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PubMed2004

As often as needed: appropriate use of emergency contraceptive pills.

Previous research has established that emergency contraceptive pills are safe and have the potential to reduce unintended pregnancy; however, policy makers, providers and even women themselves have expressed concern about repeat use of the method. Evidence regarding the safety, efficacy and frequency of repeat use show that the method is safe and effective, even when used multiple times. Reported rates of repeat use are actually lower than would be expected, and needed, based on the frequency of unprotected intercourse and contraceptive failure reported in most countries. Healthcare providers should encourage use of emergency contraceptive pills as a backup after recognizable failure of barrier methods or other hormonal contraceptive methods, and should expect that women may need emergency contraceptive pills multiple times during their reproductive years.

Contraceptives, Oral, Combined↗
PubMed1999

Knowledge of likely time of ovulation and contraceptive use in unintended pregnancies.

This investigation analyzed social and demographic characteristics of women having an unwanted or mistimed pregnancy (unintended pregnancies at the current time) in South America. A sample of 5135 women having had a normal non-malformed live-born infant were interviewed immediately postpartum at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations (Spanish acronym: ECLAMC). Half (2568/5135 = 50%) reported that their pregnancies had been unintended, and, of those, 59.3% (1522/2568 = 59.3%) declared that they were trying to avoid conception. The latter group (n = 1522) was the main sample for this study. Patients were asked about their knowledge of when during the menstrual cycle conception is most likely to occur, their biomedical and social characteristics, the type of contraceptive methods used, their opinion of reasons for contraceptive failure, and their reasons for not using contraceptive methods. Among women with unintended pregnancies who attempted to avoid conception, only 61.6% were using contraceptive methods. Reasons given for not using contraceptives included health problems, lack of knowledge and lack of access to contraception. Women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning when during the cycle pregnancy is most likely to occur. Thus, reproductive health policies should be aimed at this target group.

Age Factors↗
PubMedDate not supplied

[Emergency contraception].

INTRODUCTION: The aim of this study was to point to the significance of emergency contraception following unsafe sexual intercourse. This method of contraception has been in use since the middle sixties, although in our country it is not applied very often. Indications for emergency contraception comprise every woman who experiences contraceptive failure or those not using any common contraception for any reason. MATERIAL AND METHODS: Emergency contraceptive devices are most often applied either in combination with estrogen and progesterone or only progesterone in high dosage (0.25 mg levonorgestrel and 50 mg ethinyl-estradiol) during 72 hours after the intercourse and a repeated dose 12 hours later. CONCLUSION: Emergency contraception is recommended as a single procedure. If used several times during a year, the risk of unwanted pregnancy increases. The mechanism of effect of emergency contraception depends on the timing during menstrual cycle; it can prevent ovulation, fertilization or implantation. Emergency contraception does not cause abortion and it is not effective if the process of implantation has started. Unwanted side-effects are not known.

Contraceptives, Postcoital↗
PubMed2001

Peri-abortion contraceptive care: can we reduce the incidence of repeat abortions?

INTRODUCTION: It is of great importance for repeat unwanted pregnancies to be prevented rather than aborted. We therefore sought to: determine the reasons for contraceptive failure in women seeking repeat abortions; audit the peri-abortion contraception services offered at our hospital, and make recommendations regarding peri-abortion contraception services based on the above findings. METHOD: A self-administered questionnaire was used to determine the contraceptive practices and details of peri-abortion contraceptive counselling received by 50 women undergoing a repeat, and 83 women undergoing a first-time, abortion. RESULTS: Ninety-eight percent of women undergoing a repeat abortion reported using contraception at the time of conception, as compared to 83% of women undergoing a first-time abortion. This difference was significant (p = 0.009). Condoms were the main method used by 57% of women undergoing a repeat and 70% of women undergoing a first-time abortion. The oral contraceptive pill (OCP), including both combined oral contraceptive and progestogen-only pill, was the main method used by 37% of women undergoing a repeat and 25% undergoing a first-time abortion. Both these methods were found to be ineffective because of user-dependent failures. All women received peri-abortion contraceptive counselling, but the perceived contents varied. Follow-up contraceptive appointments were made in less than half of women. Although most women chose an optimal contraceptive method as a result of the counselling, compliance with the chosen method in women undergoing repeat abortions was poor. CONCLUSIONS: Standards of audit were met with regards to receipt of contraceptive counselling and agreeing a contraceptive method before discharge. The content of this counselling needs to be improved. The ineffectiveness of the OCP and barrier methods of contraception needs to be highlighted during counselling. Adequate follow-up arrangements need to be provided to ensure compliance of the chosen method of contraception.

