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PubMed2003

Why are uneducated women in India using contraception? A multilevel analysis.

While women's education continues to be strongly associated with lower fertility in India, an important feature of India's current fertility transition is the spread of contraceptive use among uneducated women. Indeed, changes in their fertility are now making the major contribution to the country's overall fertility decline. We use multilevel statistical procedures to investigate the variation in contraceptive use among uneducated women across India. The analysis suggests that, while many of the expected socio-economic variables play their part, there are also considerable diffusion effects in progress, many of which operate at levels beyond the uneducated women's own individual circumstances. For example, we find significant relationships with others' use of contraception and others' education. Mass media exposure also emerges as an important diffusion channel. The multilevel analysis also reveals significant clustering of contraceptive use at different levels, much of which is accounted for by the variables included in the models.

Contraception↗
PubMed1978

Postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250).

The results obtained from postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250) are presented. The study was prompted by a pilot study in the Netherlands which showed that few expulsions occurred with "postplacental" insertion of the multiload intra-uterine device. Seventy-five patients had devices inserted between 6 and 72 hours postpartum, and the patients were followed up for 6 months after insertion, with an overall continuation rate of 77,6%. This study showed that the postpartum insertion of this device is a safe and acceptable form of contraception, particularly in patients who are unlikely to continue with other forms of contraception.

Female↗
PubMed1998

[30 years of contraception in France].

Modern contraceptive methods have diffused almost continuously over the last 30 years in France. The progress of the pill has been masqued during the recent years by the spread of new treatments of perimenopause, while the use of IUD seems to have reached a ceiling. French couples rely now basically on these two methods for their contraception, and sterilisations remain uncommon. The use of pill is highest among younger women, while IUD is at a maximum between 35 and 45 years. Differences by social status are limited, and the number of unplanned births has decreased dramatically. The relatively high number of abortions, however, shows that the situation is not yet fully satisfactory.

Abortion, Induced↗
PubMed2003

New options in contraception for teenagers.

PURPOSE OF REVIEW: Unintended pregnancy continues to exact a considerable economic, social and personal cost in industrialized nations despite the ready availability of safe, reliable and highly effective methods of contraception. Adolescents still demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options that provide unique side effect profiles or delivery systems that could facilitate and improve compliance of contraceptive methods. RECENT FINDINGS: The recent launch of several new combination oral contraceptive pills with novel side effect profiles has expanded the choices for teenagers who choose to use a daily oral contraceptive. Of potentially greater interest is the recent availability of several nondaily contraceptives, as compliance remains a critical issue with successful contraceptive use in adolescents. SUMMARY: New contraceptive methods bring unique side effect profiles and delivery systems that may improve overall contraceptive compliance, especially among teenagers who are more prone to misuse from a wide array of side effect and compliance issues. Even the most accepted method, however, will not provide effective contraception if the process by which contraception is provided fails to address the unique concerns and lifestyle issues of each individual adolescent.

Absorbable Implants↗
PubMed2005

Practical approaches to prescribing contraception in the office setting.

Caring for the contraceptive needs of an adolescent young woman can be a challenge on many levels. Adolescents are often called young adults, but they are not adults developmentally. Therefore, adult strategies for contraceptive teaching, decision-making, and compliance are often inappropriate and unsuccessful. Health care providers are faced with increasing constraints in the office that can make it difficult to find the time to counsel the adolescent appropriately. Parental involvement in contraceptive decision making, compliance, and continuation will be different with each adolescent and her family. Although this interaction can be a problem, it is also an area where the clinician may make a positive impact for the adolescent and her family.

Adolescent↗
PubMed1981

Vaginal bleeding disturbances associated with the discontinuation of long-acting injectable contraceptives. From the World Health Organization Special Programme for Research, Development, and Research Training in Human Reproduction; Task Force on Long-acting Systemic Agents for the Regulation of Fertility.

A randomized comparative trial of 832 women receiving norethisterone oenanthate (NET-OEN) and 846 women receiving depot medroxyprogesterone acetate (DMPA) injections at 12 week intervals was conducted in 10 centers. The pregnancy rate with NET-OEN was significantly higher than with DMPA. The termination rate for amenorrhoea was substantially lowe with NET-OEN than DMPA, whereas the discontinuation rates for bleeding problems were similar with the two drugs. Analysis of bleeding patterns among continuing and discontinuing users suggests that women tolerated frequent bleeding episodes, but found prolonged bleeding or prolonged bleeding-free intervals unacceptable. Bleeding for more than 30 days during an injection interval and complete amenorrhoea for a whole injection interval were jointly associated with 43.7% of all terminations among NET-OEN users and 64.5% of all terminations among DMPA users. In future efforts to improve the acceptability of long-acting injectable contraceptives, more attention should be given to the control of prolonged amenorrhoea and prolonged bleeding.

