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PubMed2000

Factors affecting the selection of a reversible or an irreversible contraceptive method in a developing country.

OBJECTIVES: To evaluate the factors that may affect the selection of a reversible or an irreversible contraceptive method. METHODS: In an urban area of a developing country, demographic characteristics, educational and income levels, and previously used contraceptive methods were retrospectively reviewed for 3 years from the files of women who had chosen reversible or irreversible contraceptive methods. Student's t test and the chi2 test were used to analyze the data obtained from the two groups of women. RESULTS: Out of a total of 8078 women, 595 (7.4%) selected surgical sterilization, while 7483 (92.6%) preferred reversible methods such as intrauterine devices (38.1%), combined oral contraceptives (13.9%), condoms (40%) and Norplant (0.6%). Compared to those who preferred reversible methods, the women with surgical sterilization had a higher mean age (33.9 +/- 4.2 years versus 29.6 +/- 3.9 years), mean gravidity (3.8 +/- 0.9 versus 2.3 +/- 1.2) and mean number of living children (2.6 +/- 0.8 versus 2.1 +/- 1.1) (p < 0.01). These women had also higher rates of high-school education (37.3% versus 30.1%) and previous modern contraceptive use (78.1% versus 71.2%) (p < 0.01). None of the women with surgical sterilization, but 1770 (33.0%) of those who chose reversible methods, had fewer than two living children. CONCLUSIONS: These data suggest that irreversible contraceptive methods tend to be chosen by older women with higher educational levels, who have decided that their family is complete and who have at least two children.

Adult↗
PubMed2004

The resistance to contraceptive use in young Italian women.

OBJECTIVE: To investigate the personal relationship and social factors that influence young women not to use contraceptives. METHODS: A total of 104 young women aged 14-23 years were studied using a 26-item questionnaire which was to be filled out individually. The questionnaire addressed use of contraceptives at the first intercourse and current use, together with various items related to age, educational level, self-image, fantasy about parenthood, and characteristics of the relationships with the partner and the family. A descriptive analysis and a multivariate logistic regression model investigated the relationship between contraceptive non-use and selected variables. RESULTS: Twenty-four percent of the girls did not use any effective contraceptive method at the first sexual intercourse and 21% were current non-users. The study of characteristics associated with inconsistent contraceptive use shows a complex picture where young age, poor knowledge of the partner, an older partner and living in a incomplete family nucleus or outside the family represent significant risk factors. Considering our results as a whole, contraceptive non-use is not only a marker of risk-taking behavior, but sometimes expresses irrational feelings which emerge when facing new sexual experience.

Adolescent↗
PubMed1975

Effect of oral contraceptives and pyridoxine on the metabolism of vitamin B6 and on plasma tryptophan and alpha-amino nitrogen.

The effect of supplementary pyridoxine on the metabolism of vitamin B6 as well as plasma tryptophan and alpha-amino nitrogen was determined in women using oral contraceptive agents. Ten women who were taking oral contraceptive agents and 11 who had never taken them served as subjects. Blood from the various biochemical measurements was drawn from fasting subjects before and after they had received an oral dose of 50 mg of pyridoxine-HCl daily fo 2 days. The use of oral contraceptive agents had no effect on the levels of blood vitamin B6, plasma pyridoxal phosphate, and plasma tryptophan. The activity of erythrocyte glutamic oxaloacetic transaminase was higher (P less than 0.05) in the oral contraceptive agent users than in the nonusers but the stimulation in vitro by pyridoxal phosphate was similar for the two groups. Plasma alpha-amino nitrogen was slightly lower in the oral contraceptive agent users than in the nonusers, but the difference was not statistically significant. The rise in blood vitamin B6 in response to pyridoxine was similar in the two groups, but the rise in plasma pyridoxal phosphate tended to be lower in the oral contraceptive agent treated subjects. Following pyridoxine supplementation, the basal activity of erythrocyte glutamic oxalocetic transaminase increased (P less than 0.01) in both groups of subjects and the stimulation in vitro by pyridoxal phosphate decreased correspondingly. Plasma tryptophan and alpha-amino nitrogen were unaffected by the supplementary pyridoxine.

