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PubMedDate not supplied

The availability and accessibility of the contraceptive implant from family planning agencies in the United States, 1991-1992.

During the first year and a half after the hormonal contraceptive implant became available in February 1991, an estimated 81,100 women obtained this method from family planning agencies in the United States. Nevertheless, according to a recent survey of family planning providers, implant availability through the family planning clinic system is still far from universal. By September 30, 1992, only 40% of all family planning agencies were offering implant services to their clients: That proportion ranged from 30% of health department family planning providers to 80% of Planned Parenthood affiliates. Some of the key reasons cited by agencies that do not yet provide implants include the special clinician training required to learn insertion and removal procedures, and the cost of the method. Furthermore, full accessibility of this method to low-income women attending family planning clinics has been limited primarily to those who receive Medicaid, which has paid for more than 60% of all hormonal implants inserted by family planning agencies.

Contraceptive Agents, Female↗
PubMed1998

The use of testosterone as a male contraceptive.

Testosterone functions as a contraceptive by suppressing secretion of the pituitary gonadotropins luteinizing hormone and follicle stimulating hormone. Low levels of these hormones decrease endogenous testosterone secretion from the testis and deprive developing sperm of the signals required for normal maturation. Interference with sperm maturation causes a decline in sperm production and can lead to reversible infertility in men, raising the possibility that testosterone could be utilized in a commercially available contraceptive. To this end, testosterone has been studied alone and in combination with either gonadotropin releasing hormone analogues or progestins in efforts to improve its contraceptive efficacy. In this chapter, we will review efforts to use testosterone to create a safe, convenient, efficacious contraceptive method for men.

Contraception↗
PubMed1993

Respecting the autonomy of chronic mentally ill women in decisions about contraception.

Treatment of women patients with chronic mental illness who are at risk of unwanted pregnancies presents ethical challenges to the clinician who wishes to respect the patient's autonomy while also helping her avert the potential adverse consequences of unwanted pregnancy. The clinician who simply allows the patient to continue at risk or coerces her into using contraception may not have adequately considered the variable nature of the patient's autonomy. The authors suggest that the clinician should assess and treat conditions underlying the patient's variable impairment of autonomy to maximize her ability to participate in family planning decisions. Case examples are used to illustrate assessment of patients' decision-making capacity, development of family planning approaches that respect patients' autonomy, and use of a newly available contraceptive implant.

Adult↗
PubMed2004

Contraceptive failure in the United States.

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

Amenorrhea↗
PubMed1990

Knowledge and use of postcoital contraception: a survey among health professionals in Tower Hamlets.

The knowledge and estimated retrospective use of postcoital contraception was ascertained from health professionals in Tower Hamlets in the summer of 1988 using a postal questionnaire. Eighty five per cent of general practitioners responded and 91% of these had received requests for postcoital contraception within the previous six months. Only one third of general practitioners had information about postcoital contraception available in their surgeries. Family planning doctors and nurses had the most accurate knowledge of the method but many health professionals appeared to lack sufficient knowledge to ensure appropriate prescribing and to publicize this method to their women patients. It is concluded that if the high rate of abortion in the borough is to be reduced, health professionals as well as women need to be further educated as part of a postcoital contraception publicity campaign. Use of the term 'emergency contraception' rather than the non-medical term 'the morning after pill' may be more effective and reduce the present confusion among both groups.

Adult↗
PubMed2002

Take a fresh look at IUDs. Things have changed.

BACKGROUND: Over the past few years, the intrauterine contraceptive device (IUD) has overcome many of the problems that had initially made it unpopular. Today it is probably the most cost effective reversible form of contraception available. OBJECTIVE: To examine the reasons for poor utilisation of IUDs in Australia and to describe recent developments in the field of intrauterine devices/systems. DISCUSSION: Myths concerning mechanisms of action and the potential for pelvic inflammatory disease, lack of familiarity, training and high insurance costs continue to limit the ability of general practitioners to fully utilise the potential of IUDs. The introduction of the levonorgestrel releasing intrauterine system has however, broadened the indication for IUDs from just being contraceptive to being therapeutic for several gynaecological conditions.

Attitude of Health Personnel↗
PubMed1994

Breast cancer among young U.S. women in relation to oral contraceptive use.

