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PubMed2005

Contraception usage over the age of 40 in Polish female population aged 45 - 54.

OBJECTIVE: Analysis of particular contraception method usage over the age of 40 as declared by Polish women aged 45-54 according to their education level and place of residence. METHOD: The research was conducted with help of a standardized questionnaire in a Polish nationwide representative sample of women aged 45-54 years (n = 1083) in April 2004. RESULTS: 28% of sexually active women over 40 years old did not use any contraception methods. Most of them were country dwellers (41%), a lower proportion lived in small/moderate towns (27%), and a significantly lower percentage was made by big city dwellers (14%). Among the most popular contraception methods the respondents indicated coitus interruptus (32%), condoms (30%) and the calendar method (26%). Oral contraception was used by 12% of women. CONCLUSION: A considerable percentage of sexually active women aged more than 40 years do not use any contraception method at all or use unreliable methods. Highly reliable methods (condoms, contraception pills) are much more popular among city dwellers. Contraception pills are used by twice as many city dwellers as rural dwellers (16% versus 8%) and by 12% of women from small/moderate towns. Rates of condom usage are also differentiated and vary from 42% in big cities to 26-27% in rural areas and small/moderate towns. Although poor availability of the contraception pill might explain some differences in its usage, it is difficult to quote this factor in the case of condoms.

Adult↗
PubMed2006

Contraceptive use, fertility, and unsafe abortion in developing countries.

OBJECTIVES: Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive prevalence and unsafe abortion in developing regions with different levels of fertility. These relationships manifest the extent to which the desire to regulate fertility is addressed by contraception or by unsafe abortion, where access to safe abortion is legally restricted. METHODS: Secondary analysis of estimates of unsafe abortion, total fertility rate and contraceptive prevalence, by geographical regions. RESULTS: High levels of unsafe abortion persist even where contraceptive prevalence is increasing and fertility is declining. It appears that a high dependence on sterilization for limiting family size may by be preceded by reliance on unsafe abortion, where abortion is restricted, for birth spacing. CONCLUSIONS: The reliance on unsafe abortion could be reduced during fertility transition by improving women's access to reversible contraceptives for spacing births as well as to sterilization for terminating childbearing. Expanding contraceptive choices and a balanced method mix can serve as an effective strategy to prevent unsafe abortion where reliance on sterilization to limit childbearing is not preceded by the use of reversible modern methods for spacing and where access to safe abortion is restricted by law. The intriguing association between contraceptive method choice and the incidence of unsafe abortion deserves further exploration.

Abortion, Illegal↗
PubMed2006

Images of American sexuality in debates over nonprescription access to emergency contraceptive pills.

The debate over emergency contraceptive pill access in the United States revolves around speculations about Americans' sexual lives. The recently released internal U.S. Food and Drug Administration (FDA) memo that expresses fears that adolescents will form "sex-based cults" around emergency contraceptive pills echoes arguments made against the nonprescription switch at the 2003 FDA hearings. In these hearings, opponents argued that nonprescription access would lead to adolescent promiscuity and disease transmission and that adult predators would use the drug to facilitate the sexual abuse of young women. In contrast, proponents of expanded access to emergency contraceptive pills overwhelmingly portrayed their model user as a responsible adult who experiences a torn condom during consensual sex. These imaginations of American sexuality are tied to competing models of the role of medical providers in women's sexual decision making. Opponents of the nonprescription switch argued that women need a learned intermediary, not only to determine their need for emergency contraception, but also to educate them about proper sexual behavior and protect them from abuse. Proponents advocated putting more responsibility for sexual health decision making in the hands of women, not doctors, and complained about the moralizing scrutiny of medical providers. In the absence of nonprescription access to emergency contraception, advance prescription of emergency contraceptive pills can ensure that contraceptive education is not tied to a specific sexual act and therefore not perceived as a judgment about women's sexual decisions. However, advance prescription does not help women who lack access to health care or women who make sexual and contraceptive decisions without consulting physicians.

