Why some women fail to use their contraceptive method: a psychological investigation.
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Contraceptive use by breastfeeding women in developing countries has led to concern about potentially harmful effects of steroid contraceptives on the health of breastfed children. In this paper, breastfeeding women's use of the pill and hormonal injections is investigated using survey data from 17 Latin American, Asian, and African countries. The results indicate that while the proportions of breastfeeding women who use these methods were small in most countries at the time of the surveys, the proportion using the pill was not inconsequential. In general, younger lactating women with higher education and more live births who live in urban areas are more likely to use the pill than other breastfeeding women.
In a large prospective study, set up to determine whether reproductive outcomes are affected by prior contraceptive use, 34,344 women were recruited at their first antenatal visit and followed until pregnancy termination. This paper summarizes the study methods and describes the demographic differences between subjects who used various contraceptives shortly before conception, and those who experienced contraceptive failures. Thirty percent of the women had used oral contraceptives (OCs) during the 5 months prior to conception and 2.4% had continued using them after their LMP. IUDs had been used by 5.8% of women before conception and 1.1% after. If these rates are also true for the whole population of the U.S., they indicate that approximately 70,000 babies are born each year following pill-failures and 30,000 following failures of IUD's. Exposure to other fetal hazards was common, with 48% of pregnant women drinking alcohol, 28% smoking, and 15% receiving diagnostic X-rays. OC use was more common among smokers and drinkers, and OC failures were significantly associated with the use of anti-epileptics, aspirin, and with exposure to radiation.
A pharmacodynamic and pharmacokinetic study of the Chinese No. 1 pill, a combined oral contraceptive containing 35 micrograms ethynyloestradiol (EE) and 600 micrograms norethisterone (NET), was performed in 29 women over a period of six months. Blood samples for analysis were taken during a pretreatment cycle, the first and 6th treatment cycles and post-treatment. Minor changes in carbohydrate metabolism occurred and these were particularly noticeable when the incremental areas under the serum concentration-time curves for both glucose and insulin in response to a glucose tolerance test were calculated. No changes occurred in the serum glycosylated haemoglobin levels. The serum concentrations of all the lipids measured (total cholesterol, triglycerides, LDL-C, HDL-C and apolipoproteins AI, AII and B) were significantly increased on treatment as were levels of Factor X, SHBG and caeruloplasmin whereas antithrombin III decreased. In 38 of the 40 treatment cycles, ovulation was suppressed. In one cycle serum oestradiol and progesterone levels showed a typical ovulatory pattern and in another there was evidence of follicular activity without ovulation. Serum EE concentrations showed a similar pattern in both treatment cycles showing that co-administration of NET did not affect EE metabolism. Serum NET levels were higher in the 6th than in the first treatment cycles. On comparing pharmacodynamic and pharmacokinetic parameters, the only statistically significant correlations were between the percentage change in triglycerides and SHBG and serum NET, but not EE concentrations, and between apolipoproteins AI and serum EE.
From October 1987 to May 1989, a total number of 527 women completed a total of 6,291 treatment cycles in 6 centers in China for the study of a triphasic oral contraceptive - Triquilar. The mean age of subjects was 30.21 +/- 2.84 years. There were 7 pregnancies during the study period. Among them, five were patient failures because of missed pill or incorrect intake; one had taken barbiturates along with Triquilar. Only one woman became pregnant in the 11th treatment cycle without any reason being found. In most cases, menstrual flow decreased and dysmenorrhea improved as treatment continued. Of the total treatment cycles, the incidence of missed withdrawal bleeding was 0.25%, spotting 0.97%, and breakthrough bleeding 0.48%. Nausea and vomiting was the most common side effect and accounted for 6.4% of the total treatment cycles. This was followed by breast tenderness (3.7%), dizziness (2.4%) and headache (1.6%). Most of the side effects occurred during the first few cycles and were alleviated later. By the end of one year, the total dropout was 64 cases. The reasons for discontinuing treatment were: pregnancy 1.33 (per hundred women), menstrual disturbances 0.76, side effects 3.80, other medical reasons 2.09, and personal reasons 4.18. The results confirm that Triquilar is an effective oral contraceptive with good cycle control and low incidence of side effects. No serious reaction has been reported. It has been well accepted by the Chinese women. However, due to the low dosage of steroids, it is of utmost importance to avoid errors in its use.(ABSTRACT TRUNCATED AT 250 WORDS)
Self-concept and autonomy are typically negotiated during adolescence, a time when many females also become sexually active. Nonuse and discontinuation of contraceptives by teenagers place them at high risk for pregnancy. The present study explores the relationship between these psychological factors and contraceptive noncompliance during adolescence. Fifty-five adolescent females beginning a contraceptive regimen were entered into the study. Compliance at four months after the initiation of an oral contraceptive was associated with scoring high on the Behavior Subscale of the Piers-Harris Self-Concept Scale and the Autonomy Scale modified from Eysenk.
