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PubMed2004

Genitourinary medicine: an opportunity to reduce unwanted pregnancy.

We sought to investigate contraceptive use in women attending a genitourinary medicine (GUM) clinic, and to assess the need for a contraceptive service in this setting. Female attendees at Nottingham GUM clinic were invited to complete an anonymous questionnaire regarding past and present contraceptive use and whether a contraceptive service within GUM would be utilized. Four hundred and eighty-nine questionnaires were analysed. The majority had previously used condoms (89.8%) or the combined oral contraceptive pill (COCP) (74.6%), and 46.6% and 37.4%, respectively were currently using these methods. Contraception was frequently used for the dual aims of avoiding both pregnancy and infection (48.5%). General practitioners (GPs) and family planning clinics were most frequently cited as sources of regular contraceptive advice, 58.1% and 47.2% respectively, and emergency contraception 50.8% and 37.3%, respectively. If a contraceptive service was available within GUM 56.9% of respondents indicated they would use it.

Adolescent↗
PubMed1977

Adolescent pregnancy: an interpersonal skill training approach to prevention.

The research literature reports numerous negative consequences of adolescent pregnancy. Unfortunately, contemporary approaches to preventing teenage pregnancies have been largely unsuccessful. Recent evidence, however, suggests that interpersonal communication skill training may represent an important step in helping adolescents deal with their sexual and contraceptive behavior. This describes a pilot study of an interpersonal skill training model for sexually active inner-city teenagers. Results show that this training model is a feasible and attractive approach to modifying the youths' communication patterns. Findings indicate that such training is a fruitful direction for future pregnancy prevention research with the adolescent target population.

Adolescent↗
PubMed1985

Magazine versus physicians: the influence of information source on intentions to use oral contraceptives.

College students read either pro or con passages about oral contraceptives. All passages contained the same statistical information, differing only in the way the information was interpreted. The passages were attributed either to a traditional physician, nontraditional physician, traditional magazine, or nontraditional magazine. Subjects in the pro condition were more favorable towards oral contraceptive use and subjects in the con condition were more opposed to oral contraceptive use than they were before reading the stimulus materials, thus suggesting that the same statistical information can be used persuasively to argue either for or against oral contraceptives. Males were significantly more likely to change their attitudes towards oral contraceptives than females.

Adolescent↗
PubMed2005

Women's contraceptive decision-making: juggling the needs of the sexual body and the fertile body.

The contradictions faced by women in the area of fertility management justify an in-depth qualitative study of contraceptive use. The experience of needing emergency contraception (EC) is an opportunity to study decision-making about fertility management. Thirty-two in-depth interviews were conducted with users of EC recruited in Melbourne, Australia. Women were juggling the needs of the sexual body and the fertile body. The sexual body was expected to be available in women's relationships, and the fertile body required protection from pregnancy in the present and preservation for the future. The needs of these two bodies were very often in conflict and women chose to resolve this conflict in subtly different ways; three strategies were identified. Some women chose to make sexual availability and security from pregnancy a priority; others felt forced to sacrifice sexual availability and security from pregnancy; and a final group chose to make the protection of the fertile body for the future a priority. This study provides a starting point for developing a context- based, woman-centered understanding of the experience of fertility management for women in developed countries.

Adolescent↗
PubMed2004

Ineffective contraceptive use and its causes in a natural fertility population in southern Jordan.

Based on our interview survey of 574 randomly selected married women from a rural population in the South Ghor district, Jordan, where traditional Arab customs have been persistently maintained, in this paper we analyze the age-specific marital fertility rates (ASMFRs) and contraceptive practices, especially the prevalence and duration of contraceptive use. The ASMFRs fitted the natural fertility pattern proposed by Coale and Trussell's model, and the total fertility rate was estimated to be 7.2. Even though the prevalence rate of modern contraceptive methods has reached 14.3%, because of the recent increase among young women in particular, the users had larger numbers of children than the nonusers and the duration of contraceptive use was short, especially at young ages (e.g., about 90% 24-month discontinuation probabilities in 15-19- and 20-24-year-olds). These ineffective contraceptive uses were related to traditional Arab norms, represented by the pooled proportion of "as many as possible" and "up to God" answers to the ideal number of children (70% of men and 30% of women).

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↗
PubMed2003

Knowledge and perception of emergency contraception among female Nigerian undergraduates.

CONTEXT: The reproductive health hazards of unintended pregnancies and unsafe abortions are well documented. The potential of emergency contraceptives to prevent unwanted pregnancy in developed countries has been described, but in Nigeria, the awareness about the method is poor and no study has looked at efficacy. METHODS: Between September and October 2001, a randomly selected sample of female undergraduate students at the University of Benin, Nigeria, were surveyed about their demographic information, sexual history and contraceptive use, and their awareness and knowledge of emergency contraception. RESULTS: Of the 880 respondents, 43% were sexually active, 39% had ever practiced contraception and 34% had ever had an induced abortion. Overall, 58% of respondents reported knowing about emergency contraception; sexually active respondents were significantly more likely than those who were not and those who had ever practiced contraception were more likely than those who had not to be aware of emergency contraceptives. However, only 18% of respondents who reported knowing about emergency contraception knew the correct time frame in which emergency contraceptives must be used to be effective. CONCLUSION: There is an urgent need to educate Nigerian young people about emergency contraception, emphasizing available methods and correct timing of use.

