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Polygamy, disrupted reproduction, and the state: Malian migrants in Paris, France.

For Malian women, migration from West Africa to France has disrupted widely shared understandings of marriage and reproduction. In response to restrictive immigration policies, men and women routinely confront the challenges of polygamy, public disapproval of high fertility, and biomedical messages promoting contraception. Although many Malians continue to be strongly pronatalist, within a family, spouses may experience contradictory pressures and objectives regarding reproduction, particularly in polygamous marriages. Because women are more likely than men to interact with nurses and doctors in the context of maternity and child health care visits, they are systematically confronted by encouragement to contracept. French population policy is contradictory in this regard, as it has been strongly pronatalist throughout the 20th century, yet is equally strongly anti-natalist with regard to immigrant populations. Recent anti-immigrant policies such as the Pasqua law prohibiting polygamy have emerged as influences shaping men's and women's contested reproductive goals. Men tend to oppose contraception, citing Islamic doctrine while women increasingly justify contraceptive use in response to government policies and biomedical encouragement. In contrast, polygamy also may generate pregnancy rivalries as wives strategize to enhance their reproductive careers and thus to retain immigrant status.

Adult↗

Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young women on oral contraceptives.

Focal nodular hyperplasia of the liver may occur with increased frequency in young women who have been taking oral contraceptives. Patients may present with massive intraperitoneal hemorrhage requiring immediate surgical intervention. These nodules may be multiple and occasionally pedunculated, mimicking ovarian cysts. Liver function tests are nondiagnostic. A liver scan and arteriogram are often helpful in determining a diagnosis. Percutaneous liver biopsy is contraindicated. Large nodules should be resected, and continued use of oral contraceptives is contraindicated.

Adult↗

Current concepts regarding use of DMPA.

Since its introduction, depot medroxyprogesterone acetate (DMPA) has proven to be among the most effective methods of reversible contraception. The unique set of characteristics that distinguish this method from other contraceptive options may render it the most suitable method of pregnancy prevention for many women. Accurate information is essential in counseling women attempting to weigh the advantages and disadvantages of this method of contraception relative to others. Since DMPA was approved in the U.S. for use as a contraceptive, clinical studies have continued to generate new details about the effect of this agent on bleeding patterns, mood and weight change. In this overview, the goal is to evaluate objective data in the context of practical management.

Contraception↗

A process model of Depo-Provera use in Canadian women.

This study investigated women's experiences with the long-acting, injectable contraceptive Depo-Provera. Fourteen women were interviewed and 57 charts of clients at a Canadian Sexual Health Centre were reviewed to generate a theory of use. A three-stage process model describes women's choice of this contraceptive and decision to continue or discontinue use. This model suggests that women's use of Depo-Provera is determined by a complex interaction of individual cognition, relational processes, and sociocultural contexts.

Adolescent↗

Contraceptive outcomes among adolescents prescribed Norplant implants versus oral contraceptives after one year of use.

OBJECTIVE: Our goal was to evaluate both the continuation and pregnancy rates and the side effects experienced during the first year of use by adolescents who selected Norplant implants as compared with those who chose oral contraceptives for contraception. Furthermore, side effects experienced at 6 versus 12 months among Norplant implant users were compared to determine whether they diminished with continued use of this method. STUDY DESIGN: We conducted a case-control study of 56 adolescents < or = 18 years old who selected implants as compared with 56 age-matched controls who chose oral contraceptive pills during the same time period. RESULTS: Only 34% of patients prescribed oral contraceptives as compared with 91% of Norplant implant patients were still using their chosen method 1 year later. As a result 25% of oral contraceptive users became pregnant within 12 months as compared with none who selected Norplant implants. Side effects were reported by > 80% of patients in both groups, with menstrual irregularities reported more often by Norplant implant users than by oral contraceptive users (73% vs 5%, p = 0.01). Furthermore, Norplant implant users gained more weight than oral contraceptive users (8.7 vs 4.2 pounds) and were twice as likely to have an abnormal Papanicolaou smear. Finally, little diminution in side effects was observed during the second 6 months of Norplant implant use. CONCLUSIONS: These data confirm that Norplant implants provide better protection against unintended pregnancy in an adolescent population but may be associated with more side effects. Clinicians should be aware of these findings so they can adequately counsel young patients about these two methods of contraception.

