Comparison of physical, public and human assets as determinants of socioeconomic inequalities in contraceptive use in Colombia - moving beyond the household wealth index

PubMed Central

2010-01-01

Background Colombia is a lower-middle income country that faces the challenge of addressing health inequalities. This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested the hypothesis that provision of Public capital compensated for low levels of Human capital. Methods This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables), Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to estimate relative indices of inequality (RII) for each measure of SEP with both outcomes. Results Socio-economic inequalities among rural women tended to be larger than those among urban women, for all measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age, Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = < 0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in household wealth but not at all by health insurance cover. Conclusions A multidimensional approach provides a framework for disentangling socioeconomic inequalities in contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital with respect to modern contraceptive behaviour. PMID:20380713

An Analysis of Adolescent Content in South Africa's Contraception Policy Using a Human Rights Framework.

PubMed

Hoopes, Andrea J; Chandra-Mouli, Venkatraman; Steyn, Petrus; Shilubane, Tlangelani; Pleaner, Melanie

2015-12-01

To evaluate whether the updated South African national contraception policy and guidelines adequately address the needs of adolescents. We used the World Health Organization (WHO) guidance and recommendations on ensuring human rights in the provision of contraceptive information and services as an analytic framework. We assessed the South African policy in relation to each WHO summary recommendation. Specifically, we determined where normative guidance pertaining to adolescents is present and whether it is adequate, normative guidance pertaining to all populations but not specifically adolescents is present, or normative guidance for that recommendation is missing from the policy. We developed an analytic table to discuss with coauthors and draw conclusions. We found specific guidance for adolescents relating to 6/9 WHO summary recommendations and 11/24 subrecommendations. Adolescents are highlighted throughout the policy as being at risk for discrimination or coercion, and laws protecting the rights of adolescents are cited. Confidentiality of services for young people is emphasized, and youth-friendly services are described as a key element of service delivery. Areas to strengthen include the need for normative guidance ensuring both availability of contraceptive information and services for young people and adolescent participation in development of community programs and services. South Africa's contraception policy and guidelines are comprehensive and forward looking. Nevertheless, there are gaps that may leave adolescents vulnerable to discrimination and coercion and create barriers to accessing contraceptive services. These findings provide insight for the revision and development of adolescent health policies in South Africa and other settings. Copyright © 2015. Published by Elsevier Inc.

78 FR 70309 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-25

... Health and Human Development Special Emphasis Panel; T32 Institutional Training Grant Award. Date... Rehabilitation Research; 93.209, Contraception and Infertility Loan Repayment Program, National Institutes of...

Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review.

PubMed

2015-04-01

Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

77 FR 58855 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

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2012-09-24

... Institute of Child Health and Human Development Special Emphasis Panel; Male Germline. Date: October 17..., Center for Medical Rehabilitation Research; 93.209, Contraception and Infertility Loan Repayment Program...

The strategic approach to contraceptive introduction.

PubMed

Simmons, R; Hall, P; Díaz, J; Díaz, M; Fajans, P; Satia, J

1997-06-01

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Antisperm contraceptive vaccines: where we are and where we are going?

PubMed

Naz, Rajesh K

2011-07-01

This is a review of current status and future perspectives on the development of antisperm contraceptive vaccines (CV) and immunocontraceptives. The development of antisperm CV is an exciting proposition. There is a strong rationale and recent data indicating that this proposition can translate into reality. The search for novel sperm-specific antigens/genes, that can be used for CV, continues using various recent developing technologies. Various approaches of proteomics, genomics, reproductive biology, mucosal immunity and vaccinology and several novel technologies such as gene knockout technology, phage display technology, antibody engineering, differential display technique, subtractive hybridization, and hybridoma technology are being used to delineate sperm-specific antigens and construct CV. Various sperm antigens/genes have been delineated, cloned, and sequenced from various laboratories. Vaccination with these sperm antigens (recombinant/synthetic peptide/DNA) causes a reversible contraceptive effect in females and males of various animal species, by inducing a systemic and local antisperm antibody response. The efficacy is enhanced by combination vaccination, including peptides based on various sperm antigens. Several human novel scFv antibodies with unique complementarity-determining regions (CDRs), that react with specific well-defined fertility-related sperm antigens, have been synthesized. These human infertility-related antibodies may find application in the development of novel immunocontraceptives. Besides finding the novel sperm antigens, the present and future focus is on enhancing the immunogenicity, bioefficacy, and on obliterating the inter-individual variability of the immune response, and proceeding for primate and human clinical trials. Multi-epitope vaccines combining sperm proteins involved in various steps of fertilization cascade have been found to enhance the immunogenicity and bioefficacy of the contraceptive effect. The in vitro synthesis of infertility-related human scFv antibodies may provide unique once-a-month immunocontraceptives, the first of its kind, for human use. The multi-epitope CV and preformed engineered human antibodies of defined specificity may obliterate the concern related to inter-individual variability of the immune response. © 2011 John Wiley & Sons A/S.

77 FR 52337 - Eunice Kennedy Shriver National Institute of Child Health & Human Development Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

... Institute of Child Health and Human Development Special Emphasis Panel; Contraceptive Clinical Trials Network (Male Studies) September. Date: September 27, 2012. Time: 2 p.m. to 4 p.m. Agenda: To review and...

Male contraceptive technology for nonhuman male mammals.

PubMed

Bowen, R A

2008-04-01

Contraceptive techniques applied to males have potential to mitigate diverse instances of overpopulation in human and animal populations. Different situations involving different species dictate that there is no ideal male contraceptive, and emphasizes the value of varying approaches to reducing male fertility. A majority of work in this field has focused on non-surgically destroying the testes or obstructing the epididymis, and suppressing gonadotropin secretion or inducing immune responses to reproductive hormones or sperm-specific antigens. Injection of tissue-destructive agents into the testes or epididymides can be very effective, but often is associated with unacceptable inflammatory responses and sometimes pain. Hormonal vaccines are often not efficacious and provide only short-term contraception, although GnRH vaccines may be an exception to this generality. Finally, there are no clearly effective contraceptive vaccines based on sperm antigens. Although several techniques have been developed to the point of commercialization, none has yet been widely deployed other than surgical castration.

Managing wildlife with contraception: why is it taking so long?

PubMed

Rutberg, Allen T

2013-12-01

Biologists have been testing wildlife contraceptives in the field for nearly a half century. Although effective new contraceptive agents have been identified, new delivery technologies developed, and some success with population management demonstrated, progress in this area should be further along. Why is it taking so long? First, the task is complex. Most drugs and vaccines fail in development. The technical leaps from in vitro to in vivo, from controlled studies to field studies, from effectiveness in individuals to management of populations, are all formidable and frequent failures are inevitable. Testing the long-acting contraceptives required for successful population management demands experiments that take 3-5 yr to complete. Development of wildlife contraceptives has been further hampered by the lack of large-scale investment and the complex and shifting regulatory landscape that often greets novel enterprises. But there has also been focused resistance to the implementation of wildlife contraceptive studies and to the dissemination of results such studies have produced. This phenomenon, which sociologists label "socially constructed ignorance," has taken a variety of forms including denial of research permits, omission from research reports and management documents, and repetition of misleading or false information in public forums and the media. The persistence and effectiveness of this social resistance suggest that the ethical foundation of wildlife contraception is incomplete. As the institutional affiliations of participants of the 7th International Conference on Fertility Control for Wildlife confirmed, wildlife contraception has its ethical roots in the animal welfare and integrated pest-management communities. Absent from the discussion are the conservation community and the values they represent. To secure societal acceptance of wildlife contraception as a management technique, researchers and advocates for wildlife contraception must address conservation issues and build an ethical foundation that balances concern for individual animals and human needs with concern for the health of biologic communities.

Development of male contraceptive vaccine--a perspective.

PubMed

Moudgal, N R; Jeyakumar, M; Krishnamurthy, H N; Sridhar, S; Krishnamurthy, H; Martin, F

1997-01-01

This paper reviews the recent advances that have occurred in the area of development of a male contraceptive vaccine. The vaccine candidates considered for review are hormone/hormone receptor-based proteins including luteinizing hormone-releasing hormone (LHRH)/LH, follicle stimulating hormone (FSH), as well as LH and FSH receptor proteins. The review also highlights the advances in our basic understanding of gonadotrophin action which have led to development of these vaccines. Focus is mainly on studies in the non-human primate which may be directly relevant to projected studies in the human. The data indicate that the vaccines are well tolerated by the primate (including the human based on limited data) and do not give rise to any known toxic symptoms or immediate health hazards. The response to the immunogen has been uniform and it may be possible to increase antibody titres as well as prolong the immune response by adding acceptable immune stimulators to the adjuvant cocktail and developing better immunization schedules or immunogen delivery systems. Contraceptive vaccines for the male are a feasible proposition and attention should now be focussed on evaluating carefully the bioefficacy of antibodies raised to recombinant ovine FSHbeta or FSH receptor protein fragments in both human and non-human primates. The advantage of the FSH/FSH receptor over the LHRH/LH-based vaccine lies in the fact that the former does not require an exogenous testosterone supplement to maintain accessory gland function, libido etc. The LHRH/LH-based vaccine results in azoospermia, while the FSH vaccine causes the production of low numbers of poor quality spermatozoa which are incapable of impregnating cycling females.

A novel methodology for strengthening human rights based monitoring in public health: Family planning indicators as an illustrative example.

PubMed

Gruskin, Sofia; Ferguson, Laura; Kumar, Shubha; Nicholson, Alexandra; Ali, Moazzam; Khosla, Rajat

2017-01-01

The last few years have seen a rise in the number of global and national initiatives that seek to incorporate human rights into public health practice. Nonetheless, a lack of clarity persists regarding the most appropriate indicators to monitor rights concerns in these efforts. The objective of this work was to develop a systematic methodology for use in determining the extent to which indicators commonly used in public health capture human rights concerns, using contraceptive services and programmes as a case study. The approach used to identify, evaluate, select and review indicators for their human rights sensitivity built on processes undertaken in previous work led by the World Health Organization (WHO). With advice from an expert advisory group, an analytic framework was developed to identify and evaluate quantitative, qualitative, and policy indicators in relation to contraception for their sensitivity to human rights. To test the framework's validity, indicators were reviewed to determine their feasibility to provide human rights analysis with attention to specific rights principles and standards. This exercise resulted in the identification of indicators that could be used to monitor human rights concerns as well as key gaps where additional indicators are required. While indicators generally used to monitor contraception programmes have some degree of sensitivity to human rights, breadth and depth are lacking. The proposed methodology can be useful to practitioners, researchers, and policy makers working in any area of health who are interested in monitoring and evaluating attention to human rights in commonly used health indicators.

A novel methodology for strengthening human rights based monitoring in public health: Family planning indicators as an illustrative example

PubMed Central

Ali, Moazzam; Khosla, Rajat

2017-01-01

Objective The last few years have seen a rise in the number of global and national initiatives that seek to incorporate human rights into public health practice. Nonetheless, a lack of clarity persists regarding the most appropriate indicators to monitor rights concerns in these efforts. The objective of this work was to develop a systematic methodology for use in determining the extent to which indicators commonly used in public health capture human rights concerns, using contraceptive services and programmes as a case study. Methods The approach used to identify, evaluate, select and review indicators for their human rights sensitivity built on processes undertaken in previous work led by the World Health Organization (WHO). With advice from an expert advisory group, an analytic framework was developed to identify and evaluate quantitative, qualitative, and policy indicators in relation to contraception for their sensitivity to human rights. To test the framework’s validity, indicators were reviewed to determine their feasibility to provide human rights analysis with attention to specific rights principles and standards. Findings This exercise resulted in the identification of indicators that could be used to monitor human rights concerns as well as key gaps where additional indicators are required. While indicators generally used to monitor contraception programmes have some degree of sensitivity to human rights, breadth and depth are lacking. Conclusion The proposed methodology can be useful to practitioners, researchers, and policy makers working in any area of health who are interested in monitoring and evaluating attention to human rights in commonly used health indicators. PMID:29220365

Name that Contraceptive! A Game for the Human Sexuality Classroom

ERIC Educational Resources Information Center

Rosenthal, Martha S.

2010-01-01

There are many contraceptive choices available to people today. Learning about them can be dry, but the game "Name that Contraceptive!" can be a fun and interactive way to review, remember, and retain the details about contraceptive options. Name that Contraceptive is a card game in which students "bid" on the number of clues it will take them to…

Opinions on population.

PubMed

1994-01-01

Great friction currently exists between family planning advocates and institutions opposed to contraception or abortion on religious grounds as the time draws near to convene the 1994 UN International Conference on Population and Development. A rift is also open between those who understand rapid population growth as a symptom of deep social inequities and those who see it only as a disease unto itself. The Human Development Report 1994 notes that human development like women's education is often the most powerful contraceptive, while the Vatican complains that the conference is about cultural imperialism. Planned Parenthood, however, counters that the Vatican has its head in the sand with regard to modern life and lifestyles. Other short comments are listed by the Executive Coordinator of the conference, the founder of Scientific American, and the Schiller Institute.

21 CFR 884.5350 - Contraceptive diaphragm and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Contraceptive diaphragm and accessories. 884.5350 Section 884.5350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Devices § 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm...

21 CFR 884.5350 - Contraceptive diaphragm and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Contraceptive diaphragm and accessories. 884.5350 Section 884.5350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Devices § 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm...

21 CFR 884.5350 - Contraceptive diaphragm and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Contraceptive diaphragm and accessories. 884.5350 Section 884.5350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Devices § 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm...

21 CFR 884.5350 - Contraceptive diaphragm and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Contraceptive diaphragm and accessories. 884.5350 Section 884.5350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Devices § 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm...

21 CFR 884.5350 - Contraceptive diaphragm and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Contraceptive diaphragm and accessories. 884.5350 Section 884.5350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Devices § 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm...

42 CFR 68c.14 - When can a CIR-LRP payment obligation be discharged in bankruptcy?

Code of Federal Regulations, 2012 CFR

2012-10-01

... HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.14 When can a CIR-LRP payment...

42 CFR 68c.14 - When can a CIR-LRP payment obligation be discharged in bankruptcy?

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.14 When can a CIR-LRP payment...

[Historical survey of modern reversible contraceptive methods].

PubMed

Mbabajende, V

1986-04-01

Because of contraception, pregnancy need not be viewed by women as punishment for sexual activity but as a planned and desired event. Most of the contraceptive methods used in developing countries at present were introduced during the 1960s, but use of contraception has a long history and some methods date back to antiquity. Contraceptive pills were already used around 2000 BC in the form of mercury and arsenic tablets. Their effectiveness was questionable. The role of hormones in human reproduction began to be understood only in the early 1900s. The discovery of progesterone in a Mexican iguana in the 1940s permitted production of progesterone on a large scale. Estrogens had been identified around 1930. Human trials of a contraceptive pill beginning in 1956 in Puerto Rico demonstrated that progestins could prevent pregnancy by suppressing ovulation. Later on, estrogen was added to reduce menstrual irregularities. The 1st generation of combined oral contraceptives contained very high levels of hormones associated with high rates of side effects. Numerous formulations with lower hormonal contents became available beginning around 1970 and constitute the principal formulations in use today. A number of long acting hormonal methods based on progestins have been developed, including injectables, some IUDs and vaginal rings, and implants. The 1st commercially available injectable, norethisterone enanthate, did not acquire the wide distribution of medroxyprogesterone acetate, sold as Depo Provera and used to treat various pathological conditions as well as for contraception. The 1st true IUDs were small stones placed within the uteri of camels by nomads to prevent pregnancy during long caravans. An IUD was developed in 1909 by Richter, and the 2 most widely used models before 1960 were the Grafenberg and Ota silver rings. Use of the 2 rings became rare for medical reasons after 1935 despite their efficacy. Safe plastic IUDs which appeared beginning in the early 1960s were flexible and capable of returning to their original shape after insertion. The Lippes loop was the 1st highly successful IUD. Bioactive IUDs containing copper were developed in the 1970s. Research is underway to develop IUDs which will resist expulsion, reduce bleeding, be more appropriate for multiparas, and last longer. IUDs are used to treat intrauterine adhesions as well as for contraception. A gummy substance used to block the cervix was described in Egypt in 1850 BC. Japanese and Chinese prostitutes of antiquity placed oiled bamboo paper at the cervical opening for contraception. Diaphragms and cervical caps were developed in the 19th century in Germany. Large scale production became possible after 1880 with the development of better, more durable, and cheaper rubber. An Egyptian writing in 3500 BC began the study of spermicides. Numerous substances such as lemon juice and honey have been placed in the vagina to avoid pregnancy. Such substances are available to all women and some were reasonably effective. Current research is directed toward development of spermicides which will also prevent sexually transmitted diseases. The 1st condoms were made of animal skins by an English physician to prevent transmission of venereal diseases. Rubber condoms appeared in the early 20th century and are widely utilized in some family planning programs. Pregnancy vaccines and a reversible hormonal method for men are among methods under development.

42 CFR 68c.13 - Under what circumstances can the service or payment obligation be canceled, waived, or suspended?

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.13 Under...

You and Me and Human Sexuality: A Student Booklet Written for Deaf Adolescents.

ERIC Educational Resources Information Center

Texas School for the Deaf, Austin.

This student booklet, designed to teach deaf adolescents about human sexuality, is written for students with a second- to fourth-grade reading level. Topics include: (1) relationships; (2) adolescent growth and development; (3) female and male anatomy; (4) conception, fetal development, and birth; (5) contraception; and (6) sexual intercourse and…

Contraceptive prevalence, reproductive health and our common future. The C. Donald Christian Memorial Lecture.

PubMed

Diczfalusy, E

1993-05-01

Worldwide, female sterilization is the most common contraceptive method, followed by IUDs and oral contraceptives. As unwanted pregnancy for women in developing countries can mean life or death, which may explain why modern contraceptive methods with low failure rates (e.g., sterilization, IUDs. and hormonal methods) predominate in developing countries. Conventional methods with relatively high failure rates (e.g., natural family planning, barrier methods, and withdrawal) predominate in developed countries. Developing-country governments first supported family planning programs for demographic reasons. They now embrace them because they save the lives of women and children. The four fundamental pillars of reproductive health policy are family planning, maternal care, infant and child care, and control of sexually transmitted diseases (STDs). Indicators of reproductive health include, rates of maternal mortality and morbidity; induced abortion; infertility; perinatal, infant, and child mortality; and STDs (including AIDS). Governments in the poorest countries invest only US$5 per capita for health, compared to US$400 per capita for developed countries. If the poorest countries increased that $5 figure by just $2 per capita, they could immunize all children, eradicate polio, and provide the drugs to cure the most common diseases. Further, if humans were to use resources more reasonably, we could greatly decrease the number of people living in poverty. Three UN population projections show that the population will continue to grow well within the next century. With strong commitment from governments and individuals, we can increase contraceptive use and reduce total fertility rates. Barriers to achieving those goals are few funds allocated to family planning methods and services; politicians; religious and community leaders; culture; low women's status; limited accessibility to information, methods, and quality services; and limited contraceptive choice.

Contraception and abortion: Fruits of the same rotten tree?

PubMed

Newton, William

2015-05-01

This article seeks to show how contraception, when generally accepted in a society, helps to bring about a radical change in social perceptions of sexual intercourse, human life, the human person, science, and morality in general. On account of this, contraception helps to ingrain abortion and other anti-life practices into the culture that accepts it and, therefore, in no sense can be considered as a panacea for abortion. Particular attention is given to the thought of John Paul II on this matter who noted that "despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree" (Evangelium vitae, n. 13). Lay summary: The article considers the connection between contraception and abortion and defends Pope John Paul II's claim that "despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree." The thesis is that contraception is a "game-changer" in the sense that it changes the way we think about some very fundamental realities such as attitudes to sex, to life, to science, to the human person, and to morality. Any one of these changes would have a significant impact on a society in terms of promoting a culture of death: together they are devastating.

Contraception and abortion: Fruits of the same rotten tree?

PubMed Central

Newton, William

2015-01-01

This article seeks to show how contraception, when generally accepted in a society, helps to bring about a radical change in social perceptions of sexual intercourse, human life, the human person, science, and morality in general. On account of this, contraception helps to ingrain abortion and other anti-life practices into the culture that accepts it and, therefore, in no sense can be considered as a panacea for abortion. Particular attention is given to the thought of John Paul II on this matter who noted that “despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree” (Evangelium vitae, n. 13). Lay summary: The article considers the connection between contraception and abortion and defends Pope John Paul II's claim that “despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree.” The thesis is that contraception is a “game-changer” in the sense that it changes the way we think about some very fundamental realities such as attitudes to sex, to life, to science, to the human person, and to morality. Any one of these changes would have a significant impact on a society in terms of promoting a culture of death: together they are devastating. PMID:25999612

42 CFR 68c.10 - What does an individual have to do in return for loan repayments received under the CIR-LRP?

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.10 What does...

Beyond the Condom: Frontiers in Male Contraception

PubMed Central

Roth, Mara Y.; Amory, John K.

2016-01-01

Nearly half of all pregnancies worldwide are unplanned, despite numerous contraceptive options available. No new contraceptive method has been developed for men since the invention of condom. Nevertheless, more than 25% of contraception worldwide relies on male methods. Therefore, novel effective methods of male contraception are of interest. Herein we review the physiologic basis for both male hormonal and nonhormonal methods of contraception. We review the history of male hormonal contraception development, current hormonal agents in development, as well as the potential risks and benefits of male hormonal contraception options for men. Nonhormonal methods reviewed will include both pharmacological and mechanical approaches in development, with specific focus on methods which inhibit the testicular retinoic acid synthesis and action. Multiple hormonal and nonhormonal methods of male contraception are in the drug development pathway, with the hope that a reversible, reliable, safe method of male contraception will be available to couples in the not too distant future. PMID:26947703

Contraceptive Vaccines Targeting Factors Involved in Establishment of Pregnancy

PubMed Central

Lemons, Angela R.; Naz, Rajesh K.

2011-01-01

Problem Current methods of contraception lack specificity and are accompanied with serious side effects. A more specific method of contraception is needed. Contraceptive vaccines can provide most, if not all, the desired characteristics of an ideal contraceptive. Approach This article reviews several factors involved in the establishment of pregnancy, focusing on those that are essential for successful implantation. Factors that are both essential and pregnancy-specific can provide potential targets for contraception. Conclusion Using database search, 76 factors (cytokines/chemokines/growth factors/others) were identified that are involved in various steps of the establishment of pregnancy. Among these factors, three, namely chorionic gonadotropin (CG), leukemia inhibitory factor (LIF), and preimplantation factor (PIF), are found to be unique and exciting molecules. Human CG is a well-known pregnancy-specific protein that has undergone phase I and phase II clinical trials, in women, as a contraceptive vaccine with encouraging results. LIF and PIF are pregnancy-specific and essential for successful implantation. These molecules are intriguing and may provide viable targets for immunocontraception. A multiepitope vaccine combining factors/antigens involved in various steps of the fertilization cascade and pregnancy establishment, may provide a highly immunogenic and efficacious modality for contraception in humans. PMID:21481058

42 CFR 68c.15 - Additional conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Additional conditions. 68c.15 Section 68c.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN...

42 CFR 68c.15 - Additional conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Additional conditions. 68c.15 Section 68c.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN...

42 CFR 68c.15 - Additional conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Additional conditions. 68c.15 Section 68c.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN...

42 CFR 68c.4 - Who is eligible to participate?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Who is eligible to participate? 68c.4 Section 68c.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

42 CFR 68c.5 - Who is ineligible to participate?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Who is ineligible to participate? 68c.5 Section 68c.5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.3 - Who is eligible to apply?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Who is eligible to apply? 68c.3 Section 68c.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

42 CFR 68c.9 - What loans qualify for repayment?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What loans qualify for repayment? 68c.9 Section 68c.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.3 - Who is eligible to apply?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Who is eligible to apply? 68c.3 Section 68c.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

42 CFR 68c.4 - Who is eligible to participate?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Who is eligible to participate? 68c.4 Section 68c.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

42 CFR 68c.5 - Who is ineligible to participate?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Who is ineligible to participate? 68c.5 Section 68c.5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.4 - Who is eligible to participate?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Who is eligible to participate? 68c.4 Section 68c.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

42 CFR 68c.5 - Who is ineligible to participate?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Who is ineligible to participate? 68c.5 Section 68c.5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.3 - Who is eligible to apply?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Who is eligible to apply? 68c.3 Section 68c.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH...

Beyond the Condom: Frontiers in Male Contraception.

PubMed

Roth, Mara Y; Amory, John K

2016-05-01

Nearly half of all pregnancies worldwide are unplanned, despite numerous contraceptive options available. No new contraceptive method has been developed for men since the invention of condom. Nevertheless, more than 25% of contraception worldwide relies on male methods. Therefore, novel effective methods of male contraception are of interest. Herein we review the physiologic basis for both male hormonal and nonhormonal methods of contraception. We review the history of male hormonal contraception development, current hormonal agents in development, as well as the potential risks and benefits of male hormonal contraception options for men. Nonhormonal methods reviewed will include both pharmacological and mechanical approaches in development, with specific focus on methods which inhibit the testicular retinoic acid synthesis and action. Multiple hormonal and nonhormonal methods of male contraception are in the drug development pathway, with the hope that a reversible, reliable, safe method of male contraception will be available to couples in the not too distant future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention. Combined contraceptive practices among urban African-American early adolescents.

PubMed

Stanton, B F; Li, X; Galbraith, J; Feigelman, S; Kaljee, L

1996-01-01

To evaluate the success of efforts to educate youth not only to use prescription contraceptives to avoid pregnancy, but also to use condoms to avoid sexually transmitted diseases, including infection with the human immunodeficiency virus. Longitudinal study of 383 African-American youth aged 9 to 15 years enrolled in a randomized, controlled trial of an acquired immunodeficiency syndrome (AIDS) risk reduction intervention. Data about contraceptive practices were obtained at baseline and 6, 12, and 18 months later using a culturally and developmentally appropriate risk assessment tool administered with "talking" computers (Macintosh, Apple Computer Inc, Cupertino, Calif). Approximately three fourths of sexually active youth used some form of contraception in each 6-month round, with almost half of the youth using combinations of contraceptives. Among all youth at baseline and among control youth throughout the study, more than half used condoms and more than two thirds who used oral contraceptives also used condoms. Receipt of an AIDS education intervention was associated with use of more effective contraceptive practices (eg, condoms and another prescription or nonprescription method of birth control). After receiving the intervention, more than 80% of the youth who used oral contraceptives also used condoms. Contraceptive practices showed considerable stability. Knowledge about AIDS was positively associated with use of more effective contraceptive methods. Many youth are using condoms and prescription birth control simultaneously, and these use rates can be increased through AIDS education interventions.

The state of the contraceptive art.

PubMed

Tyrer, L B; Duarte, J

1983-01-01

The high failure rates of available contraceptive methods attest to the fact that the present technology is inadequate to meet the needs of many women, and new, safer, and highly effective contraceptive methods must be developed for both the female and the male. Previously, industry was largely responsible for the research and development of many of the currently available contraceptives, but at this time it is less than enthusiastic about carrying out further research because of the time and cost associated with the approval of new drugs. Additionally, because of the medico legal climate that exists today, particularly concerning present contraceptive drugs and devices, pharmaceutical companies are concentrating on developing drugs for the treatent of disease conditions, a less risky area. The US federal government, which currently is the single largest funder in the world of contraceptive and related research, is directing little attention to this particular area. The most obvious obstacles to enhanced federal support is the debate over the federal budget priorities. Other deterring factors include the controversy over abortion which has discouraged efforts to call attention to contraceptive research because of concern that it might result in funding cuts instead of increases. Another factor is the traditional allocation of 40% of National Institute of Health funds to population research and 60% to maternal and child health. An overview of currently available contraceptive methods covers oral contraception (OC), long lasting injectable contraception, IUDs, the condom, vaginal contraceptive sponge, the diagphragm, and fertility awareness techniques. Determining the actual benefits versus the risks of OC has proved difficult. OC has changed considerably since it came into use. The most serious side effects attributed to the OCs involve the cardiovascular system, specifically thromboembolism, stroke, and heart attack. The risk of developing these diseases has declined as the dosage of hormones in the pill has been decreased. Yet, other specific factors can increase the degree of risk. Overall, the OC is still one of the safest and most effective methods of preventing unwanted pregnancy. The Food and Drug Administration (FDA) has denied its approval of Depo-Provera, 1 of several long acting progestins, because of its association with breast tumors in the beagle dog and because of bleeding problems and delays in the return of fertility in human females. All IUDs have potential adverse side effects. The major ones continue to be cramping, bleeding, and infection. The IUD requires only a single act of motivation on the part of the patient, a definite advantage. Condoms of all types continue to be one of the most widely used forms of contraception at this time. The major disadvantage of vaginal chemical contraceptives is that they are coitally related and not aesthetically pleasing. The FDA recently approved for consumer use a polyurethane foam sponge containing a spermicide that is released gradually over a 24-hour period. The diaphragm is effective and has no serious side effects. The failure rate of the various fertility awareness methods is higher than other methods.

Male Hormonal Contraception: Looking Back and Moving Forward

PubMed Central

Roth, Mara Y.; Page, Stephanie T.; Bremner, William J.

2015-01-01

Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development, as well as the potential risks and benefits of male hormonal contraception for men. PMID:26453296

Urokinase-type plasminogen activator: a new target for male contraception?

PubMed

Qin, Ying; Han, Yan; Xiong, Cheng-Liang; Li, Hong-Gang; Hu, Lian; Zhang, Ling

2015-01-01

Urokinase-type plasminogen activator (uPA) is closely related to male reproduction. With the aim of investigating the possibility for uPA as a potential contraceptive target, in the present work, Kunming male mice were immunized by human uPA subcutaneous injection at three separate doses for 3 times. Then the potency of the anti-human uPA antibody in serum was analyzed, and mouse fertility was evaluated. Serum antibody titers for human uPA in immunized groups all reached 1:10,240 or higher levels by enzyme linked immunosorbent assay, and mating experiments revealed that pregnancy rates and the mean number of embryos implanted after mating declined obviously (P < 0.05) when compared with control groups. However, the mating capacity and reproductive organ weights had no obvious change, and histological analysis of the testes and epididymides also showed normal morphology for immunized male mice. Sperm function tests suggested that the sperm concentration, sperm viability, sperm motility, and in vitro fertilization rate for the cauda epididymis sperm in uPA-immunized groups were lower than those in the controls (P < 0.05). Together, these observations indicated that subcutaneous injection human uPA to the male mice could effectively reduce their fertility, and uPA could become a new target for immunocontraception in male contraceptive development.

Male contraception: history and development.

PubMed

Kogan, Paul; Wald, Moshe

2014-02-01

Although the twentieth century has seen great strides in the development of female contraception, not a single new agent has been introduced as an approved method for common use for male contraception. Condoms (considered uncomfortable by some) and vasectomy (a permanent invasive procedure) are the only options provided to men, leaving an undue burden on women to bear contraceptive responsibility. Significant developments have, however, been made with regard to hormonal and nonhormonal contraception, and minor, reversible, procedural contraception. This article reviews the currently available, soon to be available, and theoretically possible methods of male contraception. Copyright © 2014 Elsevier Inc. All rights reserved.

Contraceptive choices, pregnancy rates, and outcomes in a microbicide trial.

PubMed

Sibeko, Sengeziwe; Baxter, Cheryl; Yende, Nonhlanhla; Karim, Quarraisha Abdool; Karim, Salim S Abdool

2011-10-01

Women who become pregnant during the conduct of biomedical human immunodeficiency virus prevention trials are taken off the study product for safety reasons. High pregnancy rates can compromise statistical integrity in these trials. The comprehensive contraceptive curriculum developed for the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial was evaluated for its ability to enhance contraceptive uptake, reduce pregnancy rates, and preserve statistical integrity. Contraceptive- and pregnancy-related eligibility criteria were specified in the protocol. We enrolled women who opted for a nonbarrier method of contraceptive and provided hormonal contraceptives onsite at no cost. At each monthly study visit, we provided pregnancy prevention counseling and performed pregnancy testing. Study product was withheld on pregnancy diagnosis, but women continued with monthly follow-up. Contraceptive use was high throughout the study with 100% uptake at baseline and 94.71% use after a mean of 18 months follow-up at exit. Injectable progestins, particularly medroxyprogesterone acetate, remained the preferred choice of contraceptive. After 30 months of follow-up, 54 pregnancies were reported out of 889 participants, giving a pregnancy incidence rate of 3.95 per 100 woman-years (95% confidence interval 2.96-5.17). Of all pregnancies, two thirds (64.81%) resulted in a full-term live birth, whereas 18.52% and 11.11% pregnancies culminated as miscarriage and terminated pregnancies, respectively. There were no congenital anomalies in the early neonatal period. Pregnancies resulted in 1.56% of woman-years of study follow-up lost as a result of temporary product withdrawal. The CAPRISA 004 contraceptive curriculum was an effective strategy for maintaining low pregnancy rates, thereby minimizing product withdrawal and loss of follow-up time. III.

Male hormonal contraception: looking back and moving forward.

PubMed

Roth, M Y; Page, S T; Bremner, W J

2016-01-01

Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development as well as the potential risks and benefits of male hormonal contraception for men. © 2015 American Society of Andrology and European Academy of Andrology.

42 CFR 68c.8 - What does the CIR-LRP provide to participants?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false What does the CIR-LRP provide to participants? 68c.8 Section 68c.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND...

42 CFR 68c.16 - What other regulations and statutes apply?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What other regulations and statutes apply? 68c.16 Section 68c.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.8 - What does the CIR-LRP provide to participants?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What does the CIR-LRP provide to participants? 68c.8 Section 68c.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND...

42 CFR 68c.16 - What other regulations and statutes apply?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false What other regulations and statutes apply? 68c.16 Section 68c.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

42 CFR 68c.16 - What other regulations and statutes apply?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false What other regulations and statutes apply? 68c.16 Section 68c.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

Ligula intestinalis--a tapeworm contraceptive.

PubMed

Arme, Chris

2002-12-01

Human contraceptives are 'big business', but might the real breakthrough come out from the pharmaceutical industry but from a tapeworm? Ligula intestinalis can induce infertility in infected fish of the carp family - both males and females. If the mechanism for this can be discovered, this humble flatworm could drastically change contraceptive practices with one pill for all.

Sperm-specific ion channels: targets holding the most potential for male contraceptives in development.

PubMed

Zheng, Li-Ping; Wang, Hua-Feng; Li, Bao-Ming; Zeng, Xu-Hui

2013-10-01

There is a global need for an ideal method of male contraception. However, the development of male contraceptives has not been well successful. Research on sperm-specific ion channels, especially the recent advance obtained from electrophysiological studies, has emphasized the conception that those channels are targets with the most potential to develop non-hormonal male contraceptives. While summarizing the general options for male contraception, this review focuses on the properties and functions of sperm ion channels together with the attempts of utilizing these channels to develop male contraceptives. We believe that a deeper insight into the signaling and molecular mechanisms by which ion channels regulate sperm functions will pave the way for developing novel male-based contraceptives. Copyright © 2013 Elsevier Inc. All rights reserved.

78 FR 66752 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... Special Emphasis Panel; Preserving Male Fertility After Cancer Therapy by Kyle E. Orwig. Date: November 14....929, Center for Medical Rehabilitation Research; 93.209, Contraception and Infertility Loan Repayment...

Effect of contraceptive steroids on monoamine oxidase activity

PubMed Central

Southgate, Jennifer; Collins, G. G. S.; Pryse-Davies, J.; Sandler, M.

1969-01-01

Cyclical variations in monoamine oxidase activity during the human menstrual cycle, specific to the endometrium and modified in women undergoing contraceptive steroid treatment, may reflect changes in hormonal environment. Treatment of rats with individual constituents of the contraceptive pill causes analogous changes: oestrogens inhibit and progestogens potentiate uterine monoamine oxidase activity. ImagesFig. 2Fig. 3

42 CFR 68c.6 - How do individuals apply to participate in the CIR-LRP?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false How do individuals apply to participate in the CIR-LRP? 68c.6 Section 68c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND...

42 CFR 68c.6 - How do individuals apply to participate in the CIR-LRP?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false How do individuals apply to participate in the CIR-LRP? 68c.6 Section 68c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND...

Editorial.

PubMed

Singh, I P; Shiva, M

1994-06-01

Even though India was the first country to address population, it is behind those who came later. The government of India framed population within the context of health, but it eventually shifted the approach to health and family planning. Compartmentalism and adhoc-ism removed the programs far from the people. Eventually family welfare replaced family planning. The 8 Five Year Plan document provides a framework for appropriate, positive change in addressing the population issue. Yet, contraceptive intervention, particularly tubectomy, remains the core of population issues. In fact, tubectomy increased from about 11% of total sterilizations in the late 1960s to 96% in 1994. Women remain the target of population control. In fact, female-targeted contraceptive technology has produced IUDs, oral contraceptives, tubectomy, subdermal contraceptive implants, and the injectable contraceptive. Improvement of women's health services, their status, and their economic independence has not been attempted. Before improvement can occur, female literacy; skill development; meeting of basic needs of food, water, and health care for children to survive; and safe living and working conditions are needed. Male responsibility has risen somewhat over time. India needs to work towards a shift from contraception-oriented population control to reducing births by choice (RBBC), making RBBC a grassroots movement, a holistic approach, coordination between various government agencies, addressing demographic fundamentalism (e.g., son preference and child marriage), provision of primary health care, and equitable distribution of local and global resources. Population policy must be human.

Discovery of human posterior head 20 (hPH20) and homo sapiens sperm acrosome associated 1 (hSPACA1) immunocontraceptive epitopes and their effects on fertility in male and female mice.

PubMed

Chen, Xuemei; Liu, Xiaodong; Ren, Xiuhua; Li, Xuewu; Wang, Li; Zang, Weidong

2016-03-01

The key goals of immunocontraception research are to obtain full contraceptive effects using vaccines administered to both males and females. Current research concerning human anti-sperm contraceptive vaccines is focused on delineating infertility-related epitopes to avoid autoimmune disease. We constructed phage-display peptide libraries to select epitope peptides derived from human posterior head 20 (hPH20) and homo sapiens sperm acrosome associated 1 (hSPACA1) using sera collected from infertile women harbouring anti-sperm antibodies. Following five rounds of selection, positive colonies were reconfirmed for reactivity with the immunoinfertile sera. We biopanned and analysed the chemical properties of four epitope peptides, named P82, Sa6, Sa37 and Sa76. Synthetic peptides were made and coupled to either bovine serum albumin (BSA) or ovalbumin. We used the BSA-conjugated peptides to immunise BALB/c mice and examined the effects on fertility in female and male mice. The synthetic peptides generated a sperm-specific antibody response in female and male mice that caused a contraceptive state. The immunocontraceptive effect was reversible and, with the disappearance of peptide-specific antibodies, there was complete restoration of fertility. Vaccinations using P82, Sa6 and Sa76 peptides resulted in no apparent side effects. Thus, it is efficient and practical to identify epitope peptide candidates by phage display. These peptides may find clinical application in the specific diagnosis and treatment of male and female infertility and contraceptive vaccine development.

Contraceptive options for women living with HIV.

PubMed

Phillips, Sharon; Steyn, Petrus; Temmerman, Marleen

2014-08-01

Women living with HIV are often of reproductive age, and many desire effective contraceptive options to delay or prevent pregnancy. We review the safety of various hormonal and non-hormonal contraceptive methods for women living with human immunodeficiency virus (HIV). Additionally, we discuss drug interactions between contraceptive methods and antiretrovirals and the safety of methods with respect to onward transmission to HIV-negative partners for women in sero-discordant partnerships. In general, most methods are safe for most women living with HIV. An understanding of the reproductive goals of each individual patient, as well as her medical condition and medication, should be taken into account when counselling women on their contraceptive options. Further research is needed to understand drug interactions between contraceptives and antiretrovirals better and how to fulfil the contraceptive needs of HIV-positive women. Copyright © 2014. Published by Elsevier Ltd.

Cognitive Development, Egocentrism, Self-Esteem, and Adolescent Contraceptive Knowledge, Attitudes, and Behavior.