Adult↗
PubMed2002

Access as a factor in differential contraceptive use between Mayans and ladinos in Guatemala.

Previous studies have demonstrated consistently that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladino counterparts (e.g. 50% versus 13% in the 1998 Demographic and Health Survey - DHS). Most researchers and practitioners have attributed this to social, economic and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 km from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering family planning services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to injectables. Otherwise, the family planning supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8% of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM - which was the nearest facility for only 7% of the respondents in this study - was the source of supply for 48% of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users.

Adolescent↗
PubMed1998

Adolescent contraception.

Adolescent pregnancy rates have declined modestly, most likely because of the increased use of condoms, especially at first intercourse. Condom distribution in schools appears to be effective in promoting condom use without increasing sexual activity. Although, to date, no contraceptive has been as effective as Norplant in reducing teen pregnancy, use of the method has declined dramatically. Depo-Provera use is increasing, but continuation rates are disappointing and the impact on teen pregnancy rates is as yet unknown. Emergency contraception remains underutilized, and interventions to improve oral contraceptive compliance are beginning to be explored. School-based programs that provide contraception without adding a strong educational component fail to improve contraceptive use or reduce pregnancy rates. Use of any contraceptive by teens is cost effective.

Adolescent↗
PubMed1996

Reproductive decision-making and determinants of contraceptive use in HIV-infected women.

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Further study is needed to identify factors that influence reproductive decision-making in HIV-infected women. The determinants of contraceptive use regarding demographic factors, barriers to contraceptive use, and factors that contribute to successful contraceptive use in this population must be understood if efforts to reduce the number of unplanned pregnancies are to be successful. More conclusive data are needed on the safety and efficacy of oral contraceptives in HIV-infected women as well as data that describe the effects of longer acting hormonal contraceptives such as levonorgestrel implants (Norplant; Wyeth-Ayerst, Philadelphia, PA) and injectable medroxyprogesterone acetate (Depo Provera; Upjohn Company, Kalamazoo, MI). More research is needed to determine the effects of patient education and counseling and closer follow-up on effective long-term contraception in HIV-infected women.

Contraception↗
PubMed2001

Oral contraceptives: current status.

During the past four decades, oral contraceptives have remained a safe and effective method of birth control. Reductions in the estrogen and progestin dosages have significantly decreased the incidence of cardiovascular complications. The association between oral contraceptives and breast cancer appears to be primarily because of detection bias or possibly a promotional effect. Despite the changes in formulation, the problems related to side effects have not been totally solved. Because compliance and successful use is strongly affected by side effects, improvement in this area is probably the biggest challenge faced by developers of oral contraceptives. It is also clear that there are a growing number of significant noncontraceptive benefits that accrue in oral contraceptive users. Unfortunately, many women do not know about these benefits. Thus, one of the issues that providers need to continue to address is how to provide better information about oral contraceptives and contraception in general to patients.

Acne Vulgaris↗
PubMed1993

Contraceptive practice before female sterilization.

The reproductive profile and contraceptive practice of 402 women undergoing female sterilization at the Central Women's Hospital are presented. Most (89%) of the interviewees were urban-dwellers and housewives with primary school education. Fifty-two percent were between 30 and 34 years with a mean of 4.2 living children. Sixty-nine percent were past contraceptive users, of them; 29.9% had used more than one method. A considerable gap between knowledge and practice of different methods was found. Education level and employment had a significant effect on contraceptive practice (p < 0.01 and p < 0.5). The majority knew and used combined oral contraceptive pills and injectable progestogens, whereas rhythm, withdrawal and barrier contraception were lesser known methods. Contraceptive use was primarily for child-spacing whereas the main reasons for female sterilization were socioeconomic and achievement of desired family size.

Adult↗
PubMed2005

Jordanian married Muslim women's intentions to use oral contraceptives.