Amenorrhea↗
PubMed2006

An energy-saving development initiative increases birth rate and childhood malnutrition in rural Ethiopia.

BACKGROUND: Evolutionary life history theory predicts that, in the absence of contraception, any enhancement of maternal condition can increase human fertility. Energetic trade-offs are likely to be resolved in favour of maximizing reproductive success rather than health or longevity. Here we find support for the hypothesis that development initiatives designed to improve maternal and child welfare may also incur costs associated with increased family sizes if they do not include a family planning component. METHODS AND FINDINGS: Demographic and anthropometric data were collected in a rural Ethiopian community benefiting from a recent labour-saving development technology that reduces women's energetic expenditure (n = 1,976 households). Using logistic hazards models and general linear modelling techniques, we found that whilst infant mortality has declined, the birth rate has increased, causing greater scarcity of resources within households. CONCLUSIONS: This study is, to our knowledge, the first to demonstrate a link between a technological development intervention and an increase in both birth rate and childhood malnutrition. Women's nutritional status was not improved by the energy-saving technology, because energy was diverted into higher birth rates. We argue that the contribution of biological processes to increased birth rates in areas of the developing world without access to modern contraception has been overlooked. This highlights the continued need for development programmes to be multisectoral, including access to and promotion of contraception.

Adolescent↗
PubMed1992

A randomized, double-blind, placebo-controlled comparison of the impact of low-dose and triphasic oral contraceptives on follicular development.

OBJECTIVE: This investigation tests the hypothesis that triphasic oral contraceptives are associated with the development of large, persistent ovarian cysts. STUDY DESIGN: Weekly vaginal ultrasonography was used in a randomized, double-blind, placebo-controlled, parallel-group, single-center study that compared the incidence, risk, size, and time to resolution of ovarian follicles in healthy women who took Estrostep or Loestrin oral contraceptives (manufactured by Parke-Davis) or a placebo during three consecutive menstrual cycles. RESULTS: Sixty-three percent of placebo-treated subjects developed follicles greater than 18 mm, compared with 39% and 23% in the Estrostep and Loestrin groups. The risks for each group of developing a large follicle during a single cycle were not different. No dominant follicle persisted for greater than 2 weeks for any subject. CONCLUSION: These results demonstrate that follicular development continues during treatment with oral contraceptives. In addition, the findings fail to support the hypothesis that triphasic oral contraceptives result in persistent ovarian cysts.

Adult↗
PubMed2001

[Contraception with depot gestagens].

OBJECTIVE: Summary of contraceptive implants and injectable contraceptives. DESIGN: Review of the literature. SETTING: Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University, Prague. RESULTS: Contraceptive implants and injectable contraceptives are systems based on continuous release of small dose of progestogen in the circulation. Active substances are depo-medroxyprogesterone acetate in the Depo-Provera injections and levonogestrel in Norplant implants. Mechanisms of action are: inhibition of ovulation, impermeability of cervical mucus and synchronisation of maturation of endometrial stroma and glands. Efficacy of both of the methods is very high. Recovery of fertility is immediately in after Norplant removal and in few months after discontinuation of Depo-Provera. Progesterone only contraception has only very few contraindications which are only relative. It is possible to use her by the women with contraindications of combined oral contraception. The main side effect is altered menstrual bleeding pattern.

Contraceptive Agents, Female↗
PubMed2006

Continuation rates of Implanon in the UK: data from an observational study in a clinical setting.

BACKGROUND: Long-acting reversible methods of contraception can potentially reduce unintended pregnancy. There are few data on "real-life" continuation rates of the contraceptive implant Implanon. MATERIALS AND METHODS: Three hundred twenty-four women choosing Implanon in a community family planning clinic in Scotland were followed up by case note review (n=236) or postal questionnaire (n=87) 3 years after insertion of the implant (1 woman chose not to disclose her home address). RESULTS: Data were available for 85% of the women. Continuation rates were 89% (CI 84-91) at 6 months, 75% (CI 69-79) at 1 year, 59% (CI 52-63) at 2 years and 47% (CI 40-52) at 2 years and 9 months. Of the 68 women who discontinued Implanon within 1 year, 62 (91%) did so because of unwanted side effects, the most common being frequent and/or unpredictable bleeding (n=42, 62%). Almost half changed to a less-effective method of contraception; however, one third (n=99, 39%) chose to use a second implant when the first one expired. CONCLUSIONS: Continuation rates of Implanon in this clinic setting in the UK make it a cost-effective method of contraception and justify its widespread provision.

Adolescent↗
PubMed2003

Risks and benefits, advantages and disadvantages of levonorgestrel-releasing contraceptive implants.

