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PubMedDate not supplied

Current concepts in contraception.

BACKGROUND: Worldwide, contraceptive use has increased substantially over the past two decades. The increased demand for wider choices of contraceptive methods has resulted in extensive research and rigorous clinical trials. This has led to improvements on existing contraceptive methods and also the development of several new, more effective and acceptable methods with fewer side effects. Thus, this article presents a review of existing literature on recent developments on existing contraceptive methods. It also reviews recently developed contraceptive methods currently in use worldwide. METHODS: Relevant literature was reviewed using manual library search, electronic sources such as CD-ROMS and internet articles. CONCLUSION: More effective methods of contraception which are generally safer and easier to administer are increasingly being developed. Hopefully, as they increasingly become available in our environment, they will lead to and increase in acceptance and use of contraception by our women.

Contraception↗
PubMed1994

Rethinking patient counseling techniques for changing contraceptive use behavior.

Some women who use contraception become pregnant. Determinants of pregnancy in these women are fecundity, frequency of intercourse, contraceptive method, and contraceptive behaviors. Current counseling content emphasizes the choice of method, with "education" about a limited set of use behaviors. A listing of use behaviors for oral contraceptives (OCs) shows that "use" should be conceptualized as multidimensional with numerous levels and not a simple dichotomous concept of use versus nonuse. The multidimensional understanding of "use" suggests the need for multidimensional counseling to affect distal determinants of use behaviors: knowledge, motivation, ability, and intentions. A review of behavioral theories suggests that various techniques can be used, in addition to the current emphasis on history taking and patient education, to help women have effective use behaviors. These include assessment for need and individualized counseling. With use of techniques that are widely recognized in other intervention programs, the emphasis of contraceptive counseling would be on the future, on intentions and behaviors, and on mobilizing self-planning and action by the OC user.

Contraception↗
PubMed1999

Knowledge of likely time of ovulation and contraceptive use in unintended pregnancies.

This investigation analyzed social and demographic characteristics of women having an unwanted or mistimed pregnancy (unintended pregnancies at the current time) in South America. A sample of 5135 women having had a normal non-malformed live-born infant were interviewed immediately postpartum at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations (Spanish acronym: ECLAMC). Half (2568/5135 = 50%) reported that their pregnancies had been unintended, and, of those, 59.3% (1522/2568 = 59.3%) declared that they were trying to avoid conception. The latter group (n = 1522) was the main sample for this study. Patients were asked about their knowledge of when during the menstrual cycle conception is most likely to occur, their biomedical and social characteristics, the type of contraceptive methods used, their opinion of reasons for contraceptive failure, and their reasons for not using contraceptive methods. Among women with unintended pregnancies who attempted to avoid conception, only 61.6% were using contraceptive methods. Reasons given for not using contraceptives included health problems, lack of knowledge and lack of access to contraception. Women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning when during the cycle pregnancy is most likely to occur. Thus, reproductive health policies should be aimed at this target group.

Age Factors↗
PubMed2000

Induced abortion and contraception: survey of 576 young women in Naples.

The aim of the study was to investigate the link between induced abortion and contraceptive methods. Five hundred and seventy-six women who underwent induced abortions at the Obstetrics and Gynecology Institute of the Second University of Naples were interviewed. They were asked about their knowledge of contraception methods; age, school attendance rate and marital status were also considered. The women were 27.8 (mean age) years old, high school educated (58.5%), married (41%), nulliparous (63%). Twenty-four percent of the women admitted a previous induced abortion. Withdrawal (176 women), condoms (104) and oral contraceptives (74 women) were the most widely used contraceptive methods. Withdrawal (37%) resulted in being the most utilized method during the cycle in which conception occurred; no method had been employed by 31% of the women. We found that 35% of the women had used their contraceptive method in a regular way but become pregnant nevertheless. Another group of 40% had forgotten to use their contraceptives for a few days and became pregnant by accident. In the last group of 25% of the women had not used any contraceptive methods. The diffusion of modern methods of fertility regulation influences the number of induced abortions as shown by its reduction since 1982. Our data confirm that induced abortion is the consequence of an insufficient use of modern contraceptives. Therefore more information is necessary to get women and men to use contraceptive methods regularly.