ERIC Educational Resources Information Center

Holmbeck, Grayson N.; And Others

1994-01-01

Cognitive development, egocentrism, and self-esteem were examined in relation to contraceptive knowledge, attitudes, and behavior for 300 high school and first-year college students. Adolescents with higher cognitive development and self-esteem scores had more knowledge about sexuality and contraception and were more likely to use contraceptives.…

Pharmacists' knowledge and interest in developing counseling skills relating to oral contraceptives.

PubMed

Amin, Mohamed E K

2016-04-01

Possessing correct therapeutic information on oral contraceptives is an important prerequisite for the provision of sound advice to women who are using these products. This study examines Egyptian pharmacists' knowledge of pharmacotherapeutic aspects of oral contraceptives as well as interest in developing skills in providing counseling on oral contraceptive pills. Community pharmacies throughout Alexandria, Egypt. A cross-sectional survey was self-administered by a random sample of community pharmacists in Alexandria, Egypt. Five multiple choice questions likely to arise when counseling women on oral contraceptives were constructed. Questions covered compatibility with breastfeeding, precautions, health risks and managing missed pills of oral contraceptives. Using ordered logistic regression, a model was estimated to predict pharmacists' interest in developing skills in providing counseling on oral contraceptives. Pharmacists' aggregate scores for knowledge questions and pharmacists' interest in developing skills in providing counseling on oral contraceptive pills. Of the 181 approached pharmacists, 92 % participated. Twenty one pharmacists (13 %) did not know the correct answer to any question, 122 (73 %) answered one-two correctly, 23 (14 %) answered three-four correctly. No pharmacist answered all five questions correctly. For pharmacists' interest in developing skills in providing counseling on oral contraceptives, the percentage values for answers were: not interested at all (10.2 %), slightly interested (27.0 %), somewhat interested (23.4 %), interested (30.0 %) and extremely interested (9.6 %). Pharmacists' interest in developing skills in providing counseling on oral contraceptives was significantly associated with the number of women who requested advice from the pharmacists on oral contraceptives (OR 1.54, CI 1.24-1.91). In terms of the learning method of preference, percentage values for answers were: attending a workshop (4 %), online course (18 %), publications distributed to pharmacy (44 %), other methods (1 %) and more than one method (23 %). Ten percent were not interested in developing their skills on oral contraceptives. This study identifies considerable gaps among community pharmacists' knowledge of oral contraceptives. It also shows variation in willingness and choice of learning strategies among pharmacists to develop their skills in providing counseling on oral contraceptives.

Contraceptive knowledge, perceptions, and concerns among men in Uganda.

PubMed

Thummalachetty, Nityanjali; Mathur, Sanyukta; Mullinax, Margo; DeCosta, Kelsea; Nakyanjo, Neema; Lutalo, Tom; Brahmbhatt, Heena; Santelli, John S

2017-10-10

Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men. Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men. Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge. Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions.

42 CFR 68c.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN...; and (4) Reproductive Medicine Unit identified as a clinical site for the National Cooperative Reproductive Medicine Network, or other sites as designated by the Director. NICHD intramural laboratory means...

Preferential Cyclooxygenase 2 Inhibitors as a Nonhormonal Method of Emergency Contraception: A Look at the Evidence.

PubMed

Weiss, Erich A; Gandhi, Mona

2016-04-01

To review the literature surrounding the use of preferential cyclooxygenase 2 (COX-2) inhibitors as an alternative form of emergency contraception. MEDLINE (1950 to February 2014) was searched using the key words cyclooxygenase or COX-2 combined with contraception, emergency contraception, or ovulation. Results were limited to randomized control trials, controlled clinical trials, and clinical trials. Human trials that measured the effects of COX inhibition on female reproductive potential were included for review. The effects of the COX-2 inhibitors rofecoxib, celecoxib, and meloxicam were evaluated in 6 trials. Each of which was small in scope, enrolled women of variable fertility status, used different dosing regimens, included multiple end points, and had variable results. Insufficient evidence exists to fully support the use of preferential COX-2 inhibitors as a form of emergency contraception. Although all trials resulted in a decrease in ovulatory cycles, outcomes varied between dosing strategies and agents used. A lack of homogeneity in these studies makes comparisons difficult. However, success of meloxicam in multiple trials warrants further study. Larger human trials are necessary before the clinical utility of this method of emergency contraception can be fully appreciated. © The Author(s) 2014.

Contraceptive Development.

ERIC Educational Resources Information Center

Troen, Philip; And Others

This report provides an overview of research activities and needs in the area of contraceptive development. In a review of the present state, discussions are offered on the effectiveness and drawbacks of oral contraceptives, intrauterine devices, barrier methods, natural family planning, and sterilization. Methods of contraception that are in the…

New strategies for providing hormonal contraception in developing countries.

PubMed

Townsend, John W; Sitruk-Ware, Regine; Williams, Katherine; Askew, Ian; Brill, Klaus

2011-05-01

Even with progress in increasing access to effective contraception over the past decades, and the growing range of contraceptive methods available on the market, women in developing countries continue to report an unmet need for family planning. This constraint continues to challenge reproductive health policies and programs, while the momentum of population growth and the young age structure in developing countries leads to larger numbers of potential contraceptive users and increasing global demand in contraceptive markets. Of late, there is a renewed focus on increasing access to long-acting hormonal methods to effectively meet this need, establishing and effectively implementing new service delivery strategies. A number of processes have profoundly affected the procurement and use of hormonal contraceptive methods in developing countries: a supportive policy environment, evidence-based practices and an increasing diversity of delivery strategies play a significant part in increasing number of contraceptive users and the demand for hormonal contraception. Copyright © 2011 Elsevier Inc. All rights reserved.

Animal models of contraception: utility and limitations

PubMed Central

Liechty, Emma R; Bergin, Ingrid L; Bell, Jason D

2015-01-01

Appropriate animal modeling is vital for the successful development of novel contraceptive devices. Advances in reproductive biology have identified novel pathways for contraceptive intervention. Here we review species-specific anatomic and physiologic considerations impacting preclinical contraceptive testing, including efficacy testing, mechanistic studies, device design, and modeling off-target effects. Emphasis is placed on the use of nonhuman primate models in contraceptive device development. PMID:29386922

Contraceptive vaccines for wildlife: a review.

PubMed

Kirkpatrick, Jay F; Lyda, Robin O; Frank, Kimberly M

2011-07-01

Wildlife, free-ranging and captive, poses and causes serious population problems not unlike those encountered with human overpopulation. Traditional lethal control programs, however, are not always legal, wise, safe, or publicly acceptable; thus, alternative approaches are necessary. Immunocontraception of free-ranging wildlife has reached the management level, with success across a large variety of species. Thus far, the immunocontraceptive research and management applications emphasis have been centered on porcine zona pellucida and gonadotropin-releasing hormone vaccines. Contraceptive success has been achieved in more than 85 different wildlife species, at the level of both the individual animal and the population. At the population management level with free-ranging species, the primary focus has been on wild horses, urban deer, bison, and African elephants. The challenges in the development and application of vaccine-based wildlife contraceptives are diverse and include differences in efficacy across species, safety of vaccines during pregnancy, the development of novel delivery systems for wild and wary free-ranging animals, and the constraints of certain non-contraceptive effects, such as effects on behavior. Beyond the constraints imposed by the public and a host of regulatory concerns, there exists a real limitation for funding of well-designed programs that apply this type of fertility control. © 2011 John Wiley & Sons A/S.

Contraceptive research: still inadequate after all these years?

PubMed

Diconsiglio, J M

1992-01-01

Scientists and executives at Upjohn Company stopped further research and development of prostaglandins, mainly used for contraceptive purposes, after anti-abortion groups harassed employees, destroyed property, and camped in the parking lot for weeks. 3 million women face an unplanned pregnancy yearly due to contraceptive failure. So Upjohn's retreat from contraception research adds another obstacle to any chances of a contraceptive revolution. In 1970, there were 13 major drug companies in the world (9 in the US) doing research and development on contraception. By 1987, only 4 companies were doing such research (1 in the US). So government agencies, universities, and nongovernmental and international organizations are the only groups conducting contraceptive development. They also suffer political or economic constraints. The research and approval process make any significant new contraceptive breakthrough likely to occur only after at least 10-15 years. The cost of developing a new contraceptive ranges from US$20 to 70 million and, if the cost of failed leads is added, it ranges from US$200 to 250 million. The US National Institutes of Health (NIH) and USAID conduct most contraceptive research and most of the US$165 million dedicated to it goes to basic research on reproductive physiology. In addition, contraceptive research scientists submit only 1/10,000 new chemicals identified in laboratories to the US Food and Drug Administration (FDA). So cost of applied contraceptive development and research actually equals US$30 million. The current US administration bars NIH and USAID from conducting any research on any contraceptive that is even close to abortion, e.g., RU-486. Anti-abortion groups have also motivated the government to restrict funds it distributes for contraception research to nongovernmental groups. Thus the Population Council does not have the funds to begin the approval process for its levonorgestrel releasing IUD. FDA may soon approve the female condom and Depo-Provera, however.

Development and conceptual validation of a questionnaire to help contraceptive choice: CHLOE (Contraception: HeLping for wOmen's choicE).

PubMed

Jamin, Christian Georges; Häusler, Gunther; Lobo Abascal, Paloma; Fiala, Christian; Lete Lasa, Luis Ignacio; Nappi, Rossella Elena; Micheletti, Marie-Christine; Fernández-Dorado, Ana; Pintiaux, Axelle; Chabbert-Buffet, Natalie

2017-08-01

The aim of this research was to develop a questionnaire to facilitate choice of the most appropriate contraceptive method for individual women. A literature review was conducted to identify key aspects influencing contraceptive choice and inform development of a questionnaire for online completion. Questionnaire development was overseen by a steering committee consisting of eight gynaecologists from across Europe. The initial draft underwent conceptual validation through cognitive debriefing interviews with six native English-speaking women. A qualitative content analysis was conducted to accurately identify potential issues and areas for questionnaire improvement. A revised version of the questionnaire then underwent face-to-face and online evaluation by 115 international gynaecologists/obstetricians with expertise in contraception, prior to development of a final version. The final conceptually validated Contraception: HeLping for wOmen's choicE (CHLOE) questionnaire takes ≤10 min to complete and includes three sections to elicit general information about the individual, the health conditions that might influence contraceptive choice, and the woman's needs and preferences that might influence contraceptive choice. The questionnaire captures the core aspects of personalisation, efficacy and safety, identified as key attributes influencing contraceptive choice, and consists of 24 closed-ended questions for online completion prior to a health care provider (HCP) consultation. The HCP receives a summary of the responses. The CHLOE questionnaire has been developed to help women choose the contraception that best suits their needs and situation while optimising the HCP's time.

Long-acting injectable hormonal dosage forms for contraception.

PubMed

Wu, Linfeng; Janagam, Dileep R; Mandrell, Timothy D; Johnson, James R; Lowe, Tao L

2015-07-01

Although great efforts have been made to develop long-acting injectable hormonal contraceptives for more than four decades, few long-acting injectable contraceptives have reached the pharmaceutical market or even entered clinical trials. On the other hand, in clinical practice there is an urgent need for injectable long-acting reversible contraceptives which can provide contraceptive protection for more than 3 months after one single injection. Availability of such products will offer great flexibility to women and resolve certain continuation issues currently occurring in clinics. Herein, we reviewed the strategies exploited in the past to develop injectable hormonal contraceptive dosages including drug microcrystal suspensions, drug-loaded microsphere suspensions and in situ forming depot systems for long-term contraception and discussed the potential solutions for remaining issues met in the previous development.

77 FR 9674 - Eunice Kennedy Shriver National Institute of Child Health and Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

..., ``Male Reproduction.'' Date: March 14, 2012. Time: 2 p.m. to 4 p.m. Agenda: To review and evaluate grant..., Center for Medical Rehabilitation Research; 93.209, Contraception and Infertility Loan Repayment Program...

Facts about an implantable contraceptive: Memorandum from a WHO Meeting*

PubMed Central

1985-01-01

This Memorandum reviews the results of research undertaken in animals and human subjects on the implantable contraceptive, Norplant, and where relevant, its components, levonorgestrel and Silastic. Results from clinical trials, including effectiveness and side-effects, are evaluated and service delivery aspects commented on. The Memorandum concludes with a statement regarding the use of Norplant as an option for long-term reversible contraception. PMID:3930082

Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: evidence from cross-sectional studies

PubMed Central

Hounton, Sennen; Barros, Aluisio J. D.; Amouzou, Agbessi; Shiferaw, Solomon; Maïga, Abdoulaye; Akinyemi, Akanni; Friedman, Howard; Koroma, Desmond

2015-01-01

Background The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women's empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations’ human capital. Objectives The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes. Design Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables. Results There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation. Conclusions Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration. PMID:26562143

Patterns and trends of contraceptive use among sexually active adolescents in Burkina Faso, Ethiopia, and Nigeria: evidence from cross-sectional studies.

PubMed

Hounton, Sennen; Barros, Aluisio J D; Amouzou, Agbessi; Shiferaw, Solomon; Maïga, Abdoulaye; Akinyemi, Akanni; Friedman, Howard; Koroma, Desmond

2015-01-01

The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women's empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations' human capital. The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes. Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables. There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation. Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.

Applying clinically proven human techniques for contraception and fertility to endangered species and zoo animals: a review.

PubMed

Silber, Sherman J; Barbey, Natalie; Lenahan, Kathy; Silber, David Z

2013-12-01

Reversible contraception that does not alter natural behavior is a critical need for managing zoo populations. In addition to reversible contraception, other fertility techniques perfected in humans may be useful, such as in vitro fertilization (IVF) or oocyte and embryo banking for endangered species like amphibians and Mexican wolves (Canis lupus baileyi). Furthermore, the genetics of human fertility can give a better understanding of fertility in more exotic species. Collaborations were established to apply human fertility techniques to the captive population. Reversible vasectomy might be one solution for reversible contraception that does not alter behavior. Reversible approaches to vasectomy, avoiding secondary epididymal disruption, were attempted in South American bush dogs (Speothos venaticus), chimpanzees (Pan troglodytes), gorillas (Gorilla gorilla), Przewalski's horse (Equus przewalski poliakov), and Sika deer (Cervus nippon) in a variety of zoos around the world. These techniques were first perfected in > 4,000 humans before attempting them in zoo animals. In vitro fertilization with gestational surrogacy was used to attempt to break the vicious cycle of hand rearing of purebred orangutans, and egg and ovary vitrification in humans have led to successful gamete banking for Mexican wolves and disappearing amphibians. The study of the human Y chromosome has even explained a mechanism of extinction related to global climate change. The best results with vasectomy reversal (normal sperm counts, pregnancy, and live offspring) were obtained when the original vasectomy was performed "open-ended," so as to avoid pressure-induced epididymal disruption. The attempt at gestational surrogacy for orangutans failed because of severe male infertility and the lack of success with human ovarian hyperstimulation protocols. Vitrification of oocytes is already being employed for the Amphibian Ark Project and for Mexican wolves. Vasectomy can be a reversible contraception option in zoo animals, even in endangered species. Ongoing use of gamete and embryo freezing may salvage vanishing species.

"It Makes You Rethink Your Choice of the Pill": Theory-Based Formative Research to Design a Contraceptive Choice Campaign.

PubMed

Sundstrom, Beth; DeMaria, Andrea L; Meier, Stephanie; Jones, Annabel; Moxley, Grace E

2015-01-01

Half of all pregnancies in the United States remain unplanned despite improved access to highly effective long-acting reversible contraception, including the intrauterine device and the implant. This study conducted theory-based formative research to develop a contraceptive choice campaign aimed at increasing long-acting reversible contraception uptake by women ages 18-44 years in Charleston, South Carolina, an urban area in the southeastern United States. Researchers developed and tested message concepts and designs. Six focus groups and 18 interviews were conducted among reproductive-age women (n = 79). Qualitative data analysis revealed messages and designs that resonated with these women. Emphasizing long-acting reversible contraception as the healthy option, highlighting long-acting reversible contraception effectiveness, including relatable and trustworthy characters, and using language of control emerged as themes. Women reported a preference for statistics illustrating effectiveness combined with empowering messages of control over contraceptive decision making. Findings from this study offer practical recommendations for developing contraceptive choice campaigns targeting long-acting reversible contraception use and further the goal of reducing unintended pregnancy among women.

Male Contraception

PubMed Central

Amory, John K.

2016-01-01

NARRATIVE ABSTRACT Although female contraceptives are very effective at preventing unintended pregnancy, some women cannot use them due to health conditions or side effects, leaving some couples without effective contraceptive options. In addition, many men wish to take active responsibility for family planning. Thus, there is a great need for male contraceptives to prevent unintended pregnancy, of which 80–90 million occur annually. At present, effective male contraceptive options are condoms and vasectomy, which are not ideal for all men. Therefore, efforts are under way to develop novel male contraceptives. This paper will briefly review the advantages and disadvantages of condoms and vasectomies, and then discuss the research directed towards the development of novel methods of male contraception. PMID:27678037

[Human fertility in the Universidad de Tarapaca].

PubMed

Prenafeta Jenkin, S

1988-01-01

A group of students at the University of Tarapaca in Arica, Chile, recently surveyed 10% of the students on their knowledge of family planning and human sexuality. 47% of the 2378 students interviewed were male and 53% were female. 55% did not know the most effective contraceptive method, only 22% understood the correct use of oral contraceptives, and only 4% had any information about using natural methods. 25% of male students initiated sexual relations before the age of 15 but most did so at 15-18 years. 58% of female students had their 1st sexual relations at 17-20 years. 43.7% of sexually active students used contraception. 13.3% of the female students reported having undergone abortions, and 2.1% of the male students reported that their partners had done so. Women were more likely than men to have sought information on contraception. Their sources were books and magazines, parents and friends. 86% of those surveyed believed the responsibility for pregnancy should be shared, but 35.7% believed that the woman should be the one to use contraception.

Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya.

PubMed

Håkansson, Miranda; Oguttu, Monica; Gemzell-Danielsson, Kristina; Makenzius, Marlene

2018-01-01

Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research. Cronbach's α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women's autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling. Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.

Safety and efficacy of fertility-regulating methods: a decade of research.

PubMed Central

Skegg, D. C.

1999-01-01

An international venture was launched in 1985 to fill a recognized gap in post-marketing surveillance of fertility-regulating methods. For this purpose a new task force was set up by the Special Programme of Research, Development, and Research Training in Human Reproduction, which is cosponsored by the United Nations Development Programme, the United Nations Population Fund, the World Bank, and WHO. Research priorities were chosen and epidemiological studies inaugurated, involving a total of 47 countries--mostly from the developing world. Important progress has been made, especially in helping to define the beneficial and possible adverse effects of oral contraceptives on the risk of neoplasia; in showing that the injectable contraceptive depot-medroxyprogesterone acetate protects against endometrial cancer and does not increase the overall risk of breast cancer, in clarifying which groups of women are susceptible to the rare cardiovascular complications of oral contraceptives (myocardial infarction, stroke, and venous thromboembolism); and in establishing the long-term effectiveness and safety of intrauterine devices. The research has already made a significant impact on family planning policies and practice. Critical appraisal of this venture, which has been modestly funded, confirms the value of mission-oriented research. It also illustrates the potential of collaboration that bridges the global divide between developing and developed countries. PMID:10534894

Safety and efficacy of fertility-regulating methods: a decade of research.

PubMed

Skegg, D C

1999-01-01

An international venture was launched in 1985 to fill a recognized gap in post-marketing surveillance of fertility-regulating methods. For this purpose a new task force was set up by the Special Programme of Research, Development, and Research Training in Human Reproduction, which is cosponsored by the United Nations Development Programme, the United Nations Population Fund, the World Bank, and WHO. Research priorities were chosen and epidemiological studies inaugurated, involving a total of 47 countries--mostly from the developing world. Important progress has been made, especially in helping to define the beneficial and possible adverse effects of oral contraceptives on the risk of neoplasia; in showing that the injectable contraceptive depot-medroxyprogesterone acetate protects against endometrial cancer and does not increase the overall risk of breast cancer, in clarifying which groups of women are susceptible to the rare cardiovascular complications of oral contraceptives (myocardial infarction, stroke, and venous thromboembolism); and in establishing the long-term effectiveness and safety of intrauterine devices. The research has already made a significant impact on family planning policies and practice. Critical appraisal of this venture, which has been modestly funded, confirms the value of mission-oriented research. It also illustrates the potential of collaboration that bridges the global divide between developing and developed countries.

Predicting contraceptive vigilance in adolescent females: a projective method for assessing ego development.

PubMed

Speier, P L; Mélèse-D'Hospital, I A; Tschann, J M; Moore, P J; Adler, N E

1997-01-01

To test the hypothesis that ego development would predict contraceptive use. Problems in ego development were defined in terms of three factors: (1) realism, (2) complexity, and (3) discontinuity. Forty-one respondents aged 14-17 years were selected from a group of 233 adolescents who were administered a projective pregnancy scenario and participated in a 12-month follow-up. Twenty of these adolescents were randomly selected from the group determined to be effective contraceptive users, while 21 were randomly selected from the group of poor contraceptors. Chi-square test revealed a significant association (p < .0005) between the composite ego maturity (EM) measure and contraceptive outcome (chi 2 = 13.82, with df-1). Low scores on the ego maturity measure predicted poor contraceptive use. EM was unrelated to age but was associated with race (chi 2 = 7.535, .025 < p < .05). However, EM predicted contraceptive use when controlling for the effects of race. A simple, time-efficient projective pregnancy scenario is an effective way of determining adolescent females at risk for poor contraceptive effectiveness and, therefore, untimely pregnancy. These stories are analyzed using factors related to the ego development of the adolescent. Subjects who scored lower on this measure have poor contraceptive effectiveness while subjects with higher levels demonstrated effective contraception use, at 1-year follow-up.

Let's fight for the gender perspective.

PubMed

Lindahl, K

1994-01-01

The author, a representative of the Swedish National Preparatory Committee for the Cairo International Conference on Population and Development (ICPD), urges that each question and proposed action be considered within the framework of a gender and human rights perspective. The starting point for all discussions of population policies should be the individual rather than global population targets. Social and economic empowerment of women is essential to the success of development programs. If population growth is to match available resources, life-styles, production, and consumption strategies must be modified. In terms of sexual and reproductive health, the socioeconomic and cultural factors that impact on the decision to accept contraception must be considered. Safe methods of contraception and legal abortion must be available, and the sexual health issue should be broadened to include consideration of the sexual violence faced by many women and children. In addition, the fact the adolescents are sexually active must be accepted if unwanted pregnancies, deaths through unsafe abortion, and the transmission of sexually transmitted diseases are to be reduced. Support for contraceptive use is a necessary, but insufficient, precondition for women's health; essential is a more holistic approach.

Examining the role of oral contraceptive users as an experimental and/or control group in athletic performance studies.

PubMed

Elliott-Sale, Kirsty Jayne; Smith, Stephanie; Bacon, James; Clayton, David; McPhilimey, Martin; Goutianos, Georgios; Hampson, Jennifer; Sale, Craig

2013-09-01

This study was conducted to examine the effect of oral contraceptives on endogenous reproductive hormone levels in order to assess the suitability of oral contraceptive users as experimental and/or control groups in human performance studies. Ninety-five females who were taking a variety of oral contraceptives (2 types and 11 brands) were recruited. A single blood sample was analysed for endogenous concentrations of oestradiol and progesterone. There were significant differences (p<.05) in circulating oestradiol and progesterone as a result of oral contraceptive type and brand. Overall, oral contraceptive use resulted in low levels of oestradiol and progesterone and large variation in hormone concentration when multiple brands were analysed together. This study indicates that future studies should employ a single pill type and brand when using oral contraceptive users as either a control or experimental group and that comparison between oral contraceptive users as a control group and the early follicular phase of the menstrual cycle as an experimental group should be reconsidered. Copyright © 2013 Elsevier Inc. All rights reserved.

Male contraceptive research steps back into spotlight.

PubMed

Bonn, D

1999-01-23

The goal of male hormonal contraception is to block spermatogenesis by suppressing the secretion of pituitary gonadotropins. Prospects are good for the development of such a male contraceptive, with at least one hormonal contraceptive for men potentially available within 5-7 years. Finding an acceptable, reversible, and preferably long-lasting hormonal contraceptive for men is a top priority of the World Health Organization (WHO). Considerable evidence suggests that an androgen, with or without a progestogen, can provide effective contraception and is well tolerated. Schering and Organon are planning to collaborate with WHO in developing hormonal contraception for men. Fred Wu of the University of Manchester, UK, will soon begin a trial comparing the effectiveness of new injectable testosterone undecanoate and testosterone buciclate formulations, with or without synthetic progestogens.

Male contraception.

PubMed

Amory, John K

2016-11-01

Although female contraceptives are very effective at preventing unintended pregnancy, some women can not use them because of health conditions or side-effects, leaving some couples without effective contraceptive options. In addition, many men wish to take active responsibility for family planning. Thus, there is a great need for male contraceptives to prevent unintended pregnancies, of which 80-90 million occur annually. At present, effective male contraceptive options are condoms and vasectomy, which are not ideal for all men. Therefore, efforts are under way to develop novel male contraceptives. This paper briefly reviews the advantages and disadvantages of condoms and vasectomies and then discusses the research directed toward development of novel methods of male contraception. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

42 CFR 68c.9 - What loans qualify for repayment?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Program, Public Health and National Health Service Corps Scholarship Training Program, National Health..., INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.9 What loans qualify for repayment? (a) The CIR-LRP will repay...

42 CFR 68c.9 - What loans qualify for repayment?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Program, Public Health and National Health Service Corps Scholarship Training Program, National Health..., INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.9 What loans qualify for repayment? (a) The CIR-LRP will repay...

An Empirical Test of the Theory of Planned Behaviour Applied to Contraceptive Use in Rural Uganda

PubMed Central

Kiene, Susan M.; Hopwood, Sarah; Lule, Haruna; Wanyenze, Rhoda K.

2013-01-01

There is a high unmet need for contraceptives in developing countries such as Uganda, with high population growth, where efforts are needed to promote family planning and contraceptive use. Despite this high need, little research has investigated applications of health behaviour change theories to contraceptive use amongst this population. The present study tested the Theory of Planned Behaviour’s ability to predict contraceptive use-related behaviours among postpartum women in rural Uganda. Results gave modest support to the theory’s application and suggest an urgent need for improved theory-based interventions to promote contraceptive use in the populations of developing countries. PMID:23928989

[Contraceptive development--the view from the U.S.A. in the mid 80s].

PubMed

Potts, M; Siemens, A; Burton, N

1986-03-01

Contraceptive research and development in the US has been slowed by declining investment at a time of rising costs and increasingly complex US Food and Drug Administration (FDA) regulation. Public and private investment in contraceptive research reached its maximum in the early 1970s. Since then, investment has stagnated while research and development costs have continued to rise. Development of a new product costs between 50-60 million dollars and corresponds to over 2/3 of its legal life of 17 years. In addition, the majority of pharmaceutical liability cases in the past few years have involved contraceptives. Although recent epidemiological studies have demonstrated that oral contraceptives (OCs) have some significant benefits, such as prevention of at least 2 types of cancer, OCs continue to be held responsible for secondary cardiovascular effects as well as for some effects whose true etiology has not been demonstrated. The growing use of contraceptive sterilization at the expense of most other methods and the opposition to making contraceptives easily available among those who believe that contraception encourages premarital sexual activity are other factors which have resulted in the near abandonment of contraceptive research and development by American pharmaceutical companies, who no longer consider family planning a viable market. In the US, most research and innovation in the field of contraception now comes from not-for-profit institutions such as Family Health International (FHI) the Population Council, and to a lesser extent the Program of Applied Research for Fertility Regulation and some universities. Such organizations receive some research funds from the Agency for International Development and the National Institutes of Health. The role of FHI in the development of the contraceptive sponge and of the Population Council in developemnt of the Copper T 380A IUD demonstrate the transfer of supremacy in contraceptive development from the pharmaceutical industry to social organizations. 2 or 3 sustained release steroid systems, including the Norplant subcutaneous implant system which releases levonorgestrel, the simpler Norplan II system, biodegradable injectable microcapsules containing norethindrone, or subcutaneous steriod pellets, are likely to acheive FDA approval by the early 1990s. Other efforts are underway to develop contraceptive substances using drugs already authorized by the FDA for other indications. Examples of this approach are the use of propranolol and chlorhexidine as vaginal spermicides. A small number of studies are continuing on simplified methods of sterilization appropriate for Third World Countries. An anti-zone pellucida or anti-sperm pregnancy vaccine may be at the stage of clinical testing by 1990, but doubts about product liability may slow prevent clinical utilization in the US. FDA regulations specify the characteristics of required studies but not their location. Because funds are limited but the need for contraception is universal, it is probable that international cooperation in contraceptive development will assume increasing importance.

The control of male fertility by spermatid-specific factors: searching for contraceptive targets from spermatozoon's head to tail.

PubMed

Chen, Su-Ren; Batool, Aalia; Wang, Yu-Qian; Hao, Xiao-Xia; Chang, Chawn-Shang; Cheng, C Yan; Liu, Yi-Xun

2016-11-10

Male infertility due to abnormal spermatozoa has been reported in both animals and humans, but its pathogenic causes, including genetic abnormalities, remain largely unknown. On the other hand, contraceptive options for men are limited, and a specific, reversible and safe method of male contraception has been a long-standing quest in medicine. Some progress has recently been made in exploring the effects of spermatid-specifical genetic factors in controlling male fertility. A comprehensive search of PubMed for articles and reviews published in English before July 2016 was carried out using the search terms 'spermiogenesis failure', 'globozoospermia', 'spermatid-specific', 'acrosome', 'infertile', 'manchette', 'sperm connecting piece', 'sperm annulus', 'sperm ADAMs', 'flagellar abnormalities', 'sperm motility loss', 'sperm ion exchanger' and 'contraceptive targets'. Importantly, we have opted to focus on articles regarding spermatid-specific factors. Genetic studies to define the structure and physiology of sperm have shown that spermatozoa appear to be one of the most promising contraceptive targets. Here we summarize how these spermatid-specific factors regulate spermiogenesis and categorize them according to their localization and function from spermatid head to tail (e.g., acrosome, manchette, head-tail conjunction, annulus, principal piece of tail). In addition, we emphatically introduce small-molecule contraceptives, such as BRDT and PPP3CC/PPP3R2, which are currently being developed to target spermatogenic-specific proteins. We suggest that blocking the differentiation of haploid germ cells, which rarely affects early spermatogenic cell types and the testicular microenvironment, is a better choice than spermatogenic-specific proteins. The studies described here provide valuable information regarding the genetic and molecular defects causing male mouse infertility to improve our understanding of the importance of spermatid-specific factors in controlling fertility. Although a male contraceptive 'pill' is still many years away, research into the production of new small-molecule contraceptives targeting spermatid-specific proteins is the right avenue.

The control of male fertility by spermatid-specific factors: searching for contraceptive targets from spermatozoon's head to tail

PubMed Central

Chen, Su-Ren; Batool, Aalia; Wang, Yu-Qian; Hao, Xiao-Xia; Chang, Chawn-Shang; Cheng, C Yan; Liu, Yi-Xun

2016-01-01

Male infertility due to abnormal spermatozoa has been reported in both animals and humans, but its pathogenic causes, including genetic abnormalities, remain largely unknown. On the other hand, contraceptive options for men are limited, and a specific, reversible and safe method of male contraception has been a long-standing quest in medicine. Some progress has recently been made in exploring the effects of spermatid-specifical genetic factors in controlling male fertility. A comprehensive search of PubMed for articles and reviews published in English before July 2016 was carried out using the search terms ‘spermiogenesis failure', ‘globozoospermia', ‘spermatid-specific', ‘acrosome', ‘infertile', ‘manchette', ‘sperm connecting piece', ‘sperm annulus', ‘sperm ADAMs', ‘flagellar abnormalities', ‘sperm motility loss', ‘sperm ion exchanger' and ‘contraceptive targets'. Importantly, we have opted to focus on articles regarding spermatid-specific factors. Genetic studies to define the structure and physiology of sperm have shown that spermatozoa appear to be one of the most promising contraceptive targets. Here we summarize how these spermatid-specific factors regulate spermiogenesis and categorize them according to their localization and function from spermatid head to tail (e.g., acrosome, manchette, head-tail conjunction, annulus, principal piece of tail). In addition, we emphatically introduce small-molecule contraceptives, such as BRDT and PPP3CC/PPP3R2, which are currently being developed to target spermatogenic-specific proteins. We suggest that blocking the differentiation of haploid germ cells, which rarely affects early spermatogenic cell types and the testicular microenvironment, is a better choice than spermatogenic-specific proteins. The studies described here provide valuable information regarding the genetic and molecular defects causing male mouse infertility to improve our understanding of the importance of spermatid-specific factors in controlling fertility. Although a male contraceptive ‘pill' is still many years away, research into the production of new small-molecule contraceptives targeting spermatid-specific proteins is the right avenue. PMID:27831554

CONTRACEPTION TECHNOLOGY: PAST, PRESENT AND FUTURE

PubMed Central

Sitruk-Ware, Regine; Nath, Anita; Mishell, Daniel R.

2012-01-01

Steady progress in contraception research has been achieved over the past 50 years. Hormonal and non-hormonal modern contraceptives have improved women’s lives by reducing different health conditions that contributed to considerable morbidity. However the contraceptives available today are not suitable to all users and the need to expand contraceptive choices still exists. Novel products such as new implants, contraceptive vaginal rings, transdermal patches and newer combinations of oral contraceptives have recently been introduced in family planning programs and hormonal contraception is widely used for spacing and limiting births. Concerns over the adverse effects of hormonal contraceptives have led to research and development of new combinations with improved metabolic profile. Recent developments include use of natural compounds such as estradiol (E2) and estradiol valerate (E2V) with the hope to decrease thrombotic risk, in combination with newer progestins derived from the progesterone structure or from spirolactone, in order to avoid the androgenic effects. Progesterone antagonists and progesterone receptor modulators are highly effective in blocking ovulation and preventing follicular rupture and are undergoing investigations in the form of oral pills and in semi long-acting delivery systems. Future developments also include the combination of a contraceptive with an antiretroviral agent for dual contraception and protection against sexually transmitted diseases, to be used before intercourse or on demand, as well as for continuous use in dual-protection rings. Alhough clinical trials of male contraception have reflected promising results, limited involvement of industry in that area of research has decreased the likelihood of having a male method available in the current decade. Development of non-hormonal methods are still at an early stage of research, with the identification of specific targets within the reproductive system in ovaries and testes, as well as interactions between spermatozoa and ova. It is hoped that the introduction of new methods with additional health benefits would help women and couples with unmet needs to obtain access to a wider range of contraceptives with improved acceptability. PMID:22995540

Contraception technology: past, present and future.

PubMed

Sitruk-Ware, Regine; Nath, Anita; Mishell, Daniel R

2013-03-01

Steady progress in contraception research has been achieved over the past 50 years. Hormonal and nonhormonal modern contraceptives have improved women's lives by reducing different health conditions that contributed to considerable morbidity. However, the contraceptives available today are not suitable to all users, and the need to expand contraceptive choices still exists. Novel products such as new implants, contraceptive vaginal rings, transdermal patches and newer combinations of oral contraceptives have recently been introduced in family planning programs, and hormonal contraception is widely used for spacing and limiting births. Concerns over the adverse effects of hormonal contraceptives have led to research and development of new combinations with improved metabolic profile. Recent developments include use of natural compounds such as estradiol and estradiol valerate with the hope to decrease thrombotic risk, in combination with newer progestins derived from the progesterone structure or from spirolactone, in order to avoid the androgenic effects. Progesterone antagonists and progesterone receptor modulators are highly effective in blocking ovulation and preventing follicular rupture and are undergoing investigations in the form of oral pills and in semi-long-acting delivery systems. Future developments also include the combination of a contraceptive with an antiretroviral agent for dual contraception and protection against sexually transmitted diseases, to be used before intercourse or on demand, as well as for continuous use in dual-protection rings. Although clinical trials of male contraception have reflected promising results, limited involvement of industry in that area of research has decreased the likelihood of having a male method available in the current decade. Development of nonhormonal methods is still at an early stage of research, with the identification of specific targets within the reproductive system in ovaries and testes, as well as interactions between spermatozoa and ova. It is hoped that the introduction of new methods with additional health benefits would help women and couples with unmet needs to obtain access to a wider range of contraceptives with improved acceptability. Copyright © 2013 Elsevier Inc. All rights reserved.

New approaches to male non-hormonal contraception

PubMed Central

Nya-Ngatchou, Jean-Jacques; Amory, John K.

2012-01-01

A non-hormonal male contraceptive is a contraceptive that does not involve the administration of hormones or hormone blockers. This review will focus on the use of lonidamine derivatives and inhibitors of retinoic acid biosynthesis and function as approaches to male non-hormonal contraception. Two current lonidamine derivatives, Adjudin and H2-gamendazole, are in development as male contraceptives. These potent anti-spermatogenic compounds impair the integrity of the apical ectoplasmic specialization, resulting in premature spermiation and infertility. Another approach to male contraceptive development is the inhibition of retinoic acid in the testes, as retinoic acid signaling is necessary for spermatogenesis. The administration of the retinoic acid receptor antagonist BMS-189453 reversibly inhibits spermatogenesis in mice. Similarly, oral dosing of WIN 18,446, which inhibits testicular retinoic acid biosynthesis, effectively contracepts rabbits. Hopefully, one of these approaches to non-hormonal male contraception will prove to be safe and effective in future clinical trials. PMID:22995542

Contraception: traditional and religious attitudes.

PubMed

Schenker, J G; Rabenou, V

1993-04-01

Humans have tried to control fertility for centuries. Primitive, preliterate societies practiced infanticide and abortion. When primitive women understood the advantages of conception control, they tried, when possible, to use contraception. In the 4th century B.C., Plato and Aristotle advocated a one-child family. Greek medical literature reported a hollow tube inserted through the cervix into the uterus and a potion as contraceptives. Islamic physicians had much knowledge about conception control. The attitudes toward contraception. In the 5th century B.C., Saint Augustine condemned contraception, even among married couples. The condom emerged in the early modern period. Yet, they were usually worn to protect against disease, e.g., bilharzia in Egypt and syphilis in Europe. The cervical cap and the diaphragm are examples of occlusive pessaries. By 1880, contraceptives and spermicides were advertised. In 1928, the IUD joined the existing contraceptives. Today we have combined oral contraceptives. Judaic law requires husbands to fulfill their wives sexual needs, separate from their duty to procreate. It also calls men, not women, to procreate and forbids men from masturbating, thus Judaic law does not forbid women from practicing contraception. The Roman Catholic church forbids contraceptive use because it is a sin against nature. Some Protestant denominations have allowed contraceptive use. Islamic law states that children are gifts from Allah. Some Moslems believe that they must have many children, but Allah and the Prophet state that children have rights to education and future security. These rights allow couples to prevent pregnancy. Neither Hinduism nor Buddhism prohibit contraceptive use. Differences in husband-wife communication, sex roles, access to contraceptives, and traditional family values will have more of an effect on contraceptive use and fertility than theological barriers or the social class of religious groups.

Contraceptives with novel benefits.

PubMed

Su, Ying; Lian, Qing-Quan; Ge, Ren-Shan

2012-01-01

Progesterone receptor (PR) agonists (progestins) and antagonists are developed for female contraceptives. However, non-contraceptive applications of newer progestins and PR modulators are being given more attention. The newer PR agonists including drospirenone, nomegestrol, trimegestone, dienogest and nestorone are being evaluated as contraceptives with health benefits because of their unique pharmacological properties. The selective PR modulators (SPRM; PR antagonists with PR agonistic properties) are under development not only for emergency contraception but also for other health benefits such as the treatment of endometritis and leiomyoma. After searching the literature from PubMed, clinicaltrials.gov and patent database, this review focuses on the effects and mechanisms of these progestins, and SPRMs as contraceptives with other health benefits. PR agonists and antagonists that have novel properties may generate better contraceptive effects with other health benefits.

Utilization of contraception among sexually active HIV positive women attending art clinic in University of Gondar Hospital: a hospital based cross-sectional study.