Contraceptives, Postcoital↗
PubMed2006

The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects.

AIMS: To assess the pharmacokinetic and pharmacodynamic effects of co-administration of a combined oral contraceptive (ethinyloestradiol plus levonorgestrel) and lamotrigine. METHODS: Over a period of 130 days, healthy female subjects took lamotrigine (titrated up to 300 mg day(-1)) and the combined oral contraceptive, either individually or as co-therapy. Plasma ethinyloestradiol and levonorgestrel concentrations were measured in the presence and absence of lamotrigine, and serum lamotrigine concentrations were measured in the presence and absence of the combined oral contraceptive. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, oestradiol and sex hormone binding globulin were also determined. RESULTS: Of the 22 enrolled subjects, 16 had evaluable pharmacokinetic data. The mean (90% CI) ratios of lamotrigine area under the concentration-time curve from 0 to 24 h (AUC(0,24 h)) and maximum observed concentration (C(max)) of lamotrigine when it was given with the combined oral contraceptive and during monotherapy were 0.48 (0.44, 0.53) and 0.61 (0.57, 0.66), respectively. Ethinyloestradiol pharmacokinetics were unchanged by lamotrigine, the mean combined oral contraceptive + lamotrigine : combined oral contraceptive alone ratios (90% CI) of the AUC(0,24 h) and C(max) of levonorgestrel were 0.81 (0.76, 0.86) and 0.88 (0.82, 0.93), respectively. FSH and LH concentrations were increased (by 4.7-fold and 3.4-fold, respectively) in the presence of lamotrigine, but the low serum progesterone concentrations suggested that suppression of ovulation was maintained. Intermenstrual bleeding was reported by 7/22 (32%) of subjects during co-administration of lamotrigine and combined oral contraceptive. CONCLUSIONS: A clinically relevant pharmacokinetic interaction was observed during co-administration of a combined oral contraceptive and lamotrigine. A dosage adjustment for lamotrigine may need to be considered when these agents are co-administered. A modest decrease in the plasma concentration of levonorgestrel was also observed but there was no corresponding hormonal evidence of ovulation.

Adolescent↗
PubMed2004

Acceptance of contraceptives among women who had an unsafe abortion in Dar es Salaam.

OBJECTIVE: To assess the need for post-abortion contraception and to determine if women who had an unsafe abortion will use a contraceptive method to avoid repeated unwanted pregnancies and STDs/HIV. METHOD: Women attending Temeke Municipal Hospital, Dar es Salaam, after an unsafe abortion or an induced abortion performed at the hospital (n=788) were counselled about contraception and the risk of contracting STDs/HIV. A free ward-based contraceptive service was offered and the women were asked to return for follow-up. RESULTS: Participants (90%) accepted the post-abortion contraceptive service. Of these, 86% stated they were still using contraception 1-6 months after discharge. Initially, 55% of the women accepted to use condoms either alone or as part of double protection. After 1-6 months this proportion had dropped to 18%. Single women were significantly more likely to use condoms. CONCLUSION: High-quality contraceptive service counselling can induce women to use contraception after having had an unsafe abortion. The results of our study are encouraging and should be used to convince policy makers of the need to implement such services at municipal level to reduce the number of repeated unsafe abortions.

Abortion, Induced↗
PubMed2004

Emergency contraceptive pills in Sweden: evaluation of an information campaign.

OBJECTIVE: To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics. DESIGN: Quasi-experimental. SETTING: Two counties in Sweden. POPULATION: Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group. METHODS: Postal questionnaires before (2002) and after (2003) the intervention. MAIN OUTCOME MEASURES: Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills. RESULTS: Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group. CONCLUSIONS: Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.

Adolescent↗
PubMed1969

Investigation of relation between use of oral contraceptives and thromboembolic disease. A further report.

