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PubMed1999

Knowledge, attitudes, and practices regarding emergency contraception among nurses and nursing students in two hospitals in Nairobi, Kenya.

A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students.

Adolescent↗
PubMed2002

Vaginal wetness: an underestimated problem experienced by progestogen injectable contraceptive users in South Africa.

This paper reports on the common experience of vaginal wetness amongst South African users of progestogen-only injectable contraceptives. The observations emerged in the course of a community-based cross-sectional household survey undertaken in a rural district of KwaZulu-Natal in South Africa. The purpose of the survey was to elicit self-reporting on side effects of injectable contraceptive methods. Eight hundred and forty-eight women aged 15-49 were interviewed and 22.1% reported current use of an injectable contraceptive method, either depot medroxyprogesterone acetate (Depo-Provera) or norethisterone oenanthate (Nur-Isterate). Other modern methods used were oral hormonal contraceptives (4.5%), male condoms (1.3%), the intrauterine device (0.1%), and tubal ligation (0.1%). Vaginal wetness was reported by 18.4% of users and was one of the most common side effects, second only to amenorrhoea (62.5%). It was also what 17.5% of the women liked least about using this method. According to almost half the respondents, men regard women who use the injectable contraceptive as "wet", "cold" and/or "tasteless". These survey findings were supported by participants of 14 focus group interviews held in the sub-district. Since some South African men may prefer dry sex the perception that the injectable contraceptive increases vaginal wetness may be problematic for women who use it. Whilst vaginal wetness can only be classified as a subjective side effect at this stage, further investigations are needed as many South African women opt to use this method.

Adolescent↗
PubMedDate not supplied

Contraceptive and sexual practices among single women with an unplanned pregnancy: partner influences.

Data from an urban obstetrics clinic on 291 unmarried women with a current unplanned pregnancy show that women with only one partner in the past year are older and are more likely to use the most effective contraceptive methods than are women who have more than one partner. Women with only one partner are also more likely to be solely responsible for decision-making about the choice of contraceptive methods, and are not as likely to use drugs in conjunction with sex. However, women with one partner are also less likely than others to use condoms or to protect in some other way against sexually transmitted diseases or the human immunodeficiency virus.

Adolescent↗
PubMed1990

[Contraception and tubal sterility of infective origin].

A series of 89 caucasian women, who had been operated on for non-infectious tubal infertility were studied to find out what contraceptive methods they had used before they became infertile (oral contraception, intra-uterine contraceptive device and other methods). A matched series of 178 fertile women were used as a control group. The numbers who had chlamydia were studied as a function of the method of contraception in the group of infertile women. This work shows that women with tubal infertility due originally to infection had less often used oral contraception than the matched group of fertile women had. One can conclude that oral contraception acts as a prevention against this cause of infertility. The role played by intra-uterine contraceptive devices is difficult to establish. All the same, there is a significant relationship between the use of intra-uterine devices and tubal infertility of infectious origin, whether we look at multiparae or women between 25 and 34 years of age. This study also shows that chlamydia is not associated with the use of combined preparation oral contraceptives, nor with the use of the intra-uterine device in women who have tubal factor infertility. This study all the same shows that it does seem to be important to advise oral contraception in preference to the intra-uterine device in women who are still wanting to have a pregnancy, even if they are multiparae or multigravidae.

Adult↗
PubMed1990

Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use.

Up to the end of 1989, 206 parous women in the Oxford Family Planning Association contraceptive study had been referred to hospital with a first episode of pelvic inflammatory disease. Of these, 65 suffered from definite disease described as acute, 81 from definite disease not described as acute and 60 from 'other disease'. Considering all forms of disease together, referral was less common in those aged 25-29 and in those aged 45 or more than in those aged 30-44. Referral was more common in those of low social class, in those who smoked and in those who married young. All these factors were taken into account in analyses considering the effects of contraceptive methods. In these analyses, women currently using the contraceptive pill, the diaphragm, the sheath, female sterilization or an intrauterine device (IUCD) were compared with those currently using other methods or no method of contraception. IUCD ex-users were, however, placed in a separate category, irrespective of their current method of contraception. The relative risks obtained in these analyses, with 95% CI, were as follows: contraceptive pill 0.5 (0.2-0.9), diaphragm 0.6 (0.3-1.2), sheath 1.2 (0.6-2.4), female sterilization 0.7 (0.3-1.5), non-medicated IUCD 3.3 (2.3-5.0), medicated IUCD 1.8 (0.8-4.0), IUCD ex-users 1.3 (0.7-2.3). These data suggest that oral contraceptives, the diaphragm and female sterilization protect against pelvic inflammatory disease and that IUCDs increase the risk. Medicated devices, however, appear to carry only about half the risk of non-medicated devices, and the elevation of risks in IUCD ex-users appears to be small. Special analyses examined the risk associated with use of a Dalkon Shield. Among women currently using an IUCD (of any kind), those who had used a Dalkon Shield (at any time) had nearly five times as great a risk of hospital referral for pelvic inflammatory disease as those who had never used a Dalkon Shield (relative risk 4.7, 95% CI 2.1-9.0).

