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PubMed2006

Ethnic Korean women's perceptions about birth control.

CONTEXT: We see many Korean women in our clinics and we have found them to have negative attitudes to hormonal contraception. We need to understand their perceptions and experiences with contraception in order to improve the effectiveness of our contraceptive counseling. METHODS: This was a qualitative descriptive study, conducted in an urban family practice office. The participants were a convenience sample of 40 ethnic Korean women. Data were collected in semistructured interviews by one interviewer who is fluent in English and Korean. Transcribed interviews were analyzed to identify salient themes. RESULTS: There was a deep distrust of hormonal methods of contraception and belief that hormones caused permanent harm. Unlike the findings in our other studies of Asian women, these women were satisfied with their usual methods of combining condoms, rhythm and withdrawal. They described good communication with their partners (which is necessary for the effective use of their chosen approaches). CONCLUSION: When counseling Korean women about contraception, it is important to discuss the cultural bias against hormonal contraception involving beliefs that hormones cause permanent harm. It is also important to recognize the very successful use of condoms, rhythm and withdrawal by these couples.

Adolescent↗
PubMed1980

[Family planning-the pill or natural method of birth control (author's transl)].

Observations made at the Family Planning Clinic and a review of the literature show that there is no increased tendency towards the natural contraceptive method among advice-seeking couples. On the contrary-apart from a few exceptions-the most effective method is always chosen. The natural method presupposes a high degree of motivation, of readiness to communicate and of clarification. These prerequisites underly the relatively high rate of failure because not all couples have the right degree of understanding. Nevertheless, to many people this method is the only acceptable and morally justifiable one. Thus, precise and detailed instructions and frequent check-ups would be necessary especially during the first few months, until adequate experience is gained.

Body Temperature↗
PubMed2002

Perception of university students in Ghana about emergency contraception.

Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure, or incorrect use. There is growing worldwide acceptance and promotion of EC as a measure to reduce the level of unwanted pregnancies and, hence, unsafe abortions. The potential effect of EC in this regard could be most evident in sub-Saharan Africa. In Ghana, the Ministry of Health has since 1996 included EC in its reproductive health service policy and standards. The Planned Parenthood Association of Ghana is the only agency involved in the promotion of EC in the country. Very little is known about societal perception of EC. We undertook a study to assess knowledge and attitude toward EC among a sample of students at the University of Ghana. We used a two-page, self-administered questionnaire in a cross-sectional study among students chosen by random sampling. The aspects of EC assessed included level of knowledge, extent of use, common traditional methods of emergency contraception, as well as socially and culturally acceptable ways to promote EC in Ghana. We also assessed how the availability of EC could influence the use of condoms among male respondents. Less than half (43.2%) of the 194 respondents (88 males and 106 females) had heard of modern emergency contraceptive methods. Postinor-2, a dedicated emergency contraceptive product, which was already on the Ghanaian market, was known to 1.5% of respondents. Only 11.3% of respondents indicated correctly the recommended time within which emergency contraceptive pills (ECPs) are to be taken after unprotected sex. Taking concentrated sugar solutions, having an enema, and douching were commonly used traditional methods of EC. More than half (55.0%) of the male respondents indicated that they would either "certainly" or "probably" reduce how often they used condoms once they knew that EC was available. Almost all (97.4%) the respondents wanted to learn more about EC. The indications from this study are that the promotion of EC in Ghana is desired and must be encouraged. The fact that EC does not offer protection against sexually transmitted infections should always be emphasized.

Adult↗
PubMed1992

[Reproductive health survey of young adults in greater Santiago].

In 1988 a survey was carried out in order to obtain information on knowledge about reproduction, sexual activity, attitudes, and use of contraceptive methods among residents between 15 and 24 years of age in Greater Santiago. For this purpose, a multistage, self-weighted, non-replacement probability sample was chosen from the entire Santiago urban area. After 2,898 households were visited, 865 women and 800 men were selected and interviewed. For the interview, a questionnaire with 156 questions was developed; many questions were similar to those included in similar surveys in Brazil and Guatemala. The interviewers were professionals who had received prior training. Although 75% of the interviewees had attended sex education classes, they had erroneous ideas on various basic subjects. Sixty-nine percent of the women interviewed had undergone menarche before attending these classes. In addition, 35.4% of the women and 65.0% of the men had had sexual relations prior to marriage, and less than 20% had used any contraceptive method. More than 60% of the interviewees who had children had conceived them before marrying. These findings point up the necessity of offering sex education classes for children and young people, as well as facilitating their access to family planning services, in order to decrease the number of illegitimate and unwanted children that are born in Chile.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Criteria for appropriate birth control.

