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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↗
PubMed1995

Family planning in genitourinary medicine: an opportunistic service?

OBJECTIVE: To evaluate and serve the need for contraception in those not using conventional sources of family planning services. SETTING: South London outpatient genitourinary medicine department at King's College Hospital. DESIGN AND SUBJECTS: Prospective study of 200 women seen consecutively in the clinic by the same doctor (LM) during 1993. Women at risk of unwanted pregnancy were identified, and offered immediate contraceptive provision or referral. RESULTS: 15 women (7.5%) were using no contraception, despite being sexually active and not wishing to conceive; of these two presented with an unwanted pregnancy. A further 23 women (11.5%) were not using their chosen contraception effectively, and another 20 women were unclear about contraceptive methods and wanted advice. Young women were most at risk; 14% of those aged 25 years and under were using no contraception. Eight women wished to defer contraceptive advice; of these four defaulted from follow up. Eighteen women (9%) wanted immediate contraceptive supplies. Ten of 18 returned a follow up questionnaire; all these women were satisfied with the contraceptive advice service received. CONCLUSIONS: Absent or ineffective contraception is common in women attending an inner city genitourinary medicine clinic. Immediate provision of contraceptive education, advice and supplies is welcomed by patients.

Adolescent↗
PubMed2000

Lifetime patterns of contraception and their relationship to unintended pregnancies.

BACKGROUND: For the past 30 years many effective methods of contraception have been available, yet unintended pregnancy rates still range from 30% to 50% in many populations. We examined patterns of women's contraceptive use throughout their lives and relate them to unintended pregnancy. METHODS: A total of 396 women aged 18 to 50 years chosen by convenience sampling from a family practice residency office were interviewed in a cross-sectional study about their history of using and changing contraception, and whether they believed they became pregnant while using a method of contraception. We analyzed the data for correlations and significance using chi-square and Student t tests. RESULTS: Most women had used both condoms and oral contraceptive pills, and tried an average of 3.54 methods during a lifetime. Two patterns of women's use of contraception emerged that describe 75% of the women. One third of the women--those who indicated a pattern of following their first method with a less effective method--are significantly more likely to have an unintended pregnancy while using contraception (odds ratio=1.4). The other group (50% of the entire sample) used increasingly effective methods and were less likely to have an unintended pregnancy. CONCLUSIONS: Pregnancy is an inherent natural consequence of sexual intercourse, even when using very effective contraceptive methods. By asking a few questions about a woman's history of contraceptive use, physicians may be able to determine those who are more likely to be at risk for an unintended pregnancy.

Baltimore↗
PubMed1996

[Utilization of contraceptive methods during the lactation period].

OBJECTIVES: To find the use of family planning methods during breast-feeding and establish whether there is a relationship with social-demographic questions or the breast-feeding. Secondly, to evaluate nursing mothers' understanding of these methods. DESIGN: An observational, crossover study using a self-administered questionnaire. SETTING: Primary care. PARTICIPANTS: 398 women in their 7th month of breast-feeding were chosen by simple random sampling from the register of births. Reply rate: 85.2%. MEASUREMENTS: The use of contraceptive methods (CM), type of breast-feeding, social-demographic characteristics, information received and women understanding of family planning (additive Likert-type scale). RESULTS: 78% of the women interviewed said they used some CM after delivery: barrier methods were the most common (63.7%). Use was significantly greater in women with a lower level of information or who had previously used CM. CONCLUSIONS: Women with a lower level of information or who had used family planning methods previously said they used them more during breast-feeding. There is insufficient information about contraceptive methods during this period, especially among less educated women. Understanding of CM increases when breast-feeding lasts longer. Activities performed by health staff are not connected to women better understanding of contraception.

Adolescent↗
PubMed2004

Screening family planning needs: an operations research project in Guatemala.