Adolescent↗
PubMedDate not supplied

Partner influence on early discontinuation of the pill in a predominantly Hispanic population.

CONTEXT: Although studies have examined U.S. pill users' patterns of discontinuation, little is known about pill discontinuation, and the effects of partner influence, among Hispanics. METHODS: Follow-up data on pill use were collected from 213 predominantly Hispanic women who requested the pill in an urban family planning clinic in 2000. Logistic regression analyses were conducted to assess the association between a range of factors, including partner and relationship variables, and the odds of discontinuation within one month. RESULTS: The overall discontinuation rate within one month was 23%. Women who reported that their partner was unaware of their planned pill use had significantly elevated odds of discontinuing use (odds ratio, 3.4). Other variables that were independently associated with increased odds of early pill discontinuation were not taking the first pill during the clinic visit (3.0), feeling happy about the prospect of a pregnancy in the next six months (2.4) and intending to use the pill for one year or less (2.3). Age, which was assessed as a continuous variable, was negatively associated with the odds of early discontinuation (0.9). CONCLUSIONS: Male partners' awareness of planned pill use may be a marker for the level of communication and commitment in the relationship. Women may choose to disclose their planned pill use to supportive partners, and this may be beneficial to the relationship and the couple's contraceptive use. However, clinicians should take women's circumstances and needs into account before counseling them to tell a partner that they intend to use the pill.

Adolescent↗
PubMedDate not supplied

Improved continuation rate of depot-medroxyprogesterone acetate in adolescent mothers.

Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy.

Adolescent↗
PubMed2005

Alcohol elimination at low blood concentrations among women taking combined oral contraceptives.

OBJECTIVE: Evidence implicating a role of natural and synthetic estrogens and/or progestin on ethanol pharmacokinetics can be traced back to the mid-1970s when reports of large metabolic differences were found suggesting that sex hormones interfered with the efficient clearance of alcohol at the liver microsomal level. Research teams in this area manipulate sex hormone levels by either examining natural-cycling women at different phases of their menstrual cycle or others taking oral contraceptives that synthetically regulate the hormonal fluctuations. These collective studies (over a dozen to date involving over 200 participants) have all been similar in focus and outcome. With one important exception, the published laboratory research since 1976 has failed to replicate the earliest research suggesting sex hormone effects. One well-controlled study in 1987 did generate renewed interest in the area with the paradoxical finding that progesterone actually enhanced alcohol elimination at low blood concentrations (<.025%). The present study represented the most direct attempt to replicate this particular finding using 5-minute breath alcohol readings that extended below blood alcohol concentrations of .025%. METHOD: A total of 17 women taking combined oral contraceptives were tested during both menstruation and the luteal phase (Days 16-22) of their cycle in counterbalanced sequence. RESULTS: Pharmacokinetics differences were not found. CONCLUSION: These results contribute further to a literature base demonstrating the limited effects of both natural and synthetic sex hormones on alcohol metabolism in women.

Adult↗
PubMed1998

Reasons for first teen pregnancies predict the rate of subsequent teen conceptions.

OBJECTIVE: To identify reasons for inconsistent contraceptive use that antedate conception and continue to predispose participants in adolescent-oriented maternity programs to unsafe sexual practices after delivery. We hypothesized that teens who attributed their failure to use contraceptives before their first conception exclusively to concerns about their side effects and/or their own lack of motivation to prevent conception would report less consistent contraceptive use and more repeat conceptions than would teens who attributed their previous failure to use contraceptives to their lack of capacity to do so. METHOD: We conducted a 2-year, prospective, longitudinal study of contraceptive use and repeat conceptions in a racially/ethnically diverse population of poor 13- to 18-year-olds. The 198 study participants were enrolled consecutively during their first pregnancies from an adolescent-oriented maternity program. RESULTS: The majority (84%) of the teens attributed their failure to use contraceptives before their first pregnancy partially to a lack of capacity to do so. As hypothesized, these teen mothers were significantly more likely to use hormonal contraceptives (85% vs 62%), (particularly Norplant, 47% vs 19%) and less likely to conceive again (13% vs 41%). Most teens attributed their inconsistent contraceptive use during the postpartum study period to three factors: side effects, plans to abstain from sexual intercourse, and their lack of motivation to postpone additional childbearing. CONCLUSIONS: The reasons teen mothers give for not using contraceptives consistently before their first pregnancies predict the occurrence of subsequent conceptions during adolescence. Those who attribute their previous failure to use contraceptives consistently to side-effect concerns and their own lack of motivation to postpone childbearing are least likely to use hormonal contraceptives after delivery and most likely to conceive again. Our findings suggest that future research should focus on the development of more effective interventions for preventing repeat conceptions among adolescent mothers who had the capacity to prevent their first pregnancies.