Women seeking protection from pregnancy require adequate information about the relative merits and risks of current contraceptive options in order to make an informed choice. A basic understanding of mechanisms of action, the projected rates of efficacy, the demands on compliance, and the risks of side-effects permits women to weigh options appropriately and attain confidence in their chosen method. An informed woman is also in a better position to switch to alternative methods in the event of dissatisfaction or changing needs. Within the category of highly effective methods of birth control, to which a monthly combination injectable contraceptive has recently been added in several countries, there are important distinctions in relative reversibility, effect on menstrual cycle and confidentiality.

Contraception↗
PubMed1997

Quality of contraceptive services in Finland.

OBJECTIVE: To investigate whether the quality of contraceptive services in Finland varies by the type of care provider. DESIGN: A cross sectional questionnaire survey. PARTICIPANTS: A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994. RESULTS: Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care. CONCLUSIONS: In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.

Adolescent↗
PubMed2003

Thrombin generation assessed as endogenous thrombin potential in patients with hyper- or hypo-coagulability.

BACKGROUND AND OBJECTIVES: The endogenous thrombin potential (ETP) represents the balance between pro- and anti-coagulant forces operating in plasma and can be used to investigate hyper- and hypo-coagulability. As a preliminary step to larger clinical studies we investigated the effect on ETP of phospholipids, tissue factor (TF) and residual platelets in frozen plasma. DESIGN AND METHODS: We investigated platelet-poor and platelet-rich plasmas from healthy subjects, patients on oral anticoagulants (OA), or with hemophilia and women on oral contraceptives (OC), chosen as examples of the normal, hypo- and hyper-coagulable states in which ETP has been reported to be impaired. RESULTS: Phospholipids had only a slight effect on ETP in all conditions except in women on OC, in whom the best diagnostic efficacy was observed at 0.5 microM. TF had only a slight effect in all conditions except hemophilia, in which an ETP impairment was observed only at low (1 pM) concentration. Residual platelets had considerable effects on ETP in frozen plasmas, but this was abrogated by filtration before freezing. ETP in platelet-rich plasma at 150x103/mm3 was similar to that obtained in filtered-plasma with 1.5 microM phospholipids in healthy subjects, patients on OA and patients with severe hemophilia, but not in those with mild- or moderate-hemophilia, where the ETP was higher in platelet-rich plasma. INTERPRETATION AND CONCLUSIONS: The results suggest that the method can be used for investigations on the clinical value of ETP. Platelet-rich and platelet-poor plasma are suitable testing materials. The latter should be filtered before freezing to minimize the effect of residual platelets.

Anticoagulants↗
PubMed1982

Taking liberties with women: abortion, sterilization, and contraception.

This paper analyzes four areas in which reproductive freedom is being denied to women. The first area involves the use of sterilization without adequate counseling as to the risk of reversibility of the method or when it is made a precondition for performing an abortion. The second concerns the sterilization technique chosen, especially in developing countries, and the failure of international population agencies to note the higher complication rates of certain procedures. The third involves the inadequate information provided to women about the side-effects of the controversial injectable contraceptive, Depo-Provera. The fourth area concerns the unethical marketing of the Dalkon Shield device. It is concluded that physicians have a responsibility to avoid allowing authoritarian attitudes or racial, class, or sex prejudices to influence their treatment of women.

Abortion, Spontaneous↗
PubMed1969

Patterns of contraceptive use among clients of the Barbados Family Planning Association.

