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PubMed1977

Conception, contraception and misconception.

Because of Dr. G. A. Overbeek's interest and contributions in the field of oral contraception a survey is given of present leads and developments in this area. It is concluded that contraceptive preparations known under names such as: once-a-month pill, morning-after pill and post-coitum pill, although desired, do not really exist at the moment. It is further expected that oral contraception based on the inhibition of ovulation will stay with us for many years to come. Better preparations, not exclusively containing oestrogen progestagen combinations but possibly including a non-hormonal pituitary inhibitor as well, might be developed. This will allow better control over the endometrium, and the unwanted effects of the presently used hormonal substances. It is likely that an implantation-inhibiting compound or an abortifacient which acts shortly after implantation will be found. With respect to oral contraception for males it is concluded that, although inhibition of spermatogenesis with drugs is possible, a satisfactory contraceptive treatment for men is not yet available.

Animals↗
PubMedDate not supplied

The role of sexual self-concept in the use of contraceptives.

Sexual self-concept--defined as an individual's evaluation of his or her own sexual feelings and actions--is proposed as an important predictor of contraceptive behavior among teenagers, and a scale measuring the concept is described. In exploratory analyses among university students, sexual self-concept is found to be associated with frequency of contraceptive use and use at most recent intercourse. It is also associated with their choice of contraceptive--students who had used prescription methods at last coitus had significantly higher scores on the sexual self-concept scale than did those who had used nonprescription methods or no method. These findings, together with the finding from analysis among high school students that sexual self-concept appears to improve with age, suggest that younger teenagers may be poorer users of contraceptives because of a lower sexual self-concept. Counseling and sex education that address social and psychological issues may help improve adolescent contraceptive practice by addressing teenagers' views of their own sexuality.

Adolescent↗
PubMedDate not supplied

Do contraceptive prices affect demand?

Government-sponsored family planning services in developing countries have traditionally provided free contraceptives to couples who choose to contracept. The advisability of and need for such extensive subsidization is brought into question in this article, based on studies that have compared free and fee-for-service family planning programs. Little difference in demand exists between free and moderately priced services. The importance of price in determining family planning demand is also explored through studies of demand shifts in response to changes in contraceptive prices. Contraceptive price increases in established programs have generally had a minimal effect on utilization. Price reductions in established programs, however, have led to increases in contraceptive demand. These findings suggest that moderate fees can be imposed for family planning services without affecting demand; however, full cost recovery may pose a deterrent to low- and moderate-income couples.

Contraception↗
PubMedDate not supplied

Contraceptive use in Canada, 1984.

Canada's first national fertility survey, carried out by telephone in 1984, found that 68 percent of all women aged 18-49-73 percent of currently married women, 69 percent of the previously married women and 57 percent of single women--are practicing contraception. Overall, the most widely used method of birth control in Canada is sterilization (male and female), which is relied on by almost 60 percent of all married users and 66 percent of previously married users. Among single women, the preferred method is the pill, chosen by seven out of 10 of such users. Among all women, the major determinant of method choice is age: The pill is overwhelmingly chosen by women under 25, and sterilization, by those 30 and over. While the IUD and the condom are used by roughly 10-14 percent of women in their 20s who practice contraception, these methods decline in importance with increasing age. Highly educated women are less likely than those with little education to elect sterilization, and more likely to rely on barrier methods. Differences in contraceptive prevalence and patterns of use between Catholics and Protestants have all but disappeared in Canada, but church attendance and country of birth appear to exert a modest influence on method choice. As might be anticipated, women whose family size is complete have considerably higher levels of contraceptive use than those who expect to have more children. The survey reveals no difference in contraceptive use between Quebec women and those in the rest of Canada, thus confirming both the accuracy of earlier Quebec studies showing extremely high levels of sterilization and the applicability of these findings to all other Canadian women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

How the number of living sons influences contraceptive use in Menoufia Governorate, Egypt.

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.

Adolescent↗
PubMed1972

A study of contraception as related to unwanted pregnancy.

A study was made of 150 women requesting therapeutic abortion. Mechanical failure of the contraceptive method used accounted for unwanted pregnancy in 89 (59%) women. In the remainder no method of contraception was used by either partner. Among women requesting abortion, failure to use contraceptives was commoner in the younger and unmarried than in older and married women.The data obtained were analyzed in an attempt to explain the failure and avoidance of contraception. Suggestions are made as to how to discourage the use of abortion as a method of contraception.