BACKGROUND: While most studies have found no association between oral contraceptive use and breast cancer, several studies of younger women have reported an association with long-term oral contraceptive use. PURPOSE. We studied the relationship of patterns of oral contraceptive use to breast cancer risk among younger women. These women have had oral contraceptives available their entire reproductive lives and are now entering the breast cancer-prone years. METHODS: A population-based, case-control study of breast cancer was conducted in three counties in western Washington State among women born in 1945 or later, ages 21-45. Case patients were 747 women with breast cancer diagnosed in 1983-1990 and identified through the Seattle-Puget Sound Surveillance, Epidemiology, and End Results cancer registry. Control subjects were 961 women identified by random-digit telephone dialing. Subjects were interviewed in person, using pictures of brands of oral contraceptives and calendars of life events as recall aids. RESULTS: There was no increased incidence of breast cancer associated with ever having used oral contraceptives. Because only 8% of this cohort had never used oral contraceptives, short-term users (< 1 year) were combined with never users as the reference group for further analyses. A small increased risk of breast cancer was associated with long duration of oral contraceptive use (odds ratio for > or = 10 years = 1.3; 95% confidence interval [CI] = 0.9-1.9; P for trend = .03), particularly among women aged 35 years or younger (odds ratio for > or = 10 years = 1.7; 95% CI = 0.9-3.1). Breast cancer was also modestly related to oral contraceptive use early in reproductive life (odds ratio for use within 5 years of menarche = 1.3; 95% CI = 1.0-1.8; P for trend = .04) and to use of high-progestin-potency oral contraceptives for at least 1 year (odds ratio = 1.5; 95% CI = 1.1-2.1). These associations were adjusted for age, age at menarche, term pregnancy, induced abortion, and family history of breast cancer. The associations were not further confounded by case-control differences in education, religion, breast feeding of offspring, or infertility; in oral contraceptive contraindications, indications, or complications; or in measures of breast cancer detection such as mammography or breast biopsy. CONCLUSIONS: Long-term oral contraceptive use among young women or use beginning near menarche may be associated with a small excess breast cancer risk, possibly due to susceptibility to genetic damage in breast epithelial cells at ages of high breast cell proliferative activity. IMPLICATIONS: Future studies should investigate whether the patterns of risk we reported are present as this cohort ages.

Adult↗
PubMedDate not supplied

How the number of living sons influences contraceptive use in Menoufia Governorate, Egypt.

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.

Adolescent↗
PubMed2006

Pregnancy and oral contraceptives in congenital bleeding disorders of the vitamin K-dependent coagulation factors.

Pregnancies and deliveries represent important hemostatic challenges for congenital coagulation disorders. The same is true for the assumption of oral contraceptives. Available information mainly deals with von Willebrand's disease, factor XI (FXI) deficiency and carriers of hemophilia A. Data concerning patients with congenital prothrombin complex factor deficiencies are very scanty. In the present study, data of a total of 27 women are presented, 11 patients with homozygous or double heterozygous deficiencies of FII, FVII and FX, together with 16 cases of hemophilia B carriers. The patients with FII, FVII or FX defects had a total of 14 pregnancies and often needed transfusion therapy. Proper management resulted in a decrease in postpartum bleeding and satisfactory fetal outcome. Elective cesarean delivery seems indicated only in recent years. Carriers of hemophilia B had a total of 19 pregnancies but showed no bleeding and needed no substitutive therapy. Searching the literature, we discovered only 9 additional patients with prothrombin deficiency or FX deficiency, having a total of 16 pregnancies. On the contrary, there were at least 17 additional patients with FVII deficiency, with a total of 21 pregnancies. The management of the diseases has been variable, but in substantial agreement with the personal observations. Oral contraceptive therapy was administered in some of our patients and in a few additional cases described in the literature. Medication was always well tolerated and patients who took it for a long period of time showed a decrease in menometrorrhagia and an improvement in hematocrit levels. This led to a decrease in transfusional needs and to improved general conditions.

Adult↗
PubMed2002

The construction of community participation: village family planning groups and the Indonesian state.

Indonesia's family planning program has been one of the most effective in the developing world in promoting contraceptive use and contributing to fertility transition. In evaluating why the program has worked, analysts have given much credit to a network of village family planning groups that developed from the 1970s to the 1990s and that blanketed the archipelago. These groups, composed primarily of female volunteers, made contraception available to women in even the most remote parts of the country, and acted as agents of family planning motivation. They have been labeled by the Indonesian state family planning agency as an example of effective community participation on a national scale. In this paper, I investigate this claim and find it to be simplistic. I provide extensive evidence that the creation of this network was orchestrated by the Indonesian state. On the other hand, I show that these groups are not fully state entities, as they have several characteristics that mark them as socially embedded institutions. They are best labeled as unusual state-society hybrids. In my investigation I draw on one of the newest paradigms in the discipline of political science--the state-society approach--to uncover the odd nature of this family planning network. More deeply, I argue that the state-society approach ought to be adopted in family planning analysis on a comprehensive basis. The traditional organizational and social-demographic approaches that have dominated the field offer only limited understanding of the nature of family planning programs in developing countries. The state-society approach is ideally suited to identifying how family planning programs are institutions of a political nature, embedded in states and societies, and transformed by and transformative of each.

Community Health Planning↗
PubMed1990

Blood pressure and other cardiovascular disease risk factors in black adults with sickle cell trait or glucose-6-phosphate dehydrogenase deficiency.