Acute Disease↗
PubMed1984

Factors associated with adolescent use of family planning clinics.

Clinic records were reviewed for a sample of 498 adolescent family planning clients to document clinic use patterns. For a subsample of 359 adolescents, relationships are explored between clinic use and contraceptive use, demographic characteristics, social relationships, and contraceptive attitudes. The average adolescent was observed for 15 months and made 3.5 visits to the clinic. Twenty-two per cent of the adolescents never returned after an initial visit. Revisits tended to occur in three-month intervals. In the first six months, the probability of making the first revisit was .70; the probability of a second revisit was .45. Adolescents whose visit patterns deviated from the routine clinic protocols were more likely to be inconsistent contraceptive users. The single significant correlate of regular clinic use was the adolescents' satisfaction with their contraceptive methods. Service providers should ensure that adolescents select a suitable contraceptive method and closely follow adolescents whose clinic use patterns deviate from standard protocols.

Adolescent↗
PubMedDate not supplied

Changing men's attitudes and behavior: the Zimbabwe Male Motivation Project.

A multimedia communication campaign was conducted between 1988 and 1989 to promote family planning among men in Zimbabwe. The campaign consisted of a 52-episode semiweekly radio soap opera, about 60 motivational talks, and two pamphlets about contraceptive methods. Changes over time were measured by comparing a subset of a follow-up survey conducted from October to December 1989 to a baseline survey conducted from April to June 1988. Men exposed to the campaign were also compared to men who were not exposed. The follow-up survey revealed that the campaign reached 52 percent of men aged 18 to 55. Among married Shona-speaking men, use of modern contraceptive methods increased from about 56 percent to 59 percent during the campaign. Condom use increased from about 5 percent to 10 percent. Awareness and current use of modern contraceptives was also higher among men exposed to the campaign, primarily because of their greater awareness of condoms. Men exposed to the campaign were significantly more likely than other men to make the decision to use family planning and to say that both spouses should decide how many children to have.

Adolescent↗
PubMed2001

Post-marketing surveillance of Norplant contraceptive implants: I. Contraceptive efficacy and reproductive health.

The subject of this study to examine the safety and contraceptive efficacy of Norplant, we undertook a 5-year study of follow-up of women initiating use of Norplant, intrauterine device (IUD) or sterilization in eight developing countries. Women attending family clinics were enrolled if they consented and were medically eligible to use Norplant, IUD, or female sterilization. Women who chose to initiate use of IUDs or surgical sterilization served as controls and were frequency matched in 5-year age-bands with women who chose to use Norplant. At admission women had a physical examination, and their medical histories, demographic, and socio-economic characteristics were recorded. Follow-up visits were scheduled in the first 6 weeks after admission and semi-annually thereafter for 5 years irrespective of change of contraceptive method. Incidence rate ratios of health events were estimated for initial and current contraceptive method use. This paper reports reproductive health events and contraceptive efficacy. Altogether, 7,977 women initiating use of Norplant, 6,625 of IUD, and 1,419 of surgical sterilization were admitted. Their mean ages at initiation were 28.5, 28.5, and 29.6 years, respectively. More than 99% were married or cohabiting, and parous. Five-year follow-up was completed by 94.6% of the women. By the end of 5 years, the mean duration of first segment use per initiator was 4.16 years for Norplant, 4.10 years for IUDs, and 4.96 years for sterilization accounting for 39,337 woman-years for Norplant, 31,915 for IUDs, and 7,071 for sterilization. The study accumulated 78,323 woman-years of observation. Pearl pregnancy rates for Norplant, copper IUDs and female sterilization were 0.27, 0.88, and 0.17 per 100 woman-years, respectively. Users of Norplant, copper IUDs, and sterilization had rates of ectopic pregnancy of 0.30, 0.68, and 0.13 per 1,000 woman-years, respectively. Major health events related to the reproductive system were rare. Rates of acute PID were significantly lower among Norplant users than IUD users (p = 0.004). The rate of ovarian enlargement was significantly higher in Norplant users than controls (p <0.001), but not rates of hospitalization for this condition. Vaginitis and vaginal discharge, and low abdominal pain were significantly less frequent in Norplant users than in the other groups. Bleeding disturbances were more frequent among Norplant users than controls but not anemia. The study confirms the high contraceptive efficacy of Norplant, copper IUDs, and female sterilization. The incidence rates of major reproductive health problems were low. There was no significant excess of serious reproductive morbidity among users of Norplant compared to users of IUDs and sterilization.

