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PubMed1997

Contraceptive continuation and its determinants in Benin.

To understand better the rates of continuation of different contraceptive methods, a study in 12 family planning centers in Cotonou and Porto Novo, the two largest cities in Benin, was conducted. From January 1 to December 31, 1993, 944 questionnaires completed by new women acceptors of one of three methods of contraception (oral contraceptive, injection, or IUD) were analyzed. For all methods of contraception, the average length of follow-up was 9.5 months. From the start of the analysis, 44.4% (n = 419) of the women were regularly followed, 49.5% (n = 467) were not regularly followed, and 6.1% (n = 58) reported discontinuation of the method. One year after beginning the use of contraception, the cumulative proportion of women at risk of becoming pregnant, for all the methods together, was 42.0% (38.6-45.4%). Age was associated with the probability of abandoning oral contraception (p = 0.01). Three months after the start, the cumulative proportion of drop-out women having chosen oral contraceptive was 37.2% (22.8-51.6%) of the less than 20-year-olds, 19.0% (14.3-23.7%) of the 20- to 30-year-olds, and 23.4% (15.6-31.2%) of the over 30-year-olds. In contrast, drop-out was not associated with age for women using injection (p = 0.96) or the IUD (p = 0.47). Our results indicate a relatively high and rapid rate of discontinuation for modern contraceptive methods, particularly for young women having chosen oral contraceptive. This finding should incite the family planning educators to give more emphasis to the counseling programs, especially during the first three months.

Adolescent↗
PubMed1986

Family building in parents with Down's syndrome children.

Fertility and contraceptive practice were examined by interview with parents of 100 Down's syndrome patients. Before the birth of the affected child, fertility was low by comparison with that in married women in the general population, and to this the socioeconomic class bias in the sample is thought to be contributory. By comparison with the number of children intended had the Down's syndrome propositus been unaffected, the actual subsequent fertility was reduced. There seems to be an increased number of other types of defect in these sibships. As a contraceptive method, sterilisation was chosen by an elevated proportion of parents. Despite their acceptance of the child, the majority of mothers would wish to terminate any future pregnancy in which an abnormal fetus was diagnosed.

Adolescent↗
PubMedDate not supplied

What family planning methods women use and why they change them.

Each woman in a sample of 800 women from a nonprofit, private family planning clinic reported using at least one contraceptive method at some time in her life. Over the 15-year period that the sample represented, women made from 1 to 26 family planning visits. The women reported using as many as eight different methods and making up to 11 changes in method. The reasons for changing methods were, for the most part, logically related to the method, at least as far as common user complaints and side effects were concerned, but they also reflected misperceptions regarding relative risk of methods and a low tolerance for a method's disadvantages. A lack of congruence between choice and use was revealed, as women returned for care and reported that they had not used the contraceptive method they had chosen at the last family planning visit or had changed methods one or more times since that visit.

Adolescent↗
PubMed2004

Vesicovaginal fistula after Irving sterilization: a case report.

BACKGROUND: Patients scheduled for gynecologic surgery must be informed about the development of urogenital fistulae as a possible complication. CASE: A 49-year-old woman underwent Irving sterilization with subsequent abdominal hysterectomy due to intraabdominal abscess formation. Inadvertent damage complication to the bladder during hysterectomy led to development of a vesicovaginal fistula despite intraoperative management. The fistula was repaired at once in a second session. As a sequela of bladder injury, the patient had recurrent vesical diverticula and urolithiasis with repeated removal of the diverticula and stones. A subsequent intervention performed laparoscopically led to development of a second vesicovaginal fistula. In addition, an anesthesia-induced complication resulted in cerebral hypoxia with postoperative development of Parkinson's disease. CONCLUSION: Retrospectively, there is doubt whether the proper surgical procedures were employed in this case. The fact that the patient had type 1 diabetes mellitus gives rise to the question of why no conservative method of contraception was chosen. The type of operative approach in elective surgery should always be planned on the basis of the individual patient's overall condition and in relation to the anatomic situation.

Abdominal Abscess↗
PubMed1992

Contraception for the postpartum woman.

The postpartum woman has the full array of contraception options available to her to prevent a subsequent pregnancy. Two factors may influence the choice of the method and the timing of the onset of use (when pregnancy risk increases): the infant feeding mode chosen and the reproductive involution process. The major controversial area regarding contraception postpartum is the use of oral contraceptives if the mother is breastfeeding (ie, if and how do steroids affect the lactation process or infant health). This article reviews the physiologic and hormonal changes that occur after birth, examines the data available in relation to the influence of steroidal contraceptives on lactation, and presents postpartum implications of the use of the spectrum of contraceptive choices. The nurse can provide an important role in counseling postpartum women regarding contraceptive alternatives and supporting families in attaining their childbearing goals.