Adolescent↗

Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence.

OBJECTIVE: Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion. DESIGN: Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators. POPULATION: Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion. METHODS: Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze-Potter gross life table probabilities with denominators of person-time of exposure. MAIN OUTCOME MEASURES: Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation. RESULTS: Complication rates for immediate post-abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1,000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates. CONCLUSIONS: Post-abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.

Abortion, Induced↗

Combined protein C deficiency and protein C activated resistance as a cause of caval, peripheral, and cerebral venous thrombosis--a case report.

A 26-year-old woman suffered concomitant inferior vena cava, iliac, and femoral vein thrombosis and cerebral venous thrombosis. Ten days before symptom onset she had started using an oral contraceptive that contained low-dose ethynilestradiol and gestodene. Both protein C deficiency and protein C activated resistance were detected. To our knowledge, the association of cerebral, caval, and ilio-femoral-popliteal venous thrombosis has not been described previously. The severity of the clinical features could be a consequence of the two combined thrombophilic mechanisms and of the continuation of the oral contraceptive. A thrombophilic disorder should be considered in young patients with thromboembolic disease. Because of the high prevalence of the genetic deficiency causing protein C activated resistance, it is probably worthwhile to perform general screening before prescription of oral contraceptives.

Adult↗

A comparative study of Neo Sampoon, Ortho Vaginal Tablets and Emko Vaginal Tablets in Accra, Ghana.

Neo Sampoon is an effervescent contraceptive vaginal tablet manufactured in Japan that contains 60 mg of the spermicide menfegol. Ortho Vaginal Tablets (OVT) and Emko Vaginal Tablets (EVT), both containing 100 mg of the spermicide nonoxynol-9, were manufactured in the USA. The three products were compared in a randomized clinical trial conducted at the family planning clinics of the Korle-Bu Teaching Hospital and the Kotobaabi Polyclinic in Accra, Ghana. Three-hundred volunteers participated. At 12 months, the life-table pregnancy rates were 9.6, 11.3 and 12.5 per 100 women in the Neo Sampoon, OVT and EVT groups, respectively (p greater than 0.10). More EVT than Neo Sampoon or OVT users discontinued because of discomfort as well as for other product-related reasons (p less than 0.01). The most common reason for discontinuation was the temporary absence of sexual partner, with more than 40% of the women overall terminating for this reason. The 12-month life-table continuation rates per 100 women were higher for the Neo Sampoon group (62.4) than the OVT group (48.6) or the EVT group (38.5) (p less than 0.01). The effectiveness of the three products seems to be similar, but Neo Sampoon and OVT appear to be more acceptable than EVT in this Ghanaian population.

Adult↗

Two years of intrauterine contraception with levonorgestrel and with copper: a randomized comparison of the TCu 380Ag and levonorgestrel 20 mcg/day devices.

IUDs releasing 20 mcg/day of levonorgestrel (LNg20) were in randomized trial together with the Copper T, model TCu 380Ag, in seven centers involving 2244 women. Two-year (25 months) gross cumulative pregnancy rates were 0.2 +/- 0.2 and 0.9 +/- 0.3 for the levonorgestrel and copper releasing devices, respectively (P greater than 0.05). There were no ectopic pregnancies in more than 1600 woman-years of use of each device. Removal rates for bleeding and/or pain or for medical reasons other than menstrual problems did not differ significantly between devices. Oligomenorrhea or amenorrhea prompted 10.7 per hundred (gross rate, 8.4 net rate) women using the LNg 20 IUD to request removal in the two-year period, significantly above the 0.2 per hundred rate among women with the Copper IUD (P less than 0.001). At the end of two years an estimated 59.4 per 100 women were continuing use of the LNg 20 IUD, and 67.5 per 100 (P less than 0.001) with the TCu 380Ag. This difference is almost wholly ascribable to a marked reduction in bleeding episodes and days among women using the LNg 20 device with concomitant removal of device. Hemoglobin rose an average of 0.5 g/dl (P less than 0.001) for this group whereas women using the TCu 380Ag experienced a decline of 0.2 g/dl compared with baseline values (P less than 0.001).