Abdominal Pain↗
PubMed2005

Depo-Provera: use of a long-acting progestin injectable contraceptive in Turkish women.

OBJECTIVE: To assess the demographic and clinical characteristics and experience of Turkish women treated with depot medroxyprogesterone acetate (DMPA). STUDY DESIGN: This prospective clinical study was carried on 9262 subjects, treated with DMPA at Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey, between 1996 and 2004. RESULTS: The mean age of study population was 28.4+/-4.6 years; 1759 (19%) subjects were breast-feeding at the time of the first injection. Eight (0.08%) pregnancies occurred, within 3 months of injection in 9262 women. Of 9262 cases, irregular bleeding occurred in 80% (7410) of the women. Discontinuation rate with this contraceptive method was recorded as 71% (6576) of the subjects. The rate of other predominant side effects was observed as follows: 8% for increase in weight, 8% for breast engorgement, 7% for mastalgia, 5% for headache. CONCLUSION: The results of this study suggest that DMPA may be an attractive contraceptive choice for both the patient and the physician in some clinical situations, especially in women at risk for complications with oral hormonal contraceptives and women who have had low compliance with other contraceptive methods. Moreover, DMPA contraception might be particularly appropriate in some cases such as in the postpartum period and in lactating women.

Adult↗
PubMed1978

Adolescents and the pill.

For the sexually active adolescent girl without medical contraindications who is sufficiently motivated to adapt to daily pill-taking, orals are the most effective contraceptive method. Some medical specialists have advised that oral contraceptives should not be a routine method of contraception for young girls who have not established a regular menstrual pattern for 1 or 2 years, due to the risk of amenorrhea after discontinuing the pill. The legal position must also be considered; for instance, the age of consent in Australia varies between 13-17 years. The Family Planning and the Law Symposium held in Melbourne in 1976 confirmed the ambiguity of the law on fertility control and minors. The current advice to family planning doctors is: 1) No doctor in Australia has yet been prosecuted for prescribing the pill to a minor. 2) It is preferable to prescribe to girls over 16 years but doctors have no confirmation of client's ages. 3) Parents ringing up about their child's attendance at Family Planning Association Centres are not entitled to information. Doctors observe normal discretion about their clients. 4) Girls who come to ask for the pill are usually already involved in a sexual relationship. "Studies of cervical cancer and its precursors in users of oral contraceptives have produced varied results. Most found no links between the use of orals and the risk of developing malignant or premalignant neoplasms, but several have reported a positive relationship and several a negative relationship." There may not be any link between the early use of oral contraceptives and subsequent neoplasia, however, there may be an association between early coitus and subsequent cervical neoplasia. In individual cases, the known risks of unwanted pregnancy must be weighed against the potential risks of taking the pill.

Adolescent↗
PubMed1996

Haiti: unions, fertility and the quest for survival.

This essay examines Haitian cultural and programmatic barriers to modern contraception and reports on types of unions as they relate to pregnancy and the prevalence of contraception. Findings from three mini-surveys representing 2383 rural and urban women in unions show that the most popular unions are maryé and plasé (legal marriage and setting up an household). Among rural women living in unstable relationships, vivav'ek, remen and menaj (living with someone, lovers, living as a pair), about 18% reported being pregnant at the time of the surveys. Findings also reveal that more urban women use contraceptive methods (23%) than do rural women (13%). However, the choice of contraceptive method appears to be influenced by medical staff and the availability of methods. Discussion examines the results of the surveys, women's position within the culture and attitudes toward the use of modern contraception. It also gives suggestions for improving family planning services by reinforcing the training of providers and supplementing their work with a team of volunteers who would encourage and support first-time users and dissatisfied users with meetings and home visits. It is also suggested that the promotion of informal education and the teaching of practical skills in mothers' clubs would encourage women to become economically independent from their partners so they would not focus on reproduction as a means to tie a man to them for emotional and economic purposes.