PubMed

Worke, Mulugeta Dile; Bezabih, Lealem Meseret; Woldetasdik, Mulat Adefris

2016-10-21

Contraception helps to prevent unplanned pregnancies among human immune virus positive women. The contraceptive utilization status and associated factors were not well addressed in the study area. Therefore, this study aimed to assess utilization of contraceptives and associated factors among human immune virus positive reproductive age group women appearing at anti-retroviral therapy clinic at the University of Gondar Hospital, North West Ethiopia. An institution based cross-sectional study was conducted among 397 systematically selected HIV positive reproductive age women who visited ART unit of the University of Gondar teaching referral hospital from January 8-20, 2014. The data were collected using pre tested and structured questionnaires through face-to-face interviews. The data were entered into Epi-Info version 3.5, and cleaned and analyzed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95 % confidence interval and P-value of 0.05. The study revealed that the overall utilization of any type of contraception was 50 %. Of them, 4.1 % got contraception from anti-retroviral therapy unit. Fear of side effects was the most common (42 %) reason for not using contraception. Women who attended secondary education, married and who had 4-6 children were more likely to use contraception than their counterparts were; (AOR: 5.63; 95 % CI: 1.74-18.21), (AOR: 8.07; 95 % CI: 3.10-20.99) and (AOR: 3.61; 95 % CI: 1.16-11.26) respectively. However, Women between 35-49 years, had no intention to have another child and discordant couples were 83 %, 76 % and 65 % less likely to use contraception respectively than their counterparts. The results of this study revealed that the utilization of contraception was low. Women between 35-49 years, those who had no intention to have another child and whose partner was HIV sero-negative and fear of side effect of the contraception played an important role for not using contraception. Therefore, there is a need to give attention about integration of family planning service with HIV care and support service.

42 CFR 68c.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Secretary, wherein the applicant agrees to participate in research on infertility or contraceptive... as required. Contraceptive development means research whose ultimate goal is to provide new or... determined by the Secretary. Research on infertility or contraceptive development means activities which...

42 CFR 68c.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Secretary, wherein the applicant agrees to participate in research on infertility or contraceptive... as required. Contraceptive development means research whose ultimate goal is to provide new or... determined by the Secretary. Research on infertility or contraceptive development means activities which...

An empirical test of the Theory of Planned Behaviour applied to contraceptive use in rural Uganda.

PubMed

Kiene, Susan M; Hopwood, Sarah; Lule, Haruna; Wanyenze, Rhoda K

2014-12-01

There is a high unmet need for contraceptives in developing countries such as Uganda, with high population growth, where efforts are needed to promote family planning and contraceptive use. Despite this high need, little research has investigated applications of health-behaviour-change theories to contraceptive use among this population. This study tested the Theory of Planned Behaviour's ability to predict contraceptive-use-related behaviours among post-partum women in rural Uganda. Results gave modest support to the theory's application and suggest an urgent need for improved theory-based interventions to promote contraceptive use in the populations of developing countries. © The Author(s) 2013.

Ends versus means: the role of markets in expanding access to contraceptives.

PubMed

Hanson, K; Kumaranayake, L; Thomas, I

2001-06-01

Achieving and sustaining universal access to contraceptives are key policy goals of interventions supplying contraceptive commodities. Donor support for contraceptive supplies is substantial and many public and national programmes rely on donated and subsidized supplies of contraceptives. Sustainability of programme benefits is a concern to both national governments and donor agencies. At the same time, market-based provision of contraceptives has become a major source of contraceptives for individuals in a number of countries. While the goals or 'ends' of policy are to increase and sustain universal access to contraceptives, there is debate about the role of markets and their negative impacts on equity and universality. There is also concern that while public programmes supplying free contraceptives may, in the medium-term, achieve high coverage, they may hamper the achievement of long-term sustainability and the development of commercial markets. This paper focuses on the tension between the public health and market paradigms, and uses economic analysis as a framework in order to examine the relative roles or 'means' for subsidized public and commercial private sector supply of contraceptives. The review of the theory and evidence focuses on the trade-offs between public sector and market provision of contraceptives, examining the role for the public sector given the potential for market failures, the impact of public provision on the development of markets, and the role of price in demand. However, because of the potential conflict between these policy objectives, we argue that strategies to deliver contraceptives should be based on the specific characteristics of the context. In particular four variables (contraceptive prevalence rates, HIV prevalence, income level of country, size and geographic spread of private sector development) are important in characterizing this context, and these are highlighted in a matrix of programme priorities. Public choices need to take into account the ways in which they will affect the potential for development of sustainable private sources of supply. Undertaking a 'market assessment' should be a key stage in the analysis of policy options. Such an assessment should address demand factors, health priorities, actual and potential sources of supply and the relationships between public and private supply. Clearly the development of markets for contraceptives is not an end in itself, but may prove an important means of improving the health of women and men.

The development of a multi-criteria decision analysis aid to help with contraceptive choices: My Contraception Tool.

PubMed

French, Rebecca S; Cowan, Frances M; Wellings, Kaye; Dowie, Jack

2014-04-01

My Contraception Tool (MCT) applies the principles of multi-criteria decision analysis to the choice of contraceptive method. Its purpose is to make the decision-making process transparent to the user and to suggest a method to them based on their own preferences. The contraceptive option that emerges as optimal from the analysis takes account of the probability of a range of outcomes and the relative weight ascribed to them by the user. The development of MCT was a collaborative project between London School of Hygiene & Tropical Medicine, Brook, FPA and Maldaba Ltd. MCT is available online via the Brook and FPA websites. In this article we describe MCT's development and how it works. Further work is needed to assess the impact it has on decision quality and contraceptive behaviour.

Contraception for adolescents in low and middle income countries: needs, barriers, and access

PubMed Central

2014-01-01

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents. PMID:24383405

Achieving a new controllable male contraception by the photothermal effect of gold nanorods.

PubMed

Li, Wen-qing; Sun, Chun-yang; Wang, Feng; Wang, Yu-cai; Zhai, Yi-wen; Liang, Meng; Liu, Wen-jing; Liu, Zhi-min; Wang, Jun; Sun, Fei

2013-06-12

During the process of human civilization, owning household pets has become increasingly popular. However, dogs and cats may be reservoirs or vectors of transmissible diseases to humans. Confronted with the overpopulation of pets, traditional contraception methods, surgical methods of sterilization, for animals are used, namely, ovariohysterectomy and orchidectomy. Therefore, a simple, nonsurgical, controllable, more effective and less expensive contraception method is highly desirable. In this study, we show that in situ testicular injection of methoxy poly(ethylene glycol)-modified gold nanorods with near-infrared irradiation in male mice can achieve short-lived or permanent male infertility. In a lower hyperthermia treatment, the morphology of testes and seminiferous tubules is only partly injured, and fertility indices are decreased to 10% at day 7, then recovered to 50% at day 60. In a higher hyperthermia treatment, the morphology of testes and seminiferous tubules are totally destroyed, and fertility indices are decreased to 0 at day 7. Overall, our results indicate a potential application of plasmonic nanomaterials for male contraception.

Initiatives: Nigeria. Traditional healers and PPFN in wedlock.

PubMed

Adejo, A A

1996-04-01

The Planned Parenthood Federation of Nigeria (PPFN) runs a program to integrate modern contraception into the practice of traditional medicine. Under the project, traditional healers, largely male, are trained on the ideals of nonprescriptive contraceptives such as condoms, the oral contraceptive pill, and foaming tablets, and how to offer such services to their clients. They participate in a two-week, highly participatory training course which confers a comprehensive introduction to basic and integrated reproductive health care service delivery, simple human anatomy and physiology, and human reproduction. The benefits of modern contraception are reviewed along with community mobilization and counseling. Simple communication techniques such as songs, drama, and role play are discussed. Information on maternal and child health and child survival, basic hygiene, nutrition, and AIDS is also incorporated into the course. 136 traditional healers have thus far been trained in three local government areas (LGAs) of Lagos State and 150 in six other LGAs in Benue State. The project has resulted in strong referral linkages between traditional healers, modern practitioners, and PPFN.

Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya

PubMed Central

Oguttu, Monica; Gemzell-Danielsson, Kristina

2018-01-01

Introduction Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. Methods A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research. Results Cronbach’s α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women’s autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling. Conclusion Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women. PMID:29527357

Pipeline for contraceptive development.

PubMed

Blithe, Diana L

2016-11-01

The high rates of unplanned pregnancy reflect an unmet need for effective contraceptive methods for women, especially for individuals with health risks such as obesity, diabetes, hypertension, and other conditions that may contraindicate use of an estrogen-containing product. Improvements in safety, user convenience, acceptability, and availability of products remain important goals of the contraceptive development program. Another important goal is to minimize the impact of the products on the environment. Development of new methods for male contraception has the potential to address many of these issues of safety for women who have contraindications to effective contraceptive methods but want to protect against pregnancy. It would also address a huge unmet need for men who want to control their fertility. Products under development for men would not introduce ecotoxic hormones into the water system. Published by Elsevier Inc.

Gender, Contraceptives and Individual Metabolic Predisposition Shape a Healthy Plasma Lipidome.

PubMed

Sales, Susanne; Graessler, Juergen; Ciucci, Sara; Al-Atrib, Rania; Vihervaara, Terhi; Schuhmann, Kai; Kauhanen, Dimple; Sysi-Aho, Marko; Bornstein, Stefan R; Bickle, Marc; Cannistraci, Carlo V; Ekroos, Kim; Shevchenko, Andrej

2016-06-14

Lipidomics of human blood plasma is an emerging biomarker discovery approach that compares lipid profiles under pathological and physiologically normal conditions, but how a healthy lipidome varies within the population is poorly understood. By quantifying 281 molecular species from 27 major lipid classes in the plasma of 71 healthy young Caucasians whose 35 clinical blood test and anthropometric indices matched the medical norm, we provided a comprehensive, expandable and clinically relevant resource of reference molar concentrations of individual lipids. We established that gender is a major lipidomic factor, whose impact is strongly enhanced by hormonal contraceptives and mediated by sex hormone-binding globulin. In lipidomics epidemiological studies should avoid mixed-gender cohorts and females taking hormonal contraceptives should be considered as a separate sub-cohort. Within a gender-restricted cohort lipidomics revealed a compositional signature that indicates the predisposition towards an early development of metabolic syndrome in ca. 25% of healthy male individuals suggesting a healthy plasma lipidome as resource for early biomarker discovery.

New approaches to male non-hormonal contraception.

PubMed

Nya-Ngatchou, Jean-Jacques; Amory, John K

2013-03-01

A non-hormonal male contraceptive is a contraceptive that does not involve the administration of hormones or hormone blockers. This review will focus on the use of lonidamine derivatives and inhibitors of retinoic acid biosynthesis and function as approaches to male non-hormonal contraception. Two current lonidamine derivatives, adjudin and H2-gamendazole, are in development as male contraceptives. These potent anti-spermatogenic compounds impair the integrity of the apical ectoplasmic specialization, resulting in premature spermiation and infertility. Another approach to male contraceptive development is the inhibition of retinoic acid in the testes, as retinoic acid signaling is necessary for spermatogenesis. The administration of the retinoic acid receptor antagonist BMS-189453 reversibly inhibits spermatogenesis in mice. Similarly, oral dosing of WIN 18,446, which inhibits testicular retinoic acid biosynthesis, effectively contracepts rabbits. Hopefully, one of these approaches to non-hormonal male contraception will prove to be safe and effective in future clinical trials. Copyright © 2013 Elsevier Inc. All rights reserved.

Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods.

PubMed

Bahamondes, Luis; Valeria Bahamondes, M; Shulman, Lee P

2015-01-01

Most contraceptive methods present benefits beyond contraception; however, despite a large body of evidence, many healthcare professionals (HCPs), users and potential users are unaware of those benefits. This review evaluates the evidence for non-contraceptive benefits of hormonal and non-hormonal contraceptive methods. We searched the medical publications in PubMed, POPLINE, CENTRAL, EMBASE and LILACS for relevant articles, on non-contraceptive benefits of the use of hormonal and intrauterine reversible contraceptive methods, which were published in English between 1980 and July 2014. Articles were identified using the following search terms: 'contraceptive methods', 'benefits', 'cancer', 'anaemia', 'heavy menstrual bleeding (HMB)', 'endometrial hyperplasia', 'endometriosis' and 'leiomyoma'. We identified, through the literature search, evidence that some combined oral contraceptives have benefits in controlling HMB and anaemia, reducing the rate of endometrial, ovarian and colorectal cancer and ectopic pregnancy as well as alleviating symptoms of premenstrual dysphoric disorder. Furthermore, the use of the levonorgestrel-releasing intrauterine system also controls HMB and anaemia and endometrial hyperplasia and cancer, reduces rates of endometrial polyps in users of tamoxifen and alleviates pain associated with endometriosis and adenomyosis. Depot medroxyprogesterone acetate controls crises of pain associated with sickle cell disease and endometriosis. Users of the etonogestrel-releasing contraceptive implant have the benefits of a reduction of pain associated with endometriosis, and users of the copper intrauterine device have reduced rates of endometrial and cervical cancer. Despite the high contraceptive effectiveness of many hormonal and intrauterine reversible contraceptive methods, many HCPs, users and potential users are concerned mainly about side effects and safety of both hormonal and non-hormonal contraceptive methods, and there is scarce information about the many benefits that these methods offer beyond contraception. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Approaches to the identification of new nonhormonal targets for male contraception.

PubMed

Kopf, Gregory S

2008-10-01

Fertility control is a global health issue with major personal and societal impact. Although, currently, there are several different options for contraception, the technologies behind these are antiquated, and the options for male-based contraception (i.e., withdrawal, condom and vasectomy) are inadequate. The genomic, proteomic and bioinformatic revolutions have provided new tools and new targets for contraceptive development, and the results of such approaches have identified gene products that play critical roles in male reproduction, thus expanding the array of potential targets for novel and innovative male-based contraceptives. This article will review the types of targets being considered in the development of nonhormonal male contraceptives and the technologies used to identify and validate these targets.

Semaglutide, a Once-Weekly Human GLP-1 Analog, Does Not Reduce the Bioavailability of the Combined Oral Contraceptive, Ethinylestradiol/Levonorgestrel

PubMed Central

Kapitza, Christoph; Nosek, Leszek; Jensen, Lene; Hartvig, Helle; Jensen, Christine B; Flint, Anne

2015-01-01

The effect of semaglutide, a once-weekly human glucagon-like peptide-1 (GLP-1) analog in development for type 2 diabetes (T2D), on the bioavailability of a combined oral contraceptive was investigated. Postmenopausal women with T2D (n = 43) on diet/exercise ± metformin received ethinylestradiol (0.03 mg)/levonorgestrel (0.15 mg) once daily for 8 days before (semaglutide-free) and during (steady-state 1.0 mg) semaglutide treatment (subcutaneous once weekly; dose escalation: 0.25 mg 4 weeks; 0.5 mg 4 weeks; 1.0 mg 5 weeks). Bioequivalence of oral contraceptives was established if 90%CI for the ratio of pharmacokinetic parameters during semaglutide steady-state and semaglutide-free periods was within prespecified limits (0.80–1.25). The bioequivalence criterion was met for ethinylestradiol area under the curve (AUC0–24 h) for semaglutide steady-state/semaglutide-free; 1.11 (1.06–1.15). AUC0–24 h was 20% higher for levonorgestrel at semaglutide steady-state vs. semaglutide-free (1.20 [1.15–1.26]). Cmax was within bioequivalence criterion for both contraceptives. Reductions (mean ± SD) in HbA1c (–1.1 ± 0.6%) and weight (–4.3 ± 3.1 kg) were observed. Semaglutide pharmacokinetics were compatible with once-weekly dosing; the semaglutide dose and dose-escalation regimen were well tolerated. Adverse events, mainly gastrointestinal, were mild to moderate in severity. Asymptomatic increases in mean amylase and lipase were observed. Three subjects had elevated alanine aminotransferase levels ≥3x the upper limit of normal during semaglutide/oral contraceptive coadministration, which were reported as adverse events, but resolved during follow-up. Semaglutide did not reduce the bioavailability of ethinylestradiol and levonorgestrel. PMID:25475122

Semaglutide, a once-weekly human GLP-1 analog, does not reduce the bioavailability of the combined oral contraceptive, ethinylestradiol/levonorgestrel.

PubMed

Kapitza, Christoph; Nosek, Leszek; Jensen, Lene; Hartvig, Helle; Jensen, Christine B; Flint, Anne

2015-05-01

The effect of semaglutide, a once-weekly human glucagon-like peptide-1 (GLP-1) analog in development for type 2 diabetes (T2D), on the bioavailability of a combined oral contraceptive was investigated. Postmenopausal women with T2D (n = 43) on diet/exercise ± metformin received ethinylestradiol (0.03 mg)/levonorgestrel (0.15 mg) once daily for 8 days before (semaglutide-free) and during (steady-state 1.0 mg) semaglutide treatment (subcutaneous once weekly; dose escalation: 0.25 mg 4 weeks; 0.5 mg 4 weeks; 1.0 mg 5 weeks). Bioequivalence of oral contraceptives was established if 90%CI for the ratio of pharmacokinetic parameters during semaglutide steady-state and semaglutide-free periods was within prespecified limits (0.80-1.25). The bioequivalence criterion was met for ethinylestradiol area under the curve (AUC0-24 h ) for semaglutide steady-state/semaglutide-free; 1.11 (1.06-1.15). AUC0-24 h was 20% higher for levonorgestrel at semaglutide steady-state vs. semaglutide-free (1.20 [1.15-1.26]). Cmax was within bioequivalence criterion for both contraceptives. Reductions (mean ± SD) in HbA1c (-1.1 ± 0.6%) and weight (-4.3 ± 3.1 kg) were observed. Semaglutide pharmacokinetics were compatible with once-weekly dosing; the semaglutide dose and dose-escalation regimen were well tolerated. Adverse events, mainly gastrointestinal, were mild to moderate in severity. Asymptomatic increases in mean amylase and lipase were observed. Three subjects had elevated alanine aminotransferase levels ≥3x the upper limit of normal during semaglutide/oral contraceptive coadministration, which were reported as adverse events, but resolved during follow-up. Semaglutide did not reduce the bioavailability of ethinylestradiol and levonorgestrel. © 2015 The Authors. The Journal of Clinical Pharmacology Published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

The mother of the pill.

PubMed

Djerassi, C

1995-01-01

The first synthesis of an active ingredient of the pill was performed on October 15, 1951, at Syntex in Mexico City. These preliminary results, obtained in late 1951, encouraged the submission of a synthetic progestin, norethindrone (19-nor-17alpha-ethynyltestosterone), to a number of outside investigators for more extensive biological scrutiny. Norethynodrel, together with many other steroids synthesized in the Searle laboratories, as well as Syntex's norethindrone, were examined by Pincus and collaborators for ovulation inhibition in animals and humans. Contrary to predictions, orally effective steroid ovulation inhibitors became the most widely used method of reversible birth control in most parts of the world some 40 years after their first synthesis. Toward the end of the 1960s, at least 13 international pharmaceutical companies (9 of them US) had active research and development programs dedicated to new advances in the field of contraception. Every drug to which a woman or man is exposed to for long periods of time (e.g., vaccines, systemic contraceptives, cholesterol-lowering agents, antihypertensives) in the end has to pass through large-scale postmarketing experiments. The most damaging was the requirement for 6-year toxicology in beagle dogs, which resulted in enormous development costs. Another setback was a 1986 judgment in Georgia against Ortho Pharmaceutical Company for the amount of $5,151,030 for alleged birth defects caused by the use of its spermicide Ortho-Gynol in spite of overwhelming epidemiological evidence against such a cause-effect relationship. Mifepristone (RU-486) is clearly the most significant new development in birth control as an important alternative to conventional abortion. A priority list of six new contraceptive methods for future development includes a spermicide with antiviral properties, a once-a-month menses inducer, a reliable ovulation predictor, easily reversible male sterilization, a male contraceptive pill, and an antifertility vaccine.

Searching for Ideal Contraceptives.

ERIC Educational Resources Information Center

Djerassi, Carl

1985-01-01

Discusses the problem of adolescent pregnancy and focuses on improving contraception as a practical solution. Describes the advantages and disadvantages of existing methods (the condom, the pill, and the contraceptive sponge). Predicts that the development of a fundamentally new contraceptive, such as a monthly menses-inducer pill, will not occur…

Cognitive Development and Adolescent Contraception: Integrating Theory and Practice.

ERIC Educational Resources Information Center

Gruber, Enid; Chambers, Christopher V.

1987-01-01

Asserts that cognitive skills that develop during adolescence are crucial to successful contraceptive practice and that practitioners must understand special developmental setting in which adolescent sexual growth and experimentation occur in order to impact contraceptive use. Demonstrates how health and medical providers can work together to…

Depo-Provera--ethical issues in its testing and distribution.

PubMed Central

Potts, M; Paxman, J M

1984-01-01

Ethical issues relating to the use of the injectable contraceptive in developed and developing countries alike involve public policy decisions concerning both criteria for testing a new drug and individual choices about using a specific form of contraception approved for national distribution. Drug testing consists of an important but still evolving set of procedures. Depo-Provera is not qualitatively different from any other drug and some unpredictable risks are inevitable, even after extensive animal experiments and clinical trials. In assessing the risks and benefits of Depo-Provera use, epidemiological data from large-scale human use is now beginning to become more important than data from animal experiments and clinical trials. The consumer's best interest is central to any ethically responsible system of drug distribution. Systems of informed choice are needed, even in societies where illiteracy remains common and medical services are weak. In the case of a contraceptive, the risks of non-use leading to unintended pregnancy, which can result in high mortality, are relevant as well as the side-effects of the method. An attempt, therefore, is made here to categorise those issues which are universal and those which are country-specific. PMID:6231379

Are modern contraceptives acceptable to people and where do they source them from across Nigeria?

PubMed

Onwujekwe, Obinna E; Enemuoh, Jane C; Ogbonna, Chinwe; Mbachu, Chinyere; Uzochukwu, Benjamin Sc; Lawson, Agathe; Ndyanabangi, Bannet

2013-01-23

Understanding the extent that different modern contraceptives are acceptable to different populations groups and where they get the commodities from will help in developing specific interventions that will help to scale-up the availability of the contraceptives. The study took place in urban and rural sites in six states across Nigeria. Data on acceptability and sources of the contraceptives was collected from at least 770 randomly selected mostly female householders from each state respectively using a questionnaire. Acceptability of the different contraceptives was scored by the respondents on a scale of 1 (lowest) to 10 (highest). The relationships between acceptability and sources of the contraceptives with socio-economic status and geographic location of the respondents were examined. The use of modern contraceptives in general was acceptable to 87% of the respondents. Male condom was the most acceptable means of contraceptive with an average score of 5.0. It was followed by implants with and oral contraceptive pill with average scores of 4.0, whilst IUD was the least acceptable with an average score of 2.9. The private sector was the major source of contraceptives to different population groups. Both male and female condoms were mostly procured from patent medicine dealers (PMD) and pharmacy shops. Intra Uterine Devices (IUDs) and implants were mostly sourced from public and private hospitals in the urban areas, whilst injectibles were mostly sourced from private hospitals. Oral contraceptives were mostly sourced from pharmacy shops and patent medicine dealers. There were SES and geographic differences for both acceptability and sources of the contraceptives. Also, the sources of different contraceptives depended on the type of the contraceptive. The different contraceptives were acceptable to the respondents and the major source of the contraceptives was the private sector. Hence, public-private partnership arrangements should be explored so that universal coverage with contraceptives could be easily achieved. Interventions should be developed to eliminate the inequities in both acceptability and sources of different contraceptives. The acceptability of all the contraceptives should be enhanced with relevant behaviour change communication interventions especially in areas with the lowest levels of acceptability.

Are modern contraceptives acceptable to people and where do they source them from across Nigeria?

PubMed Central

2013-01-01

Background Understanding the extent that different modern contraceptives are acceptable to different populations groups and where they get the commodities from will help in developing specific interventions that will help to scale-up the availability of the contraceptives. Methods The study took place in urban and rural sites in six states across Nigeria. Data on acceptability and sources of the contraceptives was collected from at least 770 randomly selected mostly female householders from each state respectively using a questionnaire. Acceptability of the different contraceptives was scored by the respondents on a scale of 1 (lowest) to 10 (highest). The relationships between acceptability and sources of the contraceptives with socio-economic status and geographic location of the respondents were examined. Results The use of modern contraceptives in general was acceptable to 87% of the respondents. Male condom was the most acceptable means of contraceptive with an average score of 5.0. It was followed by implants with and oral contraceptive pill with average scores of 4.0, whilst IUD was the least acceptable with an average score of 2.9. The private sector was the major source of contraceptives to different population groups. Both male and female condoms were mostly procured from patent medicine dealers (PMD) and pharmacy shops. Intra Uterine Devices (IUDs) and implants were mostly sourced from public and private hospitals in the urban areas, whilst injectibles were mostly sourced from private hospitals. Oral contraceptives were mostly sourced from pharmacy shops and patent medicine dealers. There were SES and geographic differences for both acceptability and sources of the contraceptives. Also, the sources of different contraceptives depended on the type of the contraceptive. Conclusion The different contraceptives were acceptable to the respondents and the major source of the contraceptives was the private sector. Hence, public-private partnership arrangements should be explored so that universal coverage with contraceptives could be easily achieved. Interventions should be developed to eliminate the inequities in both acceptability and sources of different contraceptives. The acceptability of all the contraceptives should be enhanced with relevant behaviour change communication interventions especially in areas with the lowest levels of acceptability. PMID:23343579

Vaginal ring delivery of selective progesterone receptor modulators for contraception

PubMed Central

Jensen, Jeffrey T.

2013-01-01

Vaginal ring delivery of selective progesterone receptor modulators (SPRMs) are under development to address limitations of current hormonal methods that affect use and effectiveness. This method would be appropriate for use in women with contraindications to, or preferences to avoid, estrogens. A contraceptive vaginal ring (CVR) also eliminates the need for daily dosing, and therefore might improve the effectiveness of contraception. The principle contraceptive effect of SPRMs is the suppression of ovulation. One limiting factor of chronic SPRM administration is the development of benign endometrial thickening characterized as PRM-associated endometrial changes. Ulipristal acetate is approved for use as an emergency contraceptive pill, but no SPRM is approved for regular contraception. The Population Council is developing an ulipristal acetate CVR for regular contraception. The CVR studied is of a matrix design composed of micronized UPA mixed in a silicone rubber matrix The target product is a ring designed for continuous use over 3 months delivering near steady-state drug levels that will suppress ovulation. Results from Phase 1–2 studies demonstrate that suppression of ovulation occurs with UPA levels above 6–7 ng/mL. PMID:23040126

Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

PubMed

Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

2017-03-15

Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

Azoospermia in rabbits following an intravas injection of Vasalgel ™.

PubMed

Waller, Donald; Bolick, David; Lissner, Elaine; Premanandan, Christopher; Gamerman, Gary

2016-01-01

Vasectomy is currently the only long-acting contraceptive option available for men, despite increasing demand and potentially significant positive impacts on human health of additional male contraceptive options. Vasalgel ™ is a high molecular weight hydrogel polymer being developed as a non-hormonal long-acting reversible male contraceptive. Vasalgel consists of styrene-alt-maleic acid dissolved in dimethyl sulfoxide, which is distinct from styrene-alt-maleic anhydride materials previously studied. The goal of the study was to determine the contraceptive efficacy of two test articles with different levels of styrene maleic acid (100 %, and 80 % acid/20 % anhydride). The test articles were injected bilaterally in the vasa deferentia of mature male rabbits. Post-implantation analyses of semen parameters were completed over a 12 month period and compared to baseline measures of sperm concentration, motility and forward progression. Both test articles were effective in blocking the passage of spermatozoa through the vasa deferentia in the 12 subjects completing the study. A significant decrease in sperm concentration occurred following implantation of the test material, with no measurable sperm concentration except for a few samples in one animal that were markedly oligospermic. Vasalgel produced a rapid onset of azoospermia, with no sperm in semen samples collected as early as 29-36 days post-implantation, and was durable over a 12 month period. This study indicated that Vasalgel is an effective non-hormonal long-acting male contraceptive in a rabbit model.

Association between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix.

PubMed

Volpato, Lia Karina; Siqueira, Isabela Ribeiro; Nunes, Rodrigo Dias; Piovezan, Anna Paula

2018-04-01

 To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina.  A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ 2 ) test was used for the qualitative variables, and the Student t-test, for the quantitative variables.  When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p  = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presenting with low-grade squamous intraepithelial lesion was 2.1 times higher ( p  = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed.  Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India.

PubMed

Mody, Sheila K; Nair, Saritha; Dasgupta, Anindita; Raj, Anita; Donta, Balaiah; Saggurti, Niranjan; Naik, D D; Silverman, Jay G

2014-06-01

The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization. Postpartum women aged 17-45 years (N=1049) completed the survey; 44.5% (n=467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47-1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum, and the most common method used was condoms 77.8% (n=126). Contraception nonuse was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling. This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India

PubMed Central

Mody, Sheila K; Nair, Saritha; Dasgupta, Anindita; Raj, Anita; Donta, Balaiah; Saggurti, Niranjan; Naik, DD; Silverman, Jay G

2014-01-01

Objective To examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. Study Design We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data was collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization. Results Postpartum women aged 17–45 years (N=1049) completed the survey; 44.5% (n= 467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and who had experienced physical violence or forced sex were more likely to not use postpartum contraception (AORs = 1.47–1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum and the most common method used was condoms 77.8% (n=126). Conclusion Contraception non-use was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling. Implications This original research study is a unique contribution to the literature because it presents data regarding the non-use of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions. PMID:24560478

The value and use of different contraceptive methods.

PubMed

Kumar, T C

1994-04-01

Reductions in the rates of maternal and child mortality as well as in demographic growth are directly linked to contraceptive usage. The development and availability of safer, improved contraceptives which are convenient to use could be expected to be used by a larger group of individuals and thus make an impact on reproductive health as well as on population growth rates. Such arguments have been used to support contraceptive research. This article deals with some of the developments that have occurred as a consequence of such efforts.

Condom use within marriage: a neglected HIV intervention.

PubMed Central

Ali, Mohamed M.; Cleland, John; Shah, Iqbal H.

2004-01-01

OBJECTIVE: To assess the contraceptive effectiveness of condoms versus oral contraceptive pills and estimate the reproductive consequences of a major shift from pill to condom use. METHODS: Secondary analysis was performed on nationally representative cross-sectional surveys of women in 16 developing countries. FINDINGS: In the 16 countries, the median per cent of married couples currently using condoms was 2%, compared with 13% for the pill. Condom users reported a higher 12-month failure and higher method-related discontinuation rates than pill users (9% and 44% vs 6% and 30%, respectively). Condom users were more likely to report subsequent abortion following failure (21% vs 14%), and also more likely to switch rapidly to another method (76% vs 58%). The reproductive consequences, in terms of abortion and unwanted births, of a hypothetical reversal of the relative prevalence of condom and pill were estimated to be minor. The main reason for this unexpected result is that the majority of abortions and unwanted births arise from non-use of any contraceptive method. CONCLUSION: A massive shift from the more effective oral contraceptive pills to the less effective condom would not jeopardize policy goals of reducing abortions and unwanted births. However, such a shift would potentially have an added benefit of preventing human immunodeficiency virus (HIV) infections, especially in countries with generalized HIV epidemics. PMID:15112006

New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes.

PubMed Central

Stang, A.; Schwingl, P.; Rivera, R.

2000-01-01

Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA). As safety information changes, however, checklists can quickly become outdated. Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives. In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods. Based on these criteria, new checklists for COCs and DMPA were developed. This article describes the new checklists and their development. Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements. Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility. These findings indicated the need for a checklist guide. In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use. The article reflects also the resulting updated checklist. PMID:10994285

Smelling wrong: hormonal contraception in lemurs alters critical female odour cues

PubMed Central

Crawford, Jeremy Chase; Boulet, Marylène; Drea, Christine M.

2011-01-01

Animals, including humans, use olfaction to assess potential social and sexual partners. Although hormones modulate olfactory cues, we know little about whether contraception affects semiochemical signals and, ultimately, mate choice. We examined the effects of a common contraceptive, medroxyprogesterone acetate (MPA), on the olfactory cues of female ring-tailed lemurs (Lemur catta), and the behavioural response these cues generated in male conspecifics. The genital odorants of contracepted females were dramatically altered, falling well outside the range of normal female variation: MPA decreased the richness and modified the relative abundances of volatile chemicals expressed in labial secretions. Comparisons between treatment groups revealed several indicator compounds that could reliably signal female reproductive status to conspecifics. MPA also changed a female's individual chemical ‘signature’, while minimizing her chemical distinctiveness relative to other contracepted females. Most remarkably, MPA degraded the chemical patterns that encode honest information about genetic constitution, including individual diversity (heterozygosity) and pairwise relatedness to conspecifics. Lastly, males preferentially investigated the odorants of intact over contracepted females, clearly distinguishing those with immediate reproductive potential. By altering the olfactory cues that signal fertility, individuality, genetic quality and relatedness, contraceptives may disrupt intraspecific interactions in primates, including those relevant to kin recognition and mate choice. PMID:20667870

Contraception for adolescents.

PubMed

2014-10-01

Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report. Copyright © 2014 by the American Academy of Pediatrics.

Contraceptive development: why the snail's pace?

PubMed

Kaeser, L

1990-01-01

Current contraceptive methods are not well-suited to many Americans. More safe and effective methods would be desirable. A report, "Developing New Contraceptives: Obstacles and Opportunities" was released in January 1990. It summarized 2 years of data collection by the Committee on Contraceptive Development which includes pharmaceutical company executives, physicians, reproductive biologists, public health, legal, and public policy experts, demographers, and economists. Barrier facing the development of new methods in the US were analyzed and ways to speed up research suggested. Particularly ill served are teenagers, young mothers, and comparatively older couples. The health risks of pregnancy, delivery, and labor "may be underrated." The pill is now the most common form of contraception in the US, followed by female sterilization, condoms, and vasectomy. 95% of women, aged 15-44, who have ever had intercourse, have used 1 or more contraceptive methods. Contraceptive discontinuation and failure rates are high, too. No fundamentally new contraceptives have been approved for use since the IUD and the pill in the 60s. Modifications of existing methods are in clinical trials. Obstacles cited were attitudes of the public, federal regulations and product liability, and the organization of and resources available for research. Public attitudes are very conservative. There is no great demand for more products. Since the 1960s, only 1 large pharmaceutical company (Ortho Pharmaceutical Corp.) is still involved in contraceptive research. Activity by small firms, nonprofit organizations, and universities has increased. Federal research funding in reproductive biology has only increased modestly since the mid 1970s. Private foundation support has dramatically declined. The time involved in the great costs of data required for Food and Drug Administration (FDA) approval have reduced research incentives. The average time it takes to get FDA approval has increased in the past 20 years. Weighing the risks and benefits of contraceptives is different from doing that with other drugs, yet FDA procedures do not allow for this. Product liability laws are different in each of the 50 states. Contraceptive development was greatly damaged by the mid 1980s insurance crisis. The committee recommended that the FDA put more importance on the effectiveness and convenience of new contraceptives. A comprehensive postmarketing surveillance system should be set up, and congress should pass a federal products liability law.

Attitudes toward family planning.

PubMed

Gille, H

1984-06-01

Many of the 135 countries participating in the 1974 UN World Population Conference were far from accepting the basic human right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so. Considerable progress has been made since then, and the number of developing countries that provide direct government support for family planning has increased to over 60%. Many have liberalized laws and regulations which restricted access to modern contraceptive methods, and a growing number provide family planning services within their health care programs. A few have recognized the practice of family planning as a constitutional right. In late 1983 at the Second African Population Conference, recognition of family as a human right was strongly contested by several governments, particularly those of West Africa. in developed countries most of the women at risk of unwanted pregnancy are using contraceptives. Of the major developing regions the highest use level is in Latin America, wherein most countries 1/3 to 1/2 of married women are users. Levels in Asian countries range from up to 10% in Afghanistan, Nepal, and Pakistan to up to 40% in the southeastern countries. China, a special case, now probably exceeds an overall use level of 2/3 of married women. Contraceptive use is lowest in Africa. There is room for improvement even among many of the successful family planning programs, as access to contraceptives usually is not sufficient to overcome limiting factors. To ensure the individual's free choice and strengthen the acceptability and practice of family planning, all available methods should be provided in service programs and inluded in information and education activities. Family planning programs should engage local community groups, including voluntary organizations, in all aspects of planning, management, and allocation of resources. At the government level a clear political commitment to family planning and population policies is essential as is administrative support. All government agencies concerned with socioeconomic benefit to the family and the community need to be involved in the coordinated planning and implementation.

Review on research of suppression male fertility and male contraceptive drug development by natural products.

PubMed

Bajaj, Vijay Kumar; Gupta, Radhey S

2013-08-01

Male contraceptive development in the present scenario is most viable aspect of research due to uncontrolled population growth in the world. In this respect investigators are busy to find out a safe male contraceptive drug. Researchers have started their finding for a suitable drug from natural sources because these are safe and easily acceptable for common man, most of natural sources are plants and their products. In this review 137 plants and their effects on reproduction and reproductive physiology are summarized. Some of them have intense effect on male reproductive system and do not produce any side effects. Reproductive toxicological studies are also important aspects of these kinds of researches, so it is important that drugs are safe and widely acceptable. An ideal male contraceptive can influence semen, testes, hormone level, accessory reproductive organs and general physiology of animals and produced some alterations. Many plants in this review are showing antifertility as well as antispermatogenic effects, so these may be used for further study for contraceptives development but it is important to find out the mechanism of reaction and further laboratory and clinical research on some plants are needed for final male contraceptive drug development. In conclusion this review will help for finding suitable plant products for male contraceptive clinical and laboratory studies.

Ongoing contraception after use of emergency contraception from a specialist contraceptive service.

PubMed

Cameron, Sharon T; Glasier, Anna; Johnstone, Anne; Rae, Leanne

2011-10-01

A consultation for emergency contraception (EC) gives way to an opportunity to provide women with an ongoing effective method of contraception. A review of the case notes of women seeking EC from a large family planning clinic in Edinburgh, Scotland, was conducted to determine what percentage of women were provided with an effective method of ongoing contraception. Case notes of 460 women presenting for EC over a 2-year period were reviewed. Women were of mean age 26 years (range 15-49 years) and presented because they had used no contraception (47%), experienced condom failure (42%) or missed oral contraceptive pills (9%). Only 2% (n=11) were given an intrauterine device for EC. All women who had missed contraceptive pills prior to taking EC opted to continue this method. Only 23% (n=89) of women using no method or condoms at EC received supplies of an effective contraceptive method (pills, patch, injectable). Two thirds (n=263) of the women chose condoms for ongoing contraception. Research is required to develop strategies to improve the uptake of effective contraception after EC. Copyright © 2011 Elsevier Inc. All rights reserved.

Contraceptive choice and acceptability: the future for STI risk in Kelantan, Malaysia.

PubMed

Shiely, Frances; Saifuddin, Mohammed Syafiek

2014-03-01

More than 150 million women become pregnant in developing countries annually and an estimated 287,000 die from pregnancy-related causes. Contraception is vital to prevent unnecessary maternal deaths, as well as sexually transmitted infections. The objective of this study was to investigate preferred contraceptive methods and the factors that influence contraceptive choice among women in Kelantan, Malaysia. A cross-sectional study using interview-based questionnaires was conducted, during July and August 2009, in local family planning clinics in Kelantan. The questionnaire was administered to adult women (age 20-50). Prevalence of unplanned pregnancies was high (48%). Contraceptive preference was Depo contraceptive injection (32%), oral contraceptive pills (27%), intrauterine devices (15%) and contraceptive implants (12%); 9% used condoms. Only 2% used contraception to protect against sexually transmitted infections or HIV/AIDS. Younger women (OR 0.90; 95% CI 0.807-0.993) were more likely to use contraception. In conclusion, non-interrupted contraceptive methods were preferred. More than 60% would stop using contraception if it interrupted intercourse. From both a public health and infectious disease perspective, this is extremely worrying.

21 CFR 310.501 - Patient package inserts for oral contraceptives.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Patient package inserts for oral contraceptives. 310.501 Section 310.501 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... the requirements of this section is misbranded under section 502 of the Federal Food, Drug, and...

21 CFR 310.501 - Patient package inserts for oral contraceptives.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Patient package inserts for oral contraceptives. 310.501 Section 310.501 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... the requirements of this section is misbranded under section 502 of the Federal Food, Drug, and...

Male Contraception: Research, New Methods, and Implications for Marginalized Populations.