Adolescent↗

[The effect of two low dose oral contraceptive with gestodene on the systems of natural inhibitors of coagulation].

AIM: The authors investigated the influence of two monophasic oral contraceptives with 30 and 20 microg ethynilestradiol (EE) with combination with 75 microg gestodene (GSD) upon the system of natural inhibitors of coagulation. MATERIALS AND METHODS: The study is prospective for a period of 12 months and was conducted upon 105 clinically healthy women, who use 30 microg EE/75 microg GSD (n = 35), 20 microg EE/75 microg GSD (n = 35) and a control group (n = 35). RESULTS: The continuous use of the contraceptive combination with 20 g EE/75 g GSD leads to statistically significant elevation of protein C (PrC), total protein S (TPrS) and Heparin Cofactor II (HCII). The use of the contraceptive combination with 30 microg EE/75 microg GSD is associated with statistically significant increase of Pr C and HC II. There were no statistically significant changes in the other variables. CONCLUSION: The use of both oral contraceptive combinations is associated with increased anticoagulant activity, which status prevents from thrombosis.

Adolescent↗

Postpartum contraception: the lactational amenorrhea method.

Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.

Algorithms↗

[Comparative study of the effectiveness of continuous or intermittent courses of a phlebotonic drug on venous disorders disclosed or aggravated by oral, estrogen-progesterone contraceptives].

In patients with venous disorders related to oral contraceptives, venotonic treatment should be prescribed for as long as contraception is maintained. 2,295 patients between the ages of 20 and 40 years with venous insufficiency revealed or aggravated by oral contraceptives were randomised to receive venotonic treatment for one month either continuously or in parallel with active contraceptive treatment, from the 10th to the 28th day. The results demonstrated the values of prolonged treatment of venous disease, as its effects persisted and were reinforced with time. The possibility of intermittent prescription would appear to improve compliance and lower the cost of treatment while ensuring comparable long-term efficacy.

Adult↗

IUD (Nova-T) insertion following induced abortion.

In a prospective study, 86 women who had an IUD (Nova-T) inserted immediately after induced abortion were compared to 95 abortion patients who started another contraception (control I). Additionally, the rate of complications following IUD insertion in a Family Planning Clinic (control II) were studied in 83 non-pregnant women. The overall infection rate for post-abortion patients was 4.4% (5.8% in the study group, 3.2% in control I). No infections were observed in control group II. Confidence limits (95%) for the three groups were overlapping. Among the women in the study group, bleeding and pain were not more frequent, but if one of these complications occurred, it tended to be more serious and the duration was longer. The number of days before resumption of work after abortion was 3-4 days in both abortion groups. After three months, the continuation rate was 83% (71 of 86) in the study group, 76% (72 of 95) in control I and 93% (77 of 83) in control II. Sixty-nine of the 181 women admitted for legal abortion had been admitted for the same reason previously. In this study, the recurrence rate after 12 months was 0% in the study group and 4.2% (4 of 95) in control group I. The insertion of an IUD at the time of abortion seems to be an effective and acceptable solution to the problem of recurrent abortion.

Abortion, Induced↗

Adolescent use of the monthly contraceptive injection.