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This report details the methods the authors used to conduct the Cancer and Steroid Hormone Study, a multicenter, population-based, case-control study of oral contraceptive use in relation to breast, endometrial, and ovarian cancer diagnosed during 1980-1982. The authors have documented their methods and rationale, and the results of their data collection efforts as a practical guide for the planning and conduct of large case-control studies. They observed the following: 1) the Surveillance, Epidemiology, and End Results program is a useful epidemiologic resource for identifying cases from which to evaluate risk factors for cancer in the United States; 2) random digit dialing is an effective and efficient method for screening for eligible controls for a population-based study; 3) with the cooperation of community pathologists, histologic specimen slides can be retrieved and reviewed for diagnostic confirmation and histologic subclassification of cancer for greater than 95% of the cases interviewed; and 4) data reported during personal interviews of study participants can be validated by reviewing medical records for more than 75% of study participants who reported medical events that occurred during the 10 years before the beginning of the study.
Contraceptive practices, especially oral contraceptive and intrauterine device use, were studied in four Nordic countries by recalculating published and unpublished data from previous surveys and statistics and by collecting new data from Finland. The sales of oral contraceptives were presented in defined daily doses, and the percentages of women using oral contraceptives were estimated from them. The percentages of intrauterine device users were calculated taking into account the number of intrauterine devices sold each year and the continuation of use from previous years. The results of the surveys were reanalysed. We found clear differences in contraceptive practices. Oral contraceptive use was most prevalent in Sweden and Denmark, and, especially at the end of the 1970s, Finnish intrauterine device use was very high. In the 1980s the differences dimished somewhat. These disparities in culturally and economically similar countries indicate that further research is needed to evaluate the factors influencing contraceptive practices.
Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, woman-controlled method of pregnancy and disease protection would be welcomed by these women.
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The performance of a low-dose triphasic oral contraceptive (OC) in the first four cycles of use was evaluated by 1,326 primary-care physicians and specialists across Canada in a phase-IV postmarketing trial. Data were available from 5,460 women who completed 19,756 cycles of use with Synphasic. The incidence of intermenstrual bleeding characteristically decreased over the four cycles to 10% in women who were first-time users of OCs, to 14% in women who had previously used OCs but had discontinued use until this trial, and to 16% in women who had switched from another OC to Synphasic. The women reported a low incidence of headache, nausea, weight gain, breast complaints, and acne while receiving Synphasic. The results demonstrate good endometrial control with Synphasic and a high level of patient acceptance.
An evaluation of the reproductive health programs of six diverse school-based clinics measured the impact of the clinics on sexual behavior and contraceptive use. All six clinics served low-income populations; at five of them, the great majority of the students served were black. An analysis of student visits by type of care given found that these clinics were not primarily family planning facilities; rather, they provided reproductive health care as one component of a comprehensive health program. Student survey data collected in the clinic schools and nearby comparison schools (four sites) or collected both before the clinic opened and two years later (two sites) indicated that the clinics neither hastened the onset of sexual activity nor increased its frequency. The clinics had varying effects on contraceptive use. Providing contraceptives on site was not enough to significantly increase their use; in only one of the three sites that did so were students in the clinic school significantly more likely than students in the comparison school to have used birth control during last intercourse. However, condom use rose sharply at one clinic school that had a strong AIDS education program and was located in a community where AIDS was a salient issue. At another clinic school, where pregnancy prevention was a high priority and staff issued vouchers for contraceptives, the use of condoms and pills was significantly higher than in the comparison school. A third clinic school--which focused on high-risk youth, emphasized pregnancy prevention and dispensed birth control pills--recorded a significantly higher use of pills than its comparison school. Although the data suggest that the clinics probably prevented small numbers of pregnancies at some schools, none of the clinics had a statistically significant effect on school-wide pregnancy rates.
A phase IV trial evaluated the efficacy and safety of a monophasic oral contraceptive formulation, ethynodiol diacetate, 1 mg, plus ethinyl estradiol, 35 micrograms (EDA 1 mg with EE 35 micrograms) (Demulen 1/35). Nine hundred eighty-three community-based obstetrician-gynecologists treated a total of 7,759 patients with EDA 1 mg with EE 35 micrograms for one to eight months. Clinical evaluation forms on 6,382 patients were amenable to analysis for safety (including breakthrough bleeding, ovarian cyst formation and complexion changes); 5,412 patients were evaluable for efficacy (prevention of pregnancy), with a total of 21,440 cycles recorded. The study results were interpreted in terms of the impact on clinical management of oral contraceptive users and the methods, strengths and weaknesses of phase IV trials, particularly as they relate to confirmation of the results reported here.
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This study shows the first national estimates of trends and differentials in first contraceptive use for a national sample of all women. Only 47 percent of women aged 15-44 in 1982 (or their partners) used a method at first premarital intercourse. The leading method at first intercourse was the condom, followed by the pill and withdrawal. The percentage using a method increased from the early 1960s to the late 1970s, because of increases in use of the pill and withdrawal. However, in the early 1980s, use at first intercourse increased sharply because of an increase in use of the condom. The proportion who used a method at first intercourse varied from 22 percent among Hispanic women to 74 percent among Jewish women; it was higher among white than black women, and higher in higher socioeconomic categories. After first intercourse, contraceptive use did not vary significantly by socioeconomic characteristics. While the condom was the leading method at first intercourse, women who practiced contraception for the first time after first intercourse typically used the pill.