BACKGROUND: Public sector health care providers in rural Guatemala have infrequently offered family planning information and services in routine visits. This operations research project tested a strategy to modify certain practices that prevent health workers from proactively screening clients' needs and meeting them. METHODS: The research design was quasi-experimental with a pretest-posttest-follow-up comparison group design. Health districts, which comprise health centers and posts, were purposively assigned to intervention or comparison groups to assure comparability of the two groups. The strategy was based on a job-aid designed to guide health workers in screening clients' reproductive intentions and family planning needs, help them to offer contraceptive methods if the woman expressed interest, and facilitate the provision of the method chosen at the time of the visit. The strategy was implemented at intervention sites during a period of six months. Upon completion of post-intervention measurements, the strategy was scaled up to the comparison sites, and a follow-up assessment was conducted nine months later. Results were evaluated by conducting three rounds of exit interviews with women exposed to the risk of unwanted pregnancy. RESULTS: Study results showed a two to five-fold increase in providers' screening of clients' reproductive intentions. The proportion of clients who received information about contraceptives increased from 8% at the baseline to 42% immediately post-intervention, and 36% at the follow-up survey. The intervention also proved successful in improving the role service providers play in offering women a chance to ask questions and assisting women in making a selection. The proportion of women who received a method, referral or appointment increased and remained high in the intervention group, although no change was seen in the comparison group after their participation in the strategy. CONCLUSION: The easy-to-use job aid developed for this project proved useful for screening clients' needs and reducing providers' reluctance to discuss family planning with clients and offer contraceptive services. Such family planning screening devices can be useful in traditional settings where both providers and clients shy away from discussing family planning issues.

Journal Article↗
PubMed1976

Postpartum contraception: subsequent pregnancy, delivery, and abortion rates.

The first subsequent pregnancy rate in a group of women who accepted a variety of contraceptive methods after delivery and after therapeutic abortion is reviewed. Regardless of method chosen, 20 to 30% of postdelivery and 18 to 20% of postabortion patients were pregnant again after 1 year. In those patients who chose no method, 30 to 40% of postdelivery patients and 19 to 30% of postabortion patients were pregnant again 1 year later. When the postdelivery and postabortion patients were compared by outcome of this first subsequent pregnancy, there was no indication that subsequent therapeutic abortion was utilized to a greater extent by those who had had a prior therapeutic abortion than by those who had had a prior delivery.

Abortion, Therapeutic↗
PubMed1999

Oral contraception: current use and attitudes.

Oral contraception (OC) has been available for almost four decades. During this time, changes in contraceptive use in general and OC in particular have occurred. Knowledge and attitudes about OC may not always reflect trends in use. Contraceptive use data from 1965-1995 show that OC continue to be the method chosen consistently by more than one-quarter of women contraceptors. Probably even more women would use the pill if they had more accurate information regarding the higher failure rates with barrier methods (especially the condom), if misperceptions about OC safety were put to rest, and if greater awareness of the noncontraceptive health benefits of OC could be achieved. Increased education and awareness of women as well as their healthcare providers has the potential to positively affect future contraceptive use.

Breast Neoplasms↗
PubMedDate not supplied

Adolescent clinic visits for contraception: support from mothers, male partners and friends.

CONTEXT: To increase effective contraceptive use among adolescents at high risk of pregnancy, it is important to understand what factors influence them to visit a clinic for contraception, including support from their mothers, male partners and friends. METHODS: Data from a prospective cohort study of 399 teenage clinic attendees using the pill, the implant or condoms were collected through a questionnaire at baseline and at a one-year follow-up interview. Data were analyzed using multivariate regression analysis to show differences in social support for adolescents' clinic visit at baseline and method continuation at one year. RESULTS: Almost all teenagers (96%) reported that their mother, a male partner or a friend was aware of their clinic visit for contraception; of these, 92-96% also said that their mother or a male partner was supportive. Teenagers who chose the pill or implant were more likely than condom users to report that their mother and male partner were aware and that their mother was supportive of their contraceptive clinic visit. Implant users were significantly more likely than those who chose the pill or condom to continue using their chosen method for one year. Teenagers who took part in high-risk behaviors were more likely than others to involve a friend but not their mother or a male partner in their contraceptive decision-making. CONCLUSIONS: Pregnancy prevention programs and counseling protocols that integrate supportive networks for teenagers into contraceptive services may help adolescents to use effective methods.

Adolescent↗
PubMed2005

The impact of menstrual side effects on contraceptive discontinuation: findings from a longitudinal study in Cairo, Egypt.