Breast Feeding↗
PubMed1977

Contraceptive practice by women presenting to a free-standing abortion clinic.

A study was made of the contraceptive methods practised by the first 1,007 women who presented to the Preterm Sydney Clinic regarding pregnancy termination, after the clinic opened in June, 1974. The women's use of contraception at the time of the conception in particular, and also the women's general contraceptive history are described. These factors are related to social and demographic variables of age, marital status, educational level, occupation, country of birth, and religion. Additional discussion is included on the types of contraception used, the sources of contraceptive knowledge, and the methods chosen to use after the abortion.

Abortion Applicants↗
PubMed2004

Awareness and practices of contraception among Pakistani women attending a tertiary care hospital.

Pakistan is one of the most populous nations in the world, with an annual growth rate of 2.8 and high total fertility rate, even among developing nations. The Pakistan Reproductive Health and Family Planning Survey highlighted the wide gap between knowledge (97%) and use of contraceptives (28%) among currently married women. Our actual need is to enhance contraceptive practice in our country. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. This questionnaire-based study was conducted at the Gynaecology Unit II of Sir Ganga Ram Hospital, Fatima Jinnah Medical College, Lahore, Pakistan. A total of 204 married women of reproductive age were interviewed by a registrar to record their age, occupation, educational status, number of children, knowledge about contraceptive methods, source of the knowledge, attitudes and practices of contraception. About 57% of women were between 26 and 35 years of age, while 52% of men were between 31 and 40 years. Educational status of the majority of females was below matriculation (33%), while 34% males were above matriculation; 88% of females were housewives and less than 1% of men were out of work. Regarding the social status of couples, 64% were living on income less than 5000 rupees /month (about 60 pound sterling). Of the women, 67% were para 2-5; 68% had some sort of awareness regarding contraception. The main source of information was television (26%) and relatives (24%). The majority knew about the pill (68%) and IUCD (55%). Only 47% were using some sort of contraception. The most common method chosen was the barrier method (15%), followed by IUCD (10%) and the pill (10%). The least common methods were sterilisation (2%) and the rhythm method (2%); 85% of the women and 74% of the men in the study group had a positive attitude toward contraception. In order to improve contraceptive use in Pakistan we need to use multiple media sources to educate couples and their parents regarding contraceptive services, strengthen the perceptions that religion not only allows but also recommends family planning and to create awareness among women to have their rights and opinions about the size of family. The concept of differentiation between sons and daughters should be discouraged. In addition government and non-governmental organisations (NGOs) should organise groups to provide counselling and promotion of contraceptive services at the doorstep. We must act as a team to control our growth rate for economic stabilisation of the country and to raise the living standards of our people.

Adult↗
PubMed1995

Surveillance of family planning services at Title X clinics and characteristics of women receiving these services, 1991.

PROBLEM/CONDITION: Public health surveillance data describing family planning services at Title X clinics and characteristics of women receiving these services during 1991 are contained in this report. These data update previously published information concerning characteristics of women and services at such clinics during 1981. REPORTING PERIOD COVERED: 1991. DESCRIPTION OF SYSTEM: Data characterizing patients and services were reported by family planning clinics to Title X grantees. These data for 1991 were provided by all 75 grantees to CDC's Family Planning Services Surveillance (FPSS) project. RESULTS: In 1991, 4.2 million women received services at Title X clinics. Overall, 69.5% of family planning patients had chosen oral contraceptives as their method of contraception, and 64.7% of patients were at or below the federal poverty level. In addition to information characterizing patients and services at Title X clinics, this report also evaluated current data-collection methods used by Title X grantees. Complexities in the analysis reflected variations in the quality and availability of data, including differences in definitions, data-collection instruments at the clinic level, and data categories. INTERPRETATION: The number and characteristics of family planning patients receiving services at Title X clinics during 1991 were similar to the number and characteristics during 1981. Furthermore, these results underscore the need to improve the quality and timeliness of family planning data and to facilitate program planning and operations at the grantee level. ACTIONS TAKEN: These surveillance findings have been communicated to state family planning administrators and to national Title X program administrators. This information will be used to assess how publicly funded family planning clinics currently contribute to health-care delivery and how these clinics might contribute to a national system of reproductive health-care services in the future.