STUDY OBJECTIVE: To compare weight and continuation among adolescents using monthly medroxyprogesterone acetate (MPA)/ethinyl estradiol cypionate (E2C), tri-monthly depot MPA (DMPA), and daily oral contraceptive pills (OCP). DESIGN: Medical records were reviewed for body mass index, demographics, and sexual history at baseline; and weight and continuation at 3, 6, 9, and 12 months. Bivariate analyses were performed by method, and continuation functions were compared by the log-rank and Wilcoxon tests. The effect of method on use duration was assessed by Cox regression. SETTING: Hospital adolescent clinic. PARTICIPANTS: 12- to 21-year-old patients who initiated MPA/E2C, DMPA, or OCPs in 2001. MAIN OUTCOME MEASURES: Weight gain and method continuation. RESULTS: MPA/E2C was initiated by 40 (18%) patients, DMPA by 63 (28%), and OCPs by 119 (54%, P < 0.001). OCP users were younger (P = 0.005) and more likely to be white, privately insured, and in school (P < 0.004) than MPA/E2C or DMPA users. Previous DMPA and OCP use, pregnancy, and sexually transmitted infections (STI) were more common among MPA/E2C than DMPA or OCP users (P < or = 0.001). Baseline BMI was lowest (P = 0.06) among DMPA users, and MPA/E2C users were most likely to be overweight (P = 0.03). There were non-significant differences in weight change. Continuation functions differed by the method only in the first three months of use (P = 0.03). Leading reasons for discontinuation were unavailability of MPA/E2C (20%), bleeding with DMPA (22%), and forgetting OCPs (17%). Duration of use was independently associated with white race (P < 0.005) and STI-never (P < 0.0001) but not with method type. CONCLUSIONS: Although MPA/E2C use was associated with overweight status and early discontinuation, it also was associated with previous use of other methods. For all methods, poor continuation at one year supports the ongoing search for effective contraceptive alternatives.

Adolescent↗

[Hemostatic profile of women using low-dose oral contraceptive Mercilon. (Preliminary report)].

The authors have investigated the hemostatic profile at 20 women using low-dosed oral contraceptive Mercilon (Organon) in continuation of six months. Statistically significant changes are found for factor X of hemocoagulation, plasminogen, protein C, protein S and antithrombin III. It is concluded that Mercilon causes activation of the coagulation system, which is balanced by the activation of the fibrinolytic system.

Adolescent↗

Short-term effect of oral contraceptive pills on some haemostatic parameters in healthy Nigerian women.

The objective of this study was to determine the effect of low-dose combined oral contraceptive pill, Lo-femenal, on the following haemostatic parameters: platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen, of apparently healthy Nigerian women over a period of three months. A total of sixty-seven women were recruited for the study consisting of forty-seven subjects and twenty age-matched controls, who were aged between 17 and 37 years. All haemostatic parameters were determined using standard haematological techniques described by Dacie and Lewis, before, and three months after continuous use of oral contraceptive pills in the subjects. The same parameters were determined three months apart in control subjects who were on oral contraceptive pills. Statistical analysis of data was done using the chi-squared test and statistical significance was based on p value < 0.05. The mean values of platelet count and fibrinogen were significantly increased (p=0.0000 and 0.0003 respectively), while the PT and TT reduced significantly (p=0.007 and 0.0000 respectively) after three months of contraceptive use. There was no significant difference in the value of APTT (p=0.17) before and after oral contraceptive use. No differences were observed in the values in the controls. The findings in this study indicate some degree of pro-coagulant activity in the subjects, and the need to properly assess and monitor haemostatic parameters in pills users before commencement and while on them.

Adolescent↗

Comparative acceptability of combined and progestin-only injectable contraceptives in Kenya.

OBJECTIVE: We compared 12-month continuation rates, menstrual bleeding patterns and other aspects of acceptability between users of Cyclofem and users of Depo-Provera. METHODS: The life-table method was used to calculate quarterly continuation rates. In all, 360 Kenyan women were randomly assigned to one of the two contraceptives. User-satisfaction questionnaires were administered at 6 and 12 months or at discontinuation, whichever occurred first. RESULTS: The 1-year continuation rate was 75.4% for Depo-Provera users versus 56.5% for Cyclofem users (p<.001). Main reasons for discontinuation included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for Depo-Provera), menstrual changes (14.1% vs. 12.5%) and nonmenstrual problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of the Cyclofem users claimed frequency of visits as the main reason for discontinuation. In all, 70.6% of the Depo-Provera users were amenorrheic after 12 months, as were 20.8% of the Cyclofem users. CONCLUSIONS: The 1-year continuation rate was higher for Depo-Provera than for Cyclofem. There was no important difference in discontinuation rates because of menstrual problems; the difference mainly reflected the frequency of visits required.

Adult↗

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↗