This is a study of the behavior patterns of lower class Barbadian women during the fecund period of their lives with respect to the introduction of new types of contraceptives within a multiple method family planning program. The behavior patterns of these women are examined through their use of the facilities of The Barbados Family Planning Association (BFPA). In 1955, the BFPA was set up to disseminate information on family planning and to provide the material means for family limitation. From its inception, a variety of contraceptive methods have been made available to women utilizing the services. The study is developed within a diffusion theoretic framework that focuses on the trial and adoption stages of the diffusion process. Data are drawn for this thesis from 2 samples: 1) a systematic sample of records kept by the BFPA on its clients, and 2) a systematic stratified sample chosen from patients of the Population Council Research Project (PCRP). (The PCRP was an affiliate of the BFPA between 1965 and 1967.) Patients were interviewed at both the family planning clinics and in their homes. The BFPA has followed the policy of making available at nominal cost all existing contraceptive methods. This has led to very high dropout rates after admission and a considerable amount of method changing. However, changes take place generally in the direction of increasing the reliability of the method used. The lower the reliability of the method, the greater the rate of dropout as well as the rate of change from it. The longer the time spent in the program, the greater the number of methods used; but the longer the time a method is used, the less likely that it will be given up for another method. The transition probabilities for changing from user to nonuser in a year do not remain constant over the 12 years for which the program has been in operation. This is also true for changing from nonuser to user. In the case of the users these probabilities remain constant for time spans of 4 consecutive years; decreasing from one time span to another. The transition probabilities for going from nonuser to user remain constant for time spans of 4 consecutive years over the first 8 years of operation of the program and for the last 3 years. The year 1964 was found to be deviant. However, the probability of going from nonuser to user increases from one time span to the other. Therefore, 3 time subsystems are delimited, each characterized by constant probabilities. Each subsystem represents a unique period in the development of the program.

Barbados↗
PubMed2001

Post-marketing surveillance of Norplant((R)) contraceptive implants: II. Non-reproductive health(1).

This controlled cohort study aimed to evaluate the safety and efficacy of Norplant contraceptive implants in developing countries. Women initiating Norplant implants were index subjects and women initiating intrauterine devices (IUDs) or surgical sterilization were controls. Consenting participants at 32 clinics in eight developing countries were admitted and followed-up every 6 months for 5 years. Major and less serious health events during follow-up were recorded. Incidence rate ratios of health events adjusted for clinic were estimated for initial and current method use. This paper reports non-reproductive health events. The study involved 7,977 women initiating use of Norplant, 6,625 of IUD, and 1,419 of sterilization. Five years follow-up was completed for 94.6% of the women. The study accumulated 78,323 woman-years of observation. The initial method chosen accounted for 84.4% or more of observed woman-years in users of Norplant, IUD, or sterilization. Twenty-two of the recorded 34 deaths were due to accidents, suicide or homicide. Few deaths or major health events were due to cancer or acute cardiovascular diseases and were not associated with the contraceptive method used. The incidence rates of major health events were low and with two exceptions, there was no significant excess risk of serious morbidity for Norplant users compared with controls; among Norplant initiators gallbladder disease occurred at an incidence rate of 1.5 per 1,000 woman-years and was weakly associated with use of Norplant (rate ratio 1.52 [95% C.I. 1.02, 2.27]). For current Norplant users compared to controls, the rate ratio of a combined variable of hypertension and borderline hypertension was significantly elevated (1.81, [1.12, 2.92]). The occurrence of less serious health events was also low and several of them were significantly more often reported among Norplant users. Headache-migraine, weight gain, mood disturbances, pruritus, eczema, and acne had incidence rates among Norplant users of 11.5, 4.5, 2.8, 1.5, 1.4, and 0.9 per 1,000 woman-years, respectively, and were significantly higher than in controls. Respiratory health problems, nonspecific symptoms, and several ill-defined conditions were also significantly more often reported for Norplant users, but some of the excess incidence may be attributable to reporting and detection bias. The study confirms the safety with respect to serious disease of Norplant, IUDs, and sterilization.

Accidents↗
PubMed1995

Physicians' experience with Norplant implantable contraceptives in Finland.

Norplant contraceptives are manufactured in Finland, but the majority of Norplant users live in the Third World. The objective of this study was to study Finnish family planning physicians experience with and attitudes towards Norplant contraceptives. Three data sources were used: (1) review of articles published in non-commercial Finnish medical journals between 1980 and 1990, (2) a sample of eleven physicians known to have experience with Norplant and chosen by a snow-ball method, and (3) a random sample of 22 physicians in charge of public family planning services stratified by municipality and degree of urbanization. The articles reflected a positive attitude towards Norplant, but the authors did not believe that Norplant should replace any previous method of contraception. In the random sample the amount of experience with Norplant was low. In both groups the general attitude towards Norplant was reserved. It was not used as a method of first choice, but was considered a good method for carefully selected women. Norplant was considered troublesome for the physician, requiring surgical procedures, producing side-effects and demanding time for counselling. Adequate use of Norplant calls for a good health care infrastructure, hygienic facilities and trained personnel. These are often lacking in Third World settings.

Attitude of Health Personnel↗
PubMedDate not supplied

Comparing patient telephone callback rates for different hormonal birth control delivery systems.