PubMed

Plana, Olivia

2017-07-01

The majority of research on contraception has focused on manipulating the female reproductive system. Recent studies have identified novel contraceptives for males, including hormonal- and nonhormonal-based therapeutics. Although these new contraceptives are still undergoing clinical trials, their development and potential future use in society necessitate serious consideration of their implications for reproductive health. Through my analysis of the research conducted on male contraception over time and the current therapeutics available, it is clear that male contraception has the potential to shift societal gender dynamics and provide males with greater control over their own reproduction. This article also identifies the implications of these novel contraceptives for marginalized populations, especially men of color and men of lower socioeconomic positions. To overcome barriers to contraception among these populations, public policy efforts are needed in order to motivate the development of programs that facilitate coverage of these new male contraceptives by health plans and to increase their availability to underserved communities. Health care providers will be responsible for educating patients about these novel male contraception options and the need to continue using existing methods (e.g., condoms) in order to prevent sexually transmitted infections. This article analyzes the research conducted on male contraception and identifies the implications of these novel therapeutics for marginalized groups of men in the United States to identify the interventions that will be necessary to help ensure that all men have access to these promising scientific innovations.

Male Contraception: Research, New Methods, and Implications for Marginalized Populations

PubMed Central

Plana, Olivia

2015-01-01

The majority of research on contraception has focused on manipulating the female reproductive system. Recent studies have identified novel contraceptives for males, including hormonal- and nonhormonal-based therapeutics. Although these new contraceptives are still undergoing clinical trials, their development and potential future use in society necessitate serious consideration of their implications for reproductive health. Through my analysis of the research conducted on male contraception over time and the current therapeutics available, it is clear that male contraception has the potential to shift societal gender dynamics and provide males with greater control over their own reproduction. This article also identifies the implications of these novel contraceptives for marginalized populations, especially men of color and men of lower socioeconomic positions. To overcome barriers to contraception among these populations, public policy efforts are needed in order to motivate the development of programs that facilitate coverage of these new male contraceptives by health plans and to increase their availability to underserved communities. Health care providers will be responsible for educating patients about these novel male contraception options and the need to continue using existing methods (e.g., condoms) in order to prevent sexually transmitted infections. This article analyzes the research conducted on male contraception and identifies the implications of these novel therapeutics for marginalized groups of men in the United States to identify the interventions that will be necessary to help ensure that all men have access to these promising scientific innovations. PMID:26206159

Vital signs: trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive services—United States, 2005-2013.

PubMed

Romero, Lisa; Pazol, Karen; Warner, Lee; Gavin, Lorrie; Moskosky, Susan; Besera, Ghenet; Loyola Briceno, Ana Carolina; Jatlaoui, Tara; Barfield, Wanda

2015-04-10

Nationally, the use of long-acting reversible contraception (LARC), specifically intrauterine devices (IUDs) and implants, by teens remains low, despite their effectiveness, safety, and ease of use. To examine patterns in use of LARC among females aged 15-19 years seeking contraceptive services, CDC and the U.S. Department of Health and Human Services' Office of Population Affairs analyzed 2005-2013 data from the Title X National Family Planning Program. Title X serves approximately 1 million teens each year and provides family planning and related preventive health services for low-income persons. Use of LARC among teens seeking contraceptive services at Title X service sites increased from 0.4% in 2005 to 7.1% in 2013 (p-value for trend <0.001). Of the 616,148 female teens seeking contraceptive services in 2013, 17,349 (2.8%) used IUDs, and 26,347 (4.3%) used implants. Use of LARC was higher among teens aged 18-19 years (7.6%) versus 15-17 years (6.5%) (p<0.001). The percentage of teens aged 15-19 years who used LARC varied widely by state, from 0.7% (Mississippi) to 25.8% (Colorado). Although use of LARC by teens remains low nationwide, efforts to improve access to LARC among teens seeking contraception at Title X service sites have increased use of these methods. Health centers that provide quality contraceptive services can facilitate use of LARC among teens seeking contraception. Strategies to address provider barriers to offering LARC include: 1) educating providers that LARC is safe for teens; 2) training providers on LARC insertion and a client-centered counseling approach that includes discussing the most effective contraceptive methods first; and 3) providing contraception at reduced or no cost to the client.

77 FR 23487 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... Brain. Date: April 30, 2012. Time: 2 p.m. to 4 p.m. Agenda: To review and evaluate grant applications..., Population Research; 93.865, Research for Mothers and Children; 93.929, Center for Medical Rehabilitation Research; 93.209, Contraception and Infertility Loan Repayment Program, National Institutes of Health, HHS...

Canadian Contraception Consensus (Part 1 of 4).

PubMed

Black, Amanda; Guilbert, Edith; Costescu, Dustin; Dunn, Sheila; Fisher, William; Kives, Sari; Mirosh, Melissa; Norman, Wendy V; Pymar, Helen; Reid, Robert; Roy, Geneviève; Varto, Hannah; Waddington, Ashley; Wagner, Marie-Soleil; Whelan, Anne Marie; Ferguson, Carrie; Fortin, Claude; Kielly, Maria; Mansouri, Shireen; Todd, Nicole

2015-10-01

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements 1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2) 2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2) 3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel-releasing devices/systems), are the most effective reversible contraceptive methods and have the highest continuation rates. (II-1) 4. Canada currently does not collect reliable data to determine the use of contraceptive methods, abortion rates, and the prevalence of unintended pregnancy among reproductive-age women. (II-2) 5. A universal subsidy for contraceptive methods as provided by many of Canada's peer nations and a few Canadian provinces may produce health system cost-savings. (II-2) 6. Health Canada approval processes for contraceptives have been less efficient than those of other drug approval agencies and Health Canada processes for other classes of pharmaceuticals. (II-2) 7. It is feasible and safe for contraceptives and family planning services to be provided by appropriately trained allied health professionals such as midwives, registered nurses, nurse practitioners, and pharmacists. (II-2) Recommendations 1. Contraceptive counselling should include a discussion of typical use failure rates and the importance of using the contraceptive method consistently and correctly in order to avoid pregnancy. (II-2A) 2. Women seeking contraception should be counselled on the wide range of effective methods of contraception available, including long-acting reversible contraceptive methods (LARCs). LARCs are the most effective methods of reversible contraception, have high continuation rates, and should be considered when presenting contraceptive options to any woman of reproductive age. (II-2A) 3. Family planning counselling should include counselling on the decline of fertility associated with increasing female age. (III-A) 4. Health policy supporting a universal contraception subsidy and strategies to promote the uptake of highly effective methods as cost-saving measures that improve health and health equity should be considered by Canadian health decision makers. (III-B) 5. Canadian health jurisdictions should consider expanding the scope of practice of other trained professionals such as nurses, nurse practitioners, midwives, and pharmacists and promoting task-sharing in family planning. (II-2B) 6. The Canadian Community Health Survey should include adequate reproductive health indicators in order for health care providers and policy makers to make appropriate decisions regarding reproductive health policies and services in Canada. (III-B) 7. Health Canada processes and policies should be reviewed to ensure a wide range of modern contraceptive methods are available to Canadian women. (III-B) Chapter 2: Contraceptive Care and Access Summary Statements 8. Although there are many contraceptive options in Canada, only a narrow range of contraceptive methods are commonly used by those of reproductive age. (II-3) 9. Condom use decreases with longer relationship tenure and when the sexual partner is considered to be the main partner, likely due to a lower perceived risk of sexually transmitted infection in that relationship. Condom use may also decrease markedly as an unintended consequence when an effective non-barrier method, such as hormonal contraception or intrauterine contraception, is initiated. (II-3) 10. Family planning counselling provides a natural segue into screening for concerns about sexual function or intimate partner violence. (III) 11. Well-informed and well-motivated individuals who have developed skills to practise safer sex behaviours are more likely to use contraceptive and safer sex methods effectively and consistently. (II-2) Recommendations 8. Comprehensive family planning services, including abortion services, should be accessible to all Canadians regardless of geographic location. These services should be confidential, non-judgemental, and respectful of individuals' privacy and cultural contexts. (III-A) 9. A contraceptive visit should include history taking, screening for contraindications, dispensing or prescribing a method of contraception, and exploring contraceptive choice and adherence in the broader context of the individual's sexual behaviour, reproductive health risk, social circumstances, and relevant belief systems. (III-B) 10. Health care providers should provide practical information on the wide range of contraceptive options and their potential non-contraceptive benefits and assist women and their partners in determining the best user-method fit. (III-B) 11. Health care providers should assist women and men in developing the skills necessary to negotiate the use of contraception and the correct and consistent use of a chosen method. (III-B) 12. Contraceptive care should include discussion and management of the risk of sexually transmitted infection, including appropriate recommendations for condom use and dual protection, STI screening, post-exposure prophylaxis, and Hepatitis B and human papillomavirus vaccination. (III-B) 13. Health care providers should emphasize the use of condoms not only for protection against sexually transmitted infection, but also as a back-up method when adherence to a hormonal contraceptive may be suboptimal. (I-A) 14. Health care providers should be aware of current media controversies in reproductive health and acquire relevant evidence-based information that can be briefly and directly communicated to their patients. (III-B) 15. Referral resources for intimate partner violence, sexually transmitted infections, sexual dysfunction, induced abortion services, and child protection services should be available to help clinicians provide contraceptive care in the broader context of women's health. (III-B) Chapter 3: Emergency Contraception Summary Statements 12. The copper intrauterine device is the most effective method of emergency contraception. (II-2) 13. A copper intrauterine device can be used for emergency contraception up to 7 days after unprotected intercourse provided that pregnancy has been ruled out and there are no other contraindications to its insertion. (II-2) 14. Levonorgestrel emergency contraception is effective up to 5 days (120 hours) after intercourse; its effectiveness decreases as the time between unprotected intercourse and ingestion increases. (II-2) 15. Ulipristal acetate for emergency contraception is more effective than levonorgestrel emergency contraception up to 5 days after unprotected intercourse. This difference in effectiveness is more pronounced as the time from unprotected intercourse increases, especially after 72 hours. (I) 16. Hormonal emergency contraception (levonorgestrel emergency contraception and ulipristal acetate for emergency contraception) is not effective if taken on the day of ovulation or after ovulation. (II-2) 17. Levonorgestrel emergency contraception may be less effective in women with a body mass index > 25 kg/m2 and ulipristal acetate for emergency contraception may be less effective in women with a body mass index > 35 kg/m2. However, hormonal emergency contraception may still retain some effectiveness regardless of a woman's body weight or body mass index. (II-2) 18. Hormonal emergency contraception is associated with higher failure rates when women continue to have subsequent unprotected intercourse. (II-2) 19. Hormonal contraception can be initiated the day of or the day following the use of levonorgestrel emergency contraception, with back-up contraception used for the first 7 days. (III) 20. Hormonal contraception can be initiated 5 days following the use of ulipristal acetate for emergency contraception, with back-up contraception used for the first 14 days. (III) Recommendations 16. All emergency contraception should be initiated as soon as possible after unprotected intercourse. (II-2A) 17. Women should be informed that the copper intrauterine device (IUD) is the most effective method of emergency contraception and can be used by any woman with no contraindications to IUD use. (II-3A) 18.

The influence of partnership on contraceptive use among HIV-infected women accessing antiretroviral therapy in rural Uganda.

PubMed

Nieves, Christina I; Kaida, Angela; Seage, George R; Kabakyenga, Jerome; Muyindike, Winnie; Boum, Yap; Mocello, A Rain; Martin, Jeffrey N; Hunt, Peter W; Haberer, Jessica E; Bangsberg, David R; Matthews, Lynn T

2015-08-01

The objective was to determine individual and dyadic factors associated with effective contraceptive use among human immunodeficiency virus (HIV)-infected women accessing antiretroviral therapy (ART) in rural Uganda. HIV-infected women enrolled in the Uganda AIDS Rural Treatment Outcomes cohort completed questionnaires (detailing sociobehavioral characteristics, sexual and reproductive history, contraceptive use, fertility desires) and phlebotomy (October 2011-March 2013). We describe prevalence of effective contraceptive use (i.e., consistent condom use and/or oral contraceptives, injectable hormonal contraception, intrauterine device, female sterilization) in the previous 6 months among sexually active, nonpregnant women (18-40 years). We assessed covariates of contraceptive use using multivariable logistic regression. A total of 362 women (median values: age 30 years, CD4 count 397 cells/mm(3), 4.0 years since ART initiation) were included. Among 284 sexually active women, 50% did not desire a(nother) child, and 51% had a seroconcordant partner. Forty-five percent (n=127) reported effective contraceptive use, of whom 57% (n=72) used condoms, 42% (n=53) injectables, 12% (n=15) oral contraceptives and 11% (n=14) other effective methods. Dual contraception was reported by 6% (n=8). Only "partnership fertility desire" was independently associated with contraceptive use; women who reported that neither partner desired a child had significantly increased odds of contraceptive use (adjusted odds ratio: 2.40, 95% confidence interval: 1.07-5.35) compared with women in partnerships where at least one partner desired a child. Less than half of sexually active HIV-infected women accessing ART used effective contraception, of which 44% (n=56) relied exclusively on male condoms, highlighting a continued need to expand access to a wider range of longer-acting female-controlled contraceptive methods. Association with partnership fertility desire underscores the need to include men in reproductive health programming. Less than half of sexually active HIV-infected women accessing ART in rural Uganda reported using effective contraception, of whom 44% relied exclusively on the male condom. These findings highlight the need to expand access to a wider range of longer-acting, female-controlled contraceptive methods for women seeking to limit or space pregnancies. Use of contraception was more likely when both the male and female partner expressed concordant desires to limit future fertility, emphasizing the importance of engaging men in reproductive health programming. Copyright © 2015 Elsevier Inc. All rights reserved.

Adolescents: Contraceptive Knowledge and Use, a Brazilian Study

PubMed Central

Correia, Divanise S.; Pontes, Ana C. P.; Cavalcante, Jairo C.; Egito, E. Sócrates T.; Maia, Eulália M.C.

2009-01-01

The purpose of this study was to identify the knowledge and use of contraceptive methods by female adolescent students. The study was cross-sectional and quantitative, using a semi-structured questionnaire that was administered to 12- to 19-year-old female students in Maceió, Brazil. A representative and randomized sample was calculated, taking into account the number of hospital admissions for curettage. This study was approved by the Human Research Ethics Committee, and Epi InfoTM software was used for data and result evaluation using the mean and chi-square statistical test. Our results show that the majority of students know of some contraceptive methods (95.5%), with the barrier/hormonal methods being the most mentioned (72.4%). Abortion and aborting drugs were inaccurately described as contraceptives, and 37.9% of the sexually active girls did not make use of any method. The barrier methods were the most used (35.85%). A significant association was found in the total sample (2,592) between pregnancy and the use of any contraceptive method. This association was not found, however, in the group having an active sexual life (559). The study points to a knowledge of contraceptive methods, especially by teenagers who have already been pregnant, but contraceptives were not adequately used. The low use of chemical methods of contraception brings the risk of pregnancy. Since abortion and aborting drugs were incorrectly cited as contraceptive methods, this implies a nonpreventive attitude towards pregnancy. PMID:19151897

On the horizon: new options for contraception.

PubMed

Reifsnider, E

1997-01-01

Future contraceptives include refinements of existing contraceptives and totally new methods. New formulations of oral contraceptives, subdermal hormonal implants, injectable hormones, vaginal spermicides, and intrauterine devices (IUDs) are being tested around the world. New methods that are not yet available include the use of vaginal preparations containing sperm-immobilizing agents, gonadotrophin releasing hormone agonists and antagonists, vaccines against ova and sperm, and endogenous hormones. Male contraceptive methods use hormones to suppress testosterone and vaccines to immobilize sperm. The availability of all future contraceptives is dependent on ample funds for research, development, and testing, and such funds are in jeopardy.

Contraceptive Counseling: Best Practices to Ensure Quality Communication and Enable Effective Contraceptive Use

PubMed Central

Dehlendorf, Christine; Krajewski, Colleen; Borrero, Sonya

2014-01-01

Improving the quality of contraceptive counseling is one strategy to prevent unintended pregnancy. We identify aspects of relational and task-oriented communication in family planning care that can assist providers in meeting their patients’ needs. Approaches to optimizing women's experiences of contraceptive counseling include working to develop a close, trusting relationship with patients and using a shared decision-making approach that focuses on eliciting and responding to patient preferences. Providing counseling about side effects and using strategies to promote contraceptive continuation and adherence can also help optimize women's use of contraception. PMID:25264697

Development, validation and utilization of a highly sensitive LC-MS/MS method for quantification of levonorgestrel released from a subdermal implant in human plasma.

PubMed

Cirrincione, Lauren R; Penchala, Sujan Dilly; Scarsi, Kimberly K; Podany, Anthony T; Winchester, Lee C; Back, David J; Khoo, Saye H; Fletcher, Courtney V; Siccardi, Marco; Else, Laura J

2018-05-01

Levonorgestrel (LNG) is a synthetic progestin that is available in oral contraceptive tablets, a subdermal implant, and an intrauterine system for contraception. LNG pharmacokinetics are a pivotal determinant of contraceptive efficacy and essential in assessing drug-drug interactions influencing LNG exposure following different routes of LNG administration. A highly sensitive LC-MS/MS method was developed and validated to quantify levonorgestrel in human plasma. Liquid-liquid extraction was utilized with a sample volume of 500 μL to extract levonorgestrel from plasma. Chromatographic separation of LNG was achieved with a Fortis™ C18 (3 μm: 100 mm × 2.1 mm) reverse phase analytical column. The mobile phases consisted of de-ionized water plus 0.1% NH 4 OH (100:0.1%, v/v) (A), and methanol plus 0.1% NH 4 OH (100:0.1%, v/v) (B) delivered as a gradient at a flow rate of 400 μL/min. Detection of LNG and internal standard (D-(-)-norgestrel-d7) was achieved using positive polarity mode monitoring at 313.2-245.2 amu and 320.1-251.2 amu, respectively. The assay was linear over the calibration range of 49.6 to 1500 pg/mL. This method was used to quantify plasma LNG released by subdermal implant in support of a drug interaction study among women with HIV receiving efavirenz- or nevirapine-based antiretroviral therapy. Copyright © 2018 Elsevier B.V. All rights reserved.

Over-the-counter vaginal contraceptive and spermicide drug products containing nonoxynol 9; required labeling. Final rule.

PubMed

2007-12-19

The Food and Drug Administration (FDA) is issuing a final rule establishing new warning statements and other labeling information for all over-the-counter (OTC) vaginal contraceptive drug products (also known as spermicides, hereinafter referred to as vaginal contraceptives or vaginal contraceptives/spermicides) containing nonoxynol 9 (N9). These warning statements will advise consumers that vaginal contraceptives/spermicides containing N9 do not protect against infection from the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), or against getting other sexually transmitted diseases (STDs). The warnings and labeling information will also advise consumers that use of vaginal contraceptives and spermicides containing N9 can irritate the vagina and rectum and may increase the risk of getting the AIDS virus (HIV) from an infected partner. This final rule is part of FDA's ongoing review of OTC drug products. FDA is issuing this final rule after considering public comments on its proposed regulation, and all relevant data and information on N9 that have come to our attention.

Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

ERIC Educational Resources Information Center

Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

2010-01-01

Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

Anchoring Junctions As Drug Targets: Role in Contraceptive Development

PubMed Central

Mruk, Dolores D.; Silvestrini, Bruno; Cheng, C. Yan

2010-01-01

In multicellular organisms, cell-cell interactions are mediated in part by cell junctions, which underlie tissue architecture. Throughout spermatogenesis, for instance, preleptotene leptotene spermatocytes residing in the basal compartment of the seminiferous epithelium must traverse the blood-testis barrier to enter the adluminal compartment for continued development. At the same time, germ cells must also remain attached to Sertoli cells, and numerous studies have reported extensive restructuring at the Sertoli-Sertoli and Sertoli-germ cell interface during germ cell movement across the seminiferous epithelium. Furthermore, the proteins and signaling cascades that regulate adhesion between testicular cells have been largely delineated. These findings have unveiled a number of potential “druggable” targets that can be used to induce premature release of germ cells from the seminiferous epithelium, resulting in transient infertility. Herein, we discuss a novel approach with the aim of developing a nonhormonal male contraceptive for future human use, one that involves perturbing adhesion between Sertoli and germ cells in the testis. PMID:18483144

Status and future direction of male contraceptive development.

PubMed

Lyttle, C Richard; Kopf, Gregory S

2003-12-01

Control of fertility constitutes a global health issue, as overpopulation and unintended pregnancy have both major personal and societal impact. Although the contraceptive revolution in the 1960s following the development of hormonal-based oral contraceptives for women has had a major impact on societal dynamics in several cultures, little product innovation has occurred since then. One solution to this global health issue lies in the development of new and innovative contraceptives for both women and men, the goal of which is to provide a range of options for people at all stages and walks of life. Currently, three options for male-based contraception exist (i.e. withdrawal, condoms and vasectomy), and these are acknowledged as woefully inadequate. Introduction of new forms of male contraception based on both hormonal and non-hormonal paradigms are wanted and needed; this need is now becoming recognized by both the public and private sectors. New and innovative products will come from our knowledge of the unique physiology and genetics of reproduction, as well as by exploiting existing and future genomics, proteomics and protein network platforms.

Reproduction (II): Human Control of Reproductive Processes

ERIC Educational Resources Information Center

Jost, Alfred

1970-01-01

Describes methods of intervening in reproduction of animals and humans (artificial insemination, contraception, ovular and blastodisc transplants, pre selection of sex, cloning) and discusses the social implications of their use with humans. (AL)

Development and testing of an iOS waiting room "app" for contraceptive counseling in a Title X family planning clinic.

PubMed

Gilliam, Melissa L; Martins, Summer L; Bartlett, Emily; Mistretta, Stephanie Q; Holl, Jane L

2014-11-01

Long-acting reversible contraceptive (LARC) methods, such as the intrauterine device and implant, are highly effective but used by less than 10% of US women. The objective of our study was to improve LARC interest by enhancing clinic counseling. A quality improvement methodology was used to evaluate intrauterine device service delivery in 3 Chicago Title X clinics. To address identified barriers, we developed a theory-based iOS application (app) for patients to use in the clinic waiting room using human-centered design. The final prototype was tested in a randomized controlled trial in a Title X clinic with sexually active females (79% African American) under age 30 years. Our sample of 60 was chosen to detect an increase from 10% (baseline) to 45% (app intervention) in the proportion of patients expressing interest in discussing a LARC method during their clinic visit with 80% power and two-sided α = 0.05. After completing demographic and baseline knowledge questionnaires, participants were randomized 1:1 to intervention (app) or standard care arms. App users also completed a posttest. Our primary outcome was expressed interest in discussing a LARC method during the clinic visit. Secondary outcomes were contraceptive knowledge and LARC selection. App testers (n = 17) preferred interactive, visually appealing design and video testimonials. In the pilot randomized controlled trial (n = 52), app users had a significantly higher knowledge of contraceptive effectiveness (P = .0001) and increased interest in the implant (7.1-32.1%, P = .02) after the intervention. Users were highly satisfied with the app. Staff reported no problems using the app in the clinic. Use of a theory-based counseling app offers a novel method to optimize wait time while minimizing clinic flow disruption. Preliminary data demonstrate that app use was associated with improvements in patients' contraceptive knowledge and interest in the implant. Copyright © 2014 Elsevier Inc. All rights reserved.

42 CFR 68c.12 - What will happen if an individual does not comply with the terms and conditions of participation...

Code of Federal Regulations, 2011 CFR

2011-10-01

... NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN... subject to assessment of monetary damages and penalties as follows: (1) Participants who leave during the... participant will not be considered a breach of contract and monetary damages will not be assessed. (2) The...

42 CFR 68c.12 - What will happen if an individual does not comply with the terms and conditions of participation...

Code of Federal Regulations, 2012 CFR

2012-10-01

... NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN... subject to assessment of monetary damages and penalties as follows: (1) Participants who leave during the... participant will not be considered a breach of contract and monetary damages will not be assessed. (2) The...

42 CFR 68c.12 - What will happen if an individual does not comply with the terms and conditions of participation...

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN... subject to assessment of monetary damages and penalties as follows: (1) Participants who leave during the... participant will not be considered a breach of contract and monetary damages will not be assessed. (2) The...

Rural development and family planning behavior in Bangladesh Villages.

PubMed

Alauddin, M

1979-01-01

Variarion in knowledge and usage of contraceptive methods was examined across Bangladesh villages. It was hypothesized that the variation can be explained by 3 sets of factors measured at the village level: development programs, family planning program efforts, and given environmental and socioeconomic conditions. The data were drawn from the Bangladesh Fertility Survey and the 1974 Bangladesh Population Census. The 3 sets of factors taken together explained a greater proportion of the variance in knowledge and contraceptive usage than each of the sets taken either singly or in paired combination. Knowledge of clinical contraceptive methods was found to be affected more by development programs than by either family planning or environmental and socioeconomic conditions. Despite the fact that both development and family planning variables have independent and about equal effects on ever use of contraception, each of them separately is not likely to produce as much contraceptive usage as would both of them jointly. In terms of policy, if both development and family planning programs are provided to the villages, the effect on fertility may be maximized.

Resting state alpha frequency is associated with menstrual cycle phase, estradiol and use of oral contraceptives.

PubMed

Brötzner, Christina P; Klimesch, Wolfgang; Doppelmayr, Michael; Zauner, Andrea; Kerschbaum, Hubert H

2014-08-19

Ongoing intrinsic brain activity in resting, but awake humans is dominated by alpha oscillations. In human, individual alpha frequency (IAF) is associated with cognitive performance. Noticeable, performance in cognitive and emotional tasks in women is associated with menstrual cycle phase and sex hormone levels, respectively. In the present study, we correlated frequency of alpha oscillation in resting women with menstrual cycle phase, sex hormone level, or use of oral contraceptives. Electroencephalogram (EEG) was recorded from 57 women (aged 24.07 ± 3.67 years) having a natural menstrual cycle as well as from 57 women (aged 22.37 ± 2.20 years) using oral contraceptives while they sat in an armchair with eyes closed. Alpha frequency was related to the menstrual cycle phase. Luteal women showed highest and late follicular women showed lowest IAF or center frequency. Furthermore, IAF as well as center frequency correlated negatively with endogenous estradiol level, but did not reveal an association with endogenous progesterone. Women using oral contraceptives showed an alpha frequency similar to women in the early follicular phase. We suggest that endogenous estradiol modulate resting alpha frequency. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Unmet need for contraception and its association with unintended pregnancy in Bangladesh.

PubMed

Bishwajit, Ghose; Tang, Shangfeng; Yaya, Sanni; Feng, Zhanchun

2017-06-12

Unmet need for contraception and unintended pregnancy are important public health concerns both in developing and developed countries. Previous researches have attempted to study the factors that influence unintended pregnancy. However, the association between unmet need for contraception and unwanted pregnancy is not studied adequately. The aim of the present study was to measure the prevalence of unmet need for contraception and unwanted pregnancy, and to explore the association between these two in a nationally representative sample in Bangladesh. Data for the present study were collected from Bangladesh demographic and health survey conducted in 2011. Participants were 7338 mothers ageing between 13 and 49 years selected from both rural and urban residencies. Planning status of last pregnancy was the main outcome variable and unmet need for contraception was the explanatory variable of primary interest. Cross tabulation, chi-square tests and logistic regression (Generalised estimating equations) methods were used for data analysis. Mean age of the sample population was 25.6 years (SD 6.4). Prevalence of unmet need for contraception was 13.5%, and about 30% of the women described their last pregnancy as unintended. In the adjusted model, the odds of unintended pregnancy were about 16 fold among women who reported facing unmet need for contraception compared to those who did not (95% CI = 11.63-23.79). National rates of unintended pregnancy and of unmet need for contraception remain considerably high and warrant increased policy attention. Findings suggests that programs targeting to reduce unmet need for contraception could contribute to a lower rate of unintended pregnancy in Bangladesh. More in-depth and qualitative studies on the underlying sociocultural causes of unmet need can help develop context specific solutions to unintended pregnancies.

Oral contraceptives and dysmenorrhea.

PubMed

Cholst, I N; Carlon, A T

1987-01-01

This artical examines the risks and benefits associated with use of the oral contraceptive pill (OCP) by adolescents and the various alternatives and methods of prescribing OCPs. Any adolescent who is either sexually active or contemplating sexual activity should be offered a contraceptive method that is appropriate to her individual needs. The contraceptive needs to be highly effective, safe and within the means and desires of the adolescent. For the majority of teenagers, the contraceptive of choice will be the OCP. The IUD should almost never be prescribed to the adolescent. Most OCPs marketed today are combination pills containing both an estrogen and a progestin in each pill. A variety of contraceptive actions combines to create a contraceptive method that is 99.3-99.9% effective. OCPs provide some protection against the development of pelvic inflammatory disease (PID). Oral contraceptives also decrease the incidence of anemia by decreasing the amount and duration of menstrual flow. Ovarian cysts do not form in the ovaries of the OCP user. On the other hand, a serious risk of the use of OCPs is the increased danger of thromboembolic events including deep venous thrombosis, pulmonary embolus, and myocardial infarction. The increased risk of myocardial infarction in OCP users is additive with other risk factors including hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes mellitus, and age. OCP use seems to provide some protection against development of endometrial or ovarian cancer. Oral contraceptives are associated with the development of benign hepatocellular adenomas. A variety of metabolic and hormonal alterations also occur in pill users. Most appropriate for the adolescent is a formulation containing a low dose of estrogen because of the decreased risk of thromboembolic complications. Dysmenorrhea effects more than 1/2 of female adolescents, and can best be treated with ibuprofen.

Canadian Contraception Consensus (Part 2 of 4).

PubMed

Black, Amanda; Guilbert, Edith; Costescu, Dustin; Dunn, Sheila; Fisher, William; Kives, Sari; Mirosh, Melissa; Norman, Wendy V; Pymar, Helen; Reid, Robert; Roy, Geneviève; Varto, Hannah; Waddington, Ashley; Wagner, Marie-Soleil; Whelan, Anne Marie; Ferguson, Carrie; Fortin, Claude; Kielly, Maria; Mansouri, Shireen; Todd, Nicole

2015-11-01

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada. Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements  1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2)  2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2)  3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel-releasing devices/systems), are the most effective reversible contraceptive methods and have the highest continuation rates. (II-1)  4. Canada currently does not collect reliable data to determine the use of contraceptive methods, abortion rates, and the prevalence of unintended pregnancy among reproductive-age women. (II-2)  5. A universal subsidy for contraceptive methods as provided by many of Canada's peer nations and a few Canadian provinces may produce health system cost-savings. (II-2)  6. Health Canada approval processes for contraceptives have been less efficient than those of other drug approval agencies and Health Canada processes for other classes of pharmaceuticals. (II-2)  7. It is feasible and safe for contraceptives and family planning services to be provided by appropriately trained allied health professionals such as midwives, registered nurses, nurse practitioners, and pharmacists. (II-2) Recommendations 1. Contraceptive counselling should include a discussion of typical use failure rates and the importance of using the contraceptive method consistently and correctly in order to avoid pregnancy. (II-2A) 2. Women seeking contraception should be counselled on the wide range of effective methods of contraception available, including long-acting reversible contraceptive methods (LARCs). LARCs are the most effective methods of reversible contraception, have high continuation rates, and should be considered when presenting contraceptive options to any woman of reproductive age. (II-2A) 3. Family planning counselling should include counselling on the decline of fertility associated with increasing female age. (III-A) 4. Health policy supporting a universal contraception subsidy and strategies to promote the uptake of highly effective methods as cost-saving measures that improve health and health equity should be considered by Canadian health decision makers. (III-B) 5. Canadian health jurisdictions should consider expanding the scope of practice of other trained professionals such as nurses, nurse practitioners, midwives, and pharmacists and promoting task-sharing in family planning. (II-2B) 6. The Canadian Community Health Survey should include adequate reproductive health indicators in order for health care providers and policy makers to make appropriate decisions regarding reproductive health policies and services in Canada. (III-B) 7. Health Canada processes and policies should be reviewed to ensure a wide range of modern contraceptive methods are available to Canadian women. (III-B) Chapter 2: Contraceptive Care and Access Summary Statements  8. Although there are many contraceptive options in Canada, only a narrow range of contraceptive methods are commonly used by those of reproductive age. (II-3)  9. Condom use decreases with longer relationship tenure and when the sexual partner is considered to be the main partner, likely due to a lower perceived risk of sexually transmitted infection in that relationship. Condom use may also decrease markedly as an unintended consequence when an effective non-barrier method, such as hormonal contraception or intrauterine contraception, is initiated. (II-3) 10. Family planning counselling provides a natural segue into screening for concerns about sexual function or intimate partner violence. (III) 11. Well-informed and well-motivated individuals who have developed skills to practise safer sex behaviours are more likely to use contraceptive and safer sex methods effectively and consistently. (II-2) Recommendations 8. Comprehensive family planning services, including abortion services, should be accessible to all Canadians regardless of geographic location. These services should be confidential, non-judgemental, and respectful of individuals' privacy and cultural contexts. (III-A) 9. A contraceptive visit should include history taking, screening for contraindications, dispensing or prescribing a method of contraception, and exploring contraceptive choice and adherence in the broader context of the individual's sexual behaviour, reproductive health risk, social circumstances, and relevant belief systems. (III-B) 10. Health care providers should provide practical information on the wide range of contraceptive options and their potential non-contraceptive benefits and assist women and their partners in determining the best user-method fit. (III-B) 11. Health care providers should assist women and men in developing the skills necessary to negotiate the use of contraception and the correct and consistent use of a chosen method. (III-B) 12. Contraceptive care should include discussion and management of the risk of sexually transmitted infection, including appropriate recommendations for condom use and dual protection, STI screening, post-exposure prophylaxis, and Hepatitis B and human papillomavirus vaccination. (III-B) 13. Health care providers should emphasize the use of condoms not only for protection against sexually transmitted infection, but also as a back-up method when adherence to a hormonal contraceptive may be suboptimal. (I-A) 14. Health care providers should be aware of current media controversies in reproductive health and acquire relevant evidence-based information that can be briefly and directly communicated to their patients. (III-B) 15. Referral resources for intimate partner violence, sexually transmitted infections, sexual dysfunction, induced abortion services, and child protection services should be available to help clinicians provide contraceptive care in the broader context of women's health. (III-B) Chapter 3: Emergency Contraception Summary Statements 12. The copper intrauterine device is the most effective method of emergency contraception. (II-2) 13. A copper intrauterine device can be used for emergency contraception up to 7 days after unprotected intercourse provided that pregnancy has been ruled out and there are no other contraindications to its insertion. (II-2) 14. Levonorgestrel emergency contraception is effective up to 5 days (120 hours) after intercourse; its effectiveness decreases as the time between unprotected intercourse and ingestion increases. (II-2) 15. Ulipristal acetate for emergency contraception is more effective than levonorgestrel emergency contraception up to 5 days after unprotected intercourse. This difference in effectiveness is more pronounced as the time from unprotected intercourse increases, especially after 72 hours. (I) 16. Hormonal emergency contraception (levonorgestrel emergency contraception and ulipristal acetate for emergency contraception) is not effective if taken on the day of ovulation or after ovulation. (II-2) 17. Levonorgestrel emergency contraception may be less effective in women with a body mass index > 25 kg/m2 and ulipristal acetate for emergency contraception may be less effective in women with a body mass index > 35 kg/m2. However, hormonal emergency contraception may still retain some effectiveness regardless of a woman's body weight or body mass index. (II-2) 18. Hormonal emergency contraception is associated with higher failure rates when women continue to have subsequent unprotected intercourse. (II-2) 19. Hormonal contraception can be initiated the day of or the day following the use of levonorgestrel emergency contraception, with back-up contraception used for the first 7 days. (III) 20. Hormonal contraception can be initiated 5 days following the use of ulipristal acetate for emergency contraception, with back-up contraception used for the first 14 days. (III) Recommendations 16. All emergency contraception should be initiated as soon as possible after unprotected intercourse. (II-2A) 17. Women should be informed that the copper intrauterine device (IUD) is the most effective method of emergency contraception and can be used by any woman with no contraindications to IUD use. (II-3A) 18.

Development of a Brief Questionnaire to Assess Contraceptive Intent

PubMed Central

Raine-Bennett, Tina R; Rocca, Corinne H

2015-01-01

Objective We sought to develop and validate an instrument that can enable providers to identify young women who may be at risk of contraceptive non-adherence. Methods Item response theory based methods were used to evaluate the psychometric properties of the Contraceptive Intent Questionnaire, a 15-item self-administered questionnaire, based on theory and prior qualitative and quantitative research. The questionnaire was administered to 200 women aged 15–24 years who were initiating contraceptives. We assessed item fit to the item response model, internal consistency, internal structure validity, and differential item functioning. Results All items fit a one-dimensional model. The separation reliability coefficient was 0.73. Participants’ overall scores covered the full range of the scale (0–15), and items appropriately matched the range of participants’ contraceptive intent. Items met the criteria for internal structure validity and most items functioned similarly between groups of women. Conclusion The Contraceptive Intent Questionnaire appears to be a reliable and valid tool. Future testing is needed to assess predictive ability and clinical utility. Practice Implications The Contraceptive Intent Questionnaire may serve as a valid tool to help providers identify women who may have problems with contraceptive adherence, as well as to pinpoint areas in which counseling may be directed. PMID:26104994

Development of a brief questionnaire to assess contraceptive intent.

PubMed

Raine-Bennett, Tina R; Rocca, Corinne H

2015-11-01

We sought to develop and validate an instrument that can enable providers to identify young women who may be at risk of contraceptive non-adherence. Item response theory based methods were used to evaluate the psychometric properties of the Contraceptive Intent Questionnaire, a 15-item self-administered questionnaire, based on theory and prior qualitative and quantitative research. The questionnaire was administered to 200 women aged 15-24 years who were initiating contraceptives. We assessed item fit to the item response model, internal consistency, internal structure validity, and differential item functioning. All items fit a one-dimensional model. The separation reliability coefficient was 0.73. Participants' overall scores covered the full range of the scale (0-15), and items appropriately matched the range of participants' contraceptive intent. Items met the criteria for internal structure validity and most items functioned similarly between groups of women. The Contraceptive Intent Questionnaire appears to be a reliable and valid tool. Future testing is needed to assess predictive ability and clinical utility. The Contraceptive Intent Questionnaire may serve as a valid tool to help providers identify women who may have problems with contraceptive adherence, as well as to pinpoint areas in which counseling may be directed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

History of oral contraception.

PubMed

Dhont, Marc

2010-12-01

On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time. Animal experiments on the effect of sex steroids on ovulation, and the synthesis of sex steroids and orally active analogues were the necessary preliminaries. We owe the development of oral contraceptives to a handful of persons: two determined feminists, Margaret Sanger and Katherine McCormick; a biologist, Gregory Pincus; and a gynaecologist, John Rock. Soon after the introduction of the first pills, some nasty and life-threatening side effects emerged, which were due to the high doses of sex steroids. This led to the development of new preparations with reduced oestrogen content, progestins with more specific action, and alternative administration routes. Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception. Finally, all's well that ends well: recent reports have substantiated the multiple noncontraceptive health benefits paving the way for a bright future for this 50-year-old product.

Vital Signs: Trends in Use of Long-Acting Reversible Contraception Among Teens Aged 15–19 Years Seeking Contraceptive Services — United States, 2005–2013

PubMed Central

Romero, Lisa; Pazol, Karen; Warner, Lee; Gavin, Lorrie; Moskosky, Susan; Besera, Ghenet; Briceno, Ana Carolina Loyola; Jatlaoui, Tara; Barfield, Wanda

2015-01-01

Background Nationally, the use of long-acting reversible contraception (LARC), specifically intrauterine devices (IUDs) and implants, by teens remains low, despite their effectiveness, safety, and ease of use. Methods To examine patterns in use of LARC among females aged 15–19 years seeking contraceptive services, CDC and the U.S. Department of Health and Human Services’ Office of Population Affairs analyzed 2005–2013 data from the Title X National Family Planning Program. Title X serves approximately 1 million teens each year and provides family planning and related preventive health services for low-income persons. Results Use of LARC among teens* seeking contraceptive services at Title X service sites increased from 0.4% in 2005 to 7.1% in 2013 (p-value for trend <0.001). Of the 616,148 female teens seeking contraceptive services in 2013, 17,349 (2.8%) used IUDs, and 26,347 (4.3%) used implants. Use of LARC was higher among teens aged 18–19 years (7.6%) versus 15–17 years (6.5%) (p<0.001). The percentage of teens aged 15–19 years who used LARC varied widely by state, from 0.7% (Mississippi) to 25.8% (Colorado). Conclusions Although use of LARC by teens remains low nationwide, efforts to improve access to LARC among teens seeking contraception at Title X service sites have increased use of these methods. Implications for public health practice: Health centers that provide quality contraceptive services can facilitate use of LARC among teens seeking contraception. Strategies to address provider barriers to offering LARC include: 1) educating providers that LARC is safe for teens; 2) training providers on LARC insertion and a client-centered counseling approach that includes discussing the most effective contraceptive methods first; and 3) providing contraception at reduced or no cost to the client. PMID:25856258

Applying human rights to improve access to reproductive health services.