The results of a previous study of the use of oral contraceptives by married women discharged from hospital with a diagnosis of thromboembolic disease in the years 1964-6 were reported by us last year. The present paper adds results relating to patients discharged during 1967 and a few data, that could not be sought previously, for patients discharged with cerebral or coronary thrombosis from three of the hospitals in the earlier period.Of 84 patients with deep-vein thrombosis or pulmonary embolism 42 (50%) had used oral contraceptives during the month preceding the onset of their illness, while only 23 of the 168 controls (14%) had done so. No differences in risk were found either for the types of preparation or for the duration of use. After allowance for age and height, the patients with venous thromboembolism were about 10 lb. (4,535 g.) heavier than the control patients, irrespective of whether they were using oral contraceptives or not. No appreciable difference was found between the smoking habits of patients with and without venous thromboembolism treated during 1967, nor between women who were using oral contraceptives and those who were not. The trend in hospital admissions for venous thromboembolism with time corresponded to the trend in the use of oral contraceptives, and there was no evidence to suggest that the number of admissions was affected by publicity about the risk of using the preparations. Of 19 patients with cerebral thrombosis 11 (58%) had been using oral contraceptives, compared with an expected figure of 3.5 from the experience of the control subjects. All the published data (clinical, angiographic, and post-mortem) show that the thrombosis affects the cerebral arteries rather than the cerebral veins. Of 17 patients with coronary thrombosis 2 (12%) had been using oral contraceptives, compared with an expected figure of 2.1. The patients with coronary thrombosis smoked more than the control patients and were, on average, 8.3 lb. (3,765 g.) heavier than control women of the same age and height.The new evidence strengthens the belief that oral contraceptives are a cause of venous thromboembolism and cerebral thrombosis but does not indicate that they are a cause of coronary thrombosis.

Adolescent↗
PubMed1995

Contraceptive services for teenagers: do we need family planning clinics?

OBJECTIVE: To determine whether the effectiveness of contraceptive services for teenagers is related to the balance of service provision between general practitioners and specialist family planning services. DESIGN: Cross sectional study with routinely collected data from family planning clinics and family health services authorities and published data on births and abortions. SETTING: Eight health districts in the former Oxford region. SUBJECTS: Girls aged under 16 and women aged 16-19 who attended a contraceptive service during 1991-2 or who gave birth or had an abortion during 1990-2. MAIN OUTCOME MEASURES: Attenders at family planning clinics as a percentage of all users of contraceptive services. The conception rate:uptake of contraceptive services ratio was used as a measure of effectiveness. RESULTS: In comparisons between districts the percentage of all users of contraceptive services who attended a clinic varied from 38% (95% confidence interval 28% to 48%) to 79% (72% to 86%) among 13-15 year olds and from 14% (12% to 15%) to 44% (42% to 46%) among women aged 16-19 years. The conception rate: uptake of contraceptive services ratio varied twofold in the older age group and more than threefold in the younger age group. It was lowest in districts where clinic attenders comprised a large percentage of all users of contraceptive services. CONCLUSION: Contraceptive services for teenagers may be more effective in districts where clinics play a large part in delivering the service, particularly for girls aged under 16.

Abortion, Induced↗
PubMed1999

Oral contraceptive use and the clinical course of Crohn's disease: a prospective cohort study.

BACKGROUND: Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease. AIM: To assess the effect of oral contraceptive use on the clinical course of Crohn's disease. PATIENTS: 331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index <200, were enrolled consecutively during a one year period. Patients were classified at inclusion as oral contraceptive users or non-users and smokers or non-smokers. METHODS: A prospective 12-18 month cohort study was used. The main outcome measures were flare up rate and time to flare up. RESULTS: In total, 134 women used oral contraceptives, in most cases low oestrogen formulations. During the study period, 61 oral contraceptive users (46%) developed a flare up, compared with 85 non-users (43%). The hazard ratio for oral contraceptive use was 1.11 (95% confidence interval 0.80 to 1.55). Variables associated with flare up were smoking status, recently active disease, baseline Crohn's disease activity index, and presence of anoperineal lesions. The same results were obtained when the analysis was restricted to patients eligible for a relapse prevention trial. CONCLUSION: Unlike smoking, oral contraceptives have no effect on Crohn's disease activity.

