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PubMed2006

Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.

OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.

Adolescent↗
PubMed1992

The effects of fetal exposure to danazol.

OBJECTIVE: To assess the consequences of exposure to danazol in utero. Additionally, by assessing the risk, to facilitate the counselling of pregnant women inadvertently exposed to danazol in early pregnancy. DESIGN: Retrospective review of reported case histories. SUBJECTS: 129 women exposed to danazol during pregnancy were identified from individual case reports, data from the Australian Drug Reactions Advisory Committee and the United States Food and Drug Administration and from the reports of danazol exposure made directly to the manufacturers. MAIN OUTCOME MEASURES: Teratogenic effects of fetal exposure to danazol in relation to dosage and duration of exposure. RESULTS: Of the 129 reported pregnancies, 12 miscarried and 23 were aborted. Of the 94 completed pregnancies, 37 resulted in the birth of normal males, 34 in non-virilized females and 23 in virilized females. Virilization occurred in a proportion of female fetuses with a pattern of cliteromegaly, fused labia and urogenital sinus formation. Surgery to the genital tract was usually, but not always, required in childhood. The abnormality has not been reported where danazol therapy had been discontinued before the 8th week of pregnancy. Although more common in the higher dosages, virilization was reported in one case with a 200 mg daily dosage. CONCLUSIONS: Danazol should remain contraindicated in pregnancy and clinicians should give careful contraceptive advice to patients commencing or continuing danazol therapy. Nonetheless it is possible to be cautiously optimistic about the outcome of danazol-exposed pregnancies, particularly if treatment is discontinued before 8 completed weeks gestation.

Abnormalities, Drug-Induced↗
PubMed2001

Intra-uterine implant (GyneFix) lost via intestinal route?

Uterine perforation has long been regarded as a complication of the insertion of an intra-uterine contraceptive device (IUD). The development of modern devices with sophisticated insertion systems as well as advanced training requirements seeks to minimise the risk of adverse insertion incidents for women choosing intra-uterine contraception. This case report highlights the continuing need for intra- and post-insertion vigilance as even recent advances in IUD technique and technology do not guarantee risk-free insertion.

Adult↗
PubMed1975

Selected aspects of adolescent postpartum behavior.

Contraceptive, educational, and vocational behavior patterns of postpartum adolescents were examined. Eight months after delivery 269 teenage girls who participated in a comprehensive antepartum psycho-social program were mailed follow-up questionnaires. Eighty-three percent of teenage mothers who responded reported using birth control pills as a form of contraception. We found that single girls were more actively involved in vocational and educational training. This and other observations indicate that marital status of teenage participants is important to their postpartum actions.

Adolescent↗
PubMed1997

Condom use banned.

A traditional chief in Swaziland has banned the use of condoms by men in his chiefdom, because they were "misusing and wasting a man's reproductive fluid". The ban, which made front-page news in the Times Newspaper of Swaziland, has shocked nongovernmental organization and family planning officials in the tiny southern African kingdom, the Southern African Press Association reported. Addressing hundreds of his subjects at his Kraal during a visit by health ministry officials, Chief Jameson Ndznatabautfu Maseko said using condoms was against God's laws as stated in the Old Testament. But the chief was willing to continue to allow women to use contraceptive pills, the report said. The chief did not say how he hoped to monitor his male subjects' sex lives but gave instructions that anyone using or being forced to use condoms be reported to him immediately. In a reaction to the chief's comments, health ministry principal secretary, Myekani Vilakati said that if the reports were correct, "the family planning program would have to start all over again, this time starting with educating the country's traditional leaders".

Africa↗
PubMed2004

Breast cancer and environmental risks: where is the link?

Environmental factors may play an important role in the etiology of female breast cancer. This paper reviews existing evidence to compare and analyze environmental agents in relation to breast cancer. The authors have reviewed multiple studies focusing on xenoestrogens, organochlorines, polychlorinated biphenyls, and other environmental agents, and the results are cited. Current use of oral contraceptives and prolonged use of hormone replacement therapy moderately increase risk. Evidence regarding organochlorine exposure and breast cancer risk is mixed. Atrazine is not associated with breast cancer risk, but dieldrin and lindane are. The effects of polychlorinated biphenyls vary according to specific congeners. An observational study has linked benzene to breast cancer, but another case control study has refuted the association. Risk of breast cancer with smoking is strong in families with a history of breast cancer, ovarian cancer, or both. Studies have shown a positive association of breast cancer with heterocyclic amines in women who eat well-done meat. Thus, many environmental factors have been significantly associated with breast cancer. Differing distribution of socio-demographic factors, including race/ethnicity, parity, and, possibly, nutritional status, may explain some of the inconsistencies across studies. Further research is needed to verify associations.

Breast Neoplasms↗
PubMed2005

Same-day initiation of the transdermal hormonal delivery system (contraceptive patch) versus traditional initiation methods.

