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PubMed2001

Contraceptive use in Jordan.

OBJECTIVE: To compare women in the child bearing age for the years 1983, 1990, 1997 regarding their use of contraceptives and the variations in the source of intrauterine contraceptive devices, as it was recently observed that women are more likely to use intrauterine contraceptive devices. METHODS: Three national surveys carried out in 1983, 1990, 1997 were compared. The samples selected in the 3 surveys were women in the child bearing age. A multistage sampling procedure was used to ensure the representativeness of the samples in the 3 surveys. RESULTS: The use of contraceptives increased from 26% in 1983 to 40% in 1990 and 53% in 1997. Women became more likely to use intrauterine contraceptive devices where the percentage of use increased from 32% in 1983 to 44% in 1997. The percentage of users of contraceptives in general and intrauterine contraceptive devices in particular was higher in urban areas and in educated women with a high number of children. CONCLUSION: Women at risk of not using contraceptives should be identified and contacted to convince them to use contraceptives. All barriers to access, use and quality of contraceptives should be investigated. The identification of such barriers will be useful for decision makers and health planners in the country.

Adolescent↗
PubMed2004

What do young people from Mostar, Bosnia and Herzegovina know about contraception and sexual health?

AIM: To determine the knowledge of adolescents living in Mostar, Bosnia and Herzegovina, about contraception and sexual health. METHODS: We used an anonymous questionnaire to survey a random sample of 120 high school students, 60 from two general high schools and 60 from a vocational school. There were 30 male and 30 female students aged 15-17 years from each type of school. The questionnaire consisted of 24 questions: 17 tested the students' knowledge on the menstrual cycle, contraception, emergency contraception, and sexually transmitted diseases (STDs), and six inquired how they obtained the information on these issues. Student t-test was used to test for score differences between male and female students, and between general high school and vocational school students in their general and specific knowledge. Pearson's r coefficient was used to test the correlation between average grades and knowledge. RESULTS: Female students had greater general knowledge (t=3.69, df=118, p<0.001), knowledge on contraception (t=3.66, df=118, p<0.001), and knowledge on STDs (t=2.71, df=118, p=0.008) than their male peers. General high school students also had greater general knowledge (t=2.44, df=118, p=0.016), and knowledge on contraception (t=2.18, df=118, p=0.031) or STDs (t=2.36, df=118, p=0.020) than their vocational school peers. Major sources of information were magazines (69%), TV/radio (50%), school (37%), and friends (36%). The most common reason that kept our examinees from obtaining information on these issues was shame (52%). The two most common contraception methods known to them were a condom (82%) and contraception pill (77%), whereas 17% of all students were unfamiliar with any contraception method. When asked what could be done to improve their knowledge on sexuality, contraception, and STDs, most students opted for the inclusion of sexual education into the school curricula. CONCLUSION: Female students knew more about contraception and sexual health than their male peers. Young people should be provided with more information on sexual health.

Adolescent↗
PubMed2004

Contraceptive care by family physicians and general practitioners in Japan: attitudes and practices.

BACKGROUND AND OBJECTIVES: Japan has one of the highest rates of unintended pregnancies among developed countries. Family physicians and general practitioners (FPs/GPs) have unique opportunities to provide family planning. The purpose of this research was to elucidate the attitudes and practices about contraceptive care by FPs/GPs in Japan. METHODS: In this cross-sectional study, we distributed to physician members of the Japanese Academy of Family Medicine a survey that addressed their educational experiences with contraceptive care, frequency of contraceptive care in their practices, attitudes toward providing it, and attitudes toward providing medical students and residents with contraception education. RESULTS: A total of 265 physicians responded (response rate 77.2%). Many physicians reported receiving limited education about contraception, and 75% reported offering no contraceptive care in practice. While 60% of participants reported a desire to provide information about contraception, one of four physicians reported no interest. About 90% of the physicians indicated that medical students should have contraception education. Eighty percent reported that residents should receive such education. CONCLUSIONS: Most FPs/GPs in Japan have received limited education about contraception. Few provide it currently, but 60% are willing to do so. Further investigation is needed to fully understand barriers to Japanese FPs/GPs providing contraceptive care.