Abortion, Habitual↗
PubMed1987

Reversible contraception for women at high risk of fetal anomalies.

Women at risk of pregnancy who are taking potentially teratogenic drugs need to use highly effective contraception. The choice of contraception should reflect the woman's feelings about induced abortion as a backup in case of contraceptive failure. If abortion is acceptable, use of any contraceptive seems reasonable. If abortion is not acceptable, depomedroxyprogesterone acetate, oral contraceptives, and intrauterine devices (each used with a condom) should provide the greatest protection against pregnancy. For most young women, the contraceptive of choice will be a low-dose oral contraceptive.

Abnormalities, Drug-Induced↗
PubMed1998

Emergency postcoital contraception.

Of the estimated 3.5 million unintended pregnancies that occur each year in the United States, some 1.7 million are thought to be the result of contraceptive failure. The extremely high numbers of unintended pregnancies not only in the United States but also worldwide indicates that emergency contraception remains an important but underused method of pregnancy prevention. Emergency postcoital contraception via mechanical or pharmacological means inhibits fertilization and/or implantation from unprotected sexual intercourse. Although emergency contraception has been used primarily in victims of sexual assault, it offers a low-cost, highly effective method to reduce the incidence of unintended pregnancy. Emergency contraception decreases the costs and emotional and physical risks to women who have had unprotected intercourse. Emergency contraception also increases the latitude women have to make reproductive decisions by offering an alternative to abortion and childbearing. The heart of the problem with emergency contraception is not the failure rate or side effects of specific methods but the fact that so few women and adolescents who have had unprotected intercourse know the option exists, and their providers may be reluctant to prescribe the method.

Adolescent↗
PubMed1979

Factors associated with ex-nuptial birth.

The paper examines the background to 210 live exnuptial births studied in the first phase of the Christ-church Child Development Study. The results show: 1. That nearly half of the children had been conceived within cohabiting situations. 2. That nearly one in five ex-nuptial children was the result of a planned pregnancy. 3. Maternal reactions to the birth and pregnancy varied with the mother's situation: cohabiting mothers reported considerably less adverse reaction to the birth than did non-cohabiting mothers. 4. Overall, mothers of ex-nuptial children had a fairly sophisticated appreciation of contraceptive methods. 5. One quarter of unplanned ex-nuptial pregnancies were the result of contraceptive failure and three-quarters were the result of contraceptive non-usage. 6. In common with previous findings for nuptial pregnancies, about 35 percent of unplanned ex-nuptial pregnancies were ascribed to a breakdown in the mother's pattern of usage of the contraceptive pill.

Adolescent↗
PubMed2006

The determinants and circumstances of use of emergency contraceptive pills in France in the context of direct pharmacy access.