Abortion, Induced↗
PubMedDate not supplied

Reproductive health: an international perspective.

The twentieth century began with approximately 1.6 billion human beings in the world and, with an increase of 96 million people per year, will end with over 6 billion people. Unless this trend is directly confronted by the world governments and their citizens, there will be nearly 8 billion by 2025 and over 11 billion by 2050. Thus, reproductive health is and will remain an issue of critical importance for all countries to realize and study. Part of this trend is because of the many pregnancies which occur in adolescents around the world. A number of issues have developed this century contributing to the many pregnant teenagers. For example, India has one of the world's largest populations of teenagers--over 23 million, representing over 26% of the total in the world. Effective methods for contraception and sexually transmitted diseases prevention are available, but not to all sexually active humans. However, many barriers to effective contraception exist around the globe. This article discusses some of them and also reviews use of contraceptive methods in various countries. These include oral contraceptives, emergency contraceptives, injectable and implantable contraceptives, intrauterine devices, barrier contraceptives and others. Reproductive health remains a critical, universal issue for all humans in the world. We all must examine the many pitfalls to controlling the world's populations, including lack of sex education, limited access to effective contraceptives, and others. We cannot afford to let the population continue unchecked. Effective strategies are needed at this time; otherwise, the population will continue to run out of control, negatively damaging the world for the coming generations. There is need to leave a positive, and not negative legacy for the next generation.

Adolescent↗
PubMed2003

[Contraceptive use among adolescents at public schools in Brazil].

OBJECTIVE: There has been a growing interest in patterns of contraceptive use among adolescents, due, in particular, to the social relevance attached to pregnancy in this age group. Therefore, the objective of the study was to investigate factors associated with the use of contraceptive methods among female and male adolescent students. METHOD: A cross-sectional study was conducted, by means of self-applied questionnaires, among 4,774 students ranging from 11 to 19 years of age. Prevalence with respect to the use of contraceptive methods during the first experience of sexual intercourse as well as the most recent one was calculated both separately, that is, for each of these events, and in conjunction as a measure of consistent use. Logistic regression was carried out for simultaneous analysis of factors associated with the use of contraceptive methods and in order to calculate adjusted measures. RESULTS: Among the 1,664 students who reported being sexually active, the factors positively associated with the consistent use of contraceptive methods among male students included a) postponing their first experience of sexual intercourse and interaction with a stable partner, b) the family as a potential supplier of contraceptive methods, and c) access to health services. On the other hand, among female students factors positively associated with the consistent use of contraceptive methods included a) recent sexual initiation, and b) having a father as their source of information regarding sexuality, contraception and STD/AIDS prevention. Pregnancy was reported by 6.4% of the boys and 18.1% of the girls, its absence was associated with the consistent use of contraceptives by them (the girls) (Odds Ratio=3.83; 2.06-7.15). CONCLUSIONS: The results confirm the complexity of determining contraceptive behavior among adolescents and therefore reinforce the need to include multi-dimensional aspects of this theme in order to ensure the efficacy of sex education programs.

Adolescent↗
PubMed2006

Family planning services quality as a determinant of use of IUD in Egypt.

