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PubMed1993

A multicenter clinical trial of a progestin-only oral contraceptive in lactating women.

A non-comparative study of a progestin-only oral contraceptive (POC) containing 75 micrograms norgestrel was conducted at 22 sites in 14 countries. This study was designed to evaluate safety, contraceptive efficacy, and the overall acceptability of a POC in breastfeeding women. A total of 4,088 women entered the study over a three-year period and 29,399 woman-months of experience was gathered. Women had follow-up visits at 2, 6, and 11 months after admission. Headaches and vaginal discharge were the medical complaints most commonly reported by women, both prior to and after admission. Menstrual problems were reported by 59% of the women after admission. Of the 3,714 women who returned for at least one follow-up visit, 1,101 (29.6%) discontinued through month 11. The 11-month total discontinuation percentage, including those lost to follow-up (25.3%) was 51.6%. The most common reason given for discontinuation was a woman's desire for a change in contraceptive method. Only 4.9% discontinued pill use for menstrual problems, a percentage far below those generally reported for POCs. Twenty-nine unintended pregnancies occurred through 11 months giving a gross cumulative life table rate of 1.2 per 100 women (Pearl Index = 1.4). The POC appears to be a safe, effective and acceptable contraceptive option for postpartum breastfeeding women.

Adolescent↗
PubMed1994

Sex, drugs, relationships, contraception, and fears of disease on a college campus over 17 years.

Sexual behavior was surveyed in 1991 for the fourth time in 17 years at a northeastern college with 98 male and 148 female participants. Variables included virginity, religiosity, relationship to parents, relationship to last sex partner, sex philosophy, attractiveness, drug use, contraceptives used, fear of AIDS and effect of this fear on behavior. Results indicated a 91% nonvirginity rate for men, 76% for women. Both genders initiated sex at the same age. Men exhibited a more liberal sexual philosophy. Neither gender had a sexual double standard. Women's attractiveness, but not men's, related to nonvirginity. Relationship with parents was not associated with virginity, but religiosity was. Drug use was related to nonvirginity. Frequent drug users had less commitment to last sex partner than did infrequent users. Nondisease-protective contraceptive methods decreased. Despite fear of AIDS, only one-third of the students practiced "safe sex" consistently, and men were less concerned with practicing it than women. Commitment has not increased since the 1986 survey.

Adult↗
PubMed1993

Contraception in Spain.

This report analyzes various aspects of contraception in Spain. One notable finding is the wide socioeconomic, cultural and health variation among regions. Since 1975 a significant drop in the birth rate has been observed overall. Twenty per cent of the women studied at risk of pregnancy are using oral contraceptives. The most widespread contraceptive method is still coitus interruptus, followed by oral contraception and the condom, as well as the rhythm method. The highest use of oral contraceptive and IUDs is seen in Catalonia (20% and 26% respectively) followed by Andalusia, Madrid and Valencia. Although contraception has only recently become legal in Spain, it is widely available either without charge or very inexpensively; all methods including abortion are available. At present, priority is given to special interest groups such as women in special circumstances, teenagers, etc. and to special programs like "Integrated Care for Women" which includes contraception, STD, pregnancy monitoring, early diagnosis of gynaecologic cancer and menopause.

Abortion, Induced↗
PubMed1989

Risk factors for cervical cancer in Greenland and Denmark: a population-based cross-sectional study.

The incidence of cervical cancer in Greenlandic women aged 20-39 years is nearly 6 times higher than in Danish women of the same age. Possible determinants of cervical cancer incidence were investigated in a population-based cross-sectional study. From Nuuk (Greenland) and Nykøbing Falster (Denmark) a sample of 800 women aged 20-39 years was drawn at random. A total of 586 and 661 women were studied in Greenland and Denmark, respectively. All underwent a personal interview. In Greenland, 13% of the women reported first intercourse before the age of 14 in contrast to 3.5% in Denmark, and nearly 85% of the Greenlanders had their sexual debut before the end of the 16th year of age whereas this applied to only 45% of the Danish women. The prevalence of women with 0-1 lifetime sexual partner was 20.4% in Denmark, and only 1.7% in Greenland. In contrast, 53.2% of the Greenlandic women reported more than 20 partners and 22.4% more than 40 partners. The corresponding figures for Denmark were 3.6% and 0.3%, respectively. In Greenland the most common contraceptive method was the use of intra-uterine devices (73.6%), whereas, in Denmark, oral contraceptive use was most frequent (87.9%). Few Greenlanders had ever used "barrier" contraceptives (diaphragm: 1.4%; condom: 18.1%) compared to Denmark (diaphragm: 10.1%; condom: 53.9%). As many as 87.4% were current smokers in Greenland (Denmark: 53.6%) and 5.6% claimed to have never smoked, whereas this applied to 35.3% in Denmark. The indications of a higher sexual activity (multiple partners, early age at first intercourse) in Greenland compared to Denmark are in line with the observed higher rates of sexually transmitted diseases and with the hypothesis that differences in cervical cancer incidence between Greenland and Denmark are determined by aspects of sexual background.