BACKGROUND: In France, the 1999 introduction of a dedicated emergency contraceptive pill (ECP) available without a prescription has resulted in a 72% increase in its use over the past 5 years, especially among younger women. METHODS: We used a population-based health survey conducted in 1999 and in 2004 to examine the changes in the determinants of lifetime ECP use among women aged between 15 and 24 years. We also explored the determinants and circumstances of recent use of ECPs in 2004 among women aged between 15 and 44 years who are at risk for unplanned pregnancy. RESULTS: In 1999, 14.6% of women aged between 15 and 24 years had ever used ECPs; this proportion rose to 31.7% in 2004. Results show consistent patterns of lifetime ECP use in 1999 and in 2004, with greater use among higher-educated women and women living in large cities. In 2004, 22% of women were using no contraceptive at the time they used ECPs and 84% resumed use of a regular contraceptive after ECP use. However, 5.5% had unprotected intercourse after taking ECPs in the same menstrual cycle and in the next. CONCLUSION: Despite direct pharmacy access, differences in ECP use remain by social and residential status. Emergency contraceptive pills were used as a backup method in case of contraceptive failure and did not impede the use of subsequent regular contraception.

Adolescent↗
PubMed1978

Factors associated with planned and unplanned nuptial births.

The incidence of unplanned pregnancy in a cohort of 1038 mothers of nuptial children was examined. The major findings were: (1) about one third of the pregnancies were unplanned but there was little evidence that unplanned children were unwanted; (2) there was no evidence to suggest that unplanned birth was related to poor education, low socio-economic status or lack of knowledge of contraception; (3) 40 percent of unplanned births were the result of contraceptive failure; (4) a common denominator in 38 percent of unplanned births was failure or breakdown in the woman's usage of the contraceptive pill.

Contraception↗
PubMed2002

The prevalent use of contraception among teenagers in Denmark and the corresponding low pregnancy rate.

In Denmark the number of births and induced abortions among teenagers has reduced and teenage parenthood is now rare. This paper evaluates the correlation between this observed fertility and reported sexual and contraceptive behaviour. In 1989 a sample of 16-20-year-olds in Denmark was selected at random and personally interviewed about sexual and contraceptive behaviour. Ninety-five per cent of the young women who had experienced sexual intercourse used contraception at the most recent sexual intercourse. In order to support the validity of this finding a model was developed to estimate an expected number of conceptions in the age groups concerned. The model included both the information on coital frequency and use of contraception from the questionnaire and available efficacy rates on contraception. The estimates derived by the model were compared with the registered number of births and induced abortions derived from public registers. The analysis revealed a high accordance between the estimated number of conceptions and the registered number of births and induced abortions for each age group. This underlines the validity of the data on sexual and contraceptive behaviour sampled among teenagers in Denmark. The findings indicate that contraceptive failure is a much greater problem than non-use of contraception for teenagers in Denmark.

Abortion, Induced↗
PubMedDate not supplied

Determinants of contraceptive choice among single women in the United States.

Data from the 1983 National Survey of Unmarried Women are used to analyze characteristics that affect contraceptive decision-making among single women aged 20-29 who are exposed to the risk of pregnancy. Factors found to affect whether these women use a relatively effective method such as the pill or the IUD, use coitus-dependent methods or use no method include family structure at age 15, educational level, work status, religious affiliation, fertility relative to desired fertility, and past contraceptive failure. Bivariate analyses revealed notable differences between whites and blacks in contraceptive behavior. Multivariate analyses showed that while the decision to use a contraceptive method was somewhat affected by race, method choice was not. Overall, contraceptive decision-making was relatively unaffected by race, length of the relationship and current living arrangement.

Adult↗
PubMed2003

[Epidemiology of ectopic pregnancy: incidence, risk factors and outcomes].

Two entities must be differentiated in ectopic pregnancy (EP) epidemiology: EP occurring in women without contraception (reproductive failure) and with contraception (contraceptive failure). These two entities differ on almost all issues. After a great increase between 1970 and 1990, incidence of EP has decreased over the next 10 years. At the present time, the incidence of EP with contraception goes on decreasing while the incidence of EP without contraception is increasing. Three quarters of EP are ampullary, and 4.5% are extra-tubal. The two main risk factors for EP without contraception are a history of infection or tubal surgery and smoking. Quantitatively, their relationships with EP risk are similar. The other risk factors are age, prior spontaneous abortion, prior induced abortion, previous use of an intra-uterine device, and history of infertility. The total attributable risk of all these factor is 76%. Maternal mortality following EP is quite uncommon in developed countries. Immediate morbidity is not sufficiently documented, however long-term psychological consequences may be important.