BACKGROUND: High fertility rates and moderate to low contraceptive use in the Arab Islamic countries, and Jordan in particular, are issues of international nursing importance. AIM: By using the Theory of Planned Behaviour (TPB) as the conceptual framework, the relationships between married Jordanian Muslim women's previous contraceptive use, type of experience, and intention to use oral contraceptives (OCs) were examined. The relationship between selected demographic variables and intention to use OCs was also examined. METHODS: The study was part of a large cross-sectional survey. The Intention to Use Oral Contraceptive Tool was used to elicit participants' intentions and beliefs regarding oral contraceptive use. SAMPLE: The study sample was composed of 245 Jordanian married Muslim women. RESULTS: Results revealed a significant relationship between previous oral contraceptive use and intention to use OCs. The relationships between type of experience, whether successful or unsuccessful, with previous OC use, and intention to use OCs were not significant. CONCLUSION: Nursing implications regarding the provision of family planning services that are sensitive to Jordanian Muslim women's religious preferences are discussed.

Adolescent↗
PubMed2000

Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives.

OBJECTIVE: To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 microg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age. DESIGN: A systematic review and meta-analysis of randomised controlled trials. IDENTIFICATION: Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field. MAIN OUTCOME MEASURES: Unplanned pregnancy and continuation of contraceptive method. RESULTS: Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380A intrauterine devices) and those < or = 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices < or = 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. CONCLUSIONS: The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.

Contraception↗
PubMed2005

Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects.

Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women's tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman's ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women's health and improve the acceptability and continuation of hormonal contraceptives.

Contraception Behavior↗
PubMed1970

Depressive symptoms and oral contraceptives.

Of 261 women who completed a self-rating scale for measuring depression, 168 were taking oral contraceptives and 93 were using physical methods of contraception. Of the group of women taking oral contraceptives 6.6% were more severely depressed than any of the control group. There was a significant variation in the depth of depression related to the day of the menstrual cycle in the control group. This association was not found in the oral contraceptive group, where premenstrual depression was limited to the one or two days preceding menstruation.Women taking a contraceptive containing lynoestrenol 2.5 mg. and mestranol 0.075 mg. showed a significantly increased incidence of pessimism, feelings of dissatisfaction, crying, and tension, compared with women taking other oral contraceptives and the control group.

Adolescent↗
PubMed2003

Evra--a patch on oral contraception?

Evra (Janssen-Cilag) is the first contraceptive to be available as a skin patch. In promotional material aimed at healthcare professionals, the company claims that Evra offers a "once-weekly method of contraception" with "more than 99% effectiveness and excellent compliance". The company's website for women using Evra carries the slogan "Evra The Right Contraceptive Choice" and claims that the patch is "just as effective as the contraceptive pill". Each patch is intended to be worn for 7 days, in contrast to combined oral contraceptives (COCs), which need to be taken daily. Here we assess whether Evra offers real advantages over COCs and consider its place as a contraceptive option.

Administration, Cutaneous↗
PubMed1988

Trace elements during 2 years' oral contraception with low-estrogen preparations.

In 17 healthy women, taking either a combination of 0.030 mg of ethinyl estradiol and 0.150 mg of levonorgestrel (n = 9) or a combination of 0.030 mg of ethinyl estradiol and 0.150 mg of desogestrel (n = 8) for oral contraception, the profiles of iron, calcium, copper, and zinc levels were investigated. The blood samplings were performed prior to oral contraception and after 3, 12, and 24 months' contraception, as well as within 2 months after discontinuation of the pill. No changes occurred in iron, calcium, and zinc levels. On the other hand, the copper level was significantly increased during oral contraception, yet returned to the initial level after discontinuation of contraception. No differences occurred between the two preparations for oral contraception.

Calcium↗
PubMed2001

Effects of contraceptive use on bone biochemical markers in young women.