CONTEXT: Although many research studies have documented the relationship between menstrual side effects of contraceptives and discontinuation of use, few have sought to identify factors that predispose women to discontinue because of changes in bleeding patterns. Such information is important to enable family planning providers to better help women and couples choose appropriate methods and use them successfully. METHODS: Forty-eight women participating in six focus group discussions described their experiences using the IUD, the hormonal implant or the three-month injectable. Subsequently, 259 women using one of these methods for the first time were followed for up to 18 months to determine patterns of menstrual bleeding and perceptions of menstrual cycle change over time. Multivariable analytical methods were used to examine the associations between selected measures and method discontinuation. RESULTS: Contraceptive discontinuation differed by method: Nearly 70% of injectable users had stopped using their chosen method after one year, compared with 34% of IUD users and 10% of implant users. Before initiating a method, women reported an average of five bleeding days per cycle. During the first six months of use, IUD users reported an average of six days of bleeding per cycle; injectable and implant users reported 11-12. In multivariable models, each additional day of bleeding was significantly associated with a 2-4% increase in discontinuation, depending on method type. Among IUD users, women whose husbands knew that they had visited a clinic to initiate a method were less likely than others to discontinue method use (hazard ratio, -1.9). Age was significantly associated with decreased discontinuation among implant users. CONCLUSION: Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.

Adult↗
PubMed2001

The effect of low-dose combined oral contraceptive pills versus injectable contraceptive (Depot Provera) on liver function tests of women with compensated bilharzial liver fibrosis.

This was an open comparative trial of two types of hormonal contraceptives, a low-dose combined oral contraceptive and the injectable depot-medroxyprogerone acetate, with a control group using an intrauterine device (copper T-380). Clients were recruited from bilharzial patients attending the maternal-child health and family centers affiliated with the National Liver Institute. Clients with compensated bilharzial liver disease were chosen and were divided into three subgroups according to their own preference for the method of contraception. Baseline, 2-, and 4-months liver function tests were compared, and abdominal ultrasound scanning of the liver was done. There was a nonsignificant change in liver function tests, and the portal vein diameter measured by ultrasound scanning was not changed with steroidal contraceptives. The use of combined oral contraceptive containing low-dose estrogen or using depot medroxyprogertone acetate injectables are safe and can be prescribed in cases with compensated bilharzial hepatic fibrosis with normal function.

Alanine Transaminase↗
PubMed2005

[Is gestagen IUD a realistic alternative to female sterilization?].

INTRODUCTION: For years, female sterilization has been regarded as the most reliable contraceptive method available. However, sterilization is irreversible and requires a surgical procedure. The purpose of our investigation was to see how many women who were offered a reversible, long-term, non-surgical method would prefer it as an alternative to sterilization. MATERIALS AND METHODS: All women referred to our unit for sterilization in the years 2000 and 2001 were offered a consultation in non-operative methods of long-term contraception. All women were offered a levonorgestrel intrauterine system (LNG-IUS) while waiting to be sterilized. The women who chose LNG-IUS were followed for 1-3 years to see if they were later sterilized. RESULTS: Of the 151 women, 14 didn't come in for consultation. Among the 137 remaining women, the primary choice for 69 (50%) was sterilization; 58 women (43%) chose LNG-IUS, and 10 (7%) chose other alternatives. By the end of the observation period, 6 (10%) of the 58 women in the LNG-IUS group had chosen to be sterilized. DISCUSSION: LNG-IUS is a long-term reversible contraceptive method with an efficacy comparable to that of female sterilization. The results suggest that all women referred for sterilization should be counselled about effective alternative methods before proceeding with sterilization.

Adult↗
PubMed1980

Contraception in the adolescent: current concepts for the pediatrician.

An overview is presented of the major methods of contraception available to the sexually active adolescent. Emphasis is given to the combined birth control pill, while the literature describing absolute and relative contraindications to oral contraception is reviewed. It is noted that adolescents with chronic illness must also be evaluated for contraceptive needs. Other methods covered include the intrauterine device, barrier methods (diaphragm, condom, and vaginal contraceptives), injectable contraceptives, postcoital contraception, and methods under current investigation. The approach to each patient must be individualized, based on her coital activity, understanding of alternatives, medical status, and what method is chosen.