Adolescent↗
PubMed1993

Spermicidal and antiviral properties of cholic acid: contraceptive efficacy of a new vaginal sponge (Protectaid) containing sodium cholate.

Cholic acid (sodium cholate) exhibits a strong spermicidal and antiviral [anti-human immunodeficiency virus (HIV)-1] activity. The same effects are observed for F-5 Gel, the active mixture of a new contraceptive sponge (Protectaid), which contains sodium cholate in association with low concentrations (0.5%) of nonoxynol-9 and benzalkonium chloride. Both cholic acid and the F-5 Gel exert a dose-dependent, in-vitro inhibitory effect (i) on the activity of HIV-1 associated reverse transcriptase in an acellular system and (ii) on the potential of HIV-1 efficiently to infect human lymphocytes. During 12 months use, the contraceptive efficacy of the 'Protectaid' sponge was 100% in 20 young women who had chosen this method for reasons of both contraception and anti-sexually transmitted disease. No side-effects were recorded throughout this period. Cervical cultures at 6-month intervals showed the presence of Mycoplasma hominis and Candida albicans in one or two cases. The combined spermicidal and anti-HIV properties of cholic acid reported in this paper and used in the 'Protectaid' sponge offer a new and modern protective method of contraception.

Adult↗
PubMed2000

[Contraception from the viewpoint of women (2): Long-term pill users are especially pleased by the advantages of hormonal contraception. Comprehensive study of motives at first and refill prescription of the pill and evaluation after 3 months of hormonal contraception].

The pill is the most famous contraceptive method beside the condom. It has a positive image both with women taking it for the first time as with women taking it again after an interruption: they appreciate its efficacy and its easy use. They consider a potential weight increase as a major disadvantage of the pill but do not fear serious health risks. Younger women are significantly more concerned by the lack of protection from AIDS. Young women start their "contraception carrier" with the condom and switch to the pill later. Middle-aged women had usually chosen the pill as first contraception method. The quality of life with the pill is considered as positive, especially its effects on skin and menses.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Contraceptive efficacy of daily administration of 0.5 mg mifepristone.

The antiprogestin mifepristone has shown potential to be used as a contraceptive. If 200 mg mifepristone is administered immediately after ovulation, the endometrium shows sufficient impairment of secretory development to prevent implantation. Low daily doses of mifepristone have been shown to reduce several of the local factors regarded as crucial for implantation in human endometrium. To find out if this regimen is sufficient to prevent pregnancy, 32 women were recruited for a study where 0.5 mg mifepristone was administered daily. A total of 141 cycles were studied. Five pregnancies occurred, which was significantly less than if no contraceptive method had been used. However, the dose chosen did not seem sufficient to act as a contraceptive although it is probably not possible to increase the dose without disturbing ovulation and bleeding pattern.

Adult↗
PubMed1997

Contraceptive outcomes among adolescents prescribed Norplant implants versus oral contraceptives after one year of use.

OBJECTIVE: Our goal was to evaluate both the continuation and pregnancy rates and the side effects experienced during the first year of use by adolescents who selected Norplant implants as compared with those who chose oral contraceptives for contraception. Furthermore, side effects experienced at 6 versus 12 months among Norplant implant users were compared to determine whether they diminished with continued use of this method. STUDY DESIGN: We conducted a case-control study of 56 adolescents < or = 18 years old who selected implants as compared with 56 age-matched controls who chose oral contraceptive pills during the same time period. RESULTS: Only 34% of patients prescribed oral contraceptives as compared with 91% of Norplant implant patients were still using their chosen method 1 year later. As a result 25% of oral contraceptive users became pregnant within 12 months as compared with none who selected Norplant implants. Side effects were reported by > 80% of patients in both groups, with menstrual irregularities reported more often by Norplant implant users than by oral contraceptive users (73% vs 5%, p = 0.01). Furthermore, Norplant implant users gained more weight than oral contraceptive users (8.7 vs 4.2 pounds) and were twice as likely to have an abnormal Papanicolaou smear. Finally, little diminution in side effects was observed during the second 6 months of Norplant implant use. CONCLUSIONS: These data confirm that Norplant implants provide better protection against unintended pregnancy in an adolescent population but may be associated with more side effects. Clinicians should be aware of these findings so they can adequately counsel young patients about these two methods of contraception.