Adult↗
PubMed2006

Emergency contraception in Wisconsin: a review.

Emergency contraception is used to prevent pregnancy in the event of unprotected sexual intercourse. The most common methods of emergency contraception are combination and progestin-only oral contraceptive pills. They are effective, safe, and have few side effects. Most physicians are aware of emergency contraception, yet it is not widely prescribed or used. The American Medical Association and the American College of Obstetricians and Gynecologists recommend providing information and access to emergency contraceptive pills at routine gynecologic visits. Evidence has shown that women provided with advance supplies of emergency contraceptive pills were more likely to use them. There is no evidence of increased sexual risk-taking behavior or reduction in use of regular birth control methods. It is estimated that with wider use of emergency contraceptive, nearly half of unplanned pregnancies and abortions could be prevented. Access and knowledge of emergency contraception are the biggest barriers to use. Many emergency departments in Wisconsin do not prescribe emergency contraception, making access for women in rural areas difficult. By increasing use of emergency contraceptive pills by improving access and improving patient knowledge, unplanned pregnancies and abortions may be reduced.

Adolescent↗
PubMed1991

Barrier contraceptive methods and preeclampsia.

Recent investigations have suggested that women who use barrier methods of contraception may be at increased risk for preeclampsia. We used data from two prospective pregnancy studies to examine the relationship between contraceptive use before conception and preeclampsia. The preeclampsia rates among women using barrier contraceptives were not significantly higher than the rates in women using nonbarrier contraceptives or the rates in women using no contraceptives in either study. The odds ratios for preeclampsia in barrier contraceptive users in the two studies were 0.89 (95% confidence interval [Cl], 0.71 to 1.12) and 0.85 (95% Cl, 0.49 to 1.45) compared with nonbarrier contraceptive users and 0.91 (95% Cl, 0.71 to 1.16) and 0.81 (95% Cl, 0.48 to 1.35) compared with women using no contraceptives. After adjusting for other risk factors, we found no association between preeclampsia and barrier contraceptive use. Additional studies are needed to resolve this issue; however, we would recommend that women not be advised to avoid barrier contraceptives unless more data linking their use to preeclampsia appear.

Adolescent↗
PubMedDate not supplied

Private physicians and the provision of contraceptives to adolescents.

Data from a national sample of private physicians show that 86 percent of obstetrician-gynecologists, general practitioners and pediatricians are willing to prescribe contraceptive methods to adolescent women. However, only 59 percent are willing to serve unmarried minors without parental consent. The obstetrician-gynecologists are more likely to provide contraceptives than the other two specialists, and are likely to have fewer policy restrictions. Although pediatricians are the least willing to prescribe contraceptives (only 32 percent say they would do so for a 15-year-old patient), they are the most likely to refer such patients to other sources of care (61 percent of those who will not provide primary contraceptive care do so). The parental consent requirements that physicians set for contraceptive services are somewhat related to state policies. Seventy-five percent of physicians who provide contraceptive care for adolescents and who practice in states that clearly authorize minors to give their own consent for family planning services will serve unmarried minors on their own consent, compared with 62 percent in states without explicit minor consent laws. Physicians practicing in the Southwest are the most likely to provide contraceptive services to unmarried patients younger than 18, while those in the North are least likely to do so (88 and 67 percent, respectively). Ninety percent of private physicians who prescribe contraceptives for adolescent women will prescribe the pill, but smaller proportions will make the diaphragm or IUD available (61 and 23 percent, respectively). Among the physicians surveyed, the average fee that an adolescent would have to pay for an initial contraceptive visit, including laboratory tests, is $37. Of those who accept teenage contraceptive patients, only 53 percent will accept Medicaid reimbursement and only one percent indicate that they will instead provide free services to adolescents who cannot afford to pay the fee.

Adolescent↗
PubMed1981

Contraceptive use and fertility in the Republic of Panama.