Abortion, Legal↗
PubMed1981

The relation between oral contraceptive use and subsequent development of hyperprolactinemia.

Serum prolactin levels were determined in 123 patients who presented with menstrual irregularities and/or infertility of more than 1 year's duration. Sixty-three patients had hyperprolactinemia with serum prolactin levels of 26 to 843 ng/ml (normal 5 to 22 ng/ml); 44.4% of this group of patients received oral contraceptive for a period of 2 months to 7 years. Sixty patients were normoprolactinemic, with serum prolactin levels of 3 to 22 ng/ml; 33.4% of this group received oral contraceptives for a period of 6 months to 7 years. The age of presentation, onset of symptoms, age at which they started on oral contraceptives, and duration of use were tabulated. The data were analyzed using chi 2 test corrected for continuity. There was no significant difference in age at the time of evaluation between oral contraceptive users and nonusers with hyperprolactinemia. The relative odds developing hyperprolactinemia were 2.64 times greater among women who has used oral contraceptives for more than 1 year and 6.25 times greater if this use started before the age of 25.

Adolescent↗
PubMedDate not supplied

The causes of unmet need for contraception and the social content of services.

Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. This study analyzes survey data and related anthropological studies on the causes of unmet need and concludes that the conventional explanation is inadequate. Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.

Contraception Behavior↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1993

Oral contraceptives for the prevention of osteoporosis.

Oral contraceptives are a safe and acceptable form of contraception in perimenopausal women and may be effective in maintaining bone mass prior to menopause. Studies of the bone-sparing properties of oral contraceptives are difficult to interpret because of confounding variables, such as age, smoking, duration of use, exercise, menstrual function and endocrine diseases. Nevertheless, the results of many studies suggest that premenopausal use of oral contraceptives is associated with higher bone density than is nonuse. Long-term premenopausal oral contraceptive use allows women to enter menopause with bone density that is 2-3% higher than in nonusers. The optimal duration of use and dosage of estrogen and the clinical importance of this effect remain to be determined.

Adolescent↗
PubMed1993

Risks of oral contraceptive use in women over 35.

Oral contraceptives are a reliable and convenient method of birth control. Nevertheless, physicians are reluctant to use them in women over 35 because of concerns about increased risks of cardiovascular disease, stroke and cancer despite evidence to the contrary. Well-designed studies have shown that the incidence of thromboembolic disease is related to the estrogen dose and that the risk of thromboembolism is highest in women who smoke. With current oral contraceptive formulations, there is no increased risk of cardiovascular disease or stroke in women without other risk factors. Oral contraceptives have been shown to protect against endometrial and ovarian cancer. The risk of breast cancer appears to be increased only minimally among current oral contraceptive users. Thus, oral contraceptives offer a safe and effective means of birth control in women over 35, especially in the absence of other risk factors.

Adult↗
PubMed1997

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

Africa↗
PubMed1998

Factors determining the choice of contraceptive methods at the Family Planning Clinic, University College Hospital, Ibadan, Nigeria.

In a study of 2000 women volunteers seeking contraceptive services at the Family Planning Clinic (FPC), University College Hospital, Ibadan, Nigeria, 66.2 per cent chose the intrauterine device (IUD) making it the most common method of contraception. Factors influencing choice of contraceptive methods were advice from friends and family members, intended duration of use and information from the media. Ignorance, fear and unfounded cultural beliefs were factors responsible for the delay in seeking contraceptive advice. The mass media was an important source of information for most of the women. We conclude that the IUD is the contraceptive of choice in our clinic because of the highly selective nature of our clients. In order to provide a service with a broader clientele, we suggest the incorporation of other priority reproductive health services such as cervical and breast cancer screening, prevention and treatment of reproductive tract infections and sexually transmitted diseases including HIV/AIDS.

Adolescent↗
PubMed1982

The influence of oral contraceptives on the composition of bile.

The increased risk of cholelithiasis during intake of oral contraceptives may be due to estrogen-induced saturation of the bile with cholesterol. In a randomized, prospective, crossed-over double-blind study 20 healthy women after roentgenological exclusion of gall-stones received either 1.0 mg of norethindrone acetate and 50 microgram ethinyl estradiol daily - as usual in oral contraception - for 21 days with 7 days of placebo treatment in each cycle or one fifth of this hormone dose in form of a continuous daily medication. After a 4 month's treatment the medication form was crossed-over. At the beginning of the study, before the cross-over and after the study bile was collected by duodenal intubation after a 12-h fast and the lithogenic index as a measure for cholesterol saturation of the bile was determined. No correlation between the dose and the lithogenic index was demonstrated, neither in 15 women, who had used oral contraceptives before the study nor in five women without any previous hormonal contraceptives.