PubMed

Shaw, Dorothy; Cook, Rebecca J

2012-10-01

Universal access to reproductive health is a target of Millennium Development Goal (MDG) 5B, and along with MDG 5A to reduce maternal mortality by three-quarters, progress is currently too slow for most countries to achieve these targets by 2015. Critical to success are increased and sustainable numbers of skilled healthcare workers and financing of essential medicines by governments, who have made political commitments in United Nations forums to renew their efforts to reduce maternal mortality. National essential medicine lists are not reflective of medicines available free or at cost in facilities or in the community. The WHO Essential Medicines List indicates medicines required for maternal and newborn health including the full range of contraceptives and emergency contraception, but there is no consistent monitoring of implementation of national lists through procurement and supply even for basic essential drugs. Health advocates are using human rights mechanisms to ensure governments honor their legal commitments to ensure access to services essential for reproductive health. Maternal mortality is recognized as a human rights violation by the United Nations and constitutional and human rights are being used, and could be used more effectively, to improve maternity services and to ensure access to drugs essential for reproductive health. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Costs, payments, and incentives in family planning programs: a review for developing countries.

PubMed

Ross, J A; Isaacs, S L

1988-01-01

Anxieties about financing health and family planning programs have grown in recent years, leading to discussions of cost-recovery measures that would raise charges to the consumer. Yet some governments wish to lower cost to encourage contraceptive use, and a few use incentives and disincentives. Data from numerous developing countries are presented on contraceptive cost topics: charges for contraceptive supplies and services, in both public and private sectors, and conversely, payments made to clients and providers to offset costs and to increase contraceptive use. The data show great diversity, and much inconsistency within countries, indicating that the structures of charges, payments, and incentives in many programs could be improved. Ethical considerations are discussed, and guidelines are suggested for developing effective financial policies.

Human ecology and behavior and sexually transmitted bacterial infections.

PubMed Central

Holmes, K K

1994-01-01

The three direct determinants of the rate of spread of sexually transmitted diseases (STDs) are sexual behaviors, the mean duration of infectiousness, and the mean efficiency of sexual transmission of each STD. Underlying ecological and behavioral factors that operate through one or more of these direct determinants lie on a continuum, ranging from those most proximate back to those more remote (in time or mechanism) from the direct determinants. Most remote and least modifiable are the historical stages of economic development that even today conspicuously influence patterns of sexual behavior. Next are the distribution and changing patterns of climate, hygiene, and population density; the global population explosion and stages of the demographic transition; and ongoing changes in human physiology (e.g., menarche at younger age) and culture (e.g., later marriage). More proximate on the continuum are war, migration, and travel; and current policies for economic development and social welfare. Most recent or modifiable are technologic and commercial product development (e.g., oral contraceptives); circumcision, condom, spermicide, and contraception practices; patterns of illicit drug use that influence sexual behaviors; and the accessibility, quality, and use of STD health care. These underlying factors help explain why the curable bacterial STDs are epidemic in developing countries and why the United States is the only industrialized country that has failed to control bacterial STDs during the AIDS era. Images PMID:8146138

An intravaginal ring that releases three antiviral agents and a contraceptive blocks SHIV-RT infection, reduces HSV-2 shedding, and suppresses hormonal cycling in rhesus macaques.

PubMed

Derby, Nina; Aravantinou, Meropi; Kenney, Jessica; Ugaonkar, Shweta R; Wesenberg, Asa; Wilk, Jolanta; Kizima, Larisa; Rodriguez, Aixa; Zhang, Shimin; Mizenina, Olga; Levendosky, Keith; Cooney, Michael L; Seidor, Samantha; Gettie, Agegnehu; Grasperge, Brooke; Blanchard, James; Piatak, Michael; Lifson, Jeffrey D; Fernández-Romero, José; Zydowsky, Thomas M; Robbiani, Melissa

2017-12-01

Women globally need access to multipurpose prevention technologies (MPTs) that prevent human immunodeficiency virus (HIV), sexually transmitted infections that increase HIV acquisition/transmission risk, and unintended pregnancy. Seeking an MPT with activity against HIV, herpes simplex virus-2 (HSV-2), and human papillomavirus (HPV), we developed a prototype intravaginal ring (IVR), the MZCL IVR, which released the antiviral agents MIV-150, zinc acetate, and carrageenan (MZC for short) and the contraceptive levonorgestrel (LNG). Previously, we showed that an MZC gel has potent activity against immunodeficiency viruses, HSV-2, and HPV and that the MZCL (MZC with LNG) IVR releases all four components in macaques in vivo at levels associated with efficacy. Vaginal fluid from treated macaques has in vitro activity against HIV, HSV-2, and HPV. Herein, we assessed the ability of the MZCL IVR to protect macaques against repeated co-challenge with HSV-2 and SHIV-RT (simian immunodeficiency virus [SIV] containing the reverse transcriptase gene from HIV) and prevent hormonal cycling. We evaluated in vivo drug release in co-challenged macaques by measuring drug levels in blood and vaginal fluid and residual drug levels in used IVRs. The MZCL IVR significantly prevented SHIV-RT infection, reduced HSV-2 vaginal shedding, and prevented cycling. No non-nucleoside HIV reverse transcriptase inhibitor (NNRTI)-resistant SHIV was detected in macaques that became infected after continuous exposure to MZC from the IVR. Macaques wearing the MZCL IVR also had carrageenan levels in vaginal fluid expected to protect from HPV (extrapolated from mice) and LNG levels in blood associated with contraceptive efficacy. The MZCL IVR is a promising MPT candidate that warrants further development.

Developmental Exposure to Low Levels of Ethinylestradiol Affects Play Behavior in Juvenile Female Rats.

PubMed

Zaccaroni, Marco; Massolo, Alessandro; Della Seta, Daniele; Farabollini, Francesca; Giannelli, Giulietta; Fusani, Leonida; Dessì-Fulgheri, Francesco

2018-05-01

Juvenile social play contributes to the development of adult social and emotional skills in humans and non-human animals, and is therefore a useful endpoint to study the effects of endocrine disrupters on behavior in animal models. Ethinylestradiol (EE 2 ) is a widely produced, powerful synthetic estrogen that is widespread in the environment mainly because is a component of the contraceptive pill. In addition, fetuses may be exposed to EE2 when pregnancy is undetected during contraceptive treatment. To understand whether exposure to EE 2 during gestation or lactation affects social play, we exposed 72 female Sprague-Dawley rats to EE 2 or vehicle either during gestation (gestation day (GD) 5 through GD 20) or during lactation (from postnatal day (PND) 1 through PND 21). Two doses of EE 2 were used to treat the dams: a lower dose in the range of possible environmental exposure (4 ng/kg/day) and a higher dose equivalent to that received during contraceptive treatment (400 ng/kg/day). Behavioral testing was carried out between PND 40 and 45. A principal component analysis of frequencies of behavioral items observed during play sessions identified three main components: defensive-like play, aggressive-like play, and exploration. Aggressive-like play was significantly increased by both doses of EE 2 , and the gestational administration was in general more effective than the lactational one. Defensive-like play and exploration were not significantly affected by treatment. This research showed that low and very low doses of EE 2 that mimic clinical or environmental exposure during development can affect important aspects of social behavior even during restricted time windows.

Introducing new contraceptives.

PubMed

Segal, S J; Coutinho, E

1986-12-01

At this time, private research efforts to discover new contraceptives are threatened. Drug companies, particularly in the US, have reduced their interest in contraceptive development due to concern over the rising cost of product liability insurance, the cost of lawsuits in defense of liability claims, and the fear of extremely high awards by juries in product liability cases. The current form of private-public collaboration, now threatened by the liability crisis, works under a few simple principles of agreement. Private industry agrees to supply its patented chemical compounds for assessment as contraceptive agents, to be willing to enter into negotiations with public sector organizations to develop the contraceptive drugs if initial tests warrant it, and to release compounds to another company if the patent-holder declines to proceed with contraceptive development. The public-sector program agrees to fund the studies, keep the industry informed, and maintain confidentiality. When the technology is discovered by the public sector and is of potential interest to private industry, the collaboration involves other issues. The public agency agrees to supply manufacturing know-how and all biological and clinical information, to license under applicable patents, and to permit cross reference to regulatory agency filings. Private industry agrees to use its best efforts to bring the product to market, to manufacture the product at reduced cost for public sector use, or to provide know-how for others to do so. It also agrees to assume product liability and to grant the public sector agency licenses to any patented improvement in its product. Contraceptive research both within and outside the US is feeling the effects of the US litigious atmosphere. Companies from abroad now wish to steer clear of contraceptive research, even though these companies would be prepared to meet the requirements of the Food and Drug Administration. Contraceptives, considered to be high risk targets for lawsuits, are receiving little of the research budgets of pharmaceutical companies. Opposition anti-abortion forces also has had an effect. When the Population Council received new drug approval for the Copper-T-200, it was the 1st time the FDA had issued approval to a noncommercial sponsor. This unprecedented event established a new phase in the cooperative efforts between industry and the nonprofit sector to develop contraceptive products. It showed that given adequate funding, nonprofit agencies can carry out full product development, including the initial regulatory agency clearances.

Hot issues in female and male hormonal contraception.

PubMed

Gava, Giulia; Lantadilla, Claudia; Martelli, Valentina; Fattorini, Anna; Seracchioli, Renato; Meriggiola, Maria C

2016-02-01

In recent years a number of significant developments in the field of female hormonal contraception have been made which have produced new formulations and delivery systems providing high efficacy, safety and important non-contraceptive benefits. In particular long-acting reversible contraception (LARC) formulations have been demonstrated to ensure extremely high efficacy in typical use, minimal contraindications, optimal safety in all women thereby representing the best option for most women of all ages. Their effectiveness is not reliant upon user adherence and their ability to reduce unintended pregnancies and abortions has been proven. Unfortunately the same considerations cannot be made for male hormonal contraception. Although a large number of men are interested and would welcome the opportunity to use male contraceptive methods, no safe, effective and reversible methods are available on the market. Current methods available for men are limited to condoms and vasectomy. Highly effective prototype regimens have been developed but the pharmaceutical industry is unwilling to pursue further development and market these products. Of all new approaches to male contraception, hormonal methods are the closest to clinical application. These are based on the reversible suppression of luteinizing hormone and follicle stimulating hormone with subsequent reversible inhibition of spermatogenesis and consequent replacement to maintain androgen dependent physiological functions. Most approaches tested combination regimens such as testosterone and a progestin or testosterone and a GnRH analog.

Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country.

PubMed

Mir, Azeem Sultan; Malik, Raees

2010-08-01

Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to 'evil' practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force.

New male contraceptive entering clinical trials worldwide.

PubMed

1989-10-01

250 men are participating in a clinical trial of a reversible male testosterone contraceptive at the University of Washington in Seattle and at 9 other centers in Europe, Asia, and Australia. Clinicians inject the WHO-developed testosterone enanthate (200 mg) into these men once a week. The testosterone contraceptive instructs the pituitary gland to deactivate 2 hormones which normally maintain the testes' function resulting in a temporary stop of spermatogenesis just like the female oral contraceptive instructs the pituitary gland to suppress ovulation. Tests of 5 ejaculates in preliminary trials have indicated that 50-60% of the men experience azoospermia. Investigators are concerned with the possibility that ejaculates during normal intercourse may contain enough sperm to impregnate the partner. An investigator at the University of Washington believes this clinical trial of 250 men will determine whether this is indeed the case. The concern about contraceptive failure is the main problem with contraceptive testosterone. The minor side effects include weight gain which may be due to increased muscle mass and some sodium retention, acne, and possible reduction of libido but that has not yet occurred in the 250 men in the clinical trial. This contraceptive testosterone does not remain active for long periods of time if administered orally. Researchers are now developing a newer form of the contraceptive which will increase the intervals between administrations from 1 week to 3 months. An investigator from Seattle guesses that this male contraceptive will not be available for marketing in the US until at least 1994.

How the Pill Became a Lifestyle Drug: The Pharmaceutical Industry and Birth Control in the United States Since 1960

PubMed Central

Watkins, Elizabeth Siegel

2012-01-01

Marketing decisions, rather than scientific innovations, have guided the development and positioning of contraceptive products in recent years. I review the stalled progress in contraceptive development in the decades following the advent of the Pill in 1960 and then examine the fine-tuning of the market for oral contraceptives in the 1990s and 2000s. Although birth control has been pitched in the United States as an individual solution, rather than a public health strategy, the purpose of oral contraceptives was understood by manufacturers, physicians, and consumers to be the prevention of pregnancy, a basic health care need for women. Since 1990, the content of that message has changed, reflecting a shift in the drug industry's view of the contraception business. Two factors contributed to bring about this change: first, the industry's move away from research and development in birth control and second, the growth of the class of medications known as lifestyle drugs. PMID:22698049

How the pill became a lifestyle drug: the pharmaceutical industry and birth control in the United States since 1960.

PubMed

Watkins, Elizabeth Siegel

2012-08-01

Marketing decisions, rather than scientific innovations, have guided the development and positioning of contraceptive products in recent years. I review the stalled progress in contraceptive development in the decades following the advent of the Pill in 1960 and then examine the fine-tuning of the market for oral contraceptives in the 1990s and 2000s. Although birth control has been pitched in the United States as an individual solution, rather than a public health strategy, the purpose of oral contraceptives was understood by manufacturers, physicians, and consumers to be the prevention of pregnancy, a basic health care need for women. Since 1990, the content of that message has changed, reflecting a shift in the drug industry's view of the contraception business. Two factors contributed to bring about this change: first, the industry's move away from research and development in birth control and second, the growth of the class of medications known as lifestyle drugs.

Adolescent sexual behavior in the eighties.

PubMed

Bigler, M O

1989-10-01

This paper summarizes what is known about adolescent sexual behavior in the 1980s. One study found that 85% of American teens have had a boyfriend or girlfriend. Overall, 43% of teens have participated in vaginal play and 40% have experienced penile manipulation. A significant number of teenagers report having participated in oral sex. Many adolescents also report that they masturbate. Surveys of American adolescents have found that, on the whole, average age at 1st intercourse ranges from 16 to 16.9 years, but some teenagers begin to have intercourse shortly after puberty. The proportion of sexually-experienced teens increases with age. Many adolescents see their 1st experience sexual intercourse as a conscious, personal choice. At all ages, males are more likely to report having had intercourse than are females. Many adolescents who have had intercourse report regular contraceptive use. More than 1/3 (33%-39%) report contraceptive use every time they engage in intercourse. However, a large number of sexually experienced teenagers use contraception irregularly. Teenagers who have had intercourse express a preference for birth control pills over condoms as their primary means of contraception. Inconsistent contraceptive use among teens is reflected in the number of adolescent pregnancies in the US each year. In 1984, there were 233 adolescent pregnancies/1000 sexually active 15-19-year-old females. A large share of adolescent pregnancies end in abortion. 1 in 7 teens contracts a sexually transmitted disease each year. Many believe that teens are at high risk of infection with Human Immunodeficiency Virus (HIV) because of poorly protected sexual experimentation and intravenous drug use. Healthy adult sexuality may depend a great deal on the earlier years of sexual development.

Contraception and HIV infection in women.

PubMed

Heikinheimo, Oskari; Lähteenmäki, Pekka

2009-01-01

More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.

Current and future contraceptive options for women living with HIV

PubMed Central

Patel, Rena C.; Bukusi, Elizabeth A.; Baeten, Jared M.

2018-01-01

Introduction Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. Areas covered First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. Expert opinion Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted. PMID:28891343

Current and future contraceptive options for women living with HIV.

PubMed

Patel, Rena C; Bukusi, Elizabeth A; Baeten, Jared M

2018-01-01

Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. Areas covered: First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. Expert opinion: Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.

Uptake of long-acting reversible contraceptive devices in Western region of The Gambia.

PubMed

Anyanwu, Matthew; Alida, Bom Wekye Ndam

2017-06-01

The contraceptive method has become an essential factor in the life of most women of reproductive age group; although it varies in different stages of their life course. The use of long acting reversible methods (LARC) is proposed as a strategy to reverse undesirable maternal health consequences in developing countries. To determine the uptake of long-acting reversible contraceptive in The Gambia. A community based cross-sectional study of women attending family planning clinic were studied using intervieweradministered questionnaire which included information on socio-demographic factors, reproductive health and contraceptive use of the participants. About 89 % of study participants used long acting reversible contraceptive methods. Of the three commonly available long acting reversible contraceptive methods, Depo Provera was the most commonly used method; 78 of 141 (55.32%); followed by implants (43.3%) and intrauterine contraceptive (1.42%). Being housewives, with 3-4 living children and having secondary level education were associated with high uptake of LARC. The uptake of long acting reversible contraceptive was high; with Depo Provera as the most commonly used contraceptive method in The Gambia. There seemed to be an increase in the uptake of implants; with intrauterine contraceptive device being the least commonly used method.

Adolescent contraception.

PubMed

Apter, Dan

2012-01-01

Sexual health for adolescents is based on three components: recognizing sexual rights, sexuality education and counseling, and confidential high-quality services. Contraception needs to include prevention of both STIs and pregnancy. The main options for adolescents are condoms backed-up by emergency contraception; and hormonal contraceptives in a longer, mutually monogamous relationship. Condoms and hormonal contraception together can be well recommended for adolescents. Condom use should not be stopped before it is reasonably certain that the partner is STI-negative. Other alternatives can be considered in special cases. Improved contraceptive methods do not automatically lead to reduced numbers of adolescent abortions. The prevention of unintended adolescent pregnancies requires four elements: a desire to use protection, a good contraceptive method, ability to obtain the contraceptive method, and ability to use it. All these components are important, and if one is missing contraception will fail. In the developed countries, we have good contraceptive methods, but improvements are still needed in the other components. When adolescent sexuality is not condemned but sexuality education and sexual health services instead are provided, it is possible to profoundly improve adolescent sexual health with comparatively small costs. Each year new groups of young people mature, requiring new efforts. Copyright © 2012 S. Karger AG, Basel.

The `natural' body, God and contraceptive use in the southeastern United States

PubMed Central

WOODSONG, CYNTHIA; SHEDLIN, MICHELE; KOO, HELEN

2011-01-01

Data collected among African-American and Caucasian women and men in the southeastern USA indicate that participants' perceptions of nature, God's will and the human body influence reproductive health and decision-making. Attitudes about the health care system, pharmaceutical companies and government programmes for fertility regulation reinforce these views and may negatively affect willingness to use contraceptive methods consistently and correctly. PMID:21972833

Under-age girls and contraception: the parent's right to be informed.

PubMed

Brahams, Diana

1983-08-06

A British barrister considers the issue of whether the giving of advice or the prescribing of contraceptives to girls younger than 16 without parental consent constitutes criminal conduct by the physician. Brahams examines relevant criminal and family law, common law, recent court decisions, and Department of Health and Human Services policy concerning the minor's right to consent, parental interests, and physician responsibilities.

Recombinant production of enzymatically active male contraceptive drug target hTSSK2 - Localization of the TSKS domain phosphorylated by TSSK2.

PubMed

Shetty, Jagathpala; Sinville, Rondedrick; Shumilin, Igor A; Minor, Wladek; Zhang, Jianhai; Hawkinson, Jon E; Georg, Gunda I; Flickinger, Charles J; Herr, John C

2016-05-01

The testis-specific serine/threonine kinase 2 (TSSK2) has been proposed as a candidate male contraceptive target. Development of a selective inhibitor for this kinase first necessitates the production of highly purified, soluble human TSSK2 and its substrate, TSKS, with high yields and retention of biological activity for crystallography and compound screening. Strategies to produce full-length, soluble, biologically active hTSSK2 in baculovirus expression systems were tested and refined. Soluble preparations of TSSK2 were purified by immobilized-metal affinity chromatography (IMAC) followed by gel filtration chromatography. The biological activities of rec.hTSSK2 were verified by in vitro kinase and mobility shift assays using bacterially produced hTSKS (isoform 2), casein, glycogen synthase peptide (GS peptide) and various TSKS peptides as target substrates. Purified recombinant hTSSK2 showed robust kinase activity in the in vitro kinase assay by phosphorylating hTSKS isoform 2 and casein. The ATP Km values were similar for highly and partially purified fractions of hTSSK2 (2.2 and 2.7 μM, respectively). The broad spectrum kinase inhibitor staurosporine was a potent inhibitor of rec.hTSSK2 (IC50 = 20 nM). In vitro phosphorylation experiments carried out with TSKS (isoform 1) fragments revealed particularly strong phosphorylation of a recombinant N-terminal region representing aa 1-150 of TSKS, indicating that the N-terminus of human TSKS is phosphorylated by human TSSK2. Production of full-length enzymatically active recombinant TSSK2 kinase represents the achievement of a key benchmark for future discovery of TSSK inhibitors as male contraceptive agents. Copyright © 2016 Elsevier Inc. All rights reserved.

A Statistical Assessment of Information, Knowledge and Attitudes of Medical Students Regarding Contraception Use.

PubMed

Simionescu, Anca A; Horobet, Alexandra; Belascu, Lucian

2017-12-01

To evaluate how contraception use is linked to information, knowledge and attitudes towards family planning and contraception of medical students. This is a voluntary cross-sectional study using an anonymous questionnaire applied to 62 medical students. The questionnaire had the following main structure: characteristics of the studied population, information on contraception, knowledge about contraception methods, attitudes regarding family planning and contraception, and contraception use. Statistical analysis was performed using STATISTICA 8.0 software and statistical significance of the data was verified using the t-statistic test. The survey had a 95% response rate. Seventy seven percent of the studied population consisted of females aged between 20-40 years, with 85.50% of them being 20-25 years old. The overwhelming majority of respondents believed it was important to be informed on the subject and considered themselves to be well informed on contraception. The internet and courses are the main sources of information. Of all respondents, 75.41% had routine discussions with their partners regarding contraception, 53.23% talked about it with family members and 46.77% with their physician; 90.16% had at least one gynecological examination and 47.54% got themselves tested for sexually transmitted diseases. The condom and the contraceptive pill were the main contraceptive methods for the respondents. Romanian medical students share similar features to their peers in European developed countries. We used a statistical analysis to demonstrate that information, knowledge and attitudes on contraception are closely linked to contraceptive choice.

Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria.

PubMed

Ozumba, B C; Obi, S N; Ijioma, N N

2005-04-01

The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.

Contraceptive Evaluation.

ERIC Educational Resources Information Center

Hulka, Barbara S.; And Others

The objective of research in contraceptive evaluation is to improve the ability of individuals to choose contraceptive methods best suited to their needs and circumstances and to provide information that will lead to the development of safer and more effective methods. There are usually three considerations in judging the importance of a method of…

Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers.

PubMed

Politi, Mary C; Estlund, Amy; Milne, Anne; Buckel, Christina M; Peipert, Jeffrey F; Madden, Tessa

2016-01-01

The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.

Men's behavior surrounding use of contraceptives in Guinea.

PubMed

Baldé, Mamadou Diouldé; Diallo, Boubacar Alpha; Compaoré, Rachidatou; Bah, Abdoul Karim; Ali, Moazzam; Kabra, Rita; Kouanda, Seni

2016-11-01

To analyze the sociocultural determinants that influence the attitude and practices of men toward contraceptive use in Guinea. A sequential, mixed methods, qualitative and quantitative study was carried out in two regions of Guinea with a low rate of contraceptive prevalence, and in the capital city of Conakry. A total of 1170 people (men and women) were interviewed. Findings showed a positive perception of family planning overall, but reluctance to use modern contraception. The reasons for non-use of contraceptive methods were primarily the hope of having many children and religious prohibition associated with customs. Making decisions on contraceptive use within a couple represents a major cause of misunderstanding between spouses. Communication within a couple on the use of contraception is quickly declined by men. The findings demonstrate the need to develop communication strategies within a couple to improve the use of contraceptives. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Pharmacologic development of male hormonal contraceptive agents.

PubMed

Roth, M Y; Amory, J K

2011-01-01

The world population continues to increase dramatically despite the existence of contraceptive technology. The use of male hormonal contraception may help in preventing un intended pregnancies and managing future population growth. Male hormonal contraception relies on the administration of exogenous hormones to suppress spermatogenesis. Clinical trials have tested several regimens using testosterone, alone or in combination with a progestin. These regimens were shown to be >90% effective in preventing conception and were not associated with serious adverse events.

Use of modern contraception by the poor is falling behind.

PubMed

Gakidou, Emmanuela; Vayena, Effy

2007-02-01

The widespread increase in the use of contraception, due to multiple factors including improved access to modern contraception, is one of the most dramatic social transformations of the past fifty years. This study explores whether the global progress in the use of modern contraceptives has also benefited the poorest. Demographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. South and Southeast Asia have relatively high rates of modern contraception in the absolute poor, on average 17% higher than in Latin America. Over time the gaps in use persist and are increasing. Latin America exhibits significantly larger gaps in use between the poor and the averages, while gaps in sub-Saharan Africa are on average smaller by 15.8% and in Southeast Asia by 11.6%. The secular trend of increasing rates of modern contraceptive use has not resulted in a decrease of the gap in use for those living in absolute poverty. Countries with large economic inequalities also exhibit large inequalities in modern contraceptive use. In addition to macro level factors that influence contraceptive use, such as economic development and provision of reproductive health services, there are strong regional variations, with sub-Saharan Africa exhibiting the lowest national rates of use, South and Southeast Asia the highest use among the poor, and Latin America the largest inequalities in use.

Implications of employer coverage of contraception: Cost-effectiveness analysis of contraception coverage under an employer mandate.

PubMed

Canestaro, W; Vodicka, E; Downing, D; Trussell, J

2017-01-01

Mandatory employer-based insurance coverage of contraception in the US has been a controversial component of the Affordable Care Act (ACA). Prior research has examined the cost-effectiveness of contraception in general; however, no studies have developed a formal decision model in the context of the new ACA provisions. As such, this study aims to estimate the relative cost-effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions. A decision model was developed from the employer perspective to simulate pregnancy costs and outcomes associated with insurance coverage. Method-specific estimates of contraception failure rates, outcomes and costs were derived from the literature. Uptake by marital status and age was drawn from a nationally representative database. Providing no contraception coverage resulted in 33 more unintended pregnancies per 1000 women (95% confidence range: 22.4; 44.0). This subsequently significantly increased the number of unintended births and terminations. Total costs were higher among uninsured women owing to higher costs of pregnancy outcomes. The effect of no insurance was greatest on unmarried women 20-29 years old. Denying female employees' full coverage of contraceptives increases total costs from the employer perspective, as well as the total number of terminations. Insurance coverage was found to be significantly associated with women's choice of contraceptive method in a large nationally representative sample. Using a decision model to extrapolate to pregnancy outcomes, we found a large and statistically significant difference in unintended pregnancy and terminations. Denying women contraception coverage may have significant consequences for pregnancy outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Fertility Regulation in an Economic Crisis

PubMed Central

McKelvey, Christopher; Thomas, Duncan; Frankenberg, Elizabeth

2015-01-01

Substantial international aid is spent reducing the cost of contraception in developing countries, as part of a larger effort to reduce global fertility and increase investment per child worldwide. The importance for fertility behaviors of keeping contraceptive prices low, however, remains unclear. Targeting of subsidies and insufficient price variation have hindered prior attempts to estimate the effect of monetary and non-monetary contraceptive costs on fertility behavior. Using longitudinal survey data from the Indonesia Family Life Survey, we exploit dramatic variation in prices and incomes that was induced by the economic crisis in the late 1990s to pin down the effect of contraceptive availability and costs as well as household resources on contraceptive use and method choice. The results are unambiguous: monetary costs of contraceptives and levels of family economic resources have a very small (and well-determined) impact on contraceptive use and choice of method. PMID:25843969

New ways of preventing HIV infection: thinking simply, simply thinking

PubMed Central

Short, R.V

2006-01-01

HIV infection is the greatest health crisis in human history. It continues to spread unchecked among the poor in the developing world because we have failed to design simple preventative methods that are available and affordable to those living on under $2 a day. Five new methods are discussed. (i) A natural microbicide. Intravaginal lime or lemon juice has been used for centuries as a traditional contraceptive. The juice can also kill HIV in the laboratory, but clinical trials are needed to see if vaginal application is acceptable, safe and effective. (ii) Intravaginal oestrogen. Monkeys can be protected from Simian immunodeficiency virus (SIV) infection by keratinizing the vagina with topical oestrogen. If women take the oral contraceptive pill vaginally it retains its contraceptive efficacy, and the oestrogen it contains should thicken the vagina and protect against HIV infection. Clinical trials are needed. (iii) Male circumcision. Removal of the inner foreskin removes the main site of HIV entry into the penis, resulting in a sevenfold reduction in susceptibility to infection. The practice needs to be promoted. (iv) Post-coital penile hygiene. Wiping the penis immediately after intercourse with lime or lemon juice or vinegar should kill the virus before it has had a chance to infect. A clinical trial of efficacy is needed. (v) PhotoVoice. Asking schoolchildren in developing countries to photograph their impressions of HIV/AIDS is a powerful way of getting them to discuss the subject openly, and develop their own preventative strategies. PMID:16627296

Abnormal Papanicolaou smears, genital tract infections, and contraception.

PubMed

Hawkins, J W; Matteson, P S; Mersha, G

1999-01-01

Cervical cancer ranks second among all cancers in women world-wide, and the rate of invasive cervical cancer among women under 50 is rising in the United States. Risk factors for abnormal Papanicolaou (Pap) smears and invasive cervical cancer include genital tract infections. This study was designed to compare the rates of genital tract infections and the contraceptive choices of a random sample of 800 women, using an ex post facto design. The Pap positive women had a significantly higher rate of genital tract infections than did the Pap negative women but did not differ significantly in use of contraceptive methods. Findings support those of other researchers suggesting genital tract infections as risk factors for abnormal Pap smears and are consistent with the literature in suggesting a role for oral contraceptive pills (OCPs) in acquisition of the human papillomavirus (HPV). Caregivers can help empower women to reduce their risks through informed choices about protection and sexual behaviors.

New frontiers in nonhormonal male contraception

PubMed Central

Cheng, C. Yan; Mruk, Dolores D.

2015-01-01

The world’s population is nearing 6.8 billion, and we are in need of a male contraceptive that is safe, effective, reversible and affordable. Hormonal approaches, which employ different formulations of testosterone administered in combination with other hormones, have shown considerable promise in clinical trials, and they are currently at the forefront of research and development. However, the long-term effects of using hormones throughout a male’s reproductive life for contraception are unknown, and it may take decades before this information becomes available. Because of this, many investigators are aiming to bring a nonhormonal male contraceptive to the consumer market. Indeed, there are several distinct but feasible avenues in which fertility can be regulated without affecting the hypothalamus-pituitary-testis axis. In this review, we discuss several approaches for fertility control involving the testis that one day may lead to the development of a nonhormonal male contraceptive. PMID:20933122

New frontiers in nonhormonal male contraception.

PubMed

Cheng, C Yan; Mruk, Dolores D

2010-11-01

The world's population is nearing 6.8 billion, and we are in need of a male contraceptive that is safe, effective, reversible and affordable. Hormonal approaches, which employ different formulations of testosterone administered in combination with other hormones, have shown considerable promise in clinical trials, and they are currently at the forefront of research and development. However, the long-term effects of using hormones throughout a male's reproductive life for contraception are unknown, and it may take decades before this information becomes available. Because of this, many investigators are aiming to bring a nonhormonal male contraceptive to the consumer market. Indeed, there are several distinct but feasible avenues in which fertility can be regulated without affecting the hypothalamus-pituitary-testis axis. In this review, we discuss several approaches for fertility control involving the testis that one day may lead to the development of a nonhormonal male contraceptive. Copyright © 2010 Elsevier Inc. All rights reserved.

Contraceptive issues of youth and adolescents in developing countries: highlights from the Philippines and other Asian countries.

PubMed

Alesna-Llanto, Emma; Raymundo, Corazon M

2005-10-01

This article highlights contraceptive issues in Asia, home to some 700 million adolescents. It starts with a description of the socio-cultural milieu of adolescents in South and Southeast Asia, their knowledge and use of contraceptives, the myriad barriers to access, and the many innovative programs to broaden contraceptive availability. The reproductive health needs of adolescents in poor countries cannot be solved by merely supplying them with contraceptives--these needs can only be fully addressed in the context of gender equality, poverty alleviation and the conviction that investing in the reproductive health of adolescents is a most urgent priority. Investing in the reproductive health of adolescents will have an impact not only on birth and abortion rates, maternal health, and the spread of STI/HIV but also on the demographics and economic development of the region--and beyond.

Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women

PubMed Central

Jenkins, Cathy A.; Shepherd, Bryan E.; Bebawy, Sally S.; Turner, Megan; Sterling, Timothy R.; Melekhin, Vlada V.

2015-01-01

Abstract Background: Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population. Methods: We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use. Results: Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32–10.4) and mood disorders, specifically (aOR 4.70 [1.87–11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64–4.12 and aOR 1.16, 95% CI 0.86–1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01–2.08). Conclusions: Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs. PMID:25751720

Predicting effective contraceptive behavior in college females.

PubMed

Hughes, C B; Torre, C

1987-09-01

This article reports the results of a preliminary research project that explored the relationship between assertiveness, cognitive development and contraceptive behavior among single young women in their freshman and senior years at college. A total of 60 college women at a university health center volunteered to participate in this pilot study. They filled out three instruments: the Galassi College Self-Expression Scale (SES), the Measure of Intellectual Development (MID) tool and an author-developed sexuality questionnaire. Although there was a significant relationship between cognitive development and assertiveness, no significant relationships were found between cognitive development, assertiveness and use of effective contraception. Interesting descriptive characteristics were identified. Clinical implications are discussed.

Effect of a new injectable male contraceptive on the seminal plasma amino acids studied by proton NMR spectroscopy.

PubMed

Chaudhury, Koel; Sharma, Uma; Jagannathan, N R; Guha, Sujoy K

2002-09-01

Effect of RISUG, a newly developed male contraceptive, on various amino acids of seminal plasma ejaculates was studied by proton magnetic resonance spectroscopy at 400 MHz. Levels of amino acids were compared with the seminal plasma of obstructive azoospermia and controls. Glutamic acid, glutamine, and arginine were found to be high in concentration in human seminal plasma. The concentration of aromatic amino acids such as tyrosine, histidine, and phenylalanine in RISUG-injected subjects showed no significant difference compared to controls (p > 0.1); however, there was a statistically significant decrease in the concentration of these amino acids in obstructive azoospermia. The concentration of some prominent amino acids that showed overlapping resonances, such as isoleucine+leucine+valine (p < 0.01), alanine+isoleucine+lysine (p < 0.01), arginine+lysine+leucine (p < 0.01), and glutamic acid+glutamine (p < 0.01), showed a statistically significant decrease in RISUG-injected subjects compared to controls. Overlap of these amino acid resonances were noticed even at 600 MHz. In general, the total amino acids concentration in RISUG-injected subjects was found to be higher than in azoospermic subjects, confirming the occurrence of 'partial' obstructive azoospermia in subjects injected with this contraceptive.

Cabbages and condoms: packaging and channels of distribution.

PubMed

Potts, M

1984-12-01

Contraception is only rarely a therapy for disease. Usually, contraceptives help adults implement informed choices. Therefore, wider channels of distribution and promotion are possible and necessary than in the case of curative therapies. The more channels of distribution that are available for the same method of contraception, the higher the prevalence of use. Establishing new channels of distribution can be as important as developing new methods of contraception. Family planning is an important element in public health, and active promotion enhances the health of individuals and physicians. Other health professionals need to understand the role of non-medical skills and channels of contraceptive distribution.

Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country

PubMed Central

Mir, Azeem Sultan; Malik, Raees

2010-01-01

Background: Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. Aims: This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. Materials and Methods: The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Results: Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to ‘evil’ practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). Conclusion: The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force. PMID:22737673

[Male hormonal contraception: past, present, future].

PubMed

Pásztor, Norbert; Hegyi, Borbála Eszter; Badó, Attila; Németh, Gábor

2017-11-01

In certain regions of the world the enormous rate of population growth raises economic and public health concerns and widely accessible contraceptive methods would be desired. In contrast, in other countries the use of effective contraception is a question of individual preferences. Today, most of the reliable contraceptive methods are applied by women, while the options for male methods are quite limited. It is well known that significant portion of pregnancies are still unplanned and several data revealed men's willingness to take part in family planning. Based on these needs, remarkable efforts have been made to develop a suitable hormonal contraceptive agent for men. With the exogenous suppression of follicle stimulating hormone and luteinizing hormone secretion, the inhibition of the testicular testosterone production and the spermatogenesis can be achieved. In the beginning, testosterone-derivatives, or testosterone-progestin combinations were administered, later synthetic androgen agents were developed. Despite of these efforts, unfortunately, there is no safe, widely feasible male hormonal contraception to date, but in the future this goal can be achieved by solving the key hurdles. Orv Hetil. 2017; 158(46): 1819-1830.

[Community marketing of contraceptives].

PubMed

Urrutia, J M

1987-09-01

The 5-year-old community contraceptive distribution program developed by PROFAMILIA, Colombia's private family planning organization, has given excellent results, but several cost-effectiveness comparisons with social marketing programs have suggested that commercial distribution programs are superior. The community contraceptive distribution program has a high content of information and education activities, which produced significant increases in knowledge and use of contraception in the communities covered. It has been a fundamental support for the social marketing program, creating much of the demand for contraceptive products that the social marketing program has filled. The social marketing program has given good results in terms of volume of sales and in cost-effectiveness since 1976, prompting calls for replacement of the community contraceptive distribution program by the social marketing program in those sectors where knowledge and use of contraception have achieved acceptable levels. An experiment in the Department of Santander in 1984 and 1985 gave very favorable results, suggesting that community contraceptive distribution programs should be replaced by social marketing programs in all more developed markets. But economic problems in 1985 and the decision of manufacturers to decrease the profit margin for PROFAMILIA jeopardized the social marketing program. The community distribution program covered about 20% of the market. Reduced profits in the social marketing program threatened its continued expansion, at the same time that potential demand was growing because of increases in the fertile aged population and increased use of contraception. To meet the need, PROFAMILIA combined the community contraceptive distribution and social marketing programs into a new entity to be called community marketing. The strategy of the community marketing program will be to maintain PROFAMILIA's participation in the market and aid the growth of demand for contraceptives through educational and informational activities. The distribution scheme must continue to cover all the established points of sale in pharmacies despite the reduced profit margins.

Female adolescents' compliance with contraceptive regimens.

PubMed

Jay, M S; DuRant, R H; Litt, I F

1989-06-01

Although today's adolescents have access to a variety of contraceptive options, they remain inconsistent and suboptimal users of these methods. A particularly frustrating problem for those caring for adolescents is the issue of noncompliance with contraceptives, which is an important antecedent of adolescent pregnancy. In the future, new fertility-related developments such as subdermal hormonal implants may reduce the likelihood of noncompliance. For the present, however, systematic monitoring rather than only when noncompliance is suspected is essential in enhancing adolescents' contraceptive compliance.

Political and economic factors influencing contraceptive uptake.

PubMed

Sai, F T

1993-01-01

International, national and local level politics influence the uptake of contraception through consensuses, laws, financial and moral support or the creation of an enabling atmosphere. Opposition to contraception generally comes from some churches and groups opposed to particular technologies. Socio-economic factors, particularly education, the health care system and the perceived or actual cost of fertility regulation as compared to benefits expected from children also powerfully influence contraceptive use. For many poor women in developing countries their powerlessness in relation to their male partners is an important obstacle.