In this study, we examined the relationship of two common genetic markers in black populations, sickle cell trait and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, to cardiovascular risk factors. The subjects were Nigerian civil servants in Benin City, Nigeria. We measured blood pressure, height, weight, sickle cell hemoglobin, G-6-PD, proteinuria, microalbuminuria and fasting serum cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, apoprotein (APO) AI, and APO B. Data were collected on age, alcohol consumption, cigarette smoking, job status, and years lived in an urban area. There were 257 males (3 SS hemoglobin, 73 AS, 181 AA) and 69 females (23 AS, 46 AA). In comparing cardiovascular risk factors, males differed only in percent of smokers (31.5 in AS vs. 17.8 in AA, P less than 0.01). Among females, only high-density lipoprotein (HDL) cholesterol differed (61.5 mg/dl in AS vs. 52.4 in AA, P less than 0.01). We hypothesize that females with sickle cell trait are more likely to use oral contraceptives than nontrait females. If so, the high-estrogen oral contraceptives available in Nigeria could elevate HDL. G-6-PD deficiency status among males (52 deficient, 207 nondeficient) and females (1 deficient, 5 carriers, 65 nondeficient) was not related to any of the cardiovascular risk factors. We conclude that sickle cell hemoglobin trait and G-6-PD deficiency are not useful genetic markers for risk factors for cardiovascular disease.

Albuminuria↗
PubMed1977

The benefits and risks of IUD use.

Next to combination oral contraceptives (OCs), intrauterine contraceptive devices (IUDs) are the most effect form of contraception available. IUDs require only one-time motivation, cause no systemic metabolic effects, and do not depend on continued action of the user for effectiveness. Risks, side effects and complications of this method, including expulsion, perforation pain, bleeding and infection, are reviewed.

Abortion, Septic↗
PubMed1990

Mortality and fertility: how large is the direct child replacement effect in China?

"The direct child replacement effect, that is the extent to which parents will have a child to replace one that died, was estime d by Olsen's method in China, using microdata from a sample survey of 4785 ever-married women in Hebei province taken in 1985. Olsen's method corrects for bias in the ordinary least squares estimate and uses mortality rates as an instrumental variable. Data for all age groups were pooled. Estimates of the direct replacement effect before and after correction for bias were 0.836 and 0.556, showing that over half of child deaths were replaced. The instrumental variable estimate produced a result of 0.614, similar to 0.613, computed by considering p1 to be random. A computation without instrumental variables yielded 0.774. The results showed that this method for calculating the direct replacement effect works well with these data because several of the alternative methods gave close estimates. There appears to be little family specific variation in child mortality rates, pointing out the effectiveness of Chinese primary health care. The direct replacement effect of about 0.6 is, however about 3 times that found by Olsen in Colombia and Malaysia, and close to the theoretical maximum. The reason for such a high value may be the small family size in China, where death of a child is more likely to provoke a response. Or it might suggest that severe government policy causes couples to attempt to have another child. Policy implications in this setting are that rather than make more contraceptives available, or improve infant survival, Chinese policymakers should make a small family size attractive, e.g., by improving education or pensions.

Asia↗
PubMed1994

Pregnancy, lactation and the use of silicone breast implants.

In the United States alone, an estimated 1-2 million women have used silicone breast implants. Many of these women are of reproductive age. Given the current controversy over the safety of silicone breast implants, medical care providers should be able to advise women if use of these implants affects the use of any of the available contraceptive methods, whether pregnancy is in any way contraindicated and/or might be associated with special complications, whether there are potential risks to the fetus and neonate, and whether breast feeding might be compromised. A review of the literature on these topics yielded very little useful information.

Breast Implants↗
PubMed1981

Contraceptive embarrassment and contraceptive behavior among young single women.

The purpose of this paper was to determine factors predictive of contraceptive embarrassment and to determine the relationship of contraceptive embarrassment to contraceptive use among young unmarried females. Contraceptive embarrassment was measured by an 8 item scale. Data were obtained from 265 nonvirgin high school and university females who were currently dating. Using simple multipe regression 30% of the variance of the embarrassment scale was explained, with the most important predictors being parental attitude toward premarital intercouse and sexual guilt. Other significant predictors were attitude to planning ahead to use contraception, perceived difficulty in obtaining contraceptive devices, and peer attitudes toward premarital intercouse. The embarrassment scale had significant correlations with contraceptive use.

Attitude↗
PubMed1988

A survey of prescribing habits for high-estrogen oral contraceptives.

A simple survey was made of health-care providers to determine their attitudes toward oral contraceptives containing more than 50 mcg of estrogen. It was found that about two-thirds of respondents prescribe this group of medication, although few do so regularly. Their use seemed correlated with providers 40 years of age or older. Even members of an association of professionals interested in contraception frequently used these pills. Although this group of contraceptives is being phased out, it is felt that professionals should have ceased their use long ago.

Adult↗
PubMed1988

Child mortality in a Nigerian city: its levels and socioeconomic differentials.

Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country.

Child, Preschool↗