Adolescent↗
PubMed2005

[Hormonal contraception for males--an option for adolescents?].

Although effective contraceptive methods are available, the incidence of teenage pregnancies and consecutive pregnancy interruptions remains high in industrial nations, including Germany. There are several reasons for this high incidence. Apart from earlier sexual maturation, the absence of contraceptive use or the use of inefficient methods contributes mainly towards this increase. Existing contraceptive methods for men either show unsatisfying efficacy (coitus interruptus, use of condoms) or problems of reversibility (vasectomy), which limits their broader use. Of the different experimental approaches towards male contraception, the hormonal approach is closest to practical implementation. Androgens are an essential part of all experimental approaches to hormonal contraception in males; they cause suppression of spermatogenesis through gonadotropin suppression. Previous clinical trials have validated the concept of hormonal contraception in men. However, the application modalities and the ineffectiveness of all self-administered androgen preparations have been unacceptable for practical use. Therefore recent developments focus either on androgen implants or on injectable, long-acting testosterone esters in combination with progestins, which also suppress gonadotropin secretion. Over the last decades various combinations of androgen preparations with different progestins or GnRH antagonists have been tested in clinical trials. Of these, testosterone with either depot medroxyprogesterone acetate, norethisterone, desogestrel or etonogestrel have shown promising efficacy in phase II clinical trials. However, whether hormonal contraception might be given to adolescent males remains to be elucidated. This will have to be assessed once a hormonal contraceptive for men has reached the market. Special attention will need to be given to bone maturation as androgens at the prescribed doses might induce premature closure of the epiphyseal joints.

Abortion, Induced↗
PubMed1999

Interaction between the G20210A mutation of the prothrombin gene and oral contraceptive use in deep vein thrombosis.

Single-point mutations in the gene coding for prothrombin (factor II:A20210) or factor V (factor V:A1691) are associated with an increased risk of venous thromboembolism. The use of oral contraceptives is also a strong and independent risk factor for the disease, and the interaction between factor V:A1691 and oral contraceptives greatly increases the risk. No information is available about the interaction between oral contraceptives and mutant prothrombin. We investigated 148 women with a first, objectively confirmed episode of deep vein thrombosis and 277 healthy women as controls. Fourteen patients (9.4%) were carriers of factor II:A20210, 24 (16.2%) of factor V:A1691, and 4 (2.7%) of both defects. Among controls, the prevalence was 2.5% for either factor II:A20210 or factor V:A1691, and there was no carrier of both the mutations. The relative risk of thrombosis was 6-fold for factor II:A20210 and 9-fold for factor V:A1691. The most prevalent circumstantial risk factor in patients and the only one observed in controls was oral contraceptive use, which per se conferred a 6-fold increased risk of thrombosis. The risk increased to 16.3 and 20.0 when women with factor II:A20210 or factor V:A1691 who used oral contraceptives were compared with noncarriers and nonusers. These figures indicate a multiplicative interaction between the genetic risk factors and oral contraceptives. No difference in the type of oral contraceptives was observed between patients and controls, those of third generation being the most frequently used (73% and 80%). We conclude that carriers of the prothrombin mutation who use oral contraceptives have a markedly increased risk of deep vein thrombosis, much higher than the risk conferred by either factor alone.

Adolescent↗
PubMed1996

Prospective study of oral contraceptives and hypertension among women in the United States.