Panama has a high prevalence of contraception, with surgical sterilization being the dominant method. Use of contraception is fairly high even in rural areas. Seventy-one percent of users named a public sector source for their contraception. High use of contraception is part of an overall program of public sector maternal and child health services that also shows substantial penetration of rural areas. The high reliance on public sector sources in panama distinguishes it from other Latin American populations with comparable levels of contraceptive use, such as Sao Paulo state, Brazil, and Costa Rica. These populations also differ in that oral contraceptives are the most prevalent method of contraception. The survey results indicate that the risk of unplanned pregnancy is greatest for unemployed married women who have children. It is particularly important to expand program coverage in rural areas, where two-thirds of those at risk of unplanned pregnancies reside; risk of an unplanned pregnancy for rural women is more than twice that for urban women. While unmarried teenage women do not appear to constitute an important group by this definition, there are other compelling reasons, some supported by other results of the survey, for a special effort oriented toward teenagers. The experience of Panama may be unique in many ways. It shows that an integrated MCH-FP public sector program can meet a high demand for surgical contraception and achieve a fairly high level of contraceptive use. Finally, the results illustrate the value of periodic surveys to gauge the impact of public health programs by monitoring trends in contraceptive use, fertility, breastfeeding, and other aspects of reproductive health.

Adolescent↗
PubMed1995

Postcoital contraception: present and future options.

PURPOSE: This article reviews information on currently available postcoital contraceptives, and discusses recent advances in postcoital contraception, mostly notably RU 486. METHODS: Postcoital contraceptives, or "morning after pills," are currently available in the form of high dose estrogens, oral contraceptives, danazol and intrauterine devices. These methods are plagued by high incidences of side effects and less than optimal success rates. RESULTS: Currently, their primary use in the adolescent age group is for victims of sexual assault, but they may also be used as back-up for consensual unprotected intercourse. RU 486, best known as a first trimester abortifacient, has a number of potential uses, including that of a postcoital contraceptive. Two recently published studies from the UK showed RU 486 to have a very low pregnancy rate and fewer side effects when compared with current methods. RU 486 may someday replace high doses of oral contraceptives as the method of choice for postcoital contraception.

Adolescent↗
PubMed2003

Male contraception: mechanical, hormonal and non-hormonal methods.

There is a definite need for an effective and reversible form of male contraception, both for maintaining a stable population in industrial countries and for diminishing population growth in developing countries. It has been agreed upon that contraception is an essential component of reproductive health for men and women (the Weimar Manifesto on Male Contraception). The development of new, effective methods of male contraception has been identified as a high priority by the WHO Task Force on methods of regulation of male fertility. Hormonal male contraception is based on suppression of gondotrophins and substitution of testosterone in order to maintain male sexual function and bone mineralisation and to prevent muscle waist. For complete interruption of spermatogenesis, an adequate suppression of intratesticular testosterone production is needed. Various contraceptive regimens have been developed and tested, including testosterone monotherapy, androgen/progestin combinations, testosterone with GnRH analogs, and selective androgen and progestin receptor modulators. The combination of testosterone with progestogen is currently the most promising approach to hormonal male contraception. Also, several non-hormonal approaches to male contraception are promising and may offer the foundation for developing new male contraceptives.

Condoms↗
PubMed1990

Contraceptive behavior among sexually active Hispanic adolescents.

The purpose of this study was to examine those factors associated with the contraceptive behavior of a national representative sample of Hispanic female adolescents. The subjects included all (n = 85) unmarried, sexually active Hispanic women, aged 15 to 19, from the 1982 National Survey of Family Growth. Contraceptive behavior was measured on a normalized scale, ranging from oral contraceptives to no contraception. Mexican/American and Central/South American background females were more likely (p less than 0.031) to use effective birth control than Puerto Rican, Cuban, and other Hispanic background subjects. Twenty additional social, behavioral, and demographic variables were found to be significantly associated (p less than 0.05) with contraceptive behavior. Based on multiple regression analysis, seven of these variables were found to explain 62% (p less than 0.0001) of the variation in the contraceptive behavior of this sample. Poorer contraceptive behavior was associated with noncompliance with the initial birth control method used (33.8%), lower coital frequency (8.3%), older postmenarchial age (5.7%), failure to use birth control at first coitus (4.6%), fewer years dating (4.0%), lower frequency of church attendance (3.3%), and never having experienced a pregnancy scare (2.0%). These findings suggest that the contraceptive behavior of Hispanic female adolescents is a dynamic process that can be understood in the context of previous sexual and contraceptive behavior.