INTRODUCTION: Published comparisons of oral contraceptive pill (OCP) initiation methods demonstrate that OCP initiation at the office visit ("Quick Start") resulted in higher continuation rates into the second cycle. This trial was performed to investigate whether Quick Start with the contraceptive patch would provide similar results. MATERIALS AND METHODS: Sixty women were randomized to initiate use of the contraceptive patch using Quick Start (Group 1, n=30) or on the first day of their next menses (Group 2, n=30). Telephone contact at 6 weeks occurred to ensure that the second cycle had been initiated. A single follow-up visit was scheduled after completion of the third patch cycle. RESULTS: Continuation rates for Groups 1 and 2 were 97% and 93% (p=1.0), respectively, into the second cycle, and 93% and 90%, respectively, into the third cycle (p=1.0). Only approximately half of the subjects planned to continue using the patch after the study. CONCLUSION: Quick Start for the contraceptive patch did not improve continuation rates into the second or third cycle.

Administration, Cutaneous↗
PubMed2003

Sexually transmitted infections and contraceptives: selective issues.

It is important to examine the successful completed research and use it to move forward in practice to halt the almost 50% unintended pregnancy rate in the United States and the continued worldwide epidemic of HIV and other STIs. A significant development has been the evidence supporting the IUD as a valuable contraceptive option available to many women, including women who are HIV infected, with no increased risks of infertility or PID. Evidence exists that OCPs may increase chlamydial infection acquisition and cervicitis, but it is unlikely that OCP use is associated with PID. The lack of female-controlled dual method protection remains a void, but with the introduction of products such as FemCap and Reality condom and the continuing progress of microbicides and spermicides, the future is brighter. Clearly research into the interactions of STIs and contraceptives must continue to discern how best to approach a resolution to these public health concerns that affect women and the global population.

Chlamydia Infections↗
PubMed1999

Acceptability of once-a-month injectable contraceptives Cyclofem and Mesigyna: focus group discussion.

This article presents the results of focus group discussion sessions conducted with a sample of continuers and discontinuers of the once-a-month injectable contraceptives Cyclofem and Mesigyna, as well as with some of the physicians who participated in the clinical trial. The sessions helped explain certain aspects related to the clients as well as the service delivery setting that affected the acceptability of these contraceptive preparations. Providing counseling and presence of a dedicated clinic staff were very essential to the success of the clinical trial. Social support in the form of both husband knowledge, approval, and support as well as the presence of other close relative or friend users helped in increasing the woman's tolerance of side effects and sometimes helped overcome adverse rumors. Reaction of the women to vaginal bleeding in an Islamic society is discussed and the need for health education in this aspect is strongly recommended. The two preparations are best suited for women who were satisfied with the use of combined hormonal contraceptive pills but had a problem with compliance, and users of other hormonal methods who are free from menstrual irregularities. On the whole, the two preparations had high acceptability among Egyptian women, provided that procedures for the selection of the appropriate candidate are adhered to, and that pre- and postservice counseling and social support are present.

Adult↗
PubMed1998

Levonorgestrel subdermal implants. A review of contraceptive efficacy and acceptability.

UNLABELLED: Levonorgestrel 6-capsule subdermal implants (Norplant) are an effective form of reversible contraception. When implanted under the skin of the upper arm, they release drug into the circulation at a relatively constant rate over 5 years. Generally, the cumulative pregnancy rate at the end of 5 years' levonorgestrel implant use is less than 2 per 100 users. The implants provide contraceptive efficacy equivalent to, or better than, that provided by other reversible methods (including oral contraceptives). Younger women are more likely than older women to become pregnant while using levonorgestrel implants. Bodyweight was positively correlated with risk of pregnancy in a number of studies, but may not be a factor with the currently available 6-capsule implant formulation. Limited data suggest that a new 2-rod levonorgestrel subdermal system (Jadelle) is as effective as the more extensively studied 6-capsule system and has a similar tolerability profile. Fertility returns rapidly after the implants are removed. Use of levonorgestrel subdermal implants is compatible with breast-feeding. In several studies, discontinuation rates were 2 to 15% during the first year of use; cumulative 5-year discontinuation rates ranged from 22 to 64 per 100 women. Despite a substantial incidence of adverse events during therapy, levels of user satisfaction are generally high. Menstrual abnormalities (increased or decreased menstrual flow, spotting, irregularity and amenorrhoea) affect most women at some time during therapy and are the most frequent reason for discontinuing levonorgestrel implants before the end of 5 years' treatment (incidence of 4.2 to 30.7 per 100 users). Mood changes and headache also may lead to discontinuation. Other reported adverse events include skin reactions (including acne), dizziness and weight gain. Serious adverse events (such as stroke, thrombotic thrombocytopenia and idiopathic intracranial hypertension) have been reported during levonorgestrel implants therapy, but the population incidence is difficult to calculate and causality is unclear. According to 3 pharmacoeconomic analyses from an institutional or managedcare perspective, all contraceptive interventions result in net cost savings. It is not clear whether levonorgestrel implants provide greater or smaller economic benefits than combined oral contraceptives. CONCLUSION: Levonorgestrel subdermal implants provide effective long term contraception. Despite a high incidence of menstrual adverse events, overall levels of user satisfaction are high, and 1-year continuation rates are better than those for combined oral contraceptives. Levonorgestrel subdermal implants are a good choice of contraceptive method in women who desire effective contraception, but who are unable to, or prefer not to, comply with an oral regimen.

