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A study on the discontinuation and failure of contraception among newly married couples in Shanghai.

The authors investigate contraceptive failure and discontinuation among newly married couples in Shanghai, China, with a focus on the questions, "What percentage of births is due to contraceptive failure? What socio-psychological and demographic characteristics of a couple are related to the discontinuation or failure of contraception? How do the continuation rate and failure rate of contraception among newly married couples reflect the acceptance and effectiveness of various forms of contraception?"

Asia↗

Contraceptive failure in the United States: estimates from the 1982 National Survey of Family Growth.

A multivariate life-table analysis of national survey data from 1982 indicates that among currently married women, the pill and IUD have the lowest use-failure rates. During the first year of use, about three percent of pill users and six percent of IUD users experience an unintended pregnancy. Failure rates for the remaining methods range from 14 percent for the condom to 22 percent for spermicides; between these lie rhythm and natural family planning (16 percent), the diaphragm (17 percent) and other methods, mainly withdrawal, douche and abstinence. Married women using no contraceptive method experience an unintended pregnancy rate of 40 percent during the first year of unprotected intercourse. A woman's age, pregnancy intention (either to delay or to prevent births), parity and income all have significant effects on the risk of unintended pregnancy. The risk generally declines with age, except for women attempting to prevent an unwanted pregnancy, among whom women under 20 have lower failure rates than do those 20-29 years of age. As expected, women attempting to prevent an unwanted pregnancy have lower failure rates than do those seeking to delay a wanted pregnancy, with the difference being greatest for women under 20 years of age and smallest for 20-29-year-olds. Use-failure rates among low-income women are higher than those among women with larger family incomes, while low-parity women have lower failure rates than do women of higher parity. On average, standardized use-failure rates for single women are lower than those for married women, probably because of a lower average level of intercourse among single women. In addition, these rates are understated because of the substantial underreporting of abortion among single women; if abortion reporting were complete, failure rates would be about 1.4 times as high as they appear here, and thus would be close to those of married women. Differences in the risk of unintended pregnancy among single women show a number of similarities with those seen among married women: Use of the pill and IUD is associated with the lowest failure rates, reliance on the condom is associated with intermediate failure rates, and use of spermicides is linked with the highest failure rates. However, while rhythm and the diaphragm exhibit use-failure rates that are among the highest found for single women, failure rates for these methods are at intermediate levels among married women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Oral contraceptive failures among women terminating their pregnancy.

BACKGROUND: There are several methodological problems when studying contraceptive efficacy. The present study focuses on efficacy issues from the use of oral contraceptives (OC). METHODS: Through a computerized system of medical records kept at the Department of Gynecology, Regional Hospital of Trondheim, Norway, 800 OC-failure pregnancies were identified among 8192 women having pregnancy termination from January 1, 1987 to December 31, 1996. Ascertainment of cases was done by validating hospital data on OC failures by data collected by the referring practitioner. Inconsistencies in failure data were found among 257 of the 800 (32%) women who claimed at the hospital that an OC was in use at time for conception. The medical record kept by their practitioners stated that 158 women had stopped using OC before last menstrual period, of the remaining 99 women neither data on actual use nor data on prescription could be confirmed. RESULTS: Over the 10-year study period the proportion of failures by brand of OC was remarkably constant from year to year and reflected the user pattern of OCs in Norway. One-third of the total number of failures (n=523) were claimed to be method failures. The annual overall OC-failure rate was estimated to be 1% during the 10-year study. CONCLUSION: Case-control studies focusing on efficacy of OCs must be carefully designed and comprise both women carrying a pregnancy to term as well as women terminating their pregnancies. Our study focused on only one segment of the population of women experiencing an OC failure: women having pregnancy termination. The present study has shown that exposure data collected from interviews have to be validated against prescription data.

Abortion, Induced↗

Contraceptive failure in the first two years of use: differences across socioeconomic subgroups.

CONTEXT: While differences in levels of contraceptive use across socioeconomic subgroups of women have narrowed greatly over time, large disparities remain in rates of unintended pregnancy. One reason is variations in the effectiveness with which women and their partners use contraceptive methods. METHODS: Data on contraceptive use and accidental pregnancy from the 1988 and 1995 National Surveys of Family Growth were corrected for abortion underreporting and pooled for analysis. Use-failure rates were estimated for reversible methods during the first year, second year and first two years of use, for subgroups of women of various characteristics. RESULTS: The average failure rate for all reversible methods, adjusted for abortion underreporting, declines from 13% to 8% from the first year of method use to the second year. First-year failure rates are highest among women using spermicides, withdrawal and periodic abstinence (on average, 23-28% in the first year), and lowest for women relying on long-acting methods and oral contraceptives (4-8%). On average, they exceed 10% for all users except women aged 30-44, married women and women in the highest poverty-status category. The chance of accidental pregnancy does not differ significantly between method users younger than 18 and those aged 18-19. CONCLUSION: Both user and method characteristics determine whether contraceptive users will be able to avoid unintended pregnancy. Family planning providers should help clients to identify methods that they are most likely to use successfully, and counsel them on how to be consistent users and to avoid behaviors that contribute to method failure.

Contraception↗

Body mass index, weight, and oral contraceptive failure risk.

OBJECTIVE: To estimate the effect of body mass index (BMI) and weight on risk of pregnancy while using oral contraceptives (OCs). METHODS: We conducted a case-control study of 248 health maintenance organization enrollees who became pregnant while using OCs between 1998 and 2001 and 533 age-matched enrollees who were nonpregnant OC users during the same period. Using logistic regression we calculated adjusted odds ratios (ORs) to estimate the risk of pregnancy according to BMI and weight quartile. RESULTS: Among all OC users, when compared with women having a BMI of 27.3 or less, the risk of pregnancy was nearly 60% higher in women with BMI greater than 27.3 (OR 1.58, 95% confidence interval [CI] 1.11-2.24) and over 70% higher in women with BMI greater than 32.2 (OR 1.72, 95% CI 1.04-2.82). Among consistent users (women who missed no pills in reference month), the risk of pregnancy was more than doubled in women with BMI greater than 27.3 (OR 2.17, 95% CI 1.38-3.41) or BMI greater than 32.2 (OR 2.22, 95% CI 1.18-4.20). When compared with women weighing 74.8 kg or less, among consistent OC users the risk of pregnancy was over 70% higher in women weighing more than 74.8 kg (OR 1.71, 95% CI 1.08-2.71) and nearly doubled in women weighing more than 86.2 kg (OR 1.95, 95% CI 1.06-3.67). CONCLUSION: Our results suggest that being overweight may increase the risk of becoming pregnant while using OCs. If causal, this association translates to an additional 2-4 pregnancies per 100 woman-years of use among overweight women, for whom consideration of additional or effective alternative contraceptive methods may be warranted.

Adult↗

Oral contraceptive failures and body weight: findings in a large cohort study.

This report looks at data from 17 032 women who took part in the Oxford Family Planning Association contraceptive study. Thirty-eight first accidental pregnancies occurred during 6779 woman-years of use of progestogen-only oral contraceptives (0.56 per 100) and 95 first accidental pregnancies occurred during 48 692 woman-years of combined oral contraceptive use (0.20 per 100). Although associations with age and parity were found, there was no evidence of any influence of body weight on the risk of accidental pregnancy with either form of oral contraceptive.

Adipose Tissue↗