Adolescent↗
PubMed2006

Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion.

BACKGROUND: Most pregnancies ending in therapeutic abortion are assumed to have been unintended. In the developed world, most arise from inconsistent or incorrect contraceptive use. Ambivalence about pregnancy might be associated with less effective contraceptive use. METHODS: Three hundred sixteen women undergoing abortion in Scotland were interviewed about contraceptive use at the time of conception. A modified measure of pregnancy intendedness was used to determine ambivalence. RESULTS: Pregnancy appeared to be clearly unintended for 92% of women. Sixteen percent were not using contraception and had higher intendedness scores (p<.001) than those using a method. Forty-four percent were using contraception inconsistently or incorrectly, almost always condoms or oral contraception, but method choice was not linked to pregnancy intendedness. DISCUSSION: Women who are ambivalent about the desire for pregnancy are less likely to use contraception. The challenge for reducing abortion rates lies in improving contraceptive use among the much larger group of women who do not intend to get pregnant but use contraception imperfectly.

Abortion, Therapeutic↗
PubMed2004

Attitudes and behavior towards contraception among Greek women during reproductive age: a country-wide survey.

OBJECTIVES: The study objectives were to explore current contraceptive behavior of Greek women during reproductive age. STUDY DESIGN: Data were drawn from a country-wide survey, conducted with the use of a self-administered questionnaire. The sample, numbering 797 women of ages 16-45 years, was representative of the Greek female population of reproductive age. RESULTS: The most common contraceptive method reported was the male condom (MC) (33.9%) followed by coitus interruptus (CI) (28.8%), oral pill (4.8%), and coil (3.6%). Other methods counted for a 5% and no use of contraception reached a 23.8%. Attitudes over responsibility of using contraception were also explored. The majority of respondents (52%) stated that contraception use is the responsibility of men. The probability of reporting that women should be responsible in using contraception was higher in women aged 25-34 years, in those with higher level of knowledge over contraception issues and in those with an experience of abortion. CONCLUSIONS: The need for sexual education and easy access to counseling services is apparent in order to promote optimal contraception decision-making. The role of women in taking active responsibility over contraception use should be of great importance in reproductive health promotion projects.

Adolescent↗
PubMed2005

Reversible, non-barrier male contraception: status and prospects.

OBJECTIVE: Male, non-barrier, contraceptive options are limited to vasectomy and inadequate methods such as withdrawal and periodic abstinence. Herein we give an overview of current research on male contraception by pharmacological means. METHODS: Literature search of PubMed documented publications and abstracts from meetings. RESULTS: Cross-cultural surveys show men's willingness to carry contraceptive responsibility. Clinical trials substantiate that hormonal contraception involving suppression of gonadotropins holds the best promise to provide a male pharmacological contraceptive. Androgens have been demonstrated to induce reversible infertility particularly in combination with certain progestins and GnRH antagonists. Advances in non-endocrine contraception include intervention with triptolide derivatives, alkylated imino sugars, and immunization by eppin. CONCLUSION: The prospect of a pharmacological, male contraceptive has been considerably advanced in recent years. Long-term studies involving a greater number of subjects may result in a safe, reversible and effective means. Asia is likely to be the first market for male, hormonal contraceptive methods. The clinical evaluation of non-endocrine approaches may ultimately lead to an alternative to hormone-based male contraception.

Animals↗
PubMed2006

Contraception in felids.