Adolescent↗
PubMed2003

[Male participation in contraceptive methods use].

This study aimed to evaluate male participation in the use of contraceptive methods and to identify relevant variables. A secondary data analysis was conducted, and the sample size was estimated at 175 men using contraceptives methods that require male participation. The study used the qui-square test to evaluate differences between groups, as well as multiple logistic regression analysis. Some 38% of interviewees used some birth control method that required male participation. Higher level of schooling was associated with the use of some form of contraception requiring male participation, i.e., condom use or vasectomy. Considering the sample's characteristics, the study concluded that it is possible for important changes to take place in Brazilian society with regard to the male perspective on contraception. For these changes to be possible it is necessary to invest in education for both men and women, shown to be an important factor for a balance in gender relations.

Adult↗
PubMed2004

Peri-abortion contraception: a qualitative study of users' experiences.

BACKGROUND: Contraceptive counselling is an essential element of induced abortion services but concerns remain about its effectiveness. OBJECTIVE: The issues that influence peri-abortion contraception were explored as part of a study on the experiences of women undergoing induced abortion. METHOD: In-depth interviews with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy, with qualitative analysis of data. RESULTS: Contraceptive risk-taking was high both before and after abortion. After abortion, only a few women had changed either to using some method, or moving to more reliable methods. Health professionals had not explored the issues around contraception with sufficient clarity or detail to be effective. Discussion of contraception was often deferred to the post-abortion follow-up visit, which only 12 respondents had attended at the time of interview. CONCLUSIONS: The effectiveness of peri-abortion contraception counselling was disappointing. We suggest that a family planning-trained outreach nurse attached to abortion providers with specific responsibility for contraception could improve uptake post-abortion.

Abortion, Induced↗
PubMed2005

Attitudes towards family planning in the Southeast Anatolian Project (SEAP) region of Turkey.

OBJECTIVE: To determine attitudes towards family size and last pregnancies in order to improve family planning services in the Southeast Anatolian Project (SEAP) region. METHODS: A questionnaire survey in the nine SEAP regional provinces was carried out under the auspices of the 'SEAP Public Health Project' from 2001 to 2002. The participants comprised 1756 women and 661 men from 1126 households. RESULTS: For men and women aged 15 years and over the median ideal number of children was three. The rate of unintended last pregnancies (43.1%) in the present study was very high compared to the national average of 18.8%. Some 30.1% of the last pregnancies were unwanted by either partner. CONCLUSIONS: The number of pregnancies and children in this region is approximately twice as high as the ideal number. Families in the region are having more children than they want. Basic education must be given to women, particularly non-Turkish speakers, to improve their knowledge and use of family planning. Family planning education for men in rural areas also needs special attention.

Adolescent↗
PubMed2005

Faculty statement from the CEU on a new publication: WHO Selected Practice Recommendations for Contraceptive Use Update. Missed pills: new recommendations.

The World Health Organisation Selected Practice Recommendations for Contraceptive Use (WHOSPR) was first published in 2002 and provides evidence-based recommendations on how to use contraception effectively. The WHOSPR was adapted for UK use by the Faculty of Family Planning and Reproductive Heath Care (FFPRHC). The UK version is available on the FFPRHC website (www.ffprhc.org). Extensive field experience with the first edition of the WHOSPR highlighted to the WHO the need for revised recommendations for missed combined oral contraceptive pills (COCs). The WHOSPR was updated in 2004 and revised guidance on missed pills published. This guidance is now available on the WHO website (www.who.int/reproductive-health). The FFPRHC endorses the new recommendations from WHO on missed COCs for the following reasons: There is new evidence on which to base guidance. The WHOSPR follow a published and rigorous process for assessing the available evidence. The recommendations were developed by an international expert panel, with UK representation. Field experience shows a need for simple, harmonised guidance. This Statement summarises the revised WHOSPR evidence-based 'missed pill rules' in formats which we hope clinicians will find useful. We recognise that different individuals favour different styles for the presentation of information. Thus, both tabular and flow chart styles of summary are provided; these convey the same information but in different ways. The FFPRHC considers that the following statements may also serve as useful aides memoir for the 'missed pill rules': Whenever a woman realises that she has missed pills, the essential advice is 'just keep going'. She should take a pill as soon as possible and then resume her usual pill-taking schedule. Also, if the missed pills are in week three, she should omit the pill-free interval. Also, a back-up method (usually condoms) or abstinence should be used for 7 days if the following numbers of pills are missed: 'Two for twenty' (ie if two or more 20 microgram ethinylestradiol pills are missed). 'Three for thirty' (ie if three or more 30-35 microgram ethinylestradiol pills are missed). The fpa (Family Planning Association) has produced a revised COC user information sheet to reflect these changes; available from April 2005.

Adolescent↗