The purpose of this study was to compare biochemical markers of bone resorption and formation in young women using different hormonal contraceptive methods. Women aged 18-39 yr who were using depot medroxyprogesterone acetate (DMPA) contraception were recruited for the study; comparison women were matched by age and clinic location. There were 116 women using DMPA, 39 using oral contraceptives containing estrogen and progestin, and 72 not currently using hormonal contraceptives. Biochemical measurements were serum calcium, PTH and osteocalcin, and urine N-telopeptide. Bone density was measured using dual-energy x-ray absorptiometry. The N-telopeptide levels, adjusted for age and other risk factors, were 42.4 +/- 2.3 nmol/mmol creatinine in the DMPA group, 26.2 +/- 3.3 nmol/mmol in the oral contraceptive group, and 35.4 +/- 2.9 nmol/mmol in the nonusers; significant differences were seen in all pairwise comparisons. Osteocalcin levels showed the same pattern, although the difference between the DMPA users and nonusers was not statistically significant. There were no differences among groups in the PTH levels. The bone density at the spine was 1.086 +/- 0.085 g/cm(2) in the DMPA group, 1.103 +/- 0.095 g/cm(2) in the oral contraceptive group, and 1.093 +/- 0.090 g/cm(2) in nonusers (P = 0.051). The results suggest that in women using DMPA bone resorption exceeded bone formation.

Adult↗
PubMed2003

Appropriate methods for analyzing the effect of method choice on contraceptive discontinuation.

The contraceptive method chosen is an important determinant of contraceptive discontinuation. However, method choice is endogenous to contraceptive discontinuation. Using data from the 1997 Indonesia Demographic and Health Survey, we apply a multilevel multi-process model to examine the impact of method choice on three types of contraceptive discontinuation. We confirm that method choice is endogenous to the processes of contraceptive abandonment and method switching, but not failure. Ignoring the endogeneity of contraceptive choice leads to various biases in the magnitude of estimated effects of method choice on abandonment and method switching, but the general conclusions are robust to these biases.

Adult↗
PubMedDate not supplied

Adolescent clinic visits for contraception: support from mothers, male partners and friends.

CONTEXT: To increase effective contraceptive use among adolescents at high risk of pregnancy, it is important to understand what factors influence them to visit a clinic for contraception, including support from their mothers, male partners and friends. METHODS: Data from a prospective cohort study of 399 teenage clinic attendees using the pill, the implant or condoms were collected through a questionnaire at baseline and at a one-year follow-up interview. Data were analyzed using multivariate regression analysis to show differences in social support for adolescents' clinic visit at baseline and method continuation at one year. RESULTS: Almost all teenagers (96%) reported that their mother, a male partner or a friend was aware of their clinic visit for contraception; of these, 92-96% also said that their mother or a male partner was supportive. Teenagers who chose the pill or implant were more likely than condom users to report that their mother and male partner were aware and that their mother was supportive of their contraceptive clinic visit. Implant users were significantly more likely than those who chose the pill or condom to continue using their chosen method for one year. Teenagers who took part in high-risk behaviors were more likely than others to involve a friend but not their mother or a male partner in their contraceptive decision-making. CONCLUSIONS: Pregnancy prevention programs and counseling protocols that integrate supportive networks for teenagers into contraceptive services may help adolescents to use effective methods.

Adolescent↗
PubMed2006

Using the theory of reasoned action to explain physician intention to prescribe emergency contraception.

CONTEXT: Although research has examined providers' knowledge, attitudes and prescribing behaviors with regard to emergency contraception, none has used a theory-based approach to understanding the interplay of these factors. METHODS: A cross-sectional survey of 96 faculty physicians from one Southern and three Midwestern universities was conducted in 2004 to assess factors associated with intention to prescribe emergency contraception. The theory of reasoned action guided the study hypotheses and survey design. Correlation and regression analyses were used to examine the data. RESULTS: Only 42% of respondents strongly intended to prescribe emergency contraception for teenagers, but 65-77% intended to do so for all other specified groups (women who ask for the method, who have had a method problem, who have experienced rape or incest, and who have had unprotected sex). Consistent with the theory of reasoned action, high intention to prescribe emergency contraception was associated with positive attitudes toward doing so and with the perception that specific colleagues or professional groups support prescribing it; however, the perception of support by colleagues or professional groups in general did not predict intention. Also consistent with the theory, physicians' knowledge about emergency contraception and their demographic characteristics were not significant. CONCLUSIONS: Interventions to encourage physicians to provide emergency contraception should take into account their attitudes toward the method and the components of those attitudes.

Adolescent↗