Adolescent↗
PubMed1998

[Contraception and pregnancy in severe systemic lupus erythematosus: a case report].

Systemic Lupus Erythematosus (SLE) during pregnancy may cause serious complications in the mother and fetus. We report a case of pregnancy in 23 years old woman with SLE. Pregnancy was complicated with spontaneous abortion and septic shock. Furthermore in our paper we discussed contraceptive methods proper for women with SLE. The choice of an optimal contraceptive method (OC) therapy is a significant problem in female SLE patients. In view of the influence of sex hormones on the evolution of SLE, oral contraceptive (OC) therapy has to be efficient, reversible and safe, without aggravating disease activity and causing metabolic and vascular side effects. As regards oral contraceptives, all authors agree that oestrogen-progestin combination pills are harmful, but the best alternative hormonal contraception remains to be determined. The management of the case and the review of current literature are presented. Our experience demonstrates the importance of interdisciplinary care.

Abortion, Spontaneous↗
PubMed2002

Techniques for the interruption of tubal patency for female sterilisation.

BACKGROUND: Female sterilization is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated. OBJECTIVES: To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties and women's and surgeons' views. SEARCH STRATEGY: The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using an Internet search service Pub Med. SELECTION CRITERIA: All randomized controlled trials comparing different techniques for tubal sterilization, regardless of the way of entry in the abdominal cavity or the method of anesthesia. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes. MAIN RESULTS: Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76). Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than with electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10). Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported. Pomeroy versus Filshie clip: In the trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months. No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices (Toplis 1988). REVIEWER'S CONCLUSIONS: Electrocoagulation was associated with less morbidity when compared with tubal ring and other methods. However the risk of burns to the small bowel might be a serious criticism of the approach. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.

Female↗
PubMed1997

[Unsuccessful contraception among patients seeking abortion on demand].

We have conducted a prospective study aimed to analyse contraceptive use among women seeking for legal abortion in the State University Hospital "Maĭchin dom"--Sofia. Our date demonstrate that the patients were well informed about the existing contraceptive methods. On the contrary the percentage of women-using contraception and especially those, using highly effective ones is relatively low. The patients claim the possible side effects of the high effective contraception as a reason against use.

Abortion, Legal↗
PubMed1995

Experience with side effects and health risks associated with Norplant implant use in adolescents.

Levonorgestrel implants (Norplant) have been recommended as a contraceptive method for teenage women. Our experience suggests that the use of Norplant implants in adolescents is associated with bleeding irregularities and modest weight gain. There is no effect on condom use or STD acquisition. Despite the bleeding irregularities, we documented high continuation rates, suggesting that with appropriate pre-insertion counseling, Norplant implants can be a successful contraceptive method for adolescent women.

Adolescent↗
PubMed1996

[Profile of the women attending a service of family planning].

OBJECTIVES: To find the profile of the Family Planning (FP) service, the contraceptive methods used, prescribed and asked for, evaluating the knowledge acquired in the prior informative talk. DESIGN: A crossover observational study. SETTING: Family Planning service in Telde (Gran Canaria). PATIENTS AND PARTICIPANTS: 317 users for whom a clinical record was opened in 1992/3. MEASUREMENTS AND MAIN RESULTS: Average age was 28.23 +/- 0.75 (SD 6.76); 77.6% were married, 66.56% without paid work and 22.71% with medium or higher education. 62.77% were from our Health Area. 82.33% attended on their own initiative. 2.26 +/- 0.07 (SD 0.59) contraceptive methods per user were used, with 71.87% medically monitored. 98.74% had used hormonal contraception (HC). The average number of pregnancies was 1.45 +/- 0.13 (SD 1.2), with the first being on average at age 22.16 +/- 0.48 (SD 3.74). 32.67% used barrier methods and 35.31% hormonal ones (36.4% smoked), with significant differences for age-groups, the referring professional and the number of children. 60% asked for an IUD and 37.38% HC, where significant differences were found for marital status, age groups, educational level and the number of children. CONCLUSIONS: We must strengthen the FP service so that people can make the most of their sexual and reproductive lives, increasing coverage for adolescents to prevent unwanted pregnancies and avoid uncontrolled risky contraceptive methods. The information in the prior talks should be improved, which would make the questionnaires administered more valid.

Adolescent↗