Adult↗
PubMed1997

Study of the pharmacokinetic interaction between ethinylestradiol and amoxicillin in rabbits.

Several antibiotics have been implicated in oral contraception failure when they are administered at the same time as the oral contraceptive (OC) pill. In the present paper, a study about amoxicillin-ethinylestradiol (EE2) pharmacokinetic potential interaction was studied. Two rabbit groups were utilized, the first group received amoxicillin (10 mg/kg) and EE2 (30, 50 and 100 micrograms/kg, respectively), both by intravenous (i.v.) route. The second group received amoxicillin (oral route, 10 mg/kg/day) and EE2 (i.v. route, 100 mu/kg) on day 1, 4 and 8 of antibiotic treatment, respectively. After compartmental (two-compartment open model) and non-compartmental analysis of plasma concentrations, the statistical study (ANOVA p < or = 0.05) revealed that the presence of amoxicillin did not modify the EE2 distribution and elimination pharmacokinetic parameters (by comparison with those obtained in a previous study where EE2 was administered alone). There also were no significant differences with the time of amoxicillin oral treatment.

Administration, Oral↗
PubMed2005

Delivery options for contraceptives.

Although a steady increase in contraceptive use has been observed in developed and less-developed countries, the contraceptive needs of a significant proportion of couples have not yet been met, resulting in an increase in unplanned pregnancies. Several new contraceptive products have reached the market during the past few years. Among these are new implants, a medicated intrauterine device, contraceptive vaginal rings, transdermal patches and several new regimen of combined oral contraceptives. These new or improved methods have been developed to expand the contraceptive choices available to women and men as well as to respond to the unmet need for contraceptives with long-term activity. New targets are being identified both in the ovary and the testes for a more specific non-hormonal contraception. This futuristic approach still keeps in mind the need for better access to existing contraceptive methods, as well as the discovery of new contraceptives that are simple to use, safe, reversible and inexpensive. In recent years, there has been great interest in agents that provide dual protection against pregnancy and sexually transmitted infections (STI), especially human immunodeficiency virus (HIV). A contraceptive method providing dual medical benefits might increase motivation for consistent use, thus reducing contraceptive failures and unwanted pregnancies.

Contraception↗
PubMed1991

[Duration of desire for a child, contraceptive behavior and rate of previous infertility treatment. An epidemiologic study of 750 consecutive patients in labor at the Oldenburg Gynecologic Clinic using a structured interview].

In order to gain current information, on how long a healthy couple desiring a child has to wait until conception, on previous contraceptive behaviour and prior infertility treatment, 750 women were interviewed within 7 days after delivery between January and November, 1989, using a standardised questionnaire. This sample represents one third of all patients, who delivered a child in an Oldenburg hospital during the time period covered. 544 women had desired a pregnancy, an additional 206 women had not directly planned a pregnancy, and 73 of these had taken no precautions against conception, since they were willing to accept a pregnancy if it should occur. 133 women called their pregnancy an "accident", which in 87 couples occurred despite some kind of contraceptive procedure. The absolute number of contraceptive failures was highest for timed intercourse (n = 38) and users of oral contraceptives (n = 32). Couples without a history of infertility treatment had to wait for an average period of 3.4 months before a conception occurred (95% confidence limits: 3.1-3.8 months). The mean age of the women in this group was 28.1 +/- 0.2 years, whereas on an average their male partners were 30.9 +/- 0.2 years of age. The likelihood to achieve pregnancy within the first 4 months of trying, varied between 13 and 15% per month. After 6 months of waiting, the pregnancy rate per cycle was reduced to 6%, whereas, after one year, the likelihood for conception was only 1%. Half of all couples desiring a pregnancy achieved this within 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