Adolescent↗
PubMed1994

[The 1st phase of a prospective study of the effectiveness of natural family planning conducted in French-speaking Belgium].

UNLABELLED: The aim of this pilot-study is to check the practical efficiency and the acceptability of a recent NFP method in Western Europe. MATERIAL AND METHODS: In a first stage, 58 participants, aged 18 to 49, provided 940 cycles (78 woman-years) being with an average of 16 cycles each, all well-documented (sympto-thermal chart and supporting card). The average age of the women was 32 years. 53% of them have chosen NFP after giving up another contraceptive method. The applied NFP method uses a double check to accurately define the beginning as well as the end of the fertile phase of the menstrual cycle. The indicators of the beginning of the fertile phase were: the first sign of cervical mucus and a calendar calculation. The indicators of the end of the fertile period were: the third morning of high temperature and the evening of the fourth day after the peak mucus or the peak cervix. Four participants out of five regularly uses the cervix index. RESULTS: No method failure was seen. One unplanned pregnancy (user failure) was recorded. Pearl-Index (practical effectiveness of the method) was: 1.75. Pure NFP (i.e. no additional contraceptive means during the fertile phase) was applied in 85% of the cycles. Moreover unprotected sexual intercourse during the fertile phase occurred in 17% of the cycles. So in 71% of the cycles, couples had accepted periodic abstinence. CONCLUSIONS: After more than 78 years of use, it appears that an accurate and thoroughly taught sympto-thermal method of NFP shows a use-effectiveness which can be compared to that of the up-to-date contraceptive methods. The acceptance of the method proved to be excellent. The acceptability turns out to be very good.

Adolescent↗
PubMed2002

Contraceptive practice in a teaching hospital in south-east Nigeria.

During the study period of 31 months (1 November 1994-31 May 1997), the sociodemographic characteristics of 200 women attending the family planning clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, South East Nigeria were studied. The peak age group of the family planning acceptors was 31-35, constituting 82 (42%) of the study population. Women of parity 5-7 constituted 99 (49.5%) of the study population; 66 (33%) women sought contraception less than 4 months after delivery and 120 (60%) within 1 year of delivery; 104 (52%) were still breastfeeding at time of visit; 120 (60%) had never used any form of contraception. The intrauterine contraceptive device was the most popular method, being chosen by 128 (64%) women, while only five (2.5%) women accepted bilateral tubal ligation. One hundred and eight (54%) women wanted more children in future. Most of the patients acquired knowledge of family planning through clinic personnel (nurses). The contraceptive prevalence rate in relation to deliveries at the hospital over the period of study was only 12.8%. There is a need for increased awareness on the availability and benefits of family planning on child spacing, family health and ultimately population control and society health.

Adolescent↗
PubMed2000

[Causes for accepting or not accepting contraceptive methods in the immediate postabortion].

OBJECTIVE: To determine the causes that motivate acceptance or not-acceptance of contraceptiva methods in the immediate post abortion period. Material and methods. 191 questionnaires were applied to immediate post abortion patients, in the "Luis Castelazo Ayala" Gynecology and Obstetrics Hospital of the Instituto mexicano del Seguro Social. Patients were divided by two groups: acceptants (n = 75) and not-acceptants (n = 116). Both groups were compared with Student's t test and contrast of proportions. RESULTS: There were not significant differences in the general characteristics of both groups like age, age at menarche, beginning of sexual intercourse, age of marriage or free union, school grade, age at first pregnancy, number of pregnancies, gestational age of the last pregnancy that ended in abortion, previous use of contraceptiva methods and previous experience with them and whether or not they wanted a new pregnancy. The contraceptive method was offered to all patients in the acceptant group. Information was given to 45.33% of them and was considered satisfactory in 75.00%. In contrast, not-acceptants that received information were only 26.72% (p < 0.05) and all of them (100.00%) considered it inadequate (p < 0.05). In 20.68% of the women the method was not offered (p < 0.05). Medical contraindications were present in only 6.03%. The accepted methods were intrauterino device (64.00%), parentheral methods (16.00%), oral contraceptives (13.33%), surgical sterilization (5.33%) and condoms (1.33%). The contraceptive coverage of post abortion patients was 39.27% in this period. CONCLUSIONS: The use of contraceptive methods in post abortion patients can be increased if it is offered systematically to all patients who have had an abortion. Information given to patients must be understandable and sufficient to dissipate fears and ciarify doubts regarding the contraceptive method; contraceptive options must be offered according to the reproductive expectancies and using the informed consent to reinforce the acceptance of the chosen method.