This study was conducted to determine the number of office telephone callbacks in the first 3 months after initiating use of the vaginal ring, the transdermal patch, or an oral contraceptive. If a patient called back, the reason for her call was noted. Patients were prospectively followed from sites in New Jersey and Florida for 3 months after initiation of hormonal contraception (oral, transdermal, vaginal) and the number of callbacks for each method was assessed. Before study recruitment, the patients had either never used or discontinued hormonal contraception for at least 1 month. All patients were given standard counseling, which included reference handouts specific to their chosen form of contraception. The number of callbacks for patients on oral contraceptives was 30/96 (26 patients, 4 of the 26 with 2 callbacks each); for the transdermal patch, 20/40 (17 patients, 3 of the 17 with 2 callbacks each); and for the vaginal ring, 11/72 (11 patients). Pearson chi2 analysis revealed that all 3 groups were significantly different from each other (P = 0.0004). Most patients called back for side effects related to their method of choice, and some patients called back more than once. Rate of callbacks after initiation of hormonal contraception was the least with the vaginal ring. Use of oral contraception, often considered the gold standard, resulted in a callback rate that was midway between the number of callbacks for the vaginal ring and the number of callbacks for the transdermal patch. The lower observed rate of callbacks with the vaginal ring compared with oral and transdermal contraception may provide clinicians the confidence that this method is well tolerated by their patients.

Administration, Cutaneous↗
PubMed2001

Contraceptive use at the family planning clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria.

During the five year review period (January 1993-December 1997), 19,470 clients visited the family planning clinic of the University of Nigeria Teaching Hospital, Enugu. Of these, 2402 clients (12%) were new patients and 17,068 (88%) were old patients. Among the new clients, 2262 (94%) eventually accepted a contraceptive method. The majority of the women (60%) chose the intrauterine contraceptive device (IUCD), 20% chose the injectables, while bilateral tubal ligation and norplant were chosen by 8% and 7%, respectively, of the clients. The oral contraceptive pill was the least popular (1%). Variations in the pattern of contraceptive use among clients at the family planning clinic were discussed. Measures to increase the contraceptive prevalence, and particularly strategies to meet the specific contraceptive needs of clients at the clinic, were also examined.

Contraception Behavior↗
PubMed2004

The North Carolina DIAL EC project: increasing access to emergency contraceptive pills by telephone.

OBJECTIVES: To evaluate a telephone prescription service designed to increase access to emergency contraceptive pills (ECPs) in North Carolina. METHODS: Women who wanted ECPs called a toll-free number and were screened over the telephone. Prescriptions were faxed to pharmacies chosen by callers. RESULTS: In 29 months, the service issued 9745 prescriptions to 7774 callers. Forty percent of callers were teens. Only 16% of callers received more than one prescription. Most callers heard about the service through referrals from Planned Parenthood staff and word-of-mouth. CONCLUSIONS: This service was successful in providing prompt access to ECPs to women throughout the state. Frequent use of the service by individual women was uncommon. Callers preferred to obtain ECPs from local pharmacies rather than from Planned Parenthood health centers, despite generally higher prices at pharmacies.

Adolescent↗
PubMedDate not supplied

Generation and characterization of antibodies against synthetic peptides of porcine zona pellucida ZP3 alpha.

OBJECTIVE: Use of synthetic zona peptides as target immunogens is a promising approach to an anti-fertility vaccine. To elucidate contraceptive epitopes, we raised polyclonal antibodies against synthetic peptides of pig ZP3 alpha and evaluated for immunogenicity, ability to inhibit in vitro boar sperm-pig zona attachment, and cross-reactivity with human zonae. METHODS: Five synthetic peptides were chosen based on hydropathicity analysis of ZP3 alpha, synthesized and coupled to keyhold limpet haemocyanin (KLH). Pairs of male rabbits were immunized with each peptide-KLH conjugate using a multi-site intradermal injection protocol. Resulting antisera were evaluated for immunoreactivity with cognate peptide and ZP3 alpha/EBGD (purified endo-beta-galactosidase-digested ZP3 alpha), contraceptive potential using an in vitro pig gamete bioassay, and cross-reactivity with human zonae using indirect immunofluorescence. RESULTS: All anti-peptide-KLH sera demonstrated immunoreactivity with cognate peptide. Anti-peptide sera, except for anti-alpha-3-KLH serum, were less immunoreactive with ZP3 alpha/ EBGD. Antisera directed against alpha-1-KLH, alpha-2-KLH, and alpha-3-KLH demonstrated significant (P < .00001) inhibition of boar sperm-pig zona attachment. Only anti-alpha-2-KLH and anti-alpha-3-KLH sera cross-reacted with human zonae. CONCLUSION: Synthetic peptides of pig ZP3 alpha are immunogenic, elicit antibodies cross-reactive with human zonae, and have in vitro contraceptive activity. These data support continued investigation of synthetic ZP3 alpha peptides as potential target immunogens for anti-fertility vaccine development.