Levonorgestrel-releasing implants are long acting contraceptives, approved for 5 years of continuous use. Two marketed systems, the six capsule Norplant use of tradenames is for product identification purposes only and does not imply endorsement. and the two rod Jadelle, have essentially equal rates of drug release, pregnancy and adverse events over 5 years of use. Randomised clinical trials and controlled cohort observations indicate that for the first 3 years, when pregnancy rates are at or almost zero, no other contraceptive system is more effective, although etonogestrel implants provide equal effectiveness. Annual pregnancy rates rise in the fifth year of continuous use but remain below 1 per 100 women. Annual pregnancy rates of Norplant users remain below 1 per 100 throughout 7 years of continuous use. Levonorgestrel implants provide low progestogen doses; 40-50 microg/day at 1 year of use, decreasing to 25-30 microg/day in the fifth year. Serum levels of levonorgestrel at 5 years are 60-65% of those levels measured at 1 month of use. Adverse effects with levonorgestrel implants are similar to those observed with progestogen only and combined oral contraceptives. Risks of ectopic pregnancy, other pregnancy complications and pelvic inflammatory disease are reduced in comparison with those of women using copper or non-medicated intrauterine devices. Risks of developing gallbladder disease and hypertension or borderline hypertension, although small, are about 1.5 and 1.8 times greater, respectively, in women using levonorgestrel implants than in women not using hormonal contraception. Other serious diseases have not been found to occur significantly more frequently in levonorgestrel implant users than in women not using hormonal contraception. The great majority of levonorgestrel implant users experience menstrual problems, but serious bleeding problems are not more frequent than in controls. Other health problems reported more frequently by levonogestrel implant users than by women not using hormonal contraception in a study of 16000 women included skin conditions, headache, upper limb neuropathies, dizziness, nervousness, malaise, minor visual disturbances, respiratory conditions, arthropathies, weight change, anxiety and non-clinical depression. Clinical depression is not more frequent in women using implants compared with those not using hormonal contraception (i.e. using intrauterine devices, sterilisation). Removal problems occur less frequently with Jadelle than with Norplant. The mean removal time for Jadelle is half that of Norplant. Levonorgestrel implants in nationally representative scientific samples, in randomised trials, and in controlled cohort studies have continuation rates as high as or higher than any other reversible contraceptive over a duration of 5 years. This would imply that the satisfaction women derive from the contraceptive effectiveness of levonorgestrel implants greatly outweighs the dissatisfaction that may accompany menstrual disturbances and other adverse effects associated with implants.

Contraceptive Agents, Female↗
PubMed1977

Management of the lost intrauterine contraceptive device.

In order to establish that a lost IUD is within the uterine cavity, a special hook-type instrument was designed to enable removal of the device when it was located within the uterine cavity. This instrument was 100% successful in removing 17 IUDs with no visivle tails and which were within the uterine cavity. Failure to remove a lost IUD by this method in 4 other patients indicated the device's absence from the uterine cavity. The technic is simple and has not been associated with any patient discomfort or complications. X-ray procedures or operative manipulations may thereby be avoided. Therefore, when the tail of an IUD is no longer visible, immediate removal can be attempted in order to establish the intrauterine location of the device. If the patient wishes to continue using this form of contraception, a new device should be inserted.

Female↗
PubMed1999

Lea's Shield contraceptive device: pilot study of its short-term patient acceptability and aspects of use.

OBJECTIVE: To assess the short term patient acceptability and aspects of use of the Lea's Shield(R). DESIGN: Observational study. Ten women were each invited to use the Lea's Shield on 10 occasions and to report their observations and experiences on structured questionnaires after each use. Thus, data on a maximum of 100 uses would become available for analysis. Answers were recorded on numerical scales and in descriptive terms. On conclusion of their study participation, patients and their partners were required to document their overall experience with the product. SETTING AND SUBJECTS: Women aged 18 to 40 years, self-selected from clients attending the Margaret Pyke Family Planning Centre. They had to be in a stable monogamous relationship, gynaecologically healthy, and willing to continue their use of oral contraceptives, IUD, or injectable. MAIN OUTCOME MEASURE: Ability to use the method without formal teaching, assessed after vaginal examination by the investigator at end of first visit. User satisfaction, as expressed in structured questionnaires and by premature withdrawal from trial. RESULTS: Ten women used Lea's Shield on a total of 70 occasions, of which 46(66 per cent) were associated with sexual intercourse. Five subjects withdrew from the trial prematurely on account of discomfort to either or both partners (four), and recurrent cystitis (one). At the enrolment visit, all but one woman inserted the device correctly without formal teaching, but there was considerable inter-patient variation in their responses concerning ease of insertion/removal, and comfort during subsequent uses. CONCLUSIONS: These preliminary observations suggest that the Lea's Shield may be acceptable to a highly select minority of women. However, much more research is required to permit a reliable assessment of its acceptability to the wider public. The product's potential for causing pain and discomfort also needs further exploration.

