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PubMed1983

Unwanted pregnancy. A failure of contraceptive education.

One thousand consecutive women presenting for first-trimester abortion at a free-standing clinic were interviewed with respect to contraceptive education and use. The vast majority had had some exposure to contraceptive information, yet more than half had not been using any form of contraception when conception occurred. More energy should be given to increasing women's motivation for using contraception.

Abortion, Legal↗
PubMed2006

Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003.

CONTEXT: Trends in teenagers' contraceptive use have received less attention than trends in adolescent sexual intercourse, despite the importance of contraceptive use to preventing teenage pregnancy. METHODS: Sexually active high school students' use of contraceptives and risk of pregnancy from 1991 to 2003 were examined using data from the national Youth Risk Behavior Survey and published contraceptive failure rates. Changes in pregnancy risk were assessed using weighted least-squares regression. RESULTS: Between 1991 and 2003, contraceptive use improved among sexually active U.S. high school students. Improvements among women included an increase in the proportion reporting condom use at last sex (from 38% to 58%) and declines in the proportions using withdrawal (from 19% to 11%) and no method (18% to 12%). Hormonal method use changed little, as a decline in pill use (from 25% to 20%) was offset by use of injectables (5% in 2003). Similar patterns were found among men. Women's risk of pregnancy declined 21% over the 12 years. The largest improvements in contraceptive use and pregnancy risk occurred among ninth graders, and whites and blacks. In 2003, 46% of pregnancy risk resulted from failure to use any method of contraception, and 54% resulted from contraceptive failure. CONCLUSIONS: Improvement in the use of contraceptives by sexually active high school students during the 1990s is encouraging. To sustain this trend, programs need to encourage contraceptive use among teenagers who do not use it and to stress consistent and correct use among those who do.

Adolescent↗
PubMed1979

Use of contraceptives prior to and after conception and exposure to other fetal hazards.

In a large prospective study, set up to determine whether reproductive outcomes are affected by prior contraceptive use, 34,344 women were recruited at their first antenatal visit and followed until pregnancy termination. This paper summarizes the study methods and describes the demographic differences between subjects who used various contraceptives shortly before conception, and those who experienced contraceptive failures. Thirty percent of the women had used oral contraceptives (OCs) during the 5 months prior to conception and 2.4% had continued using them after their LMP. IUDs had been used by 5.8% of women before conception and 1.1% after. If these rates are also true for the whole population of the U.S., they indicate that approximately 70,000 babies are born each year following pill-failures and 30,000 following failures of IUD's. Exposure to other fetal hazards was common, with 48% of pregnant women drinking alcohol, 28% smoking, and 15% receiving diagnostic X-rays. OC use was more common among smokers and drinkers, and OC failures were significantly associated with the use of anti-epileptics, aspirin, and with exposure to radiation.

Adult↗
PubMed1980

Contraceptive efficacy: the significance of method and motivation.

The relationship between contraceptive failure and selected characteristics of users is examined using data collected in the 1970 and 1975 rounds of the National Fertility Study. Intention regarding future childbearing and choice of contraceptive method are found to be the most important considerations. Within categories of intention, choice of method appears to have an important influence on differentials by age and other characteristics. The longitudinal aspect of the study design permitted the inclusion in the analyis of certainty of intention, coital frequency, and women's perceptions of their own ability to control fertility.

Adolescent↗
PubMed1999

Emergency contraception: change in knowledge of women attending for termination of pregnancy from 1984 to 1996.

OBJECTIVE: To compare the knowledge of emergency contraception in women attending hospital for termination of pregnancy in 1984 and 1996. DESIGN: A questionnaire survey. SETTING: Ninewells Hospital, Dundee. SUBJECTS: Cohorts of 100 consecutive women undergoing termination of pregnancy in 1984 and 1996. RESULTS: Over this 12 year period, there has been a significant improvement in the knowledge of emergency contraception. Seventy three per cent had a good knowledge of the postcoital pill in 1996 compared to 12 per cent in 1984 (p=</=0.0001). There has been a significant rise in the use of condoms (60 per cent vs 32 per cent; p=</=0.001) and the number of conceptions due to condom accidents (38 per cent vs eight per cent; p=</=0.0001). Although most women in the 1996 cohort recognised a reason for contraceptive failure and had adequate knowledge of emergency contraception, only 17 per cent considered the possibility of pregnancy. CONCLUSION: Poor knowledge of postcoital contraception is no longer a major factor leading to the failure of women to obtain emergency contraception. Improved uptake in the use of emergency contraception is likely to result from a greater awareness of the possibility of condom failure and easier availability of the postcoital pill.