Contraceptives are used for reversible reproductive control in genetically valuable wild felids, as permanent reproductive control in generic wild felids, and as an economically practicable means to control feral cats. The progestin contraceptives, megestrol acetate, melengesterol acetate, medroxyprogesterone acetate, and levonorgestrol (administered orally, in implants, or as depot injections), are effective in preventing pregnancy. However, long-term use is associated with endometrial hyperplasia, endometrial cancer, and mammary cancer. Gonadotropin releasing hormone analogs or luteinizing hormone vaccines that achieve contraception by suppressing ovarian or testicular function, do not have the adverse health effects of progestins. However, reliable reversibility has not been demonstrated, and male secondary sex characteristics may be suppressed. Bisdiamines also inhibit spermatogenesis and lower circulating testosterone concentrations in treated male cats. Porcine zona pellucida vaccines are ineffective contraceptives in felids and may cause serious health problems when combined with some adjuvants. Because of the limited availability of non-progestin contraceptives and side effects associated with some agents, widespread application of contraception to felids has been curtailed. More non-steroidal methods of contraception should be tested in the future to provide alternatives for controlling reproduction in felids. Furthermore, all empirical information on contraceptive safety and efficacy should be assembled in a database to provide the knowledge needed by veterinarians and managers to determine benefits/risks of currently available contraceptives in felids, both domestic and wild.

Animals↗
PubMed1997

Contraceptive practices of women requesting termination of pregnancy: a study from China.

In order to develop a program for prevention of unwanted pregnancies, we conducted a survey of contraceptive practices and reasons for contraceptive failures of 1520 women seeking abortion at eight large hospitals in Zheng Zhou City, Henan Province, P.R. China, during the period from March 1996 to May 1996. The most frequent cause of the unplanned pregnancy was contraceptive failure (71.9%) 61.7% (938) of these current pregnancies were potentially predictable by virtue of nonuse of contraception (427) or by recognition of contraceptive failures (511). Among the contraceptive failures, the proportion of condom mishaps was the highest (29.7%), next was IUD failures (23.5%), then rhythm miscalculation (15.9%). Most of abortion seekers (77.1%) used some contraceptive methods previously. But only 19.7% of them used a contraceptive method at the first sexual intercourse. Among 1520 abortion seekers. 57.6% had used condoms previously; 50.9% of the condom users had at least one instance of condom mishap. The rhythm method had been used by 31.7% of abortion seekers previously; 59.1% of the rhythm users had at least one instance of rhythm failure. Of the 16.8% of abortion seekers who had used pills, 58.0% of them had pill failures Among condom and pill failures, most of them (46.4% condom users and 56.0%, pill users) belonged to the users failure category (poor compliance). Of those seeking abortion 56.4% had experienced at least one instance of previous abortion; 5.3% had experienced previous abortions at least two times. Emergency contraception had been utilized by only 10 subjects prior to this current pregnancy.

Abortion, Induced↗
PubMed1999

Contraceptive use dynamics of Asian women in Britain.

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.

Adult↗
PubMed1992

Connotative meanings assigned to contraceptive options.

Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.

Adolescent↗
PubMed1995

Inconsistent contraceptive use among female college students: implications for intervention.

The authors evaluated the longitudinal consistency of use of contraceptive and barrier methods among female college students attending a student health clinic. The majority of students using unreliable methods of contraception during follow-up did not report unreliable contraceptive use at the baseline observation. Of 213 women who participated, 33% used unreliable contraception; 9% only at baseline, 14% only during 6-month follow-up, and 9% at both. Selection of a contraceptive method varied considerably over time. Of those using the oral contraceptive pill at baseline, 31% did not use this method during follow-up, and 43% of those using condoms at baseline had intercourse without a condom during follow-up. Single observations are inadequate to detect unreliable contraceptive use in this population; cross-sectional studies will fail to detect important transitions in contraceptive use. Interventions to prevent pregnancy and sexually transmitted disease among female college students should include a focus on the consistency of contraceptive use.

Adult↗