Hormonal contraceptive use and women's risk of HIV acquisition: priorities emerging from recent data.

PubMed

Ralph, Lauren J; Gollub, Erica L; Jones, Heidi E

2015-12-01

Understanding whether hormonal contraception increases women's risk of HIV acquisition is a public health priority. This review summarizes recent epidemiologic and biologic data, and considers the implications of new evidence on research and programmatic efforts. Two secondary analyses of HIV prevention trials demonstrated increased HIV risk among depot medroxyprogesterone acetate (DMPA) users compared with nonhormonal/no method users and norethisterone enanthate (NET-EN) users. A study of women in serodiscordant partnerships found no significant association for DMPA or implants. Two meta-analyses found elevated risks of HIV among DMPA users compared with nonhormonal/no method users, with no association for NET-EN or combined oral contraceptive pills. In-vitro and animal model studies identified plausible biological mechanisms by which progestin exposure could increase risk of HIV, depending on the type and dose of progestin, but such mechanisms have not been definitively observed in humans. Recent epidemiologic and biologic evidence on hormonal contraception and HIV suggests a harmful profile for DMPA but not combined oral contraceptives. In limited data, NET-EN appears safer than DMPA. More research is needed on other progestin-based methods, especially implants and Sayana Press. Future priorities include updating modeling studies with new pooled estimates, continued basic science to understand biological mechanisms, expanding contraceptive choice, and identifying effective ways to promote dual method use.

Does ethnicity matter in male hormonal contraceptive efficacy?

PubMed Central

Ilani, Niloufar; Liu, Peter Y; Swerdloff, Ronald S; Wang, Christina

2011-01-01

The development of male hormonal contraception has progressed significantly during the last three decades. The ultimate goal is to produce an effective, safe and reversible male method of contraception that are within reach of and can be used by all men globally. This review aims to outline the recent developments in male hormonal contraception with special emphasis on how ethnicity influences acceptability, extent of sperm suppression, and rate of recovery of spermatogenesis. Baseline differences in testicular histomorphology and testosterone metabolism between East Asian and Caucasian men have been reported, but whether this contributes significantly to varying degrees of sperm suppression in response to exogenous testosterone therapy is less known. Testosterone alone male hormonal contraceptive regimens are effective and applicable for East Asian men, and less so for Caucasians. Combinations of progestins with androgens are sufficient to optimize effectiveness of suppression and applicability to all ethnicities. New compounds such as steroidal or non-steroidal selective androgen receptor modulators with dual androgenic and progestational activities are potential compounds for further development as male hormonal contraceptive methods. At the present time, combined androgen and progestin contraceptive regimens appear to be effective, safe, reversible and convenient to use for all men with ethnic, cultural and environmental differences. Further refinements on the hormonal agent, methods of delivery, and dose optimization of the androgen relative to the progestin are necessary. This goal mandates further investment and large clinical trials in multiethnic populations to better define safety and efficacy. PMID:21317912

Emergency contraception. Widely available and effective but disappointing as a public health intervention: a review

PubMed Central

Baird, D.T.; Cameron, S.; Evers, J.L.H.; Gemzell-Danielsson, K.; Glasier, A.; Moreau, C.; Trussell, J.; von Hertzen, H.; Crosignani, P.G.; La Vecchia, C.; Volpe, A.; Glasier, A.; Crosignani, P.G.

2015-01-01

Emergency contraception (EC) prevents pregnancy after unprotected sex or contraceptive failure. Use of EC has increased markedly in countries where a product is available over the counter, yet barriers to availability and use remain. Although effective in clinical trials, it has not yet been possible to show a public health benefit of EC in terms of reduction of unintended pregnancy rates. Selective progesterone receptor modulators developed as emergency contraceptives offer better effectiveness than levonorgestrel, but still EC is less effective than use of ongoing regular contraception. Methods which inhibit ovulation whenever they are taken or which act after ovulation to prevent implantation and strategies to increase the uptake of effective ongoing contraception after EC use would prevent more pregnancies. PMID:25678571

Attitudes to current oral contraceptive use and future developments: the women's perspective.

PubMed

Fuchs, N; Prinz, H; Koch, U

1996-09-01

The study was planned to determine current trends in contraceptive usage and to examine the attitudes, needs and preferences of women with respect to oral contraceptives. Semi-structured interviews were carried out with women (n = 1201, aged 16-45 years) in Germany, the UK and France. The study revealed that oral contraceptives were the most popular method of contraception employed, followed by condoms, and that the majority of respondents were aged 16-19 years when they first used an oral contraceptive. An important finding of the study was that an oral contraceptive was first used only after having sexual intercourse for the first time (within 1 year), emphasizing the importance of effective contraceptive information and education for adolescents. Regarding non-contraceptive health benefits, protection from ovarian and endometrial cancer was perceived by respondents to be of the greatest importance; however, few women were spontaneously aware of this benefit. When given a number of different oral contraceptive intake options to assess, the established 'once daily for 21 consecutive days' option remained the most popular, although a 'once weekly' alternative was cited by many women. When asked about the preferred frequency of menstrual bleeding, there was a polarization between women favoring the normal monthly bleed and those wanting a 'no-bleed' regimen. Women are poorly informed about oral contraceptive use, and are largely unaware of the important long-term non-contraceptive benefits. Many women would prefer alternative pill intake options and a significant number would favor a 'no-bleed' regimen.

Comparisons of Contraceptive Use between Rural and Urban Teens.

PubMed

Geske, Savannah; Quevillon, Randal; Struckman-Johnson, Cindy; Hansen, Keith

2016-02-01

The purpose of the study was to determine if barriers in rural areas might decrease an adolescent's likelihood of obtaining effective contraception. Previous studies have reported mixed results in comparisons of rural and urban contraception use. Electronic survey. Midwestern Public University. Undergraduate and graduate women. Questionnaire. Participants retrospectively recalled their contraceptive use and barriers to contraceptive use between the 9th and 12th grades. A Barriers to Contraception Use Scale was created using exploratory factor analysis and yielded 31 questions with 1 underlying factor: barriers. Participants were identified as rural or urban using the Office of Management and Budget (OMB) definition and the participant's self-identification. Overall, rural participants endorsed more barriers to accessing contraceptives than urban participants using the OMB definition (χ(2) (2; n = 388) = 2.04; P < .05), and self-identification (χ(2) (2; n = 398) = 2.37; P < .05). However, no differences were found in contraception use according to the OMB definition, t (380) = -1.90; P = .06, or self-identification, t (380) = -2.11; P > .05. The Barriers to Contraception Use Scale total score predicted whether an individual would have a prescription for contraceptives 70.5% of the time compared to the base rate of 54.1%. Although no rural-urban differences in actual contraception use were found, rural participants reported more barriers to accessing contraception, and those who endorsed more barriers were less likely to obtain contraceptives while in high school. Pregnancy prevention programs should thus take these barriers into account when developing future interventions. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Prevalence of Abortion and Contraceptive Practice among Women Seeking Repeat Induced Abortion in Western Nigeria.

PubMed

Lamina, Mustafa Adelaja

2015-01-01

Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high.

Contraceptive use in Indonesia: a history of the programme and the characteristics of users.

PubMed

Samosir, O B

1992-12-01

In Indonesia, President Suharto instituted a population policy in the late 1960s to achieve national development goals. The government also introduced education, health, and economic-oriented development programs. Since then, it has continued to provide political, legal, moral, administrative, and financial support to the national family planning (FP) program. The program was first introduced in the most populous provinces of Java and Bali. It eventually spread to the remaining provinces. It has 3 component programs to achieve national population goals: on extension program (IEC activities and free contraceptives), program maintenance (community-based distribution), and an institutionalization program (integrated programs, population education, and recruiting community leaders). In 1987, the FP Self-Reliance and Blue Circle Campaign programs began to turn FP responsibilities over to communities and individuals. Between 1967 and 1981, the total fertility rate (TFR) fell from 5.61 to 4.06. The greatest fertility declines were in Bali (48.11%) and North Sulawesi (47.2%). An analysis of 1987 National Indonesian Contraceptive Prevalence Survey data shows that the TFR fell from 4.3 to 3.5 (23%) between 1984 and 1987. Between 1980 and 1987, the contraceptive use rate rose from 27 to 48%. Java and Bali had the highest contraceptive user rates. Large family size had a significant positive effect on contraceptive use. Educated women were more likely to use contraceptives than uneducated women, especially in Outer Java-Bali regions. In some regions, the husband's education affected contraceptive use. Muslim women were less likely to use contraceptives than other women in Bali and Outer Java-Bali I. Even though urban women had the highest use rates, the FP program was more successful in rural areas. The success of the national FP program and other development programs accounted for the fertility decline as well as the decline in mortality, resulting in a fall in the population growth rate.

Development and Implementation of a High Throughput Screen for the Human Sperm-Specific Isoform of Glyceraldehyde 3-Phosphate Dehydrogenase (GAPDHS)

PubMed Central

Sexton, Jonathan Z; Danshina, Polina V; Lamson, David R; Hughes, Mark; House, Alan J; Yeh, Li-An; O’Brien, Deborah A; Williams, Kevin P

2011-01-01

Glycolytic isozymes that are restricted to the male germline are potential targets for the development of reversible, non-hormonal male contraceptives. GAPDHS, the sperm-specific isoform of glyceraldehyde-3-phosphate dehydrogenase, is an essential enzyme for glycolysis making it an attractive target for rational drug design. Toward this goal, we have optimized and validated a high-throughput spectrophotometric assay for GAPDHS in 384-well format. The assay was stable over time and tolerant to DMSO. Whole plate validation experiments yielded Z’ values >0.8 indicating a robust assay for HTS. Two compounds were identified and confirmed from a test screen of the Prestwick collection. This assay was used to screen a diverse chemical library and identified fourteen small molecules that modulated the activity of recombinant purified GAPDHS with confirmed IC50 values ranging from 1.8 to 42 µM. These compounds may provide useful scaffolds as molecular tools to probe the role of GAPDHS in sperm motility and long term to develop potent and selective GAPDHS inhibitors leading to novel contraceptive agents. PMID:21760877

[Periodontal status in a sample of Senegalese women using hormonal contraception].

PubMed

Seck-Diallo, A; Cissé, M L; Benoist, H M; Diouf, A; Ahnoux-Kouadio, A; Diallo, T; Sembene, M; Moreau, J C; Diallo, P D

2008-03-01

Hormonal contraception is based on the use of synthetic hormones containing variable doses of oestrogen and progesterone making it possible to avoid pregnancy in a temporary and reversible way. The objective of this study is to evaluate the periodontal status of a sample of Senegalese women under hormonal contraceptive. One hundred women using contraception since at least 6 month were paired on the age, the socio-economic profile and oral hygiene with a control group. Oral hygiene (plaque index (PI) of Silness and Löe), the inflammation (gingival index (GI) of Löe and Silness), probing depth and clinical attachment loss were recorded. With equal hygiene, the scores of the gingival index were significantly higher among women under contraceptive (p < 0.001). Inflammation was significantly more marked for the women who used contraception in injectable form compared to the control group (p < 0.001). Probing depth (3.01 +/- 0.04) and clinical attachment loss (3.19 +/- 0.08) were significantly more important among women under contraceptive (p < 0.001). The women under contraceptive seem to set up a group at risk for developing a periodontal disease, it is thus necessary to systematise periodontal appraisal before and during contraceptive use period.

IPPF re-affirms its policy on sterilization: a free, informed and unpressured choice.

PubMed

1977-01-01

The IPPF has re-affirmed its policy on sterilization that individuals have the right to voluntarily choose a contraceptive method. A sterilization acceptor should understand all the implications and that the procedure should be considered irreversible, although medical techniques should be used to give the greatest chance of reversibility. An individual should know of alternative contraceptive methods and the risks and benefits involved with each. Incentives for family planning programs should ensure that benefits be in addition to the benefits and services which are entitled to everyone; likewise, any disincentives should not conflict with basic human rights. Family planning education should promote informed decisions on contraceptive use including sterilization procedures.

Present and future contraception: does discovery of targets lead to new contraceptives?

PubMed

Jensen, Jeffrey T

2015-01-01

Although many highly effective methods of reversible contraception are available, high rates of unintended pregnancy and abortion provide evidence that current methods do not meet the needs of all couples. In recent years, a number of highly specific targets have been identified in key pathways that regulate the development of male and female gametes. Support for development of novel approaches has moved from industry to governmental and foundation funders. Continued public funding will be needed to move promising leads into clinical trials.

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

PubMed

Williams, H A; Watkins, C E; Risby, J A

1996-06-01

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.

Population policies, programmes and the environment

PubMed Central

Speidel, J. Joseph; Weiss, Deborah C.; Ethelston, Sally A.; Gilbert, Sarah M.

2009-01-01

Human consumption is depleting the Earth's natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least $5 billion of the total, however, current donor assistance is less than a quarter of this funding target. PMID:19770155

Predicting fate of the contraceptive pill in wastewater treatment and discharge.

PubMed

Mastrup, M; Schäfer, A I; Khan, S J

2005-01-01

The risk of endocrine disrupters to humans and wildlife is to date poorly understood, although evidence of effects is now widespread. In understanding the risk, an important step is the determination of the partitioning, as well as chemical and biochemical transformation, of compounds in the environment, the water cycle and the food chain. This is a complex task and this paper is a first step towards estimating some of these factors from a largely theoretical approach. A chemical fate model is used to predict the fate of the contraceptive drug 17alpha-ethinylestradiol (EE2). The example of the contraceptive pill is chosen to follow the journey of the drug from human ingestion and excretion to treatment in a sewage treatment plant (STP) using fugacity-based fate models, followed by discharge into a receiving river and eventually into the estuary/sea. The model predicts how EE2 will partition into the different compartments during each stage of this journey and thereby infiltrate into the food chain. The results suggest that a person would have to ingest more than 30,000 portions of fish to consume an equivalent to a single average dose of the contraceptive pill. While this scenario is highly unlikely, the biochemical consequence of the contraceptive pill is greatly significant. Furthermore, there are many identified similarly estrogenic compounds in the environment while this study only considers one. Cumulative effects of such compounds as well as degradation into other potent compounds may be anticipated. An important message in this paper is the interrelation of wastewater effluent discharge and eventual human exposure of marginally degradable and lipophilic chemicals. While at present the main concerns regarding endocrine disrupters appear to be the fear of their occurrence in drinking water sources, it is clear that the domains of wastewater treatment and discharge, water supply and contamination of food should not be treated as separate issues. The model suggests that exposure from food (contaminated by effluent) may be much more significant than from drinking water.

Budget impact analysis of 8 hormonal contraceptive options.

PubMed

Crespi, Simone; Kerrigan, Matthew; Sood, Vipan

2013-07-01

To develop a model comparing costs of 8 hormonal contraceptives and determine whether acquisition costs for implants and intrauterine devices (IUDs) were offset by decreased pregnancy-related costs over a 3-year time horizon from a managed care perspective. A model was developed to assess the budget impact of branded or generic oral contraceptives (OCs), quarterly intramuscular depot medroxyprogesterone, etonogestrel/ethinyl estradiol vaginal ring, etonogestrel implant, levonorgestrel IUD, norelgestromin/ethinyl estradiol transdermal contraceptive, and ethinyl estradiol/levonorgestrel extended-cycle OC. Major variables included drug costs, typical use failure rates, discontinuation rates, and pregnancy costs. The base case assessed costs for 1000 women initiating each of the hormonal contraceptives. The etonogestrel implant and levonorgestrel IUD resulted in the fewest pregnancies, 63 and 85, respectively, and the least cost, $1.75 million and $2.0 million, respectively. In comparison, generic OC users accounted for a total of 243 pregnancies and $3.4 million in costs. At the end of year 1, costs for the etonogestrel implant ($800,471) and levonorgestrel IUD ($949,721) were already lower than those for generic OCs ($1,146,890). Sensitivity analysis showed that the cost of pregnancies, not product acquisition cost, was the primary cost driver. Higher initial acquisition costs for the etonogestrel implant and levonorgestrel IUD were offset within 1 year by lower contraceptive failure rates and consequent pregnancy costs. Thus, after accounting for typical use failure rates of contraceptive products, the etonogestrel implant and levonorgestrel IUD emerged as the least expensive hormonal contraceptives.

CSM in Latin America: new developments.

PubMed

1986-01-01

SOMARC is currently providing support to contraceptive social marketing efforts in Bolivia, Brazil, and Paraguay. The distinctly different family planning climates in these 3 countries have provided SOMARC with an opportunity to practice programmatic flexibility in project strategy and design. In Bolivia, the SOMARC strategy for implementing contraceptive social marketing is primarily a private sector venture in which donated products will be imported by local distributors and sold through the traditional channels. Distribution services through a network of local private family planning groups will provide SOMARC with direct access to Bolivian trade unions and work organizations. These family planning groups will in turn be strengthened by their association with the social marketing program as a potential source of revenue. In Brazil, where many low-priced contraceptives are already on the market, SOMARC's role will be in the areas of communication and promotion to increase contraceptive prevalence. The first task will be to identify target areas where there is a combination of low prevalence and an existing market infrastructure. A Brazil Contraceptive Social Marketing Program Advisory Council has been formed to provide a consolidated approach to family planning activities. Efforts toward developing a contraceptive social marketing program in Paraguay remain at an exploratory level. The introduction of social marketing in Paraguay is complicated by the existence of a pervasive contraband system. Although consumer awareness of contraception is high, the contraceptive prevalence rate is low. Efforts in all 3 countries reflect SOMAR's strategy of broadening the scope of project alternatives to meet the special needs of each nation.

A prostaglandin E2 receptor antagonist prevents pregnancies during a preclinical contraceptive trial with female macaques.

PubMed

Peluffo, M C; Stanley, J; Braeuer, N; Rotgeri, A; Fritzemeier, K-H; Fuhrmann, U; Buchmann, B; Adevai, T; Murphy, M J; Zelinski, M B; Lindenthal, B; Hennebold, J D; Stouffer, R L

2014-07-01

Can administration of a prostaglandin (PG) E2 receptor 2 (PTGER2) antagonist prevent pregnancy in adult female monkeys by blocking periovulatory events in the follicle without altering menstrual cyclicity or general health? This is the first study to demonstrate that a PTGER2 antagonist can serve as an effective non-hormonal contraceptive in primates. The requirement for PGE2 in ovulation and the release of an oocyte surrounded by expanded cumulus cells (cumulus-oocyte expansion; C-OE) was established through the generation of PTGS2 and PTGER2 null-mutant mice. A critical role for PGE2 in primate ovulation is supported by evidence that intrafollicular injection of indomethacin in rhesus monkeys suppressed follicle rupture, whereas co-injection of PGE2 with indomethacin resulted in ovulation. First, controlled ovulation protocols were performed in adult, female rhesus monkeys to analyze the mRNA levels for genes encoding PGE2 synthesis and signaling components in the naturally selected pre-ovulatory follicle at different times after the ovulatory hCG stimulus (0, 12, 24, 36 h pre-ovulation; 36 h post-ovulation, n = 3-4/time point). Second, controlled ovarian stimulation cycles were utilized to obtain multiple cumulus-oocyte complexes (COCs) from rhesus monkeys to evaluate the role of PGE2 in C-OE in vitro (n = 3-4 animals/treatment; ≥3 COCs/animal/treatment). Third, adult cycling female cynomolgus macaques were randomly assigned (n = 10/group) to vehicle (control) or PTGER2 antagonist (BAY06) groups to perform a contraceptive trial. After the first treatment cycle, a male of proven fertility was introduced into each group and they remained housed together for the duration of the 5-month contraceptive trial that was followed by a post-treatment reversibility trial. Quantitative real-time PCR, COC culture and expansion, immunofluorescence/confocal microscopy, enzyme immunoassay, contraceptive trial, ultrasonography, complete blood counts, serum biochemistry tests and blood lipid profiles. Several mRNAs encoding proteins involved in PGE2 synthesis, metabolism and signaling increase (P < 0.05) in the periovulatory follicle after administration of an ovulatory hCG bolus. PGE2 signaling through PTGER2 induces cumulus cell expansion and production of hyaluronic acid, which are critical events for fertilization. Moreover, chronic administration of a selective PTGER2 antagonist resulted in a significant (P < 0.05 versus vehicle-treated controls) contraceptive effect without altering steroid hormone patterns or menstrual cyclicity during a 5-months contraceptive trial. Fertility recovered as early as 1 month after ending treatment. This is a proof-of-concept study in a non-human primate model. Further investigations are warranted to elucidate the mechanism(s) of PTGER2 antagonist action in the primate ovary. Although PTGER2 antagonist treatment did not produce any obvious undesirable effects, improvements in the mode of administration, as well as the efficacy of these compounds, are necessary to consider such a contraceptive for women. Monitoring as well as improving the efficacy and safety of female contraceptives is an important public health activity. Even though hormonal contraceptives are effective for women, concerns remain regarding their side-effects and long-term use because of the widespread actions of such steroidal products in many tissues. Moreover, some women cannot take hormones for medical reasons. Thus, development of non-hormonal contraceptives for women is warranted. Supported by Bayer HealthCare Pharmaceuticals, The Eunice Kennedy Shriver NICHD Contraceptive Development and Research Center (U54 HD055744), NIH Office of the Director (Oregon National Primate Research Center P51 OD011092), and a Lalor Foundation Postdoctoral Basic Research Fellowship (MCP). The use of the Leica confocal was supported by grant number S10RR024585. Some of the authors (N.B., A.R., K.-H.F., U.F., B.B. and B.L.) are employees of Bayer Healthcare Pharma.

Male contraception

PubMed Central

Chao, Jing; Page, Stephanie T.; Anderson, Richard A.

2015-01-01

Clear evidence shows that many men and women would welcome new male methods of contraception, but none have become available. The hormonal approach is based on suppression of gonadotropins and thus of testicular function and spermatogenesis, and has been investigated for several decades. This approach can achieve sufficient suppression of spermatogenesis for effective contraception in most men, but not all; the basis for these men responding insufficiently is unclear. Alternatively, the nonhormonal approach is based on identifying specific processes in sperm development, maturation and function. A range of targets has been identified in animal models, and targeted effectively. This approach, however, remains in the pre-clinical domain at present. There are, therefore, grounds for considering that safe, effective and reversible methods of contraception for men can be developed. PMID:24947599

The use of testosterone as a male contraceptive.

PubMed

Amory, J K; Bremner, W J

1998-10-01

Testosterone functions as a contraceptive by suppressing secretion of the pituitary gonadotropins luteinizing hormone and follicle stimulating hormone. Low levels of these hormones decrease endogenous testosterone secretion from the testis and deprive developing sperm of the signals required for normal maturation. Interference with sperm maturation causes a decline in sperm production and can lead to reversible infertility in men, raising the possibility that testosterone could be utilized in a commercially available contraceptive. To this end, testosterone has been studied alone and in combination with either gonadotropin releasing hormone analogues or progestins in efforts to improve its contraceptive efficacy. In this chapter, we will review efforts to use testosterone to create a safe, convenient, efficacious contraceptive method for men.

7α-methyl-19-nortestosterone (MENTR): the population council's contribution to research on male contraception and treatment of hypogonadism.

PubMed

Nieschlag, Eberhard; Kumar, Narender; Sitruk-Ware, Régine

2013-03-01

Testosterone is an essential part of all regimens for hormonal male contraception tested to date. Initial efficacy trials revealed that the half-life of the testosterone preparations available at that time was too short to be used for male contraception. The ensuing search for long-acting preparations yielded testosterone buciclate and undecanoate as well as 7α-methyl-19-nortestosterone (MENT). Following description of the principle of male hormonal contraception and the efficacy trials performed to date, the systematic development of MENT for substitution of male hypogonadism and use in male contraception by the Population Council is reviewed here. Copyright © 2013. Published by Elsevier Inc.

Contraceptive prescriptions for US servicewomen, 2008-2013.

PubMed

Witkop, Catherine T; Webber, Bryant J; Chu, Kasi M; Clark, Leslie L

2017-07-01

To determine the proportion and characteristics of US servicewomen who were prescribed contraception between 2008 and 2013 and to estimate the prevalence of contraceptive utilization among women who deployed during the surveillance period. This is a descriptive study of all servicewomen of child-bearing potential serving in the active component of the US armed forces at any time between 2008 and 2013. We estimated contraceptive utilization status using pharmacy, procedural and diagnostic codes as recorded in the Defense Medical Surveillance System and Pharmacy Data Transaction Service. Estimates of contraceptive utilization were compared by demographic and military variables, including deployment status. Poisson regression with robust error variance was used to estimate adjusted prevalence ratios and 95% confidence intervals. Among eligible servicewomen (N=375,847), 68.7% received at least one form of contraception during the surveillance period. Contraceptive methods included short acting only (55.6%), long-acting (11.9%), permanent (1.0%) and barrier methods (0.2%). An additional 8.2% received counseling services only without an associated procedure or prescription. After adjusting by several demographic variables, receipt of contraception was highest among women aged 25-29 years and lowest among those aged 17-19 and 45-49 years. Receipt of any contraception was similar across racial/ethnic groups, although Hispanic and black, non-Hispanic women were more likely to receive long-acting reversible contraception. Of those who deployed (N=131,597), 53.6% received contraception before or during their deployment, with 7.9% using long-acting contraception. US servicewomen utilize contraception at high levels, with few demographic disparities. Gaps still exist, especially among the youngest women and around the time of deployment. US servicewomen are prescribed contraception at high levels, but utilization is lower in the youngest servicewomen and around the time of deployment. Such data provide opportunities for development and evaluation of interventions designed to improve access to contraceptive services for all servicewomen and to reduce the rate of unintended pregnancy. Published by Elsevier Inc.

Biliary lipids, bile acids, and gallbladder function in the human female:effects of contraceptive steroids

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kern, F., Jr.; Everson, G.T.; DeMark, B.

Reported are biliary lipid composition and secretion, bile acid composition and kinetics, and gallbladder function in a group of healthy, nonobese women taking a contraceptive steroid preparation. A comparable group of healthy women served as controls. Biliary lipid secretion rate was measured by the marker perfusion technique. Bile acid distribution was determined by gas-lipid chromatography. The pool size, FTR, and synthesis rate of each bile acid were measured by using CA and CDCA labeled with the stable isotope of carbon, /sup 13/C. In some of the subjects gallbladder storage and emptying were measured during the kinetic study, by real-time ultrasonography.more » Contraceptive steroid use was associated with a significant increase in biliary cholesterol saturation and in the lithogenic index of bile. The rate of cholesterol secretion in the contraceptive steroid group was 50% greater than in the control (p << 0.001) and the rate of bile acid secretion was reduced (p < 0.02). The total bile acid pool size was significantly increased by contraceptive steroids. The major increase occurred in the CA pool (p < 0.04). The daily rate of enterohepatic cycles of the bile acid pool was decreased by contraceptive steroids from 6.6 to 4.3 (p < 0.01). The only effect of contraceptive steroids on gallbladder function was a slower emptying rate in response to intraduodenal amino acid infusion. No index of gallbladder function correlated significantly with any parameter of bile acid kinetics in this small group of subjects. The findings confirm the lithogenic effect of contraceptive steroids and indicate that its causes are an increase in cholesterol secretion and a decrease in bile acid secretion.« less

Out from behind the contraceptive Iron Curtain.

PubMed

Jacobson, J L

1990-01-01

In the early 1950s, the Soviet Union and several of its Eastern European satellites completed their transition from high to low fertility before the US and Western Europe. They did this even though there were not enough modern contraceptives available to meet the needs of its citizens. As late as 1990, the Soviet Union had no factories manufacturing modern contraceptives. A gynecologist in Poland described domestically produced oral contraceptives (OCs) as being good for horses, but not for humans. The Romanian government under Ceaucescu banned all contraceptives and safe abortion services. Therefore, women relied on abortion as their principal means of birth control, even in Catholic Poland. The legal abortion rates in the Soviet Union and Romania stood at 100/1000 (1985) and 91/1000 (1987) as compared to 18/1000 in Denmark and 13/1000 in France. All too often these abortion were prohibited and occurred under unsafe conditions giving rise to complications and death. Further, the lack of contraceptives in the region precipitated and increase in AIDS and other sexually transmitted diseases. On the other hand, abortion rates were minimalized in Czechoslovakia, East Germany, and Hungary due to the availability of modern contraceptives and reproductive health services. Hungary and East Germany even manufactured OCs. OC use in these 2 nations rated as among the world's highest. East Germany also treated infertility and sexually transmitted diseases. The region experienced a political opening in latecomer 1989. In 1989, IPPF gave approximately 15 million condoms and 3000 monthly OC packets to the Soviet Union to ease the transition. More international assistance for contraceptive supplies and equipment and training to modernize abortion practices is necessary.

Knowledge, attitude and practice of contraception in rural kashmir.

PubMed

Hayat, Humera; Khan, Parwez Sajad; Imtiyaz, Bhat; Hayat, Gazala; Hayat, Rehana

2013-12-01

Human fertility is determined by many factors such as customs, morals and habits of social groups with regard to marital obligation of life. Acceptance of family planning methods varies within and between societies and there are many factors which are responsible for such variation at community, family and individual level. Socioeconomic environment, culture and education are few of them that play a vital role. Jammu and Kashmir state in general and Kashmir valley in particular is a Muslim-dominated population with traditionally a conservative society. Apart from family customs and influence of the elders, religious background has always been behind the passive resistance, or at the best indifference towards contraception. This study makes an attempt to assess the knowledge, attitude and practice of contraception in rural Kashmir. To assess the knowledge, attitude and practice of contraception in rural Kashmir. Community-based Cross-Sectional study. December 2006 to May 2008. 1900 currently married women in the age group of 15-49 years of age. Rural households. 1900 currently married women, aged 15-49 years, selected by multi-stage random sampling technique from three districts of Kashmir valley who were interviewed at home using a pretested oral questionnaire. The assessment of various socioeconomic and other variables made as per the available standard procedures and scales. Percentage, Chi square test and Bivariate analysis. Knowledge of the contraceptive methods was fairly good especially for terminal methods i.e. female sterilization (97.7 %). Main source of information on contraception was obtained from mass media (60.4 %). Contraceptive practice was significantly related to number of living children, literacy, socioeconomic status and type of family. What is needed is to promote and stress contraceptive methods and their advantages using mass media approach and to explore more and more participation of private sector.

Young adults' contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy.

PubMed

Frost, Jennifer J; Lindberg, Laura Duberstein; Finer, Lawrence B

2012-06-01

Women aged 18-29 have higher rates of unintended pregnancy than any other age-group. Information is needed to understand what characteristics are associated with risky contraceptive use practices among this population and to develop new strategies for reducing these women's risk of unintended pregnancy. Data related to unintended pregnancy risk were collected from a nationally representative sample of 1,800 unmarried women and men aged 18-29 surveyed by telephone in 2009. Among those at risk of unintended pregnancy, multiple logistic regression was used to assess associations between contraceptive knowledge, norms and attitudes and selected risky contraceptive behaviors. More than half of young men and a quarter of young women received low scores on contraceptive knowledge, and six in 10 underestimated the effectiveness of oral contraceptives. Among women, for each correct response on a contraceptive knowledge scale, the odds of expecting to have unprotected sex in the next three months decreased by 9%, of currently using a hormonal or long-acting reversible method increased by 17%, and of using no method decreased by 17%. Fear of side effects, norms and attitudes that favor nonmarital pregnancy or undervalue the importance of contraception, pregnancy ambivalence and mistrust of government's role in promoting contraception were also associated with one or more risky contraceptive use behaviors. Programs to increase young adults' knowledge about contraceptive methods and use are urgently needed. Given the demonstrated link between method knowledge and contraceptive behaviors, such programs may be useful in addressing risky behavior in this population. Copyright © 2012 by the Guttmacher Institute.

Young women's contraceptive microbicide preferences: associations with contraceptive behavior and sexual relationship characteristics.

PubMed

Best, Candace; Tanner, Amanda E; Hensel, Devon J; Fortenberry, J Dennis; Zimet, Gregory D

2014-03-01

In time, microbicides may provide women with dual prevention against pregnancy and STDs. Although several microbicide dimensions have been evaluated, little is known about women's preferences for contraceptive microbicides and correlates of these preferences. Acceptability of a hypothetical contraceptive microbicide cream or jelly was examined among a -clinic-based sample of 266 women in Indianapolis from 2004 (when participants were aged 14-22) to 2008. Group conjoint analyses and individual conjoint analyses were used to compare preferences with respect to four microbicide -dimensions: contraceptive ability, efficacy in relation to condoms, timing of use and texture. Pearson's product moment correlations were used to examine the relationship between preferences for a contraceptive microbicide and selected characteristics of the women. Overall, the top-rated microbicide dimensions were efficacy in relation to that of condoms and contraceptive ability (importance scores, 40.0 and 35.4 out of 100.0, respectively). When all dimension levels were compared, contraceptive ability was the most strongly preferred (part-worth utility score, 8.9), and lower efficacy than that of -condoms was the least strongly preferred (-11.9). Preference for contraceptive microbicides was positively -associated with current contraceptive use, sexual agency, partner communication, commitment to avoiding pregnancy and -perceived partner agreement about avoiding pregnancy (coefficients, 0.07-0.18). It was negatively associated with current or past nonuse of contraceptives, seeking pregnancy and perceived partner agreement about seeking -pregnancy (-0.08 to -0.14). Microbicides with dual prevention properties may be attractive to young women. Microbicide development and subsequent clinical trials should incorporate contraceptive microbicides. Copyright © 2013 by the Guttmacher Institute.

Contraceptive counselling for women with multiple unintended pregnancies: the abortion client's perspective.

PubMed

Loeber, Olga E; Muntinga, Maaike E

2017-04-01

Some women have multiple unintended pregnancies. Appropriate interventions could prevent some of the abortions that follow. This article presents the opinions of some abortion clients about their contraception and the counselling they received. It also formulates suggestions for counselling strategies of health care providers (HCPs) and other interventions that can support effective contraceptive behaviour. A mixed method approach was used. A quantitative survey was carried out in one clinic in the Netherlands (N = 201), assessing topics related to contraceptive use and counselling. Semi-structured interviews (n = 11) were conducted with women who had had at least three unintended pregnancies. Interview topics included the type of contraceptive counselling, experience with contraceptive counselling and preferences regarding access to contraceptive information. Women who had had multiple abortions were more likely to express a need for contraceptive counselling and more often discussed contraception with their HCP compared with women who had had one abortion. Several themes emerged from the semi-structured interviews that had partially contributed to further unplanned pregnancies: experience with counselling, acceptability of the contraceptive method, sources of information and cultural influences. Many women with multiple unintended pregnancies could not find suitable advice and stated preferences for future decision making. This study offers insight into the motives for contraceptive use of women with multiple unintended pregnancies. Contraceptive efficacy could be improved by implementing counselling that is adapted to individual needs. The respondents stated that they would appreciate other sources of information, such as support through other forms of communication. The formation of a working group would be helpful in developing these services.

Oral contraceptives and cancer of the liver: a review with two additional cases.

PubMed

Helling, T S; Wood, W G

1982-07-01

The hormonal milieu that follows the ingestion of contraceptive agents promotes the growth of hepatic tumors, particularly hepatocellular adenomas. Evidence that the use of contraceptive drugs can also cause carcinoma of the liver is less convincing; this article describes the cases of 2 young women who had taken contraceptives and contracted hepatocellular carcinoma. Both women had no prior history of liver disease and died as a result of the carcinoma. Hepatocellular carcinoma has been a distinctly uncommon disease in the U.S. ranging in incidence from 0.23-0.47% in reported autopsy cases and being typically described as occurring mostly in men over 50 and associated with preexisting cirrhosis. Recent surveys show a greater proportion of female patients; in the U.S. patients at risk now include women in the reproductive age group with no history of prior liver disease. Some recorded changes in the human liver caused by oral contraceptives (OCs) include: 1) impairment of bile secretory function, 2) hepatomegaly associated with peripheral and midzonal sinusoidal congestion, and 3) peliosis hepatis. Significant risk factors in the occurrence of hepatic tumors in OC users are: 1) prolonged usage (1-3 years), 2) age over 30, and 3) use of compounds of high hormonal potency. Products containing mestranol have been implicated to a greater degree than those containing ethinyl estradiol. The link between use of OCs and development of hepatocellular carcinoma is not certain; however, the latter has been firmly linked with the use of anabolic steroids in men. Specifically only the C-17 substituted anabolic steroids oxymetholone and methyltestosterone have been implicated which are closely related to the C-17 substituted 19-norsteroids used in OCs. The following observations have also been made: 1) when hepatocellular carcinoma occurs in women it is mostly in those of reproductive age, and 2) OCs are associated with the development of benign hepatic tumors. Withdrawal from OCs is almost uniformly recommended after definitive diagnosis of a hepatic tumor along with surgery to avoid the risk of rupture and possible mortality.

More Than a Destination: Contraceptive Decision Making as a Journey.

PubMed

Downey, Margaret Mary; Arteaga, Stephanie; Villaseñor, Elodia; Gomez, Anu Manchikanti

Contraceptive use is widely recognized as a means of reducing adverse health-related outcomes. However, dominant paradigms of contraceptive counseling may rely on a narrow definition of "evidence" (i.e., scientifically accurate but exclusive of individual women's experiences). Given increased enthusiasm for long-acting, reversible contraceptive methods, such paradigms may reinforce counseling that overprivileges effectiveness, particularly for groups considered at high risk of unintended pregnancy. This study investigates where and how women's experiences fit into the definition of evidence these counseling protocols use. Using a qualitative approach, this analysis draws on semistructured interviews with 38 young (ages 18-24) Black and Latina women. We use a qualitative content analysis approach, with coding categories derived directly from the textual data. Our analysis suggests that contraceptive decision making is an iterative, relational, reflective journey. Throughout contraceptive histories, participants described experiences evolving to create a foundation from which decision-making power was drawn. The same contraceptive-related decisions were revisited repeatedly, with knowledge accrued along the way. The cumulative experience of using, assigning meanings to, and developing values around contraception meant that young women experienced contraceptive decision making as a dynamic process. This journey creates a rich body of evidence that informs contraceptive decision making. To provide appropriate, acceptable, patient-centered family planning care, providers must engage with evidence grounded in women's expertise on their contraceptive use in addition to medically accurate data on method effectiveness, side effects, and contraindications. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

[Induced abortion: a vulnerable public health problem].

PubMed

Requena, M

1991-03-01

Induced abortion is an urgent public health problem that can be controlled if it is approached in its true complexity and with a social and humanist perspective. Induced abortion has been discussed in Chile since the last century, but not always openly. Abortion is not just an individual and collective medical problem, it is also an ethical, religious, legal, demographic, political, and psychological problem. Above all it is a problem of human rights. In the past 60 years, more than 50 countries representing 76% of the world population have liberalized their abortion legislation. Around 980 million women have some degrees of access of legal abortion. The magnitude of illegal abortion is difficult to determine because of the desire of women to hide their experiences. Estimates of the incidence of abortion in Chile made some 25 years ago are no longer valid because of the numerous social changes in the intervening years. The number of abortions in Chile in 1987 was estimated using an indirect residual method at 195,441, of which 90%, or 175,897, were induced. By this estimate, 38.8% of pregnancies in Chile end in abortion. Data on hospitalizations for complications of induced abortion show an increase from 13.9/1000 fertile aged women in 1940 to 29.1 in 1965. By 1987, with increased contraceptive usage, the rate declined to 10.5 abortions per 1000 fertile aged women. The cost of hospitalization for abortion complications in 1987, despite the decline, was still estimated at US $4.3 million, a large sum in an era of declining health resources. The problem of induced abortion can be analyzed by placing it in the context of elements affecting the desire to control fertility. 4 complexes of variables are involved: those affecting the supply of contraceptive, the demand for contraceptives, the various costs of fertility control measure, and alternatives to fertility control for satisfying various needs. The analysis is further complicated when efforts are made to understand the dynamics of the process. Awareness of fertility control is a social process that matures slowly. Contraception and abortion have different significance for fertility control, with contraception preventing pregnancy and abortion is a sense curing it. Chile has progressed far in its fertility control awareness. 2/3 of sexually active women use some form of contraception. At the same time, induced abortion is also used. It is estimated that 58% of abortions occur after a contraceptive failure. It appears that recourse to abortion would be minimized if strategies centered on supply of contraceptives were complemented by stronger efforts to develop awareness of fertility control. Delivery of contraceptives should be accompanied by complete information on their effective use. Efforts should be targeted especially at groups at high risk abortion, including adolescents and women hospitalized for complications.