Adolescent↗
PubMed1989

Sociodemographic determinants of contraceptive method choice in Sri Lanka: 1975-82.

The determinants of contraceptive method choice in Sri Lanka are examined during a period in which contraceptive prevalence increased by over 60% and involved substantial use of sterilization and traditional methods. Data are from the 1975 World Fertility and 1982 Contraceptive Prevalence Surveys. Polytomous logistic regression is used to model four current contraceptive choices: non-use, use of a traditional method, use of a modern temporary method and use of sterilization. The analysis shows, in 1975 and 1982, strong socioeconomic as well as demographic effects on whether any method is used. However, in both years the type of method chosen is primarily a function of demographic considerations related to the couple's family-building stage rather than social status, implying that in Sri Lanka there are few socioeconomic barriers limiting access to different contraceptive methods. The family planning programme, however, has emphasized sterilization rather than birth spacing methods.

Age Factors↗
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↗
PubMed1996

Dihydroxyprogesterone acetophenide 150 mg + estradiol enantate 10 mg as monthly injectable contraceptives.

A survey among users and health personnel participating in the Salvadorian Social Security Institute (ISSS) Family Planning Program revealed interest in including a monthly preparation for injection as a contraceptive method offered by this Institution. The formulation containing dihydroxyprogesterone acetophenide (DHPA) 150 mg + estradiol enantate (E2EN) 10 mg was chosen for conducting an open and prospective study of efficacy and tolerability. Between January 1992 and March 1994, 7054 women were treated with this product for a total of 60010 months. A sample composed of 4505 women treated at this Institution confirmed that average users are young, have one or two children, do not show a particular geographical distribution and choose the monthly injection instead of oral contraceptives as the first contraceptive method or for the puerperium. The study formulation showed a high efficacy (Pearl Index: 0.018) and tolerability (general withdrawal rate throughout the study: 27.09%). The most frequent adverse events included bleeding disorders, headache and mastalgia; their incidence decreased spontaneously from the sixth month (3.9%), reaching 0% after two years. Treatment was discontinued due to adverse events in 3.47% of women. No significant bodyweight or systolic and diastolic blood pressure alterations were observed. Based on these results, the monthly injectable contraceptive was included in the basic product list at ISSS.

Adolescent↗
PubMed1988

Women in search of stability.

This paper is based on a study of 97 recruits--50 sterilized and 47 non-sterilized--to a family planning programme in Kingston, Jamaica and tries to account for the reluctance of Jamaican women to accept contraceptive sterilization. The study demonstrates the association between mating patterns in the island and the acceptance of sterilization. This irreversible method was more likely to be chosen by women in more stable sexual unions.

Adult↗
PubMed2000

Post-abortion contraceptive acceptability in Blantyre, Malawi.

BACKGROUND: Unsafe abortion remains one of the major reproductive and public health challenges globally, but more so in developing countries. Lack of or poor contraception has been shown to be one of predisposing factors. OBJECTIVE: To determine contraceptive acceptance amongst post-abortion patients in Blantyre, Malawi. DESIGN: A cross-sectional pilot study. SETTING: The study was conducted in the gynaecological ward of the Queen Elizabeth Central Hospital, Blantyre, Malawi, the University Teaching Hospital. RESULTS: A total of 464 patients were studied. Their mean age and parity were 24 (SD 6.1) and 1.5 (SD 1.9) respectively. The single comprised 20.3% and students 16.4%. The index pregnancy was reportedly unwanted by 45.3% and 17.2% said they had unsafe abortion. Of these 373 (80.4%) accepted contraception. There was no relationship between acceptance and one's age (p = 0.28), marital status (p = 0.59); or parity (p = 0.5). The most commonly chosen methods were oral pills (45.3%), DMPA (21.8%) and male condoms (20.7%). The young (<25 years old), single, more educated, and women of low parity, preferred relatively less reliable contraceptives. CONCLUSION: The results of this study indicate that with proper planning postabortion contraception is acceptable in Malawi. It will provide an additional contraceptive service opportunity, thus increasing the currently low National CPR, and reduce repeat unwanted pregnancy, unsafe abortion, with all its potential sequel. We therefore recommend its integration into emergency post-abortion care.

Abortion, Induced↗
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↗