Abortion, Induced↗
PubMed1990

Gastrointestinal disease and oral contraception.

Oral contraceptive steroids play a major role in modern family planning. With the present tendency to decrease the doses of both estrogens and progestogens, any factor that reduces the bioavailability of the lower-dose preparations may have an impact on contraceptive protection. Although ethinyl estradiol, the most commonly used oral estrogen, is liable to an enterohepatic circulation as unchanged drug, the commonly used progestogens are not. At present, no convincing evidence exists in the human subject that disruption of the enterohepatic circulation by antibiotics or antacids does reduce contraceptive efficacy of the pill. Oral contraceptive steroids are mainly absorbed from the small bowel, and contraceptive efficacy depends on its absorptive capacity. Enhanced passage of gastrointestinal contents or impaired absorption may thus contribute to contraceptive failures in patients who have chronic inflammatory disease, diarrhea, ileostomy, or jejunoileal bypass.

Antacids↗
PubMedDate not supplied

Mortality associated with fertility and fertility control: 1983.

This analysis demonstrates that levels of mortality associated with all major methods of fertility control (tubal sterilization, the pill, IUD, condom, diaphragm, spermicides, rhythm and abortion) are low in comparison with the risk of death associated with childbirth and ectopic pregnancy when no fertility control method is used. The exceptions are the risks associated with pill use after the age of 40 for women who do not smoke, and with pill use after the age of 35 for smokers. The safest approach to fertility control is to use the condom and to back it up by abortion in case of method failure. Except for the lowest-risk method of fertility control (condom and abortion) and the highest (pill use by a smoker), most strategies of fertility control result in a similar risk of mortality until the woman reaches 35 years of age. At that point, risk from pill use rises more sharply than risk associated with other methods. The above conclusions are based on the lowest contraceptive failure rates reported by Schirm and his colleagues for married American women. If, instead, the highest failure rates are employed, use of the pill by a nonsmoker or the IUD clearly is safer than reliance on barrier methods or rhythm. As noted earlier, there are few women who make their contraceptive choices solely on the basis of perceived risk of mortality. Very few, for example, would consider abortion as a primary method of birth control; and for many, abortion would not be acceptable even as a backup for failed contraception. Although the risk of mortality resulting from use of the IUD is low, many women who have not yet had children might not want to face the increased risk of infertility problems from pelvic inflammatory disease that have been associated with use of this method.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMedDate not supplied

Unintended pregnancy. Consequences and solutions for a worldwide problem.

Unintended pregnancy is a worldwide problem that affects women, their families, and society. Unintended pregnancy can result from contraceptive failure, non-use of contraceptive services, and, less commonly, rape. Abortion is a frequent consequence of unintended pregnancy and, in the developing world, can result in serious, long-term negative health effects including infertility and maternal death. In many developing countries, poverty, malnutrition, and lack of sanitation and education contribute to serious health consequences for women and their families experiencing an unintended pregnancy. Regardless of the cause, unintended pregnancy and its negative consequences can be prevented by access to contraceptive services including emergency contraception, safe and legal abortion services, and a society that allows women to determine their own reproductive choices. Addressing unintended pregnancy and its substantial human and dollar costs should be a priority in every country. The availability of reliable contraception for all, regardless of age or ability to pay, is an essential first step. Women and adolescents require access to age-appropriate and culturally sensitive reproductive health care services, including emergency contraception. Access to safe, legal abortion services is necessary to impact the staggering maternal mortality rates worldwide. Midwives throughout the world provide the majority of care for women of reproductive age. It is essential to identify those at risk for unintended pregnancy, provide the services they require, and remain diligent to ensure that those women and their families have safe options to consider when faced with an unintended pregnancy. In 1920, Magaret Sanger said, "No women can call herself free who does not control her own body." Although great strides have been made to improve the health and status of women since Ms. Sanger spoke those words, there remains much work to be done.

Contraception↗
PubMed2001

The use of emergency contraception in Australasian emergency departments.

OBJECTIVE: To review the prescribing of emergency contraception by emergency departments in Australasia and compare it with other providers. METHODS: A postal questionnaire was sent to the director of each of the 79 Australasian College for Emergency Medicine accredited emergency departments in Australasia inquiring about the availability and prescribing habits for emergency contraception within each department. RESULTS: Of the 79 emergency departments, 69 (87.3%) responded to the questionnaire and were aware of the 'emergency contraception regimen'. The majority of departments prescribed appropriately (56%) and only one department did not arrange adequate follow up. Anti-emetics are always used by 45 departments (78.9%). Discussion of future contraceptive needs at the time of presentation was only undertaken by 25 departments (43.9%). Written clinical guidelines for emergency contraception were present in 28 departments (40.6%). CONCLUSIONS: Emergency departments are accessed by patients requesting contraception following unprotected intercourse or contraceptive failure. The prescribing of emergency contraception in Australasian emergency departments is comparable with other providers but substantial improvements could be made. Suggestions to assist this improvement include written clinical guidelines and patient information and purpose-made medication packs.