Adult↗
PubMed1984

Oral contraceptives: the risks in perspective.

In 1968 three large prospective cohort studies were begun for the purpose of studying the long-term effects of oral contraceptive use. In all three studies, the major serious side effect of oral contraceptive use was an increased risk of circulatory mortality; this risk, however, was concentrated in older women who smoked and all women over the age of 45. The concept of risk is poorly understood by many consumers and providers of health care. This article explains the concept of risk and how it is determined, and reviews the most recent findings of the cohort studies relative to pill-related mortality. Comprehension of the concept of risk relative to pill-related mortality and its implications for nursing practice will assist nurses in providing their clients with the knowledge base necessary for an informed choice regarding contraceptive method.

Adolescent↗
PubMed1992

A longitudinal evaluation of computer-assisted instruction on contraception for college students.

This study assessed changes in contraceptive knowledge of 58 white female undergraduate college students following use of a computer-assisted instruction (CAI) program on contraceptive methods. The CAI program consisted of a personal-computer-based instructional lesson covering facts about and appropriate use of oral contraceptives and barrier methods, and myths about sexuality and sexually transmitted diseases. Baseline contraceptive knowledge was first compared with 171 white female undergraduate students. This comparison indicated that, overall, there were knowledge deficits regarding the safety of oral contraceptives and what to do if oral contraceptives are not used correctly. At immediate posttest, significant knowledge gains were observed for danger signs associated with using oral contraceptives, the rationale for triphasic and biphasic pills, potential medication synergism, health benefits of using oral contraceptives, potential contraceptive effect of withdrawal, and the reasons women stop using the pill. At six-month follow-up, students evidenced long-term knowledge gains on duration of pill use, the rationale for triphasics and biphasics, appropriate contingencies for missing two days of the pill, danger signs associated with using contraceptives, medication synergism, and health benefits of using oral contraceptives. The results of the evaluation are considered in the context of the widely held assumption that young women's contraceptive failure is unrelated to knowledge deficits about methods of birth control.

Adolescent↗
PubMed1995

Low-dose progestogen contraception and the nursing mother.

Breast feeding, though an important and efficient contraceptive method, suffers from one major limitation: the contraceptive protection it offers the nursing mother ends abruptly without giving any physical indication of the return of fertility. Barrier methods and progesterone-only hormonal contraceptives, either in the oral, implant or injectable form, appear to be the primary contraceptive alternative for the nursing mother today. They neither adversely affect lactation, nor does the minute quantity of progesterone (NET or LNG) transferred to the infant affect its growth and physical well-being. Puerperal insertion of IUD carries an inherent risk of pelvic inflammatory disease, high expulsion rates and menorrhagia, once menses resume. Combination contraceptives affect both the quality and quantity of breastmilk; hence they are not recommended. Sterilization is a permanent method and therefore useful only when the family has been completed.

Adult↗
PubMedDate not supplied

Advances in male contraception.

The methods devised for male contraception are meager. The authors review the various nonhormonal methods applied for contraception including vas deferens interference and heat. The former comprises the no-scalpel vasectomy, percutaneous vasal injection, the "Shug" method, and the argon laser vasal photocoagulation. Heat methods used wet heat, and artificial cryptorchidism was created by testicular suspension. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitch and ball. Two recently developed methods for male contraception--polyester-induced azoospermia and prolactin injection--are described. The azoospermic effect of the polyester sling seems to be due to (1) creation of an electrostatic field across the intrascrotal structures, and (2) disordered thermoregulation. Prolactin administration as a contraceptive method is efficient and safe and has the potential to be developed as a male contraceptive. The methods, especially testicular suspension and polyester suspensors, are simple and easily applicable and were well accepted by the subjects.

Animals↗
PubMedDate not supplied

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.

Adolescent↗
PubMed1983

Glycohemoglobin (Hb A1) levels in oral contraceptive users.