BACKGROUND: Both availability and quality of family planning services are believed to have contributed to increasing contraceptive use and declining fertility rates in developing countries. Yet, there is limited empirical evidence to show the relationship between the quality of family planning services and the population based prevalence of contraceptive methods. This study examined the relationship between quality of family planning services and use of intrauterine devices (IUD) in Egypt. METHODS: The analysis used data from the 2003 Egypt Interim Demographic and Health Survey (EIDHS) that included 8,445 married women aged 15-49, and the 2002 Egypt Service Provision Assessment (ESPA) survey that included 602 facilities offering family planning services. The EIDHS collected latitude and longitude coordinates of all sampled clusters, and the ESPA collected these coordinates for all sampled facilities. Using Geographic Information System (GIS) methods, individual women were linked to a facility located within 10 km of their community. A facility-level index was constructed to reflect the quality of family planning services. Four dimensions of quality of care were examined: counseling, examination room, supply of contraceptive methods, and management. Effects of quality of family planning services on the use of IUD and other contraceptive methods were estimated using multinomial logistic regression. Results are presented as relative risk ratios (RRR) with significance levels (p-values). RESULTS: IUD use among women who obtained their method from public sources was significantly positively associated with quality of family planning services (RRR = 1.36, p < 0.01), independent of distance to the facility, facility type, age, number of living children, education level, household wealth status, and residence. Quality of services related to counseling and examination room had strong positive effects on use of IUD (RRR = 1.61 for counseling and RRR = 1.46 for examination room). Obtaining IUD from a private source or using other contraceptive methods was not associated with quality of services. CONCLUSION: This study is one among the few that used geographic information to link data from a population-based survey with an independently sampled health facility survey. The findings demonstrate that service quality is an important determinant of use of clinical contraceptive methods in Egypt. Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility.

Adolescent↗
PubMed2006

Counselling and knowledge about contraceptive mode of action among married women; a cross-sectional study.

BACKGROUND: Family planning counselling which covers knowledge transfer about contraceptive mode of action, by enabling informed choice, improves compliance to and efficiency of contraceptive methods. The objective of this study was to investigate associations between family planning counselling, counsellor and correct knowledge about mode of action of modern contraceptive methods among married women. METHODS: For this cross-sectional study, stratified (according to current modern contraceptive method in use) random sampling was performed from the registries of two primary health care centres. Main outcomes were; prevalence of family planning counselling, professional background of the counsellor and correct knowledge about mode of action. A semi-structured questionnaire developed by the researchers was applied via face-to-face interview. The answers about mode of action were categorized as correct vs. incorrect by consensus rating. RESULTS: Prevalence of counselling and correct knowledge about mode of action was 49.0% and 39.3%, respectively. Higher educated women were significantly more likely to know the mode of action (p < 0.001). Being counselled by a physician (54.1%, n = 120) was not associated with correct knowledge about mode of action (p = 0.79). Non-barrier method users were less educated (p = 0.001), more often counselled (60.8% vs. 8.0%) and less knowledgeable (p < 0.001) about mode of action of their contraceptive method, compared to condom users. Nevertheless, counselled non-barrier method users were significantly more likely to know the correct mode of action of their chosen method (p = 0.021) than counselled condom users. CONCLUSION: The beneficial effect of counselling on knowledge about mode of action of the more complicated, medical (non-barrier) contraceptive methods suggests that the use of family planning counselling services in primary health care should be promoted; furthermore, counselling strategies and content should be re-structured for better efficacy.

Journal Article↗
PubMed2004

[Sexual initiation and use of condoms and other methods of contraception among 15-year-old adolescents in Poland and other countries].