BACKGROUND: Oral contraceptives induce hypertension in approximately 5% of users of high-dose pills that contain at least 50 micrograms estrogen and 1 to 4 mg progestin, and small increases in blood pressure have been reported even among users of modern low-dose formulations. However, neither the responsible hormone in the oral contraceptive nor particular subgroups of women who might be susceptible to the hypertensive effect of oral contraceptives have been identified. METHODS AND RESULTS: In a prospective cohort study in the United States, 68 297 female nurses aged 25 to 42 years and free of diagnosed hypertension, diabetes, coronary heart disease, stroke, and cancer at baseline were followed up for 4 years. During 231 006 person-years of follow-up, 1567 incident cases of hypertension were diagnosed. Compared with women who had never used oral contraceptives, the age-adjusted relative risk was 1.5 (95% CI = 1.2 to 1.8) for current use and 1.1 (95% CI = 0.9 to 1.2) for past use. After adjustment for age, body mass index, hormones cigarette smoking, family history of hypertension, parity, physical activity, alcohol intake, and ethnicity, current users of oral contraceptives had an increased risk of development of hypertension (RR = 1.8; 95% CI = 1.5 to 2.3) compared with women who had never used them. The multivariate relative risk for past users was 1.2 (95% CI = 1.0 to 1.4). There were no important modifying effects of age, family history of hypertension, ethnicity, or body mass index. CONCLUSIONS: Current users of oral contraceptives had a significant, moderately increased risk of hypertension. However, among this group, only 41.5 cases per 10 000 person-years could be attributed to oral contraceptive use. Risk decreased quickly with cessation of oral contraceptives, and past users appeared to have only a slightly increased risk.

Adult↗
PubMed1999

Do hormonal contraceptives influence asthma severity?

There is some evidence that endogenous progesterone and oestrogen levels influence asthma severity in females, but little is known about the effects of hormonal contraceptives. This study aimed to describe how females with asthma perceived the effects of hormonal contraceptives on symptom severity, and to describe the association between asthma severity and current use of hormonal contraceptives. A questionnaire was sent to 891 females with asthma aged 20-30 yrs recruited from general practice registers in South London, UK. It asked about perceptions of the effects of hormonal contraceptives on asthma severity, about current use of hormonal contraceptives, and included an asthma quality of life questionnaire as a measure of asthma severity. About 6% of respondents who had ever used hormonal contraceptives reported that these had influenced asthma severity, -4% reporting worsening and 2% an improvement. There were no significant differences in asthma quality of life score between females currently taking hormonal contraceptives and those not, between those taking combined and progesterone-only preparations, or between users of different progestagen types. This study found no evidence of any important effect of hormonal contraceptives or their components on asthma severity in a group of females with relatively mild asthma.

Adult↗
PubMed1994

Contraceptive risk-taking in a medically-underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the non-use of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking, and also compared levels of contraceptive knowledge and pregnancy histories of non-contraceptors versus barrier method contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger and for those whose knowledge of the fertility cycle is incorrect, but was found to be only weakly related to the women's marital status. Non-contraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to non-use of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a sub-group of the medically-underserved low-income population.

Adolescent↗
PubMed2006

Provider and health facility influences on contraceptive adoption in urban Pakistan.

CONTEXT: Although the vast majority of Pakistani women are familiar with family planning methods, use of contraceptives remains low. Identifying the characteristics of family planning providers and health facilities that are associated with women's initiation of contraception may help program administrators devise interventions to increase contraceptive use. METHODS: Logistic regression analysis of data from a survey of urban Pakistani health facilities, their clients and their staff was used to identify individual, provider and health facility characteristics that predict women's receipt of contraceptives during visits to urban clinics. RESULTS: Women who had a secondary or higher level of education and three or more children had elevated odds of receiving a method (odds ratios, 1.8-9.3). Women had reduced odds of receiving contraceptives when visiting facilities where providers had higher levels of family planning experience. They had higher odds of receiving services at facilities that displayed educational materials about family planning than at those that did not (1.8), and those odds increased with the proportion of contraceptive methods offered that were in stock, the number of staff doctors and the number of staff members who provided family planning (1.2-2.4). CONCLUSION: Providers should be aware of the contraceptive needs of women with all levels of education and parity. Additionally, family planning facilities may be able to increase clients' contraceptive use by providing diversity in method choice, keeping offered methods in stock, displaying informational materials, and raising staff levels.

Adult↗
PubMed2001

Provision of emergency contraception in general practice and confidentiality for the under 16's: results of a postal survey by general practitioners in Avon.