Amino Acid Sequence↗
PubMed1987

A case-control study of breast cancer and hormonal contraception in Costa Rica.

By 1981, 11% of married women in Costa Rica ages 20-49 years had used depot-medroxyprogesterone acetate (DMPA) and 58% had used oral contraceptives (OCs). Since 1977, the Costa Rican Ministry of Health has maintained a nationwide cancer registry. These circumstances provided an opportunity for a population-based, case-control study of DMPA, OCs, and breast cancer in Costa Rica. Cases were 171 women ages 25-58 years with breast cancer diagnosed between 1982 and 1984; controls were 826 women randomly chosen during a nationwide household survey. Cases and controls were interviewed with the use of a standard questionnaire covering their reproductive and contraceptive histories. Logistic regression methods were used to adjust for confounding factors. While few cases or controls had ever used DMPA, DMPA users had an elevated relative risk (RR) estimate of breast cancer of 2.6 (95% confidence limits = 1.4-4.7) compared with never users. However, no dose-response relationship was found; even the group of women who had used DMPA for less than 1 year had an elevated RR estimate (RR = 2.3; 95% confidence limits = 1.0-5.1). In contrast, OC users had no elevation in RR compared with never users (RR = 1.2; 95% confidence limits = 0.8-1.8). The results of the DMPA analysis are inconclusive. Before decisions are made on whether to continue providing this effective contraceptive method, other ongoing studies will need to confirm of refute these findings.

Adult↗
PubMed2004

[Choice of contraceptive methods by women attending a public health clinic].

This paper presents the perceptions of 250 women who requested contraceptive methods (CM) at a public health clinic in relation to their freedom of choice and the role of an educational activity and consultation in this degree of freedom. Satisfaction with the chosen method and continuation after 6 months were also studied. Nearly all the women (99.6%) had already chosen a CM when they came to the clinic, and 90.0% left the clinic with the method; 81.9% reported that they felt very free to choose the method, and 60.0% felt that the educational activity and consultation had improved their degree of freedom. Six months later, 87.3% were using the same CM they had chosen. The proportion of women who changed the method and the proportion of those who felt they had not received sufficient information about the CM when they initiated use were significantly higher among women who reported any dissatisfaction with that method. The educational activity and consultation legitimated the women's choices (which they had already made before attending the health clinic) on the basis of such supplementary sources of information. This fact appears to have contributed to the women's feeling that they had sufficient freedom of choice.

Adult↗
PubMed1997

How effectively do copper intrauterine devices prevent ectopic pregnancy?

OBJECTIVE: To assess the risk of ectopic pregnancy when using copper intrauterine devices relative to non-use of contraception and female sterilization. DESIGN: Case-control study. MATERIAL AND METHODS: All cases diagnosed with a histologically verified extrauterine pregnancy and who became spontaneously pregnant in one Norwegian county from January 1, 1987 through to December 31, 1990 were eligible. Non-pregnant control women were chosen at random from the Norwegian Population Registry. Eligible for study were sexually active women, from 20 to 39 years of age, and who defined themselves as fecund. Included in the final analyses were 168 cases and 1,169 controls, who had all been previously pregnant. STATISTICAL METHODS: Chi square test and unconditional logistic regression. RESULTS: Compared with non-users of contraception, the adjusted odds ratio (aOR) among current users of copper intrauterine devices was 0.09 (95%, confidence intervals (CI); 0.06-0.13). Compared with women who were sterilized, the aOR of having an ectopic pregnancy among current copper IUD users was 1.6 (95% CI; 0.7-3.5). CONCLUSION: Relative to non-users of contraception, current copper IUD users had a 91% (95% CI; 87-94%) protection against ectopic pregnancy, while compared with women who had had a tubal sterilization, current copper IUD users had a 60% non-significant increased risk of ectopic pregnancy.

Adult↗