OBJECTIVE PRESENTATION: (1) Frequency of sexual initiation and use of condoms and other methods of contraception among 15-year old adolescents in Poland and other countries in 2001/2002; (2) Trends of change in these sexual behaviours in Poland between 1990-2002. MATERIAL AND METHOD: Representative samples of adolescents in Poland (mean age 15.7 years) in 1990 (N=1548), 1994 (N=1540), 1998 (N=1638) and 2002 (N=2152) and in other 28 countries (mean age 15.2 - 16.1 years) in 2001/2002, were used. The surveys were carried out in the frame of Health Behaviour in School-Aged Children; a WHO Collaborative Cross-National Study (HBSC), according to an international research protocol. An international standard questionnaire (anonymous) was chosen as an instrument for data collection. It contained four questions concerning sexual behaviour. RESULTS: In Poland, 2002, 20.9% of boys and 9.2% of girls reported sexual intercourse with mean ages respectively 14.1 and 14.7 years. The frequency of sexual initiation was higher (in boys) and the mean age was lower among adolescents living in towns by comparison to those living in cities. More matured adolescents had earlier sexual initiations. 27% of sexually active adolescents reported that either they or their partners had used any methods of contraception during their last sexual encounter. This risk sexual behaviour was more frequent in than cities (respectively: in boys 30.2% and 23.9%; in girls 42.9% and 19.7%). The most common method used was a condom. Between 1990-1998, the percentage of adolescents having sex and using some methods of contraception during their encounter last sexual were observed. Between 1998-2002, frequency of sexual initiation decreased, whereas percentage of non-users increased. In comparison to other countries increased Poland's percentage of adolescents with early sexual initiation in 2001/2002 was low, but the percentage of non-users of contraceptives was the highest. CONCLUSIONS: At risk sexual behaviours are relatively common among 15-year-old adolescents, and more frequent among adolescents living in cities. In comparison to other countries, Polish adolescents the risk of unplanned pregnancies and sexually transmitted diseases is higher. Future monitoring of sexual behaviours is necessary for prevention (including school sexual education) of at risk behaviours.

Adolescent↗
PubMed1995

Attitudes and practice of couples regarding sexual relations during the menses and spotting.

To determine attitudes and practices regarding sexual relations during menstruation and vaginal spotting, a cross-sectional descriptive survey was performed at the Instituto de Investigaciones Materno Infantil, Universidad de Chile, Santiago, Chile. A total of 287 women and 206 men were randomly selected from an urban population. Attitudes, beliefs, and practices regarding sexual relations during vaginal bleeding were surveyed and stratified by educational level and other demographic characteristics. Overall, 70% of women and 72% of men were found to avoid sexual relations during menstruation. Fifty-four percent of women and 60% of men avoided sexual relations during vaginal spotting. Women with higher education (technical or university) were less likely to avoid sexual intercourse compared to those with a lower educational level (basic or secondary education) during menstruation (73% vs. 57%) and vaginal spotting (69% vs. 34%). Men with a higher educational level (university) avoided intercourse less frequently when their partner was spotting (48% vs. 64%). As many methods of contraception affect a woman's menstrual cycle, they therefore may affect the intimacy of a couple. Counseling and education regarding the menstrual cycle and expected alterations by a contraceptive method may reduce any negative impact of a contraceptive device on a couple's sexual life.

Adult↗
PubMed2003

Spanish population at risk of unwanted pregnancy: results of a national survey.

OBJECTIVE: We performed a personal survey in 2218 Spanish women aged from 15 to 49 years to establish the contraceptive methods used by this population and to determine the number of Spanish women of childbearing age exposed to unwanted pregnancy. METHODS: Stratified random sampling was performed to select the women to be interviewed; this sampling design ensured adequate representation of the sample in Spain. RESULTS: At the time of the survey, 69.1% of the women were using some contraceptive method, but 5% of them used poorly effective contraceptive methods, and their exposure to the risk of an unwanted pregnancy was therefore high. Moreover, among the 30.9% not using any contraceptive method, 21.1% were at risk because they were having sexual intercourse, did not want to become pregnant and did not use a contraceptive method. CONCLUSIONS: A little over one million Spanish women are exposed to the risk of having an unwanted pregnancy. Compiling the data on this significant problem is the first step in designing appropriate solutions.

Adolescent↗
PubMed2006

Surgical termination of pregnancy: evaluation of 14,903 cases.