Abortion, Spontaneous↗
PubMed2001

Will the pill make me sterile? Addressing reproductive health concerns and strategies to improve adherence to hormonal contraceptive regimens in adolescent girls.

UNLABELLED: PAPER OBJECTIVE: This paper is designed to help clinicians understand the relationship between hormonal contraceptive side effects and the potential development of general and reproductive health concerns that can impact on adherence to hormonal contraception. By understanding the concerns raised by young women, we can then make our counseling more specific to the factors that affect compliance in this population. DESIGN: Studies that specifically addressed hormonal contraceptive compliance, side effects, and method selection in adolescents and young women were chosen for this paper. All articles were from peer-reviewed journals. Medline-Ovid articles from 1980-2000 were used with the following search keywords: Contraception, Patient Compliance, Hormonal Contraception, Oral Contraceptive Pills, Norplant, Depo Provera, and Adolescents. DATA SYNTHESIS: The general public has many concerns about the safety of hormonal contraception. The development of side effects, especially those that are menstrual-related, seem to cause adolescents and young women to feel that their general and reproductive health is being threatened. CONCLUSIONS: Hormonal contraceptive counseling should include 1) explaining, in a nontechnical manner, how these methods work; 2) addressing negative information the patient has heard about the methods; 3) providing factual information about cancer risks, blood clots, and other general health concerns; 4) discussing the potential side effects and what each means to her health; 5) asking specifically about possible reproductive health worries, especially in light of the menstrual irregularities that may occur; and 6) assuring the patient that she should always feel free to share her concerns and worries with you, the provider.

Adolescent↗
PubMedDate not supplied

Vaginal flora of first time urban family planning attendants in Accra, Ghana.

OBJECTIVE: To determine the vaginal flora of first time urban Family Planning clients at Korle-Bu Teaching Hospital and to assess its implications for the contraceptive choices made. DESIGN: A cross sectional study. METHODS: A standardized questionnaire surveying the sociodemographic characteristics and the choice of Family Planning method was administered to 100 clients at the Korle Bu Teaching Hospital between March and September 2001. High vaginal and endocervical swabs were also taken during the inspection of the vagina and cervix using a sterile bivalve speculum. The specimens were transported in Amies transport medium to the Microbiology laboratory for processing. RESULTS: The age range of the clients was 19-48 years with a modal age of 28 years. Ninety-six percent of them were married while 86% lived in urban slums. Sixty-three percent were sure of their last menstrual period. Potential pathogens were isolated from culture in 56% of the clients. Organisms causing bacterial vaginosis were the most prevalent in their genital tract. The intrauterine contraceptive device (IUCD) was the most common Family Planning method chosen, followed by the Norplant and the Depo-Provera injections. Potential pathogens were isolated from culture in 50% of those who chose the IUCD. CONCLUSION: Potential pathogens were isolated from culture in 56% of these first-time clients and organisms causing bacterial vaginosis were the most prevalent in the genital tract. It is suggested that Family Planning clients who screened positive for potential pathogens and opt for the IUCD should be considered for prophylactic antibiotics at insertion.

Adult↗
PubMed2002

Advance information improves user satisfaction with the levonorgestrel intrauterine system.

OBJECTIVE: To evaluate parameters associated with and the impact of advance information given in a regular outpatient setting on user satisfaction with the levonorgestrel-releasing intrauterine system. METHODS: A questionnaire was sent to 23,885 women in Finland who had had a levonorgestrel intrauterine system inserted between 1990 and 1993. The number of returned questionnaires was 17,914 (response rate 75%). Cumulative logistic regression analysis was based on the five-grade scale of satisfaction as a dependent variable. RESULTS: Most users of the levonorgestrel-releasing intrauterine system (74%) were very or fairly satisfied with it, although over 70% of them had chosen it because of dissatisfaction with their previous method of contraception. User satisfaction increased with age and was associated with the amount of information about different symptoms (menstrual, greasiness of hair/skin, pregnancy, pelvic inflammatory disease, and missed periods) regardless of whether the symptom in question was actually experienced. The women who received information about the possibility of absence of menstruation were more satisfied than the less informed women (odds ratio 5.0, 95% confidence interval 4.1, 5.9). CONCLUSION: Information received at the insertion visit is strongly associated with increased user satisfaction among the users of the levonorgestrel intrauterine system. The association between high user satisfaction and advance information was strongest regarding the possibility of missing periods.

Adult↗