In a group of 33 healthy women, among whom 15 utilized the combined oral contraceptive pill, and 18 utilized the progesterone oral pill (ethynodiol diacetate, 0.5 mg, Femulen, we have examined the percentage of glycohemoglobin (Hb A1). In the progesterone oral pill users the percentage of Hb A1 remained unchanged, that is 5.4% before, and 5.2% 3-6 mth after using it, whereas in women taking the combined oral contraceptive pill the values increased from 5.9% before to a mean of 8.7% after 3-6 mth after administration. This increase seems to be related to the estrogen of the which, as in pregnancy, may induce glucose intolerance. From this study it may be seen that, despite its disadvantages such as reduced effectiveness and menstrual disruption, the progesterone-only pill is preferable. At the same time, the screening by the Hb A1 evaluation, a sure, inexpensive and easily performed procedure, makes it possible to detect a nonsuspected diabetes or a borderline diabetes and thus to change the contraception method used for another method.

Adolescent↗
PubMedDate not supplied

Predictors of contraceptive discontinuation in a sexually transmitted disease clinic population.

CONTEXT: Women who attend sexually transmitted disease (STD) clinics are at high risk for unintended pregnancy. Little information is available, however, on the rates of discontinuation of effective contraceptive method use among this population. METHODS: As part of a study on contraceptive services offered by an STD clinic in Denver, 406 clients who accepted these services in 1996-1999 were interviewed about their contraceptive practice, experience of side effects and method-use problems at baseline and at four, eight and 12 months of follow-up. Multivariate survival analysis was used to assess predictors of discontinuation of effective contraceptive use. RESULTS: Twenty-nine percent of women discontinued use by the end of one year. Coxproportional hazards models show that compared with women who reported no method-use problems, those who experienced one problem were three times as likely (hazard ratio, 3.0) to discontinue effective use, and women who had at least two problems were five times as likely (5.0) to discontinue use. The experience of side effects with either a past or a current method, however, was not associated with the risk of discontinuation. Furthermore, women who reported risky sexual behavior in the year before enrollment were significantly less likely to discontinue effective method use (hazard ratio, 0.4), as were women who were covered by medical insurance or who gained such coverage during a follow-up interval (hazard ratio, 0.5 for each). CONCLUSIONS: In this study population of STD clinic users, method-use problems appear to be a more fundamental issue for contraceptive compliance than the pastor current experience of side effects. The unexpected association between method-use problems and the risk of discontinuation needs to be further delineated so that effective interventions addressing these problems can be developed and implemented.

Adolescent↗
PubMedDate not supplied

Long-acting contraceptive options.

Long-acting contraceptive methods are appropriate choices for women who prefer the convenience and high contraceptive efficacy of methods not requiring frequent compliance, and women for whom contraceptive doses of estrogen are either medically contraindicated or associated with persistent intolerable side effects. Annual pregnancy rates for the three methods described below are less than 1 per 100 woman-years. As currently formulated, levonorgestrel implants (Norplant) consist of six 34 x 2.4 mm soft plastic implants, each filled with 36 mg of crystalline levonorgestrel. Irregular and often persistent menstrual bleeding and spotting constitute the most important side effects experienced by and leading to method discontinuation in implant users. Implant removal is technically more difficult and time-consuming than insertion. Depot-medroxyprogesterone acetate (DMPA or Depo-Provera) is injected as an aqueous suspension of microcrystals. Intramuscular injection of 150 mg of DMPA results in more than 3 months of contraception. Irregular bleeding and spotting followed by amenorrhea, constitute the most importance side effects experienced by DMPA users. Because DMPA use can result in prolonged (but not permanent) infertility, DMPA is not an optimum contraceptive choice for women who may want to conceive in the next one or two years. The Copper T380A intrauterine device (IUD) provides reversible contraception for up to 10 years. IUDs act as contraceptives, not early abortafacients. Recent epidemiologic data indicate that long-term IUD use does not increase the occurrence of pelvic inflammatory disease. Heavier menstrual flow and cramps constitute the main side effects experienced by women using the copper IUD. Intrauterine device insertion and removal are accomplished during brief office-based procedures.

Adolescent↗
PubMed1992

Intrauterine contraception.

Currently 85 million women use an intrauterine device (IUD), making it the most widely used, reliable, reversible contraceptive method worldwide. Although the exact mechanisms by which copper-bearing IUDs produce contraceptive action are not completely defined, recent evidence indicates that they act primarily to prevent sperm from fertilizing ova. The future of the IUD is brighter than it has been for the past 20 years. The latest generation of IUDs, such as the TCu 380A (Paragard, GynoPharma, Somerville, NJ), are safer and more effective than ever. In World Health Organization large, multicenter trials, pregnancy rates for the TCu 380A are 1.0, 1.4, 1.6, and 1.8 at 3, 5, 7, and 9 years of use, respectively. The ectopic pregnancy rates and removal for pelvic inflammatory disease are very low. The device may soon be the major IUD available in most countries. The acceptability of IUD use can be increased by good clinical management, sympathetic counseling, careful client selection, proper device selection, careful insertion, timing of insertion, and regular follow-up with quick access to medical care.