Adolescent↗
PubMed2005

Sexual activity, fertility and contraceptive use in middle-aged and older men: Men in Australia, Telephone Survey (MATeS).

BACKGROUND: With limited information regarding fertility and sexual activity in the older population, men's behaviour, attitudes and concerns were explored in a representative population of middle-aged and older men using the Men in Australia, Telephone Survey (MATeS). METHODS: A stratified random national sample of 5990 men participated in a standardized computer-assisted telephone interview. Equal numbers in the age strata 40-49, 50-59, 60-69 and >or=70 years were surveyed with findings census-standardized to the national population. Broad aspects of men's health and well-being, including reproductive health, were explored. RESULTS: The majority of men were sexually active in the last 12 months (age-standardized proportion, 78.3%) with approximately 37% of men aged >or=70 years still continuing sexual activity. Overall, 12.2% of men had never fathered children, of whom most (7.7%) had chosen not to have children. Questioning on failed attempts to produce a pregnancy suggested an involuntary infertility rate of 7.6%. The age-standardized vasectomy rate was 25.1%, with 5.6% of vasectomized men having no children. Although 9.2% of vasectomized men regretted sterilization, only 1.4% had undergone vasectomy reversal. CONCLUSIONS: Continuing sexual activity, fertility and contraception needs in middle-aged and older men suggests that education and service delivery must be more appropriately directed to an ageing population.

Adult↗
PubMed1983

Ultrasonic measurement of ovarian follicles during chronic LRH agonist treatment for contraception.

Ultrasonic examinations of ovarian follicles were performed in seven healthy women on continuous luteinizing hormone-releasing hormone (LRH) agonist treatment for contraception. Four of the women had 1-4 uterine bleedings during the four-month study period and the remaining three women developed amenorrhea. The follicle diameter varied during LRH agonist treatment up to or above the preovulatory size of the normal menstrual cycle in the menstruating group of women. No ovulation occurred as judged by the low progesterone levels in serum. Slightly raised progesterone concentrations (mean 7.6 nmol/l) were observed during four treatment cycles with persistent follicles indicating luteinization of unruptured follicles. No or only small ovarian follicles (8-10 mm) were visualized by ultrasound in the amenorrheic group of women. This study further establish previous reports that chronic LRH agonist treatment effectively inhibits normal ovulation in regularly menstruating women.

Administration, Intranasal↗
PubMed2002

Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years.

The objectives of this study were to evaluate the bleeding patterns and clinical performance during the first 2 years of use of an intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS, Mirena). Two-hundred-fifty-six women accepted use of Mirena from April 1998 through September 1998. The gross cumulative discontinuation rate due to pregnancy and expulsion were significantly higher in women who used the device because of heavy bleeding. There was one pregnancy at the 15th month of use after an inadvertent expulsion of the device. The continuation rate was 66.2 at the end of the second year. Forty-four percent of women reported amenorrhea at the 6th month of use. This rate maintained stability at 50% after 12 and 24 months of use. Spotting was present in 25% of the users at 6 months, decreasing to 8% and 11% at 18 and 24 months, respectively. Oligomenorrhea was described by one-quarter of women and was similar at each observation period. Removals due to menstrual bleeding problems were concentrated in the first 6 months of use and mostly due to amenorrhea or menorrhagia. In conclusion, LNG-IUS showed a high contraceptive efficacy and a good continuation rate up to 2 years. In addition, a reduction of blood loss was observed a few months after insertion.

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

Headache as a side effect of combination estrogen-progestin oral contraceptives: a systematic review.

OBJECTIVE: We conducted a 2-part systematic review of published studies to examine the evidence that combination oral contraceptives can aggravate or cause headache. STUDY DESIGN: We used trials with a control group to assess headache risk that was attributable to oral contraceptive use and prospective cohort trials to answer important clinical questions about the natural history and treatment response of headache that occurs with oral contraceptive use. RESULTS: Because of differences in study populations, oral contraceptive formulations, trial end points and trial duration, it was not possible to pool data; but the evidence supports several conclusions. There is little indication that oral contraceptives have a clinically important effect on headache activity in most women. CONCLUSION: Headache that occurs during early cycles of oral contraceptive use tends to improve or disappear with continued use. No evidence supports the common clinical practice of switching oral contraceptives to treat headache; however, manipulating the extent or duration of estrogen withdrawal may provide benefit.

Contraceptives, Oral, Combined↗