Prevalence of Abortion and Contraceptive Practice among Women Seeking Repeat Induced Abortion in Western Nigeria

PubMed Central

Lamina, Mustafa Adelaja

2015-01-01

Background. Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. Method. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. Results. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. Conclusion. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high. PMID:26078881

Contraceptive technology.

PubMed

Potts, M; Atkinson, L

1984-06-01

A question of the 1980s is how will contraceptive technology contribute to improving family planning services to meet the goal of making available a simple, safe, effective, and widely acceptable contraceptive method. Significant changes in existing technology in the 1970s resulted in safer and more effective contraceptive methods. Voluntary sterilization emerged as the primary method in developed and developing countries, as important modifications simplified the procedure for women. The tolerance and effectiveness of the IUD were improved by reducing its size, adding copper to its surface, or encapsulating progesterone within it. The steroid content of the birth control pill was reduced 10-fold, leading to fewer side effects, and the pill was found to be an effective postcoital contraceptive when taken at specific intervals. Vacuum aspiration for the termination of 1st trimester pregnancy proved to be 1 of the safest surgical techniques practiced. Belated attention is now being focused on adapting existing contraceptive methods for use during the postpartum period and breast feeding. The insertion of an IUD immediately following childbirth is a particularly useful option in the developing world as an increasing number of women have their babies in urban hospitals. A method of enhancing the contraceptive effect of breast feeding should neither change milk production nor transfer the drug to the nursing infant. Fortunately, progestin-only pills have been found to have no effect on breast milk and an attempt is being made to expand the use of this approved method. More simplification of female sterilization is needed. Current techniques require back-up facilities in case of complications and are unlikely to meet the developing world's enormous demand. 2 methods not widely used -- spermicides and periodic abstinence -- are coming under new scrutiny. In mid-1983 the US Food and Drug Administration approved a spermicide-impregnanated disposable sponge for over-the-counter sale in the US, and other disposable vaginal barriers might also be developed. The 1980s are likely to see some significant new ways of delivering well-known steroids for female contraception. US government policy forbids the support of research on abortion technology, and private pharmaceutical firms have been criticized for working in this field. In other parts of the world, research continues into the action of prostaglandins. Several developments are not likely to occur in the 1980s -- a contraceptive pill for males, analogs of luteinizing hormone-releasing hormone as new methods of fertility control for women, and a vaccine.

Sexual and reproductive health is our business.

PubMed

Sarjeant, H

1993-01-01

The Family Planning Association of Trinidad and Tobago (FPATT) has decided that integration of the concept of sexual and reproductive health into regular family planning activities is the best way to increase the contraceptive prevalence rate. A more holistic approach to service provision is being developed. On the basis of survey findings that early sexual activity, low contraceptive use, and limited knowledge are widespread among young people, this population group has been selected as a focus. FPATT has asked for a TT$1 million subsidy to intensify sex education programs in the schools. Issues discussed include human sexuality, values clarification, relationships, problems affecting teenagers, parenting, rape and incest, and family planning. FPATT also conducts training sessions for teachers and parents. Since young people tend to respond best to peers, peer counseling is emphasized. Education is also offered at large industrial sites, private homes in small communities, and government health centers.

Vulnerability and sexual and reproductive health among Zambian secondary school students.

PubMed

Warenius, Linnéa; Pettersson, Karen O; Nissen, Eva; Höjer, Bengt; Chishimba, Petronella; Faxelid, Elisabeth

2007-01-01

The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people.

[Male contraception and its perspectives].

PubMed

Belaisch, J

1982-11-01

Doctors specializing in male contraception are aware of the very real difficulties hindering the development of an effective method in this field. Others believe that the reason this type of contraception is lagging behind is male chauvinism or a certain fear that men have of losing their virility along with their fertilizing capacity. Since available methods of contraception (condom, vasectomy) have low levels of acceptability and reversibility, research has proceeded along other avenues. 1) Gossypol reduces the number and motility of spermatozoa but its general side effects are not exceptional. 2) Restraining hormonal action (progrestogens, LH-RH agonists) also reduce testicular function and for this reason, require simultaneous administration of androgens. Thus far this has not been resolved; azoospermia is not obtained in every case and when it is, it does not necessarily last. 3) A method involving the epididymis, with a view to preventing spermatozoa from acquiring their normal motility and fertilizing capacity by affecting protein and enzyme synthesis, is also being studied. Perhaps, as has been suggested by the Bicetre Hospital research team, we should be content with methods applicable to certain categories of men. Male contraception would then develop step by step rather than by huge bounds as female contraception. full text

Natural products as modulators of spermatogenesis: the search for a male contraceptive.

PubMed

Dias, Tania R; Alves, Marco G; Oliveira, Pedro F; Silva, Branca M

2014-01-01

Population growth in the last century has raised important social and economic questions. Thus, current methods of fertility control have been under debate for a long period. Birth rates are essentially dependent on several environmental and social factors but women, who are great users of contraceptives, play a major role. Regulation of male fertility has been widely studied in recent years with the aim of developing a new male contraceptive for further inclusion of men's choice in family planning. Based on the ancient people techniques to control the birth rates, natural products appeared as a promising source for the development of a male contraceptive. Over the years, many plants and their main constituents have been studied in the search for their antifertility properties. Interestingly, some antispermatogenic effects have been reported. Herein, we will discuss the antispermatogenic properties of some natural products. We propose to discuss specific targets and sites of action of the selected natural products. Despite the advances in this field in the last years, the molecular mechanisms by which natural products can control fertility, need to be disclosed to develop an effective, reversible and safe male contraceptive and avoid undesired toxicity in other organs. To date, no natural-based male contraceptive is available in the commercial market, mostly due to the difficulty in reversing the effects of these products in male fertility.

Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya.

PubMed

Stephenson, Rob; Bartel, Doris; Rubardt, Marcie

2012-01-01

Using samples of reproductive aged men and women from rural Ethiopia and Kenya, this study examines the associations between two scales measuring balances of power and equitable attitudes within relationships and modern contraceptive use. The scales are developed from the Sexual and Reproductive Power Scale (SRPS) and Gender Equitable Male (GEM) scale, which were originally developed to measure relationship power (SRPS) among women and gender equitable attitudes (GEM) among men. With the exception of Ethiopian women, a higher score on the balance of power scale was associated with significantly higher odds of reporting modern contraceptive use. For men and women in both countries, a higher score on the equitable attitudes scale was associated with significantly higher odds of reporting modern contraceptive use. However, only the highest categories of the scales are associated with contraceptive use, suggesting a threshold effect in the relationships between power, equity and contraceptive use. The results presented here demonstrate how elements of the GEM and SRPS scales can be used to create scales measuring balances of power and equitable attitudes within relationships that are associated with self-reporting of modern contraceptive use in two resource-poor settings. However, further work with larger sample sizes is needed to confirm these findings, and to examine the extent to which these scales can be applied to other social and cultural contexts.

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh.

PubMed

Islam, Ahmed Zohirul; Rahman, Mosiur; Mostofa, Md Golam

2017-10-01

This study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25years old. This study utilized a cross-sectional data (n=3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ 2 analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women. This study observed that 71% fecund women aged below 25years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women. Reproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use. Copyright © 2017 Elsevier B.V. All rights reserved.

Progress and prospects in male hormonal contraception

PubMed Central

Amory, John K.

2009-01-01

Purpose of review Testosterone functions as a contraceptive by suppressing the secretion of luteinizing hormone and follicle-stimulating hormone from the pituitary. Low concentrations of these hormones deprive the testes of the signals required for spermatogenesis and results in markedly decreased sperm concentrations and effective contraception in a majority of men. Male hormonal contraception is well tolerated and acceptable to most men. Unfortunately, testosterone-alone regimens fail to completely suppress spermatogenesis in all men, meaning that in some the potential for fertility remains. Recent findings Because of this, novel combinations of testosterone and progestins, which synergistically suppress gonadotropins, have been studied. Two recently published testosterone/progestin trials are particularly noteworthy. In the first, a long-acting injectable testosterone ester, testosterone decanoate, was combined with etonogestrel implants and resulted in 80–90% of subjects achieving a fewer than 1 million sperm per milliliter. In the second, a daily testosterone gel was combined with 3-monthly injections of depot medroxyprogesterone acetate producing similar results. Summary Testosterone-based hormone combinations are able to reversibly suppress human spermatogenesis; however, a uniformly effective regimen has remained elusive. Nevertheless, improvements, such as the use of injectable testosterone undecanoate, may lead to a safe, reversible and effective male contraceptive. PMID:18438174

Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

PubMed Central

2013-01-01

Background Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues. Methods A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought. Results Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate. Conclusion We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes. PMID:24066860

Eppin: a molecular strategy for male contraception.

PubMed

Wang, Zengjun; Widgren, E E; Richardson, R T; Orand, M G

2007-01-01

New male contraceptives, both hormonal and non-hormonal, have many obstacles to overcome before they reach the market as a product. For hormonal contraceptives the long-term efficacy of oligospermia in a large population of unselected men remains to be determined. For nonhormonal contraception target selection remains a primary goal. Immunocontraception, which showed great promise for many years, has recently lost its appeal. Nevertheless, immunocontraception can be utilised as a strategy, particularly in primates, to discern the function of target molecules in the male. As an example, we discuss Eppin, an epididymal protease inhibitor that coats the surface of human spermatozoa. Because Eppin is predicted to be a serine protease inhibitor with chymotrypsin-like specificity and binds semenogelin, the natural substrate of PSA (prostate specific antigen, a serine protease), we investigated whether Eppin would modulate PSA activity and the hydrolysis of semenogelin. Additionally, because antibodies to Eppin provide contraception in male monkeys, we investigated whether antibodies to Eppin would inhibit the PSA hydrolysis of semenogelin. Eppin is a specific inhibitor of PSA activity that requires leucine 87, Eppin's P1 reactive site. Although Eppin modulates the hydrolysis of semenogelin by PSA, antibodies to Eppin do not inhibit PSA activity.

When teens don't wait: encouraging contraception.

PubMed

1990-01-01

Sexually active teenagers must be diligently encouraged to use contraceptives to reduce early unintended pregnancy. Public awareness of this problem has grown and the debate about how to stop has also grown. Delaying the initiation of sexual activity is seen as the only acceptable method by some, but abstinence will not help reduce early unintended pregnancy in already sexually active teenagers. Strategies must be developed to reach these teenagers with contraception, parenting, adoption, or abortion for when contraception fails. Wide spread sexual activity is the reality of the current era. Parents and teenagers must be provided a variety of strategies that reflect the diverse value system of the current era. Efforts to encourage contraception among adolescents that are successful presuppose that strong, effective family planning services are widely available. In order to create a positive climate for adolescents to fully adopt and use a regimen of contraceptive care automatically implies that such services are acceptable and accessible to the teenagers.

Demand for male contraception.

PubMed

Dorman, Emily; Bishai, David

2012-10-01

The biological basis for male contraception was established decades ago, but despite promising breakthroughs and the financial burden men increasingly bear due to better enforcement of child support policies, no viable alternative to the condom has been brought to market. Men who wish to control their fertility must rely on female compliance with contraceptives, barrier methods, vasectomy or abstinence. Over the last 10 years, the pharmaceutical industry has abandoned most of its investment in the field, leaving only nonprofit organisations and public entities pursuing male contraception. Leading explanations are uncertain forecasts of market demand pitted against the need for critical investments to demonstrate the safety of existing candidate products. This paper explores the developments and challenges in male contraception research. We produce preliminary estimates of potential market size for a safe and effective male contraceptive based on available data to estimate the potential market for a novel male method.

Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC.

PubMed

Belaid, Loubna; Dumont, Alexandre; Chaillet, Nils; De Brouwere, Vincent; Zertal, Amel; Hounton, Sennen; Ridde, Valéry

2015-09-28

Despite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions. We will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR) DISCUSSION: The systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries. This protocol is registered in PROSPERO (CRD 42015017549).

CCR5 Expression Levels in HIV-Uninfected Women Receiving Hormonal Contraception

PubMed Central

Sciaranghella, Gaia; Wang, Cuiwei; Hu, Haihong; Anastos, Kathryn; Merhi, Zaher; Nowicki, Marek; Stanczyk, Frank Z.; Greenblatt, Ruth M.; Cohen, Mardge; Golub, Elizabeth T.; Watts, D. Heather; Alter, Galit; Young, Mary A.; Tsibris, Athe M. N.

2015-01-01

Human immunodeficiency virus (HIV) infectivity increases as receptor/coreceptor expression levels increase. We determined peripheral CD4, CCR5, and CXCR4 expression levels in HIV-uninfected women who used depot medroxyprogesterone acetate (DMPA; n = 32), the levonorgestrel-releasing intrauterine device (LNG-IUD; n = 27), oral contraceptive pills (n = 32), or no hormonal contraception (n = 33). The use of LNG-IUD increased the proportion of CD4+ and CD8+ T cells that expressed CCR5; increases in the magnitude of T-cell subset CCR5 expression were observed with DMPA and LNG-IUD use (P < .01 for all comparisons). LNG-IUD and, to a lesser extent, DMPA use were associated with increased peripheral T-cell CCR5 expression. PMID:25895986

Immunocontraception: Filamentous Bacteriophage as a Platform for Vaccine Development.

PubMed

Samoylova, Tatiana I; Braden, Timothy D; Spencer, Jennifer A; Bartol, Frank F

2017-11-20

Population control of domestic, wild, invasive, and captive animal species is a global issue of importance to public health, animal welfare and the economy. There is pressing need for effective, safe, and inexpensive contraceptive technologies to address this problem. Contraceptive vaccines, designed to stimulate the immune system in order to block critical reproductive events and suppress fertility, may provide a solution. Filamentous bacteriophages can be used as platforms for development of such vaccines. In this review authors highlight structural and immunogenic properties of filamentous phages, and discuss applications of phage-peptide vaccines for advancement of immunocontraception technology in animals. Phages can be engineered to display fusion (non-phage) peptides as coat proteins. Such modifications can be accomplished via genetic manipulation of phage DNA, or by chemical conjugation of synthetic peptides to phage surface proteins. Phage fusions with antigenic determinants induce humoral as well as cell-mediated immune responses in animals, making them attractive as vaccines. Additional advantages of the phage platform include environmental stability, low cost, and safety for immunized animals and those administering the vaccines. Filamentous phages are viable platforms for vaccine development that can be engineered with molecular and organismal specificity. Phage-based vaccines can be produced in abundance at low cost, are environmentally stable, and are immunogenic when administered via multiple routes. These features are essential for a contraceptive vaccine to be operationally practical in animal applications. Adaptability of the phage platform also makes it attractive for design of human immunocontraceptive agents. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Immunocontraception: Filamentous Bacteriophage as a Platform for Vaccine Development

PubMed Central

Samoylova, Tatiana I.; Braden, Timothy D.; Spencer, Jennifer A.; Bartol, Frank F.

2017-01-01

Background: Population control of domestic, wild, invasive, and captive animal species is a global issue of importance to public health, animal welfare and the economy. There is pressing need for effective, safe, and inexpensive contraceptive technologies to ad-dress this problem. Contraceptive vaccines, designed to stimulate the immune system in order to block critical reproductive events and suppress fertility, may provide a solution. Fil-amentous bacteriophages can be used as platforms for development of such vaccines. Objective: In this review authors highlight structural and immunogenic properties of fila-mentous phages, and discuss applications of phage-peptide vaccines for advancement of immunocontraception technology in animals. Results: Phages can be engineered to display fusion (non-phage) peptides as coat proteins. Such modifications can be accomplished via genetic manipulation of phage DNA, or by chemical conjugation of synthetic peptides to phage surface proteins. Phage fusions with antigenic determinants induce humoral as well as cell-mediated immune responses in ani-mals, making them attractive as vaccines. Additional advantages of the phage platform include environmental stability, low cost, and safety for immunized animals and those ad-ministering the vaccines. Conclusion: Filamentous phages are viable platforms for vaccine development that can be engineered with molecular and organismal specificity. Phage-based vaccines can be pro-duced in abundance at low cost, are environmentally stable, and are immunogenic when administered via multiple routes. These features are essential for a contraceptive vaccine to be operationally practical in animal applications. Adaptability of the phage platform also makes it attractive for design of human immunocontraceptive agents. PMID:28901276

In vitro and in vivo effects of ulipristal acetate on fertilization and early embryo development in mice.

PubMed

Gómez-Elías, Matías D; Munuce, María J; Bahamondes, Luis; Cuasnicú, Patricia S; Cohen, Débora J

2016-01-01

Does ulipristal acetate (UPA), a selective progesterone receptor modulator used for emergency contraception (EC), interfere with fertilization or early embryo development in vitro and in vivo? At doses similar to those used for EC, UPA does not affect mouse gamete transport, fertilization or embryo development. UPA acts as an emergency contraceptive mainly by inhibiting or delaying ovulation. However, there is little information regarding its effects on post-ovulatory events preceding implantation. This was an in vitro and in vivo experimental study involving the use of mouse gametes and embryos from at least three animals in each set of experiments. For in vitro fertilization experiments, mouse epididymal spermatozoa capacitated in the presence of different concentrations of UPA (0-1000 ng/ml) were used to inseminate cumulus-intact or cumulus-free eggs in the presence or absence of UPA during gamete co-incubation, and the percentage of fertilized eggs was determined. For in vivo fertilization experiments, superovulated females caged with proven fertile males were injected with UPA (40 mg/kg) or vehicle just before or just after mating and the percentage of fertilized eggs recovered from the ampulla was determined. To investigate the effect of UPA on embryo development, zygotes were recovered from mated females, cultured in the presence of UPA (1000 ng/ml) for 4 days and the progression of embryo development was monitored daily. In vitro studies revealed that the presence of UPA during capacitation and/or gamete co-incubation does not affect fertilization. Whereas the in vivo administration of UPA at the same time as hCG injection produced a decrease in the number of eggs ovulated compared with controls (vehicle injected animals, P < 0.05), no effects on fertilization were observed when UPA was administered shortly before or after mating. No differences were observed in either the percentage of cleaved embryos or the cleavage speed when UPA was present during in vitro embryo culture. Considering the ethical and technical limitations inherent to the use of human gametes for fertilization studies, the mouse model was used as an approach for exploring the potential effects of UPA on in vivo sperm transport and fertilization. Nevertheless, the extrapolation of these results to humans requires further investigation. This study presents new evidence on the lack of effect of UPA on gamete interaction and embryo development, providing new insights into the mechanism of action of UPA as an emergency contraceptive method with potential clinical implications. These new findings could contribute to increase the acceptability and proper use of UPA as an emergency contraceptive method. This study was partially supported by a National Agency of Scientific and Technological Promotion (ANPCyT), Argentina grants PICT 2011-061 to D.J.C. and PICT 2011-2023 to P.S.C. None of the authors has any competing interests to declare. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Male contraception.

PubMed

Chao, Jing; Page, Stephanie T; Anderson, Richard A

2014-08-01

Clear evidence shows that many men and women would welcome new male methods of contraception, but none have become available. The hormonal approach is based on suppression of gonadotropins and thus of testicular function and spermatogenesis, and has been investigated for several decades. This approach can achieve sufficient suppression of spermatogenesis for effective contraception in most men, but not all; the basis for these men responding insufficiently is unclear. Alternatively, the non-hormonal approach is based on identifying specific processes in sperm development, maturation and function. A range of targets has been identified in animal models, and targeted effectively. This approach, however, remains in the pre-clinical domain at present. There are, therefore, grounds for considering that safe, effective and reversible methods of contraception for men can be developed. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Structural equation modeling on contraception behavior of unmarried men and women in Korea: gender difference].

PubMed

Hwang, Shin Woo; Chung, Chae Weon

2014-04-01

The purpose of this study was to test and validate a model to predict contraception behavior in unmarried men and women. Data were collected from a questionnaire survey of 180 unmarried men and 186 unmarried women 20 years of age or over who had sexual relationships in the past 6 months. Participants were from Seoul, Kyunggi, Daegu, and Busan and data collection was done from February 19 to April 16, 2013. Model fit indices for the hypotheoretical model fitted to the recommended levels. Out of 15 paths, 11 were statistically significant in both. Predictors of contraception behavior in unmarried men and women were intention to use contraception and self-efficacy for contraception. Exposure to sexual content was directly significant to the intention in men only. Self-efficacy for contraception was affected by perceived threat of pregnancy and gender role attitude. In women, the two predictors were also significant except for the effect of exposure to sexual contents. Results indicate that an intervention program which increases self-efficacy in unmarried men and women contributes to effective contraception behavior. In addition, proper sexual education programs using positive aspect of mass media can help develop active participation for contraception behavior.

Expanding contraceptive choice in the developing world: lessons from the Lao People's Democratic Republic and the Republic of Zambia.

PubMed

d'Arcangues, Catherine M; Ba-Thike, Katherine; Say, Lale

2013-12-01

Women need different forms of contraception over their lifetime. In the developed world, they have access to some 20 different methods. In developing countries, only a few options are available. This paper focuses on four under-used methods: intrauterine devices, implants, emergency contraception and female condoms. It examines reasons for their low uptake, strategies used for their adoption, and challenges in sustaining these efforts, in two countries: Laos and Zambia. In-country documentation and reports from international partners were reviewed; questionnaires were sent and interviews carried out with ministry officials, senior providers, and local representatives of international organisations and international non-governmental organisations. In Laos, the family planning programme is relatively young; its challenges include ensuring the sustainability of services and supplies, improving the quality of IEC to dispel misconceptions surrounding contraception, and developing novel distribution systems to reach rural populations. Zambia has a much older programme, which lost ground in the face of competing health priorities. Its challenges include strengthening the supply chain management, coordinating the multiple groups of providers and ensuring the sustainability of services in rural areas. The contrast offered by Laos and Zambia illustrates the importance of regular evaluation to identify priority areas for improving contraceptive delivery.

Birth control vaccine targeting leukemia inhibitory factor.

PubMed

Lemons, Angela R; Naz, Rajesh K

2012-02-01

The population explosion and unintended pregnancies resulting in elective abortions continue to impose major public health issues. This calls for a better method of contraception. Immunocontraception has been proposed as a valuable alternative that can fulfill most, if not all, of the properties of an ideal contraceptive. There are several targets that are being explored for contraceptive vaccine development. Leukemia inhibitory factor (LIF), a member of interleukin-6 family, is required for embryo development and successful blastocyst implantation in several mammalian species. The present study was conducted to examine if LIF can be a target for the development of a birth control vaccine. Three sequences from LIF and two sequences from LIF-receptor (LIF-R) that span the regions involved in ligand-receptor binding were delineated, and peptides were synthesized based upon these sequences. Antibodies raised against these five peptides reduced LIF bioactivity in an in vitro culture assay using BA/F3 mLIF-R-mpg130 cells. Vaccines were prepared by conjugating these peptides to various carrier proteins. Immunization of female mice with these peptide vaccines induced a long-lasting, circulating as well as local antibody response in various parts of the genital tract, and resulted in a significant (P ≤ 0.05) inhibition in fertility in all the three trials; the LIF-R peptide vaccines proved to be a better vaccine target. The data indicate that LIF/LIF-R is an excellent target for the development of a birth control vaccine. This is the first study, to our knowledge, that examined LIF/LIF-R as a target for immunocontraception. The findings of this study can be easily translated to humans since LIF/LIF-R is also important for implantation and pregnancy in women. Copyright © 2011 Wiley Periodicals, Inc.

Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention.

PubMed

Whitaker, A K; Quinn, M T; Martins, S L; Tomlinson, A N; Woodhams, E J; Gilliam, M

2015-10-01

The objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility, impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. A single-session postabortal contraception counseling intervention for young women aged 15-24 years incorporating principles, skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention, their competency was assessed, and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants, ability to complete the full intervention without interruption and participant satisfaction with the counseling. We approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact, 95% and 77% of participants reported that the session was helpful, respectively. MI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles, skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. The use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered, directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic. Copyright © 2015 Elsevier Inc. All rights reserved.

The future of male contraception: a fertile ground

PubMed Central

Zillioux, Jacqueline; Eisenfrats, Kevin; Foley, Daniel; Smith, Ryan

2018-01-01

The continued and rapid expansion of the Earth’s population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition.

Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women.

PubMed

Westhoff, Carolyn L; Torgal, Anupama H; Mayeda, Elizabeth Rose; Petrie, Kelsey; Thomas, Tiffany; Dragoman, Monica; Cremers, Serge

2012-07-01

Many observational studies indicate higher oral contraceptive failure among obese women, but most clinical trials and physiologic studies do not support these differences. Limited data indicate higher failure rates among obese contraceptive patch users. Data regarding contraceptive vaginal ring performance in obese women are needed. Twenty normal weight (body mass index [BMI] 19.0-24.9; median, 21.65) and 20 obese (BMI 30.0-39.9; median, 33.7) women enrolled in a prospective study of ethinyl estradiol (EE(2)) and etonorgestrel pharmacokinetics and of ovarian follicle development, endometrial thickness, and bleeding patterns, all measured biweekly during the second cycle of contraceptive vaginal ring use. Thirty-seven women completed follow-up. Mean day 0-21 EE(2) concentrations were lower among obese vs normal weight women (15.0 vs 22.0 pg/mL, respectively, P = .004), whereas etonorgestrel concentrations were similar (1138 vs 1256 pg/mL, respectively, P = .39). Follicular development was minimal in both groups, with only 5 women achieving a maximum follicle diameter >13 mm at any time during 3 weeks follow-up (3 normal weight and 2 obese women); these women had serum progesterone levels <1.0. Obese women reported more bleeding or spotting than normal weight women (3.6 vs 1.4 days, respectively, P = .01). Although obese women had lower EE(2) levels during contraceptive vaginal ring use, they had excellent suppression of ovarian follicle development, similar to normal weight women. This predicts that contraceptive vaginal ring effectiveness will be similar in women with a BMI up to 39.9. The lower serum EE(2) levels in the obese women may explain the greater reported bleeding or spotting days. Copyright © 2012 Mosby, Inc. All rights reserved.

Use and knowledge of contraceptive methods by patients in two substance use disorders treatment centers in Paris.

PubMed

Clergue-Duval, Virgile; Robin, Suzanne; Fortias, Maeva; Dupuy, Gaël; Badin-de-Montjoye, Béatrice; Vorspan, Florence

2017-08-04

Studies on contraceptive use by patients with substance use disorders (SUD) show a concerning low use of contraception. Mainly conducted in USA, they could be irrelevant to patients attending European SUD treatment centers, especially since these studies mostly investigate women suffering from social exclusion, severe material deprivation andopiates use with frequent high-risk drug use and sexual behaviors including sex trade, frequently not currently attending treatment centers. The purpose of this study is to describe contraceptive use by patients, both male and female, since contraception can not only be considered as a female problem, with severe SUD in two free clinics in Paris, France. An anonymous self-report questionnaire was distributed to literate patients followed in two generalist substance use disorders treatment centers in hospitals of Paris, France: Espace Murger and Centre Cassini, during 5 weeks between February and March 2016. Out of the 78 respondents (with an age mean 40.7 years, in which women are represented as 48.1%, and 29.7% of them have children), 53 have had at least one sexual partner in the last 6 months. Contraception was "always" used by 55.3% of sexually active patients, "sometimes" by 19.1%, and "not" used by 25.5%. Male condoms were the main contraceptive method. The use of intrauterine devices was low, contrarily to what is observed in the French general population. However, the knowledge of contraceptive methods was common. In this population, with a high prevalence of at risk sexual behavior, the use of contraceptive methods is lower than in French general population. During standard care for SUD, contraception and desire to be a parent should be discussed and patients empowered to make their own choices. Lack of knowledge does not seem to be a hindrance to the use of contraception, but other sociological, psychological, or medical factors may limit contraceptive access and long-term use, especially for the long-acting reversible contraception methods. It is necessary to further develop this reflection by discussing the individual contraceptive choices with the patients themselves to clarify the nature of these constraints and maybe provide several contraceptive methods within the SUD care settings.

The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh, Pakistan: A Multilevel Analysis

PubMed Central

Tappis, Hannah; Dahar, Zaib; Ali, Anayat; Agha, Sohail

2015-01-01

Introduction Rapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan’s national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior. Methods Individual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan. Results Only 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use. Conclusions Quality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty. PMID:26485524

Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry.

PubMed

Herzog, Andrew G; Mandle, Hannah B; Cahill, Kaitlyn E; Fowler, Kristen M; Hauser, W Allen; Davis, Anne R

2016-04-01

To report the contraceptive practices of women with epilepsy (WWE) in the community, predictors of highly effective contraception use, and reasons WWE provide for the selection of a particular method. These cross-sectional data come from the Epilepsy Birth Control Registry (EBCR) web-based survey regarding the contraceptive practices of 1,144 WWE in the community, ages 18-47 years. We report demographic, epilepsy, and antiepileptic drug (AED) characteristics as well as contraceptive use. We determined the frequency of use of highly effective contraception use, that is, methods with failure rate <10%/year, and conducted binary logistic regression analysis to determine predictors of highly effective contraception use. We report frequencies of WWE who consult various health care providers regarding the selection of a method and the reasons cited for selection. Of the 796 WWE at risk of unintended pregnancy, 69.7% use what is generally considered to be highly effective contraception (hormonal, intrauterine device [IUD], tubal, vasectomy). Efficacy in WWE, especially for the 46.6% who use hormonal contraception, remains to be proven. Significant predictors of highly effective contraception use are insurance (insured 71.6% vs. noninsured 56.0%), race/ethnicity (Caucasian 71.3% vs. minority 51.0%), and age (38-47, 77.5%; 28-37, 71.8%; 18-27, 67.0%). Of the 87.2% who have a neurologist, only 25.4% consult them regarding selection of a method, although AED interaction is cited as the top reason for selection. The EBCR web-based survey is the first large-scale study of the contraceptive practices of WWE in the community. The findings suggest a need for the development of evidence-based guidelines that address the efficacy and safety of contraceptive methods in this special population, and for greater discourse between neurologists and WWE regarding contraception. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial.

PubMed

Roth, Mara Y; Shih, Grace; Ilani, Niloufar; Wang, Christina; Page, Stephanie T; Bremner, William J; Swerdloff, Ronald S; Sitruk-Ware, Regine; Blithe, Diana L; Amory, John K

2014-10-01

Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method. As part of a three-arm, 6-month, double-blind, randomized controlled trial of testosterone and nestorone gels at two academic medical centers, subjects completed a questionnaire to assess the acceptability of the regimen. Of the 99 men randomized, 79 provided data for analysis. Overall, 56% (44/79) of men were satisfied or extremely satisfied with this gel-based method of contraception, and 51% (40/79) reported that they would recommend this method to others. One third of subjects (26/79) reported that they would use this as their primary method of contraception if it were commercially available today. However, men with concerns about sexually transmitted disease were significantly less satisfied than men without such concerns (p=0.03). A majority of the men who volunteered to participate in this trial of an experimental male hormonal contraceptive were satisfied with this transdermal male hormonal contraceptive. If commercially available, a combination of topical nesterone and testosterone gels could provide a reversible, effective method of contraception that is appealing to men. A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy. Copyright © 2014 Elsevier Inc. All rights reserved.

The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh, Pakistan: A Multilevel Analysis.

PubMed

Tappis, Hannah; Kazi, Anis; Hameed, Waqas; Dahar, Zaib; Ali, Anayat; Agha, Sohail

2015-01-01

Rapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan's national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior. Individual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan. Only 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use. Quality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty.

Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial☆, ☆☆, ★

PubMed Central

Roth, Mara Y.; Shih, Grace; Ilani, Niloufar; Wang, Christina; Page, Stephanie T.; Bremner, William J.; Swerdloff, Ronald S.; Sitruk-Ware, Regine; Blithe, Diana L.; Amory, John K.

2014-01-01

Objective Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method. Study Design As part of a three-arm, 6-month, double-blind, randomized controlled trial of testosterone and nestorone gels at two academic medical centers, subjects completed a questionnaire to assess the acceptability of the regimen. Of the 99 men randomized, 79 provided data for analysis. Results Overall, 56% (44/79) of men were satisfied or extremely satisfied with this gel-based method of contraception, and 51% (40/79) reported that they would recommend this method to others. One third of subjects (26/79) reported that they would use this as their primary method of contraception if it were commercially available today. However, men with concerns about sexually transmitted disease were significantly less satisfied than men without such concerns (p=0.03). Conclusions A majority of the men who volunteered to participate in this trial of an experimental male hormonal contraceptive were satisfied with this transdermal male hormonal contraceptive. If commercially available, a combination of topical nesterone and testosterone gels could provide a reversible, effective method of contraception that is appealing to men. Implications A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy. PMID:24981149

Factor associated with experience of modern contraceptive use before pregnancy among women who gave birth in Kersa HDSS, Ethiopia.

PubMed

Musa, Abdulbasit; Assefa, Nega; Weldegebreal, Fitsum; Mitiku, Habtamu; Teklemariam, Zelalem

2016-07-22

Worldwide, every year 289,000 women die related to pregnancy and its complications. Nearly, all of these deaths occur in developing countries and more than half of this deaths occur in sub-Saharan Africa. Report suggested that using contraceptives can reduce this maternal mortality by 44 %. Even if, Ethiopia is one of the countries with highest maternal mortality, only 41 % of married women are using family planning. This analysis aimed at assessing factor associated with experience of contraceptive use before pregnancy among women who gave birth in Kersa Health and Demographic Surveillance System, Ethiopia. This study was part of data generated for Kersa Health and Demographic Surveillance System. Women who gave birth during October 2011 to September 2012 were asked whether they had used contraceptive before getting their last pregnancy. Data were collected by using Kersa Health and Demographic Surveillance System questionnaire. Both bi-variate and multivariate analysis were used to identify associated factors. The proportion of modern contraceptive before pregnancy among the study participants was found to be 383 (40.9 %). The most commonly used modern contraceptives was Injectable contraceptive 270 (70.0 %) followed by oral contraceptives, 66 (17.23 %). Modern contraceptive use was negatively association with being Muslim (AOR = 0.2, 95 % CI = 0.05, 0.72) and being young mother (AOR = 0.44, 95 % CI = 0.22, 0.86). Rural town residence (AOR = 2.23, 95 % CI = 1.15, 4.35) was found to have positive association with utilization of modern contraceptives. Among women giving birth, only a minority had attempted to delay or prevent their recent birth by using contraception. Being young, being Muslim and living in rural area were significantly associated with low utilization of modern contraceptive. Increasing family planning education and involving religious leaders in family planning promotion would improve utilization of modern contraceptive use.

Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC

PubMed Central

Garfinkel, Danielle; Thanel, Katherine; Esch, Keith; Workalemahu, Endale; Anyanti, Jennifer; Mpanya, Godéfroid; Binanga, Arsène; Pope, Jen; Longfield, Kim; Bertrand, Jane; Shaw, Bryan

2018-01-01

Background An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector’s role in increasing contraceptive coverage and choice. Methods In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. Findings Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. Discussion There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector’s role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC. PMID:29444140

Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC.

PubMed

Riley, Christina; Garfinkel, Danielle; Thanel, Katherine; Esch, Keith; Workalemahu, Endale; Anyanti, Jennifer; Mpanya, Godéfroid; Binanga, Arsène; Pope, Jen; Longfield, Kim; Bertrand, Jane; Shaw, Bryan

2018-01-01

An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector's role in increasing contraceptive coverage and choice. In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector's role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.

Emergency contraception for prevention of adolescent pregnancy.

PubMed

Lindberg, Claire E

2003-01-01

Adolescent pregnancy remains a significant problem in the United States today, despite availability of effective contraceptive methods. Not all sexually active adolescents use contraception, and even those who do use contraception sometimes use it incorrectly. Emergency contraception, which refers to methods of pregnancy prevention used after unprotected intercourse, has the potential to prevent most unplanned adolescent pregnancies. Emergency contraceptive pills (ECP) containing estrogen and progestin or progestin alone are more than 75% effective when the first dose is taken within 72 hours after unprotected sex and the second dose is taken 12 hours later. However, barriers to accessing ECPs include lack of knowledge of the method, fear of loss of privacy, difficulties in finding a provider, and cost. Another barrier is that controversy exists about the mechanisms of action of emergency contraception about its role in pregnancy prevention. As a result, some nurses are not comfortable with suggesting emergency contraception to their patients. Nurses can play a critical role in providing ECPs to adolescents by developing programs to streamline distribution of ECPs, while maintaining adolescent privacy. Other essential roles for nurses include providing education about ECPs to parents, other healthcare providers and community members, and advocating for political and legal changes that will ease restrictions on ECP distribution. Nurses who are personally uncomfortable discussing emergency contraception can refer their patients to other providers for information and access to this method.

Barriers of modern contraceptive practices among Asian women: a mini literature review.

PubMed

Najafi-Sharjabad, Fatemeh; Zainiyah Syed Yahya, Sharifah; Abdul Rahman, Hejar; Hanafiah Juni, Muhamad; Abdul Manaf, Rosliza

2013-07-22

Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.

Barriers of Modern Contraceptive Practices among Asian Women: A Mini Literature Review

PubMed Central

Najafi-Sharjabad, Fatemeh; Syed Yahya, Sharifah Zainiyah; Rahman, Hejar Abdul; Hanafiah, Muhamad; Abdul Manaf, Rosliza

2013-01-01

Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women. PMID:23985120

Advances in Male Contraception

PubMed Central

Page, Stephanie T.; Amory, John K.; Bremner, William J.

2008-01-01

Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704

What Are the Different Types of Contraception?

MedlinePlus

... certain diseases. Long-Acting Reversible Contraception (LARC) Intrauterine Methods An intrauterine device (IUD), also known as an ... in clinical development. Hormonal Methods Short-Acting Hormonal Methods Hormonal methods of birth control use hormones to ...

How economic development and family planning programs combined to reduce Indonesian fertility.

PubMed

Gertler, P J; Molyneaux, J W

1994-02-01

This paper examines the contributions of family planning programs, economic development, and women's status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single "structural" proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.

Male contraception: another Holy Grail.

PubMed

Murdoch, Fern E; Goldberg, Erwin

2014-01-15

The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

[For the harmonious development of the human being].

PubMed

Sadeler, L

1993-01-01

In Benin, women's social status determines the number of births. In fact, a woman's attitude towards procreation hinges on her educational and social status. An average pregnancy rate of 7 and an illiteracy rate of 75% accounts for the limited interest in contraceptive use in Benin. It appears, therefore, that people have not clearly grasped the importance of family planning. The key to birth spacing is to promote education, especially education of youth and women. Policymakers and opinion leaders have a big role to play in sensitizing the population to adjusting procreation to available resources, to curb irresponsible sex behavior, and to assure human development and potential. Thus, women in Benin will be able to free themselves from sociocultural constraints based on traditional values which do not always favor their full potential. This shift in attitude at the national level will curb child mortality, maternal mortality, malnutrition, preventable deaths, prostitution, sexually transmitted disease, and AIDS. Therefore, responsible family planning thrusts itself as one of the most effective and accessible methods to assure a quality life today and tomorrow. The Benin Association for the Promotion of the Family is open every day providing counseling and direction, loans for family planning services, and provision of contraceptive methods. Legal provisions, especially adoption of text popularizing family planning activities, contribute greatly to the success of all development partners in Benin intervening in the field of demographic planning. This act will mark a decisive turning point in the fight for economic, cultural, and social progress.

[Family planning in a suburban development of Mexico City].

PubMed

Gutiérrez Avila, J H; González Cortés, A; González Cortés, A

1982-01-01

To study the prevalence of contraceptive use among women in reproductive age, 15-50, and living in urban slums, the female population of Colonia Ajusco was surveyed. Colonia Ajusco is situated south of Mexico City; 70% of its population comes from the interior of the country; there is no drinkable water and no sewage system; housing conditions and urban services are very poor. 606 women were investigated; 58% of them were below age 36, and 53.5% were parity 4 and over. 56.4% used contraception; of these 36.7% used the IUD, 23.1% the pill, and 16.7% had been sterilized. The contraceptive method used seemed to be strictly related to the type of medical services used; women using the IUD were mostly patients of the Social Security medical services, while women using the pill were mostly clients of private physicians. There was no association between age and the method used. 88.4% of women not using contraception did not have easy availability of medical services. The percentage of women using contraception, 56.4% seems high in relation to other Latin American countries, but it is very low in relation to the percentage of contraceptive users in more developed countries (93% in England). The use of the IUD as the method of choice can be explained by several factors: the massive national advertising campaign, low cost, ease of insertion, and no need for sustained motivation to use contraception. From all studies on contraceptive prevalence in Mexico it appears that women start to regulate their fertility after the 1st child, or even after the 4th child. Women below 20 still tend to resort to illegal abortion.