Aftercare↗
PubMed1988

Knowledge and use of contraception in rural and urban Iraq.

"This paper investigates variation in birth control knowledge and practices in Iraq as reported in the 1974 National Fertility Sample Survey. The descriptive and inferential statistical analysis indicated the existence of significant rural-urban differentials in knowledge and use of contraceptive methods by ever-married women. With the continuation of the war with Iran, the Iraqi government has adopted pro-natal policy to spur population growth. Whether such a policy achieves its goals is a matter deserving further investigation."

Asia↗
PubMed2004

The 2002 Canadian Contraception Study: Part 2.

The 2002 Canadian Contraception Study investigated the contraception and sexual health-related knowledge, attitudes, and practices of a representative sample of Canadian women of childbearing age. In Part 2 of the report of this research, the authors focus on the contraceptive attitudes and practices of adolescent women and women in their later reproductive years, provide data on sexual and reproductive health indicators of Canadian women, describe 2-decade trends in the awareness, opinion, and utilization of contraceptive methods among Canadian women, and describe contraception counselling strategies that may be used to improve patient choice and adherence to method. This report closes with an overall discussion of the findings of the 2002 Canadian Contraception Study.

Adolescent↗
PubMedDate not supplied

The effects of contraceptive education on method use at first intercourse.

Despite long-standing public support for sex education in the schools, it has been difficult to show concrete effects of sex education on sexual and contraceptive behavior. Data from the 1988 National Survey of Family Growth indicate that exposure to a formal contraceptive education program increases the likelihood that a teenage woman will use a contraceptive method at first intercourse. According to the results of a multivariate analysis, the odds that a young woman will use any method and the odds that she will use a condom increase by about one-third following instruction about birth control; the effect on the likelihood of pill use, however, is nonsignificant. If contraceptive education occurs in the same year that a teenager becomes sexually active, the odds of any method use and of condom use are increased by 70-80%, and the odds of pill use are more than doubled. The results also suggest that with greater educational efforts, the proportion of teenagers who use condoms at first intercourse could increase from 52% to 59%, while the proportion using no method might decrease from 41% to 33%.

Adolescent↗
PubMedDate not supplied

[Medical aspects of adolescent sexuality].

The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. The sexual and reproductive behaviour, attitudes toward sexuality and contraception, as well as the prevalence rates of unintended pregnancy and Chlamydia trachomatis genital infections were analyzed in 300 sexually active adolescent females, aged 19 years. The first sexual intercourse was in 16.9 years, in average. Less than one-third of the total number (31.3%) of these persons had contraceptive protection at the first intercourse; condom was most frequently used (28.3%). Motives for the initiation of sexual activity were: love (45.7%), curiosity (35.7%), physical attraction and passion (8.3%), peer pressure (5.0%), on the boyfriend's insistence (4.7%), need for love (0.3%) and without answer (0.3%). Two-thirds of adolescent females (63.7%) reported more than one partner, 21.7% more than three and 10.2% more than five sexual partners. Almost half of girls (40.7%) experienced sexual intercourse in casual acquaintance, and 10.3% with a 10 or more years older partner. Use of contraceptive methods during each sexual encounter was inconsistent and sporadic. More than half of adolescent females (54.3%) relied on traditional forms of contraception, like withdrawal of the phallus. Condom was the method of contraceptive choice in one-third (34.3%) of girls, "birth-control pill" in 10.7% and spermicides in 0.7% of subjects. With a new sexual partner condom was used regularly by 55.6% of adolescents; and the remaining percentage of girls used condom irregularly (24.7%), or never (19.7%). The time interval between the initiation of sexual activity and the first gynaecological examination was more than 6 months in 56.7% of cases, and from one to three years in 31.0% of tested adolescent females. The reasons for the first gynaecological visit were as follows: fear of getting pregnant (22.0%), suspicion of contracting a sexually transmitted disease (22.0%) and symptoms indicating a pelvic inflammatory disease (18.3%). Only one-third of girls (37.7%) had their first gynaecological examination as a regular control examination or to get some contraceptive advice. During the adolescence unwanted pregnancy was noted in 16.0% of examined girls. One legal abortion had 14.4% of girls, two 1.3% and three 0.3% of adolescent females. Chlamydia trachomatis genital infection was found in 30.3% of girls. In the girls' opinion the improved knowledge about sexuality, reproduction and contraception is the best way of popularizing contraception among youth. This could be done by introduction of sexual education in school programmes (51.0%) or through mass media (33.3%). A successful health care service for young people should include: a gynaecologist who will have enough time and patience for an adolescent patient (91.3%); a female gynaecologist (36.7%); and a kind other health care workers (21.3%). In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.

Adolescent↗