Adult↗
PubMed1988

Risks and mechanisms of cardiovascular events in users of oral contraceptives.

Three large British studies on the vascular effects of oral contraceptives have established that the risk of thromboembolic episodes, both venous and arterial, rises with increasing estrogen dose. Two of these studies have also demonstrated a dose-dependent relationship between the progestogenic component of oral contraceptives and the risk of arterial disease, though not of venous events. In men, high levels of factor VII coagulant activity, VIIC, and plasma fibrinogen are associated with an increased risk for ischemic heart disease. In view of the dose-dependent relationship between estrogen and these two clotting factors, especially VIIC, it is likely that the effects of oral contraceptive usage on the risk for thromboembolism are mediated substantially through the level of coagulability. The relationship between the progestogenic component of oral contraceptives and the risk for arterial disease is probably related, at least in part, to the effects of progestogens on blood pressure.

Antigens↗
PubMed1986

Effect of oral contraceptive on liver function tests of women with schistosomiasis in the Philippines.

A prospective study was undertaken to determine the effect on liver function tests of a combined oral contraceptive containing norethisterone 1 mg and mestranol 0.05 mg, in women with schistosomiasis japonica in Leyte, Philippines. Women who volunteered and met the standard criteria for oral contraception, with and without infection, were followed for six months of pill intake. Concurrently, non-pill users, both infected and uninfected, were similarly followed. Baseline and six-month liver function tests were compared. Of the 466 subjects admitted in the study, 383 completed six months, and 83 discontinued. At the start of the study, there were no significant differences among the four groups in liver function tests except that the infected women had a higher total protein and alkaline phosphatase, and lower alanine aminotransferase levels. After six months, the only statistically significant finding was a lesser decrease in total protein among the infected pill users compared to the uninfected pill users. This finding was not clinically significant since there was no associated clinical complications; there were fewer number of subjects with abnormal values at the sixth month; and the mean values of this variable remained within normal limits. Our findings show that the use of low dose progestin and estrogen oral contraceptive in the presence of mild schistosomiasis japonica infection does not appear to have adverse effect on liver function tests of young women after six months of contraceptive use.

Adolescent↗
PubMed1989

The effects of a progestin-only oral contraceptive (levonorgestrel 0.03 mg) on breast-feeding.

This study was a non-randomized clinical trial which compared the breast-feeding experience of 250 Argentine women taking levonorgestrel 0.03 mg daily (begun one week after delivery) with that of 250 women using non-hormonal contraceptives. Weight gain of unsupplemented infants, the most important of the several criteria used to assess breast-feeding performance, was similar for the two contraceptive groups. Levonorgestrel users began supplementary feeding of their infants significantly later than did non-hormonal users; levonorgestrel users were also somewhat less likely to discontinue breast-feeding during the study period. The two contraceptive groups were similar with regard to several other measures of breast-feeding performance: growth of all infants (regardless of supplementation), patterns of contraceptive discontinuation, mothers' subjective impressions of breast-milk sufficiency, and comparison of supplementation initiation with previous experience.

Adult↗
PubMed1992

A multicenter efficacy and safety study of an oral contraceptive containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol.

The study reported herein is the primary efficacy and safety study conducted to support U.S. registration of an oral contraceptive containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol. A large multicenter study enrolled 1,221 women at 50 centers in the United Kingdom. A total of 11,656 cycles of exposure was accumulated, corresponding to approximately 879 women-years of use. Contraceptive efficacy was high; no subject conceived as a result of method failure. The product was generally well tolerated with excellent cycle control, causing fewer than 2% of the subjects to discontinue because of bleeding irregularities. The study medication demonstrated no adverse effects on cervical cytology, blood pressure, body weight or laboratory variables, while pre-existing benign breast disease generally improved. The study did not identify any medication-related adverse experiences. This study confirmed that the monophasic oral contraceptive with 150 micrograms desogestrel and 30 micrograms ethinylestradiol is a safe and effective oral contraceptive with excellent cycle control and patient acceptability.

Adolescent↗