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Sterilization. Determining a good candidate.

After 4 years, 10% of the 1800 low-income women in a 5-year study felt some regrets after the procedure. Although each individual is different, if a woman has 1 or more of the following characteristics, she may not be a good candidate for sterilization: under age 30; has few or no children; not involved in a stable relationship; made the decision to be sterilized alone and with minimal reflection; recently experienced a personal life crisis; feels sterilization will solve a sexual problem; expectations about sterilization are unrealistic; pressured by others to be sterilized. Although women who have had the procedure sometimes experience regret, other women regret not having been sterilized. Approximately 40% of the women who decided for sterilization but had their intentions blocked expressed regret at the short-term follow-up, and one-third reported regret at the second interview 4 years later. Also, women who chose not to be sterilized and then experienced a subsequent pregnancy were 7 times more likely to express regret than women who went through with the procedure. To counsel a woman who wants no more children but does not want sterilization, ask her how she would feel if she became pregnant again, and try to determine how badly she does not want to be pregnant, says Libby Antarsh, PhD, director of US programs for the Association of Voluntary Surgical Contraception in New York City. Also, make sure she has accurate information about other methods of birth control, she says.

Ambulatory Care Facilities↗

Do insertion-related problems affect subsequent IUD performance?

This investigation compares the IUD performance of 372 women who had an insertion-related problem (most with moderate or severe pain) and 372 matched women who had no such problem; all women had interval insertion. A woman in the Problem Cohort and her matched counterpart in the Comparison Cohort were inserted with the same IUD type by the same insertor on the same day or on close dates. The six IUD types used by these women were Lippes Loop D, Copper-7, Copper T-200, Copper T-380 Ag, Multiload Copper 250 and Multiload Copper 375. Cumulative gross life-table rates of the pertinent events (accidental pregnancy, expulsion and medical removal for bleeding and pain), adjusted for age and parity, were calculated. Between the Problem Cohort and the Comparison Cohort, no differences were detected in the event rates that were of either statistical or practical significance. Results from this preliminary study suggest that the insertion-related problems usually encountered during interval insertion such as insertion pain, syncope and/or mild cervical laceration are not associated with an increased risk of IUD discontinuation due to pertinent events.

Adult↗

Conceptions and misconceptions. Decisions about pregnancy.

Induced abortion has been practiced in every known society and in every era of history. Psychological concomitants of abortion are as much a product of the social and interpersonal context as of the process itself. Though abortion results in the loss of a potential human life, it is not associated with significant psychiatric morbidity, and, in fact, represents for many women--and men--a significant milestone in which they assume responsibility for the direction of their lives for the first time. However, assertions that abortion is psychologically damaging have characterized much of the recent bitter debate over the legality and availability of abortion. It is important that mental health professionals are knowledgeable about the subject of abortion so that they can discuss policy with their patients.

Abortion, Induced↗

Provision of emergency contraceptive pills to spermicide users in ghana.

This study evaluated the effect of two approaches to provision of emergency contraceptive pills (ECPs) on ECP use and unprotected intercourse among women relying on spermicides for contraception. The study enrolled 211 women at 4 family planning clinics in Ghana. At two clinics, participants were advised to return to the clinic within 3 days after unprotected intercourse to obtain ECPs. At the other two clinics, participants were given ECPs to take home for use if unprotected intercourse occurred. All participants were asked to maintain daily diaries for 8 weeks to record information on sexual activity, spermicide use, and ECP use. Women at all clinics used ECPs after at least 78% of unprotected coital acts. ECPs were used more promptly by women who had the pills at home. At three of the clinics, at most 1.3% of the coital acts were unprotected; at the fourth, 6.7% were unprotected. Our data did not suggest that the availability of ECPs increased the frequency of unprotected intercourse.

Adolescent↗