OBJECTIVE: To evaluate the demographic and clinical characteristics of patients who underwent surgical termination of pregnancy and to assess the efficacy of the termination methods. MATERIALS AND METHODS: This retrospective study was carried out on 14,903 healthy women who had intrauterine pregnancy of <or= 10 weeks of gestation as determined by transvaginal ultrasonography. All patients underwent either suction curettage (SC) with dilatation or SC only. Family planning counseling was given to all patients before the procedure and subjects were evaluated for any complications after the procedure. RESULTS: SC with dilatation was performed in 43.2% of patients and SC only was performed in 56.8%. Mean age was 31 +/- 4.3 years. Only 5% of cases were primigravidas and 87% had formal education; 91% had one or more surgical abortions for previous pregnancies. Before the procedure, 67% were using coitus interruptus, 10% condom, 6% intrauterine device, 5% vaginal lavage, and 3% oral contraceptives as the contraceptive method, and 9% did not use any contraception. Infection, excessive bleeding, retention of fetoplacental material and uterine perforation were reported as complications of the procedure. After the procedure and following family planning counseling, 92% began to use an efficient, modern contraceptive method. CONCLUSION: This study points out that surgical abortion is not a contraceptive method. Most surgical abortions can be prevented by effective usage of modern contraceptive methods. The importance of well-planned contraceptive counseling and education is emphasized. Better family planning counseling and education, and the availability of modern contraceptive methods can easily decrease the incidence of surgical abortions.

Abortion, Induced↗
PubMed1997

Trying to prevent abortion.

It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.

Abortion, Illegal↗
PubMed2000

Bone mineral density during long-term use of the progestagen contraceptive implant Implanon compared to a non-hormonal method of contraception.

An open, prospective, comparative study was done in healthy women, aged between 18 and 40 years, to study the effects of long-term etonogestrel treatment on bone mineral density (BMD). The control group used a non-hormone-medicated intrauterine device (IUD). The BMD was measured using a dual energy X-ray absorptiometry instrument. Measurements included the lumbar spine (L(2)-L(4)), the proximal femur (femoral neck, Ward's triangle, trochanter) and distal radius. The period of treatment was 2 years and 44 women in the Implanon group and 29 in the IUD group provided data. Groups were comparable at baseline with respect to age, weight, body mass index, BMD and 17beta-oestradiol status. Changes from baseline in BMD in the Implanon group were not essentially different from those in the IUD group. There was no relationship between 17beta-oestradiol concentrations and changes in BMD in this study population. The results of the present study indicate that Implanon((R)) can safely be used in young women who have not yet achieved their peak bone mass.

Absorptiometry, Photon↗
PubMed1993

China to ban unreliable IUD.

After years of hesitancy, due to financial and manufacturing problems, the Chinese Government has finally moved to replace the steel ring IUD with the Copper T. The steel ring, used by some 60 million women, has been pronounced unreliable by the WHO and is blamed for some 30% of the country's 10 million annual abortions. It will no longer be manufactured. China has received financial and technical assistance from the UNFPA to establish 2 factories to produce the Copper T 220 and next year it will expand this capacity, as well as starting production of the Copper T 380-A. The introduction of the newer IUD is likely to prevent the following events during the next 10 years: 55,600 pregnancies, 18,400 live births, 35,600 induced abortions, 16.300 maternal deaths. 365,000 infant deaths, and 28,800 child deaths. The cheaper IUD was used by more than 40% of Chinese women using modern contraception, making it the country's most common contraceptive method.

Asia↗
PubMedDate not supplied

Contraceptive choice and patient compliance. The health care provider's challenge.

Contraceptive compliance is a multifaceted issue that is influenced by many factors. These factors can directly affect the level of patient compliance, thereby affecting contraceptive method efficacy rates. A review of the literature reveals many studies about contraceptive compliance but a dearth of studies addressing how to change noncompliant behaviors. This article describes the contraceptive methods currently available and their efficacy rates. Patient characteristics and the components of compliance are described as they affect contraceptive efficacy and patient care. Suggestions are made for the use of alternative terminology to include adherence to or continuance of a contraceptive method. Health care providers should realize the impact they can have on a patient's education, decision-making process, and ultimate compliance with a contraceptive method. It is the patient, however, who ultimately makes the decision, either actively or passively, to comply or not and whether to have an unplanned pregnancy.

Contraception↗
PubMed2004

SOGC clinical practice guidelines: Canadian contraception consensus.

OBJECTIVE: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. OUTCOMES: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada. EVIDENCE: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed. VALUES: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.

Canada↗