Antiemetics↗
PubMedDate not supplied

Emergency contraception for midwifery practice.

Every year in the United States, there are an estimated 3.5 million unplanned pregnancies with nearly one third of these attributed to contraceptive failures. Despite the availability of effective contraceptive methods, far too many women still experience unwanted pregnancies. It has been estimated that emergency contraception, also referred to as postcoital contraception or "the morning after pill," can reduce the risk of pregnancy after unprotected intercourse by as much as 75%. When administered within 72 hours of unprotected intercourse, emergency contraception, inhibits implantation of a fertilized ovum. The most common method of emergency contraception, the administration of ethinyl estradiol and dL-norgestrel, was initially described by Yuzpe in 1977. In the past 20 years, multiple studies have demonstrated the effectiveness of commonly prescribed combination oral contraceptives containing ethinyl estradiol and levonorgestrel. For those women in whom estrogen is contraindicated, progestin-only pills or the synthetic androgen Danazol have been used with comparable effectiveness rates. For appropriately selected women, an intrauterine device such as the Paraguard T380A (Ortho Pharmaceuticals, Raritan, NJ) also may be inserted within 5-7 days after unprotected intercourse to reduce the risk of unintended pregnancy. Despite its success and safety, emergency contraception is underused by women and their health care providers. As providers of comprehensive health care, midwives should provide patients with accurate information concerning pregnancy prevention. For many women, obtaining emergency contraception is an entry into the health care system and provides them an opportunity to be educated about safer sex practices, contraception, and the importance of regular health screening. Regularly discussing emergency contraception with patients at routine health visits will enable them to participate fully in their health care decisions and diminish the physical, psychological, and societal stressors associated with unplanned pregnancy.

Contraceptives, Postcoital↗
PubMed2006

Access to emergency hormonal contraception from community pharmacies and family planning clinics.

AIMS: To evaluate differences in the time taken to access progestogen-only emergency hormonal contraception (EHC) by young women from family planning (FP) or community pharmacy settings. METHODS: An observational study of 203 women requesting EHC from FP clinics and community pharmacies in South-west Kent Primary Care Trust (PCT) from December 2002 to October 2003. RESULTS: Access to EHC from community pharmacy was significantly faster than from FP clinics (16 h vs. 41 h, P<0.001). Older teenagers tended to seek EHC more quickly and were more likely to have had a contraceptive failure rather than have used no contraception at all. CONCLUSION: The results provide further support for pharmacist involvement in the supply of EHC.

Adolescent↗
PubMed1991

Induced abortion in eight provinces of China.

A survey of 12,000 women in eight provinces of China was carried out in 1988. One urban and one rural area were selected purposely in each province; data on lifetime and recent pregnancies were collected from married women aged 20-44. Data on abortions included reasons, gestational age, and complications. During the five years before the survey, the number of abortions per 100 live births was 102 in urban areas and 62 in rural areas. For those with one or more previous live births in urban areas, nearly all subsequent pregnancies ended in abortion. Also in urban areas, 31% of women with a recent abortion reported the reason was contraceptive failure. Over 80% of women are contraceptive users; the high abortion rates then reflect relatively low use-effectiveness of contraception and that most unplanned pregnancies are aborted.

Abortion, Induced↗
PubMedDate not supplied

Clinical pearls: factors affecting reported contraceptive efficacy rates in clinical studies.

Current combination oral contraceptives (OCs) are among the most popular, safe, and effective methods of reversible contraception. There are, however, many factors that can affect contraceptive failure rates as reported in clinical trials, including subject characteristics, factors related to study methodology and data analysis, and publication biases. The variability of these factors among clinical trials makes meaningful comparisons of contraceptive efficacy data across studies difficult, if not misleading or erroneous. It is even more difficult to reconcile the differences between clinical trial efficacy rates and everyday use rates; for instance, the National Survey of Family Growth reported that the rate of OC failure is close to 8% in the United States, which is higher than rates reported in clinical trials. Thus, it is important for the clinician to consider the many factors that can influence reporting of contraceptive failure rates in clinical trials and be aware of the limitations in differentiating OCs on the basis of contraceptive efficacy derived from clinical trial data. Furthermore, clinical trial data may not accurately predict contraceptive efficacy in everyday use.

Adult↗