Contraceptive Agents, Female↗
PubMed1997

[The diaphragm as a contraceptive method in the experience of users in the public health services]

This study, started in August 1989, describes the acceptability of diaphragms as part of the daily routine of 194 women enrolled at five public health care centers in Osasco, (Greater São Paulo). Follow-up of the cohort was performed by semestral home interviews until August 1991. Our data indicate that the diaphragm can be a viable alternative within the public health care setting. Women, including those from low-income groups, are interested in new alternatives to currently available contraceptive practices. Nevertheless, the cumulative rate of continuity for use of the method was only 25.7% (39 women) after a period of 12 months. Only 37.1% of women opting for the diaphragm confirm its use during every act of sexual intercourse. Most of the women (72.7%) only learned about diaphragms during the process of choosing a contraceptive method. The main reasons for discontinued use were partners' complaints, discomfort, and difficulty in handling. The findings point to the need for reformulating family planning activities to provide greater support for women, introduce initiatives to enhance male participation, and promote on-going training of health professionals with regard to the management of the method and support for its users.

Journal Article↗
PubMed1996

Contraception in the 1990s.

Contraceptive technology has recently provided the market place with new barrier methods, new progestin oral contraceptives, an injectable contraceptive, the female condom, new male condoms, and the contraceptive implant. During the last decade, epidemiologists have clearly defined the non-contraceptive benefits of current contraceptive methods that include decreased infections, protection from various cancers, protection from many gynecologic problems that lead to surgery, as well as symptomatic relief from many gynecologic conditions. In conjunction with medical specialists, contraceptive researchers have established the increased safety and benefits of various contraceptive choices in women with medical conditions that, until recently, were contra-indications for their use. That these advances have occurred despite multiple legal and scientific assaults gives hope that the field will continue to grow.

Contraception↗
PubMed2002

Post-abortion depot medroxyprogesterone acetate continuation rates: a randomized trial of cyclic estradiol.

Irregular menstrual bleeding is a common reason for discontinuation of depot medroyprogesterone acetate (DMPA) contraception. We conducted a double-blind, randomized placebo controlled trial to estimate if transdermal estradiol used in a cyclic fashion could make DMPA bleeding patterns more acceptable and improve DMPA continuation rates. Women initiating DMPA contraception immediately post-abortion (N = 132) were randomized to receive either a low sustained dose of transdermal 17-beta estradiol (0.10 mg/day, Climara) or an identical placebo to be used in a cyclic manner for 3 months. Bleeding patterns, contraceptive use, and pregnancy rates were measured for 1 year after enrollment. Cyclic transdermal estrogen did not create regular bleeding patterns in new users of DMPA and had no effect on DMPA continuation rates (relative hazard = 0.93, 95%CI 0.65-1.33). By 12 months after enrollment, 19.4% of those randomized to estrogen and 23.9% of those randomized to placebo were still using DMPA for contraception. There was no difference in the frequency of DMPA discontinuation primarily for abnormal uterine bleeding between groups (relative risk ratio = 0.95, 95%CI 0.40-2.23). Few women who discontinued DMPA switched to highly effective methods of contraception and within 1 year of an abortion, there were 18 repeat pregnancies (21.9%). Compliance with the estrogen patches was poor resulting in early study termination and inadequate statistical power to detect a clinically significant difference in DMPA continuation rates. Continuation rates of DMPA were low and repeat pregnancy rates were high among women initiating DMPA at the time of abortion. Cyclic transdermal estradiol use is an unacceptable regimen for preventing the irregular bleeding associated with DMPA initiation.

Abortion, Induced↗
PubMed1980

[Nosology of contraceptives: hematological and ultrastructural observations after experimental administration of low dosage contraceptives (author's transl)].

A further experimental study on changes produced in rabbits by low dosage contraceptives is presented. The administration has been continued for six months. Serum biochemical and hepatic ultrastructural findings are in agreements with literature data. On the contrary the early changes of cardiac microcirculation and chiefly renal glomerular tuft seem to be rather unusual. The weight to be attached to the knowledges descending from the presented data in assessing allowance of contraceptive treatments in human subjects and aiming preventive medicine purposes is emphasized.

Animals↗
PubMed1990

Relevance of immuno-contraceptive vaccines for population control. II. Gamete antigens.

Some new information on the sperm and seminal plasma antigens which can induce responses which decrease fertility has been obtained. This recent development has not, however, brought the understanding of the subject to a stage where the production of a contraceptive antisperm vaccine for the female can be discussed realistically. Many laboratories are continuing the active investigation of the potentials of zona pellucida antigens for contraceptive approach. Also, passive immunization with human monoclonal antibodies promises to be an effective and safe method for short-term contraception and early pregnancy termination.

Amino Acid Sequence↗