives are among the most popular reversible contraceptives in current use. Despite their high theoretical effectiveness, typical use results in much lower effectiveness. In large part, this disparity reflects difficulties in adherence to the contraceptive regimen and low rates for long-term continuation. OBJECTIVES: To determine the effectiveness of ancillary techniques to improve adherence to, and continuation rates of, hormonal methods of contraception. SEARCH STRATEGY: We searched computerized databases for randomized controlled trials (RCTs) comparing client-provider interventions with standard family planning counseling. Sources included CENTRAL, MEDLINE, EMBASE, POPLINE, LILACS, and PsycINFO. SELECTION CRITERIA: Randomized controlled trials (RCTs) of an intensive counseling technique or client-provider intervention versus routine family planning counseling. Interventions included group motivation; structured, peer, or multi-component counseling; and intensive reminders of appointments. Outcome measures were discontinuation, reasons for discontinuation, number of missed pills and on-time injections, and pregnancy. DATA COLLECTION AND ANALYSIS: The primary author evaluated all titles and abstracts from the searches to determine eligibility. Two authors independently extracted data from the included studies. With RevMan 4.2, we calculated the odds ratio for all dichotomous outcomes and the weighted mean difference for continuous data. The studies were so different that we could not conduct a meta-analysis. MAIN RESULTS: We found six RCTs; only one showed a statistically significant benefit of the experimental intervention. In that trial, women who received repeated, structured information about the injectable contraceptive depo-medroxyprogesterone acetate (DMPA) were less likely to have discontinued the method by 12 months (OR 0.27; 95% CI 0.16 to 0.44) than were women who had routine counseling. The intervention group was also less likely to discontinue due to menstrual disturbances. In another study, the intervention group was less likely to discontinue due to dissatisfaction with the contraceptive method, but overall continuation was not affected. AUTHORS' CONCLUSIONS: Most studies to date have shown no benefit of strategies to improve adherence and continuation. These trials have important limitations, however. Two had small sample sizes, several had high losses to follow-up, and the intervention and its intensity varied across the studies. High-quality research is a priority, since adherence and continuation are fundamentally important to the successful use of hormonal contraceptives.

Contraception↗