OBJECTIVE: To describe the provision of emergency contraception and confidentiality for the under 16's by general practitioners (GPs) in Avon, in order to inform the development of a health promotion intervention in schools in Avon. DESIGN: Confidential postal questionnaire survey. SETTING: All principals in general practice in Avon Health Authority, South West England. SUBJECTS: Five hundred and eighty general practice principals were sent the questionnaire. RESULTS: Four hundred and eighty-six (84%) principals in general practice responded to the questionnaire. Only three (0.6%) GPs did not provide hormonal emergency contraception. Nearly half (232, 47.7%) would fit the intrauterine device (IUD) as emergency contraception. Fitting an IUD was associated with female gender of the GP (OR = 2.34, 95% CI 1.53-3.71), and whether the GP had a family planning qualification (OR = 4.55, 95% CI 2.41-8.60). Three hundred and fifty-two (72%) respondents would provide emergency contraception on a Sunday if requested to do so by a 14-year-old who reported having had unprotected sex the night before. Practice nurses in 26 (5%) of the respondent's practices were available to provide advice and tablets for patients requesting hormonal emergency contraception. However, 74 (21%) respondents employed a family planning trained practice nurse who was not involved in any way in the provision of emergency contraception. Practice nurses remain an under used resource in this area. CONCLUSION: Our findings suggest that most GPs provide hormonal emergency contraception. Only eight (1.6%) of respondents would need to ask for parental consent prior to providing hormonal emergency contraception to a 14-year old-girl. Young people need to be informed of GPs widespread adherence to current confidentiality guidelines.

Adolescent↗
PubMed2005

Community-based distribution and contraception usage in Iran.

OBJECTIVE: Despite the availability of free contraception from family planning clinics, the rate of unwanted pregnancy in Iran is still high. The effectiveness of other methods for contraceptive supply should, therefore, be evaluated. The aim of this study was to determine the effects of community-based distribution (CBD) on contraceptive usage in Iran. METHODS: This controlled field trial study involved 297 individuals (100 subjects in the CBD group and 197 subjects in the control group) from four major remote areas of Hamedan, Iran. Stratified random sampling was used. RESULTS: Data analysis suggested that using CBD has four major effects: (1) it increases the level of contraceptive knowledge (p<0.0001), (2) it enhances correct contraceptive choice by couples (p<0.0001), (3) it improves contraceptive usage (p<0.0001) and (4) it improves contraceptive continuation rates (p<0.0001). CONCLUSIONS: CBD facilitates better knowledge, proper choice, and correct and continuous usage of contraception. This method should, therefore, be adopted for family planning services in remote areas of Iran.

Adult↗
PubMed2006

Female sterilisation: is it what women really want or are alternative contraceptive methods acceptable?

OBJECTIVE: An initial audit was conducted in 2001 to monitor all women referred for female sterilisation. This re-audit in 2003 set out to investigate those women who initially chose alternative reversible contraception and ascertain whether they were still using that method or if they or their partner had requested sterilisation. METHODS: A telephone survey of general practitioners was conducted, 2 years after an initial sterilisation counselling appointment, of those women who initially had chosen alternative, reversible forms of contraception. RESULTS: Information regarding current contraception was obtained for 44 (85%) of the cohort of 52 women. Three women and five of their partners (15.4%) had been sterilised in the intervening 2 years. Two women had undergone hysterectomy for gynaecological reasons. Thirty-four (65.4%) women were using reversible contraceptive methods and 31 (59.6%) were still using the same contraceptive method chosen at the sterilisation counselling appointment. Information was not available for eight (15.4%) women. CONCLUSIONS: Female sterilisation counselling within a contraception and sexual health service successfully offers a full range of contraceptive alternatives. This small audit indicates that at least two-thirds of women who choose one of these alternatives will still be using this method 2 years later. Although the number of women in this audit is small, we suggest that this change in service delivery has contributed to a decline in female sterilisation within the district and has led to an increased use of effective, reversible hormonal contraception within the community and hospital services.

Cohort Studies↗