[Hyperplastic changes and oral contraceptives in Anglo-Saxon countries].

PubMed

Markuszewski, C

1978-09-18

One of the major problems being researched and studied by the World Health Organization is the incidence of harmful side effects in users of steroid contraceptives. A literature search indicates that Anglo-Saxon countries report alarming hyperplastic changes, particularly in the liver, blood clots, hyperlipidemia leading to high blood pressure, porphyria, atypical leiomyomas and cervical hyperplasia. Currently attention is being focused on the relationship between steroid contraceptives and breast cancer. Fazala and Paffenbarger in their study of 1770 women found such benign changes as fibroadenoma, mastopathia fibrosa cystica and papilloma intraductale. In women who had used oral contraceptives for 2-4 yrs, malignancies were 1.9% to 2.5% more frequent than in non-users; in 6 yrs of use, 11 times greater than in non-users. Estrogens, particularly mestranol has been recognized as being harmful to the liver. Length of usage is a definite factor. Beginning with 1960, relatively frequent occurrences of hepotoma in young women on the pill were noted. Caught at an early stage, peliosis hepatis can be reversed if the patient discontinues the use of contraceptives. In some cases, even after a long interval of 6 months to 10 yrs, the disease continued to develop. Liver cell adenoma in the U. S. occurs 1/500,00 to 1/1,000,000. After 5 to 7 yrs of using oral contraceptives, the chance of developing liver cell adenoma is 5 times greater; after 10 yrs of use, 35 times greater. Hepatomas rupture in 43.4% of cases when the patient had been on a contraceptive, while in only 22.2% in cases of non-users. The literature which the author investigated did not establish a clear proof that the hyperplastic changes discussed were due exclusively to usage of oral contraceptives.

When children have children: the teen pregnancy predicament.

PubMed

Carter, D M; Felice, M E; Rosoff, J; Zabin, L S; Beilenson, P L; Dannenberg, A L

1994-01-01

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis.

PubMed

Bird, Steven T; Hartzema, Abraham G; Brophy, James M; Etminan, Mahyar; Delaney, Joseph A C

2013-02-05

There is an increased risk of venous thromboembolism among women taking oral contraceptives. However, whether there is an additional risk among women with polycystic ovary syndrome (PCOS) is unknown. We developed a population-based cohort from the IMS LifeLink Health Plan Claims Database, which includes managed care organizations in the United States. Women aged 18-46 years taking combined oral contraceptives and who had a claim for PCOS (n = 43 506) were matched, based on a propensity score, to control women (n = 43 506) taking oral contraceptives. Venous thromboembolism was defined using administrative coding and use of anticoagulation. We used Cox proportional hazards models to assess the relative risk (RR) of venous thromboembolism among users of combined oral contraceptives with and without PCOS. The incidence of venous thromboembolism among women with PCOS was 23.7/10 000 person-years, while that for matched controls was 10.9/10 000 person-years. Women with PCOS taking combined oral contraceptives had an RR for venous thromboembolism of 2.14 (95% confidence interval [CI] 1.41-3.24) compared with other contraceptive users. The incidence of venous thromboembolism was 6.3/10 000 person-years among women with PCOS not taking oral contraceptives; the incidence was 4.1/10 000 person-years among matched controls. The RR of venous thromboembolism among women with PCOS not taking oral contraceptives was 1.55 (95% CI 1.10-2.19). We found a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives. Physicians should consider the increased risk of venous thromboembolism when prescribing contraceptive therapy to women with PCOS.

The epididymis as a target for male contraceptive development.

PubMed

Hinton, B T; Cooper, T G

2010-01-01

The epididymis is an excellent target for the development of a male contraceptive. This is because the process of sperm maturation occurs in this organ; spermatozoa become motile and are able to recognise and fertilise an egg once they have traversed the epididymal duct. However, a number of attempts to interfere in sperm maturation and epididymal function or both have not been successful. The use of transgenic animals has proved useful in identifying a few epididymal targets but has yet to open the doors for drug development. Continuous focus on identifying additional epididymal targets and sperm-specific and epididymal-specific drugs is key to bringing a male contraceptive acting on the epididymis to the public.

Artifacts, intentions, and contraceptives: the problem with having a plan B for plan B.

PubMed

Reed, Philip A

2013-12-01

It is commonly proposed that artifacts cannot be understood without reference to human intentions. This fact, I contend, has relevance to the use of artifacts in intentional action. I argue that because artifacts have intentions embedded into them antecedently, when we use artifacts we are sometimes compelled to intend descriptions of our actions that we might, for various reasons, be inclined to believe that we do not intend. I focus this argument to a specific set of artifacts, namely, medical devices, before considering an extended application to emergency contraceptive devices. Although there is some debate about whether emergency contraception has an abortifacient effect, I argue that if there is an abortifacient effect, then the effect cannot normally be a side effect of one's action.

An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest

PubMed Central

Fruzzetti, Franca; Trémollieres, Florence; Bitzer, Johannes

2012-01-01

Natural estrogens such as estradiol (E2) or its valerate ester (E2V) offer an alternative to ethinyl estradiol (EE). E2-containing combined oral contraceptives (COCs) have demonstrated sufficient ovulation inhibition and acceptable contraceptive efficacy. However, earlier formulations were generally associated with unacceptable bleeding profiles. Two E2V-containing preparations have been approved to date for contraceptive use: E2V/cypro-terone acetate (CPA) (Femilar®; only approved in Finland and only in women >40 years or women aged 35–40 years in whom a COC containing EE is not appropriate) and E2V/dienogest (DNG; Qlaira®/Natazia®). The objective of the current review is to provide an overview of the development of COCs containing natural estrogen, highlighting past issues and challenges faced by earlier formulations, as well as the current status and future directions. The majority of information to date pertains to the development of E2V/DNG. PMID:22468839

U.S. Medical Eligibility Criteria for Contraceptive Use, 2016.

PubMed

Curtis, Kathryn M; Tepper, Naomi K; Jatlaoui, Tara C; Berry-Bibee, Erin; Horton, Leah G; Zapata, Lauren B; Simmons, Katharine B; Pagano, H Pamela; Jamieson, Denise J; Whiteman, Maura K

2016-07-29

The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2010 U.S. MEC (CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010:59 [No. RR-4]). Notable updates include the addition of recommendations for women with cystic fibrosis, women with multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate; and revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases, and human immunodeficiency virus; and women who are receiving antiretroviral therapy. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.

Contraceptive Hormone Use and Cardiovascular Disease

PubMed Central

Shufelt, Chrisandra L.; Noel Bairey Merz, C.

2009-01-01

Contraceptive hormones, most commonly prescribed as oral contraceptives (OC), are a widely utilized method to prevent ovulation, implantation and therefore pregnancy. The Women’s Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting review of the safety, efficacy and side effects of other forms of hormone therapy. A variety of basic science, animal and human data suggest that contraceptive hormones have anti-atheromatous effects, however relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion and arrhythmogenesis. Newer generation OC formulations currently in use indicate no increased myocardial infarction (MI) risk for current users, but a persistent increased risk of venous thrombo-embolism (VTE). There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the non-oral routes (topical and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy and other vascular diseases including migraines, prior to use. Existing data are mixed with regard to possible protection from OC for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue. PMID:19147038

Maternal hormonal contraceptive use and offspring overweight or obesity.

PubMed

Jensen, E T; Daniels, J L; Stürmer, T; Robinson, W R; Williams, C J; Moster, D; Juliusson, P B; Vejrup, K; Magnus, P; Longnecker, M P

2014-10-01

Experiments in animal models have shown a positive association between in utero exposure to pharmacologic sex hormones and offspring obesity. The developmental effects of such hormones on human obesity are unknown. Using data from a large, prospective pregnancy cohort study (n=19 652), with linkage to a national prescription registry, we evaluated the association between use of hormonal contraceptives before and after conception (defined from dispensed prescription data and characterized by last date of use relative to conception, 12 to >4 months before (n=3392), 4 to >1 months before (n=2541), 1 to >0 months before (n=2997) and 0-12 weeks after (n=567)) in relation to offspring overweight or obesity at age 3 years. We observed a weak, inverse association between early pregnancy use of a combination oral contraceptive and offspring overweight or obesity at age 3 (adjusted odds ratio (OR): 0.75, 95% confidence interval (CI): 0.53, 1.08) and a positive, but imprecise, association with use of a progestin-only oral contraceptive in early pregnancy (adjusted OR: 1.26, 95% CI: 0.79, 2.02). In general, no association was observed between the use of a hormonal contraceptive before conception and offspring overweight or obesity. A sensitivity analysis comparing combination oral contraceptive users in early pregnancy to other unplanned pregnancies without hormonal contraceptive use further strengthened the inverse association (adjusted OR: 0.70, 95% CI: 0.48, 1.02). Other sensitivity analyses were conducted to evaluate the robustness of the associations observed given varying assumptions. Pharmacologic sex hormones in early pregnancy may be inversely or positively associated with offspring overweight or obesity at age 3, depending on the specific formulation used. The present study provides support for the potential for environmental sources of hormonally active agents to exert developmental effects.

Frequency of Candidiasis and Colonization of Candida albicans in Relation to Oral Contraceptive Pills.

PubMed

Aminzadeh, Atousa; Sabeti Sanat, Ali; Nik Akhtar, Saeed

2016-10-01

Candidiasis, the infection caused by Candida albicans , is one of the most common infections of the oral cavity in humans. Candidiasis causes irritation and is known for its carcinogenic effects. Thus, it is important to recognize the predisposing factors for this opportunistic infection. Several previous studies have demonstrated an increased frequency of vaginal candidiasis in relation to oral contraceptive consumption. Only a few studies on the relation between oral contraceptives and oral candidiasis have been previously conducted. This study aims to evaluate the possible relation between oral contraceptive pills and oral candidiasis. This analytic, case-control study included 40 non-pregnant women divided into two groups: 20 who used oral contraceptive pills and 20 who did not. The groups were matched according to age, oral health, and past and present medical history. Samples were collected from the tongue's dorsum using a cotton swab and inoculated on CHROMagar culture plates. The frequency of positive cultures and the number of Candida colonies were compared between the two groups using independent t-tests and Mann-Whitney statistical tests with SPSS18 software. The frequency of positive cultures of Candida albicans was higher (P value = 0.03) for the case group. Also, the number of C. albicans and C. krusei was significantly higher for the case group compared to the control group (P value = 0.04, P value = 0.03). The results of the present study demonstrate that oral contraceptives containing estradiol can lead to Candida colonization in the oral cavity. It is recommended that further studies comparing the influence of oral contraceptives on Candida's adherence to the epithelium is highly recommended.

Overlapping dose responses of spermatogenic and extragonadal testosterone actions jeopardize the principle of hormonal male contraception

PubMed Central

Oduwole, Olayiwola O.; Vydra, Natalia; Wood, Nicholas E. M.; Samanta, Luna; Owen, Laura; Keevil, Brian; Donaldson, Mandy; Naresh, Kikkeri; Huhtaniemi, Ilpo T.

2014-01-01

Testosterone (T), alone or in combination with progestin, provides a promising approach to hormonal male contraception. Its principle relies on enhanced negative feedback of exogenous T to suppress gonadotropins, thereby blocking the testicular T production needed for spermatogenesis, while simultaneously maintaining the extragonadal androgen actions, such as potency and libido, to avoid hypogonadism. A serious drawback of the treatment is that a significant proportion of men do not reach azoospermia or severe oligozoospermia, commensurate with contraceptive efficacy. We tested here, using hypogonadal luteinizing hormone/choriongonadotropin receptor (LHCGR) knockout (LHR−/−) mice, the basic principle of the T-based male contraceptive method, that a specific T dose could maintain extragonadal androgen actions without simultaneously activating spermatogenesis. LHR−/− mice were treated with increasing T doses, and the responses of their spermatogenesis and extragonadal androgen actions (including gonadotropin suppression and sexual behavior) were assessed. Conspicuously, all dose responses to T were practically superimposable, and no dose of T could be defined that would maintain sexual function and suppress gonadotropins without simultaneously activating spermatogenesis. This finding, never addressed in clinical contraceptive trials, is not unexpected in light of the same androgen receptor mediating androgen actions in all organs. When extrapolated to humans, our findings may jeopardize the current approach to hormonal male contraception and call for more effective means of inhibiting intratesticular T production or action, to achieve consistent spermatogenic suppression.—Oduwole, O. O., Vydra, N., Wood, N. E. M., Samanta, L., Owen, L., Keevil, B., Donaldson, M., Naresh, K., Huhtaniemi, I. T. Overlapping dose responses of spermatogenic and extragonadal testosterone actions jeopardize the principle of hormonal male contraception. PMID:24599970

Can the evolution of male contraception lead to a revolution? Review of the current state of knowledge.

PubMed

Frankiewicz, Mikołaj; Połom, Wojciech; Matuszewski, Marcin

2018-01-01

Great advances in medical research concerning methods of contraception have been achieved in recent years, however, more than 25% of couples worldwide still rely on condoms - a method with poor efficacy. Even though there is a spectrum of 11 different contraceptive methods for women, there are only 4 commonly used by men (condoms, periodic abstinence, withdrawal and vasectomy). In this review, advances and present, state-of-the-art, both hormonal and non-hormonal male contraceptive methods will be presented and evaluated. Potential novel targets that warrant greater research will be highlighted. A comprehensive literature search without a time limit was performed using the Medline database on May 2017. The terms 'male contraception' in conjunction with 'reversible inhibition of sperm under guidance' (RISUG), 'hormonal', 'non-hormonal', 'vasectomy' or 'testosterone' were used. The articles were limited to those published in English, Polish or French. There are various contraceptives currently available to regulate male fertility. Vasectomy is still the most effective permanent form of male contraceptive with a failure rate lower than 1%. Reversible, non hormonal methods of male contraception, like reversible inhibition of sperm under guidance, are very promising and close to being introduced into the market. In regards to hormonal contraception research, the use of testosterone injections has been widely studied yet they often harbor undesirable side effects and require further development. Despite continuous efforts worldwide, it seems that another several years of research is needed to provide safe, effective and affordable male contraceptives which will allow both men and women to participate fully in family planning.

[Contraception in the future].

PubMed

Hamzaoui, R; Boukhris, M

1994-02-01

In the last decade, global use of contraceptive methods has increased. About 50% of couples of childbearing age use a modern contraceptive method. This evolution and a positive change in attitude towards male contraception has encouraged research in fertility regulation to enlarge and to improve acceptance of the contraceptive mix. Current injectable contraceptives interfere with the menstrual cycle. Research is exploring ways to minimize such secondary effects by reducing the total hormone dose and by changing the way the active product is delivered (e.g., microspheres). An injectable prototype is an analogue of levonorgestrel (HRP 002). A new IUD is made of leather suspended by a nylon suture which has been inserted into the uterine muscle. RU-486, often used to interrupt early pregnancy, is being tested as an oral contraceptive (OC). It inhibits secretion of gonadotropins and ovulation. It holds promise as an OC with no estrogen component. Since it also inhibits endometrial development and thus prevents implantation, it may someday be used for emergency contraception (i.e., postcoital contraception). New contraceptive implants under study include Norplant RII (2 rods of levonorgestrel lasting for 3 years), Implanon (desogestrel), and Capranor (biodegradable implant lasting 2 years). The female condom consists of a flexible polyurethane sheath with a flexible ring at each end. It has the potential to protect against sexually transmitted diseases since it covers the labial lips and is impermeable to HIV. France and Switzerland have both approved its use. It will enter the UK market at the end of the year. Approval for marketing has been sought in the US.

Directive counseling on long-acting contraception.

PubMed Central

Moskowitz, E; Jennings, B

1996-01-01

National rates of unintended births are a major public health concern. The availability of highly effective long-acting contraceptives has prompted some public officials to promote the coercive use of these methods to reduce such problems as intergenerational poverty and child abuse. Broad-brush public policies that require long-term contraceptive use are unethical. However, persuasion to use these methods can be appropriate. One place for exerting ethically justified influence is in family planning counseling. The dominant nondirective counseling model, which excludes the possibility of vigorous persuasion, is overly rigid. Family planning professionals should develop practice protocols that permit and guide the exercise of directive counseling to use long-acting contraception. PMID:8659650

Nurse-led management of contraceptive services.

PubMed

Wilson, Emma

2014-07-01

This article discusses the role of the practice nurse (PN) in the provision of health assessment for contraceptive choices. PNs who have an extended role as an independent nurse prescriber must demonstrate the principles of safe prescribing practice, with appropriate and informed assessment of the patient's needs and risk within the limited time of a general practice appointment. With continued professional development, PNs are well placed to provide comprehensive, independent nurse-led contraceptive services.

Development of the Ovarian Cancer Cohort Consortium: Risk Factor Associations by Heterogeneity of Disease

DTIC Science & Technology

2014-10-01

we have received data. Analyses of primary ovarian cancer risk factors (e.g., oral contraceptive use, parity) by histology are complete and a...including (but not limited to) age, oral contraceptive use, tubal ligation, parity, postmenopausal hormone use, family history of ovarian cancer, body mass...of ovarian or breast cancers, menopausal status, postmenopausal hormone use (ever/never, duration, and type), use of oral contraceptives (ever/never

Does the contraceptive pill alter mate choice in humans?

PubMed

Alvergne, Alexandra; Lummaa, Virpi

2010-03-01

Female and male mate choice preferences in humans both vary according to the menstrual cycle. Women prefer more masculine, symmetrical and genetically unrelated men during ovulation compared with other phases of their cycle, and recent evidence suggests that men prefer ovulating women to others. Such monthly shifts in mate preference have been suggested to bring evolutionary benefits in terms of reproductive success. New evidence is now emerging that taking the oral contraceptive pill might significantly alter both female and male mate choice by removing the mid-cycle change in preferences. Here, we review support for such conclusions and speculate on the consequences of pill-induced choice of otherwise less-preferred partners for relationship satisfaction, durability and, ultimately, reproductive outcomes.

Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant.

PubMed

Ali, Moazzam; Akin, Ayse; Bahamondes, Luis; Brache, Vivian; Habib, Ndema; Landoulsi, Sihem; Hubacher, David

2016-11-01

Is it possible to extend the use of the 3-year one-rod etonogestrel (ENG)-releasing subdermal contraceptive implant to 5 years? The extended use of the one-rod ENG-releasing subdermal contraceptive implant showed 100% efficacy in years 4 and 5. The initial regulated trials on the ENG-releasing subdermal contraceptive implant conducted in the 1990 s were designed to measure cumulative 3-year efficacy. The ENG-implant has both well established safety and efficacy for up to 3 years. Pharmacokinetic data on ENG show high levels at 3 years and some previous clinical research confirms efficacy beyond the current approved duration of 3 years. Today, many women, because the labeled duration has been reached, have the ENG implant removed at 3 years, increasing costs, inconvenience and risks. For the first 3 years, this study was an open-label, multi-centre randomized trial comparing the 3-year ENG implant to the 5-year levonorgestrel (LNG)-releasing implant. After 3 years, a subset of 390 ENG participants, consented to extended use. We compared efficacy, side effects and removal procedures of both implants. We used Kaplan-Meier (K-M) analysis. We included an observational cohort of copper intrauterine device (IUD) users as non-users of hormonal contraceptive method for comparative purposes. The study took place in family planning clinics in seven countries worldwide. Women were enlisted after an eligibility check and informed consent, and 1328 women were enrolled: 390, 522 and 416 in the ENG-implant, LNG-implant and IUD groups, respectively. Over 200 women used the ENG implant for at least 5 years. No pregnancies occurred during the additional 2 years of follow up in the ENG or LNG implant group. The overall 5-year K-M cumulative pregnancy rates for ENG- and LNG- implants were 0.6 per 100 women-years (W-Y) [95% confidence interval (CI): 0.2-1.8] and 0.8 per 100 W-Y [95% CI: 0.2-2.3], respectively. Complaints of bleeding changes were similar; however, ENG-users were more likely than LNG-users to experience heavy bleeding (p < 0.05). The median duration of the implant removal procedure was 64 seconds shorter for the one-rod ENG-implant (inter-quartile range (IQR) = 30.5, 117.5) compared to the two-rod LNG product (IQR = 77.0, 180.0). The 2-year rate for pregnancy in the IUD group compared with the two implant groups combined was 4.1 per 100 W-Y [95% CI: 2.5-6.5]. Few women were ≤19 years old or nulligravida. Although there was no weight limit for enrolment in the study, the number of women ≥70 kg were few. The results from this study corroborate previous evidence showing high contraceptive efficacy through 4 years for the ENG-implant. Data through 5 years are a novel contribution and further proof of the product's capability to provide safe and effective contraception that rivals the current 5-year LNG-subdermal implant. The findings provide valuable information for policy makers, family planning programmers and clinicians that the ENG-releasing subdermal implant is still highly effective up to 5 years after insertion. Compared to previous efforts, our study population was geographically diverse and our study had the highest number of participants completing at least 5 years of use. The trial was registered as ISRCTN33378571. The contraceptive devices and funds for conduct of the study were provided by the United Nations Development Programme/United Nations Population Fund/World Health Organization (WHO)/UNICEF/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), WHO. This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the WHO. All stated authors have no conflict of interest, except Dr Hubacher who reported grants from United States Agency for International Development, during the conduct of the study; other from Advisory Boards (Teva, Bayer, OCON), outside the submitted work. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Programme impact on current contraception in Bangladesh.

PubMed

Latif, M A

1994-03-01

"This paper analyses the impact of three credit programmes--the Bangladesh Rural Advancement Committee (BRAC), the Bangladesh Rural Development Board's Rural Development-12 (BRDB RD-12), and the Grameen Bank (GB), on current rate of contraception. These programmes are targeted to alleviate poverty by providing group-based credit to the rural poor in creating self employment opportunities. With small credits, these programmes combine family planning activities in terms of consciousness raising, awareness building and motivation. Sample survey data are used to analyse the problem of impact evaluation. The analyses show that the BRAC and the GB programmes have [a] significantly positive impact on the current rate of contraception, while the BRDB RD-12 programme does not have any such impact. It is also found that education, both of female[s] and male[s] separately, and child survivorship have independently positive impact[s] on current contraception." excerpt

University of Venda's male students' attitudes towards contraception and family planning.

PubMed

Raselekoane, Nanga R; Morwe, Keamogetse G; Tshitangano, Takalani

2016-07-08

Many young men continue to disregard the importance of contraception and family planning in South Africa. The fact that even university students also do not take contraception and family planning seriously poses a serious threat to their own health and well-being. This paper aims at investigating the attitudes of male students towards contraception and the promotion of female students' sexual health rights and well-being at the University of Venda. Quantitative research method is used to determine how attitudes of 60 male students towards contraception can jeopardise the health and well-being of both male and female students. This study reveals that the majority of 60 male students at the University of Venda have a negative attitude towards contraceptives. As a result, male students at the University of Venda are not keen on using contraceptives. Male students' negative attitude and lack of interest in contraceptives and family planning also limit progress in achieving the Millennium Development Goals on primary health care, especially with regard to sexual and reproductive health and well-being of female students at the University of Venda. The fact that more than half of the male students interviewed did not take contraception and family planning seriously poses a serious threat to health and well-being of students, including violation of female students' sexual and reproductive health rights in South Africa. This calls for radical health promotion and sexual and reproductive rights programmes which should specifically target male students at the University of Venda.

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

PubMed

Vitzthum, Virginia J; Ringheim, Karin

2005-03-01

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.

Increasing contraceptive acceptance through empowerment of female community health volunteers in rural Nepal.

PubMed

Shrestha, Sarala

2002-06-01

The purpose of the study was to enhance contraceptive acceptance among currently-married women of reproductive age (CMWRA) through empowerment training of female community health volunteers (FCHVs). Seventeen FCHVs, who were working in Kakani Village Development Committee in the hills of central Nepal, attended an empowerment training that used participatory action research and reinforcement mechanisms. Following the training, the FCHVs were expected to empower the CMWRA to increase their contraceptive use. The impact of the intervention was assessed in a sample of 241 CMWRA, who were neither pregnant nor using contraceptives at the time of selection, by interviewing them before and six months after the intervention. The implementation of the intervention significantly increased the proportion of CMWRA knowing at least one contraceptive method (chi2(ldr)=71 .7, p=0.001). The use of modern contraceptives among the CMWRA from none before the intervention increased to 52.3% six months following the intervention. Satisfaction of the CMWRA with services provided by the FCHVs also significantly increased. The study concludes that empowerment training of FCHVs using participatory action research and peer reinforcement help increase the acceptance of contraceptives among CMWRA.

Male contraception: a clinically-oriented review.

PubMed

Kanakis, George A; Goulis, Dimitrios G

2015-01-01

Despite the variety of available female contraceptive methods, many pregnancies (~50%) are still undesired. Many men (>60%) want to participate equally with their partner in family planning; however, male contraceptive methods (MCMs) account for only 14% of those used worldwide and no pharmaceutical MCM is available so far. The only two MCMs currently available are condoms, which despite protecting against sexually transmitted diseases have high failure rates (~19%), and vasectomy, which though very efficient (99%) is poorly reversible (<50%). Among MCMs under investigation, male hormonal contraceptives (MHCs) are those that have come closest to commercialization. The action of MHCs relies on the disruption of spermatogenesis that exogenous androgen administration evokes by suppressing the hypophyseal-gonadal axis. Various regimens of androgens as monotherapy or in combination with progestins have been tested in clinical trials achieving a Pearl Index <1.0 (equal to that of the female oral contraceptive pill); however, concerns regarding the variable response rates observed (non-responders: 5-20%), the impracticality of parenteral administration and long-term prostate-associated or cardiovascular morbidity have deflected the interest of the pharmaceutical industry from further research. Non-hormonal contraception methods may be, at least theoretically, more specific by selectively disrupting spermatogenesis and sperm transport or fertilizing ability. Nevertheless, only a few have been tested in clinical trials (Reversible Inhibition of Sperm Under Guidance, RISUG, and Intra Vas Plugs); most of them are still in pre-clinical development or have been abandoned due to toxicity (gossypol). Consequently, until a reliable, safe and practical MCM is developed, women will continue to bear most of the contraception burden.

A prostaglandin E2 receptor antagonist prevents pregnancies during a preclinical contraceptive trial with female macaques

PubMed Central

Peluffo, M.C.; Stanley, J.; Braeuer, N.; Rotgeri, A.; Fritzemeier, K.-H.; Fuhrmann, U.; Buchmann, B.; Adevai, T.; Murphy, M.J.; Zelinski, M.B.; Lindenthal, B.; Hennebold, J.D.; Stouffer, R.L.

2014-01-01

STUDY QUESTION Can administration of a prostaglandin (PG) E2 receptor 2 (PTGER2) antagonist prevent pregnancy in adult female monkeys by blocking periovulatory events in the follicle without altering menstrual cyclicity or general health? SUMMARY ANSWER This is the first study to demonstrate that a PTGER2 antagonist can serve as an effective non-hormonal contraceptive in primates. WHAT IS KNOWN ALREADY The requirement for PGE2 in ovulation and the release of an oocyte surrounded by expanded cumulus cells (cumulus–oocyte expansion; C-OE) was established through the generation of PTGS2 and PTGER2 null-mutant mice. A critical role for PGE2 in primate ovulation is supported by evidence that intrafollicular injection of indomethacin in rhesus monkeys suppressed follicle rupture, whereas co-injection of PGE2 with indomethacin resulted in ovulation. STUDY DESIGN, SIZE, DURATION First, controlled ovulation protocols were performed in adult, female rhesus monkeys to analyze the mRNA levels for genes encoding PGE2 synthesis and signaling components in the naturally selected pre-ovulatory follicle at different times after the ovulatory hCG stimulus (0, 12, 24, 36 h pre-ovulation; 36 h post-ovulation, n = 3–4/time point). Second, controlled ovarian stimulation cycles were utilized to obtain multiple cumulus–oocyte complexes (COCs) from rhesus monkeys to evaluate the role of PGE2 in C-OE in vitro (n = 3–4 animals/treatment; ≥3 COCs/animal/treatment). Third, adult cycling female cynomolgus macaques were randomly assigned (n = 10/group) to vehicle (control) or PTGER2 antagonist (BAY06) groups to perform a contraceptive trial. After the first treatment cycle, a male of proven fertility was introduced into each group and they remained housed together for the duration of the 5-month contraceptive trial that was followed by a post-treatment reversibility trial. PARTICIPANTS/MATERIALS, SETTING, METHODS Quantitative real-time PCR, COC culture and expansion, immunofluorescence/confocal microscopy, enzyme immunoassay, contraceptive trial, ultrasonography, complete blood counts, serum biochemistry tests and blood lipid profiles. MAIN RESULTS AND THE ROLE OF CHANCE Several mRNAs encoding proteins involved in PGE2 synthesis, metabolism and signaling increase (P < 0.05) in the periovulatory follicle after administration of an ovulatory hCG bolus. PGE2 signaling through PTGER2 induces cumulus cell expansion and production of hyaluronic acid, which are critical events for fertilization. Moreover, chronic administration of a selective PTGER2 antagonist resulted in a significant (P < 0.05 versus vehicle-treated controls) contraceptive effect without altering steroid hormone patterns or menstrual cyclicity during a 5-months contraceptive trial. Fertility recovered as early as 1 month after ending treatment. LIMITATIONS, REASONS FOR CAUTION This is a proof-of-concept study in a non-human primate model. Further investigations are warranted to elucidate the mechanism(s) of PTGER2 antagonist action in the primate ovary. Although PTGER2 antagonist treatment did not produce any obvious undesirable effects, improvements in the mode of administration, as well as the efficacy of these compounds, are necessary to consider such a contraceptive for women. WIDER IMPLICATIONS OF THE FINDINGS Monitoring as well as improving the efficacy and safety of female contraceptives is an important public health activity. Even though hormonal contraceptives are effective for women, concerns remain regarding their side-effects and long-term use because of the widespread actions of such steroidal products in many tissues. Moreover, some women cannot take hormones for medical reasons. Thus, development of non-hormonal contraceptives for women is warranted. STUDY FUNDING/COMPETING INTEREST(S) Supported by Bayer HealthCare Pharmaceuticals, The Eunice Kennedy Shriver NICHD Contraceptive Development and Research Center (U54 HD055744), NIH Office of the Director (Oregon National Primate Research Center P51 OD011092), and a Lalor Foundation Postdoctoral Basic Research Fellowship (MCP). The use of the Leica confocal was supported by grant number S10RR024585. Some of the authors (N.B., A.R., K.-H.F., U.F., B.B. and B.L.) are employees of Bayer Healthcare Pharma. PMID:24781425

The effectiveness of family-planning programmes.

PubMed

Mauldin, W P

1989-01-01

By the mid-1960s, countries that accounted for 66% of the population of developing countries had adopted policies designed to reduce their rates of population growth; by 1986, the corresponding figure had reached 78%. In the developing regions as a whole, fertility has fallen by more than 30% since 1950. Contraceptive use has risen sharply, and there has been more than 10-fold increase in the number of couples in developing countries who use contraceptives. There is a very strong association between use of contraception and fertility in developing countries. Social and economic modernization is also taking place, although quite unevenly in the developing regions, so that the relationship of modernization is fertility is not very easy to demonstrate. In general, the experience of the developing countries suggest that a strong family- planning program effort can, and does, lead to a more rapid fertility decline than would be likely based only on socioeconomic variables. The effectiveness of family-planning programs can be enhanced by increasing the range of choice of contraceptive methods offered. However, it is difficult to disentangle the various factors that contribute to the effectiveness of family-planning programs. The public sector is the main supplier of family-planning services in most developing countries, and there is no clear trend towards the reliance on the private sector.

Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.

PubMed

Keesara, Sirina R; Juma, Pamela A; Harper, Cynthia C

2015-08-20

Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

Hormonal approaches to male contraception.

PubMed

Wang, Christina; Swerdloff, Ronald S

2010-11-01

Condoms and vasectomy are male-controlled family planning methods but suffer from limitations in compliance (condoms) and limited reversibility (vasectomy); thus many couples desire other options. Hormonal male contraceptive methods have undergone extensive clinical trials in healthy men and shown to be efficacious, reversible and appear to be well tolerated. The success rate of male hormonal contraception using injectable testosterone alone is high and comparable to methods for women. Addition of progestins to androgens improved the rate of suppression of spermatogenesis. Supported by government or nongovernment organizations, current studies aim to find the best combination of testosterone and progestins for effective spermatogenesis suppression and to explore other delivery methods for these hormones. Translation of these advances to widespread use in the developed world will need the manufacturing and marketing skills of the pharmaceutical industry. Availability of male contraceptives to the developing world may require commitments of governmental and nongovernmental agencies. In a time when imbalance of basic resources and population needs are obvious, this may prove to be a very wise investment. Male hormonal contraception is efficacious, reversible and well tolerated for the target population of younger men in stable relationships. Suppression of spermatogenesis is achieved with a combination of an androgen and a progestin. Partnership with industry will accelerate the marketing of a male hormonal contraceptive. Research is ongoing on selective androgen and progesterone receptor modulators that suppress spermatogenesis, minimize potential adverse events while retaining the androgenic and gonadotropin suppressive actions.

The relationship between female adolescent self-esteem, decision making, and contraceptive behavior.

PubMed

Commendador, Kathleen

2007-11-01

To examine the relationship between female adolescent self-esteem, decision making, and contraceptive behavior in multiethnic, 14- to 17-year-olds, residing on the Big Island of Hawaii. This was a descriptive cross-sectional survey design using a convenience sample of 98 female adolescents aged 14-17 who came to five different clinics on the Big Island of Hawaii for health care. Along with a brief demographic questionnaire, global self-esteem was measured by Rosenberg's Self-Esteem Scale, decision making was measured by the Flinders Adolescent Decision Making Questionnaire, and sexual activity and contraception use was measured by a nonnormed Sexual History and Contraceptive Use Questionnaire developed for this study. Descriptive statistics, logistic regression, and correlations were used to analyze associations and correlations between age, global self-esteem, decision self-esteem, decision coping (vigilant and maladaptive), and contraceptive use for sexually active female adolescents. No significant associations or correlations were found between age, global self-esteem, decision self-esteem, decision coping (vigilance), and the decision to use contraception in sexually active adolescent females. There was, however, significant negative correlation (p < .05) between overall maladaptive decision making and contraceptive use in sexually active female adolescents. This suggests that sexually active adolescent females with higher maladaptive scores are less likely to use contraception. There was also significant association (p < .05) between maladaptive decision making in contraceptive use and sexually active female adolescents. For every one unit increase on the maladaptive scale, the odds of using contraception were estimated to decrease by 7%. Adolescence is a period of transition that involves biological, cognitive, psychological, and social changes. During the vulnerable transition period of adolescence, decisions relating to contraception may occur. Interventions focused on improving decision-making skills and stimulating thinking around not only sexual issues but also on relationship and communication in adolescent issues may facilitate more competent decision making. Understanding the relationship between female adolescent self-esteem, decision making, and contraceptive behavior has contributed to the knowledge base about female contraceptive behavior. Gaining further insight into these relationships will help healthcare professionals provide counseling and health care to female adolescents.

Identifying factors influencing contraceptive use in Bangladesh: evidence from BDHS 2014 data.

PubMed

Hossain, M B; Khan, M H R; Ababneh, F; Shaw, J E H

2018-01-30

Birth control is the conscious control of the birth rate by methods which temporarily prevent conception by interfering with the normal process of ovulation, fertilization, and implantation. High contraceptive prevalence rate is always expected for controlling births for those countries that are experiencing high population growth rate. The factors that influence contraceptive prevalence are also important to know for policy implication purposes in Bangladesh. This study aims to explore the socio-economic, demographic and others key factors that influence the use of contraception in Bangladesh. The contraception data are extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) data which were collected by using a two stage stratified random sampling technique that is a source of nested variability. The nested sources of variability must be incorporated in the model using random effects in order to model the actual parameter effects on contraceptive prevalence. A mixed effect logistic regression model has been implemented for the binary contraceptive data, where parameters are estimated through generalized estimating equation by assuming exchangeable correlation structure to explore and identify the factors that truly affect the use of contraception in Bangladesh. The prevalence of contraception use by currently married 15-49 years aged women or their husbands is 62.4%. Our study finds that administrative division, place of residence, religion, number of household members, woman's age, occupation, body mass index, breastfeeding practice, husband's education, wish for children, living status with wife, sexual activity in past year, women amenorrheic status, abstaining status, number of children born in last five years and total children ever died were significantly associated with contraception use in Bangladesh. The odds of women experiencing the outcome of interest are not independent due to the nested structure of the data. As a result, a mixed effect model is implemented for the binary variable 'contraceptive use' to produce true estimates for the significant determinants of contraceptive use in Bangladesh. Knowing such true estimates is important for attaining future goals including increasing contraception use from 62 to 75% by 2020 by the Bangladesh government's Health, Population & Nutrition Sector Development Program (HPNSDP).

An intervention delivered by text message to increase the acceptability of effective contraception among young women in Palestine: study protocol for a randomised controlled trial.

PubMed

McCarthy, Ona L; Wazwaz, Ola; Jado, Iman; Leurent, Baptiste; Edwards, Phil; Adada, Samia; Stavridis, Amina; Free, Caroline

2017-10-03

Unintended pregnancy can negatively impact women's lives and is associated with poorer health outcomes for women and children. Many women, particularly in low- and middle-income countries, continue to face obstacles in avoiding unintended pregnancy. In the State of Palestine, a survey conducted in 2006 estimated that 38% of pregnancies are unintended. In 2014, unmet need for contraception was highest among young women aged 20-24 years, at 15%. Mobile phones are increasingly being used to deliver health support. Once developed, interventions delivered by mobile phone are often cheaper to deliver than face-to-face support. The London School of Hygiene and Tropical Medicine and the Palestinian Family Planning and Protection Association have partnered to develop and evaluate a contraceptive behavioural intervention for young women in Palestine delivered by mobile phone. The intervention was developed guided by behavioural science and consists of short, mobile phone text messages that contain information about contraception and behaviour change methods delivered over 4 months. We will evaluate the intervention by conducting a randomised controlled trial. Five hundred and seventy women aged 18-24 years, who do not report using an effective method of contraception, will be allocated with a 1:1 ratio to receive the intervention text messages or control text messages about trial participation. The primary outcome is self-reported acceptability of at least one method of effective contraception at 4 months. Secondary outcomes include the use of effective contraception, acceptability of individual methods, discontinuation, service uptake, unintended pregnancy and abortion. Process outcomes include knowledge, perceived norms, personal agency and intervention dose received. Outcomes at 4 months will be compared between arms using logistic regression. This trial will determine the effect of the intervention on young women's attitudes towards the most effective methods of contraception. If the intervention is found to be effective, the intervention will be implemented widely across Palestine. The results could also be used to design a larger trial to establish its effect on unintended pregnancy. ClinicalTrials.gov, ID: NCT02905461 . Registered on 14 September 2016.

Pharmacist prescription of hormonal contraception in Oregon: Baseline knowledge and interest in provision.

PubMed

Rodriguez, Maria I; McConnell, K John; Swartz, Jonas; Edelman, Alison B

2016-01-01

Oregon has implemented legislation expanding the scope of pharmacists to directly prescribe short-acting hormonal contraception (pill and patch) without a medical prescription. Pharmacists are crucial to the success of the new law, but relatively little is known about their intentions to prescribe contraception, or the motivators or barriers in providing this service. With the use of a cross-sectional survey of pharmacists practicing in Oregon before the legislative implementation, we analyzed responses to assess contraceptive knowledge, motivation to participate in direct provision, and perception of barriers to pharmacist prescription of contraception. A logistic regression model was used to examine the association between years in pharmacy practice and intention to provide direct access to contraception. A total of 509 pharmacists responded (17%). If training and reimbursement were offered, more than one-half of pharmacists would potentially be interested in prescribing contraception, managing side-effects, or moving women to a different hormonal method (57%, 61%, and 54%, respectively). However, only 39.1% of pharmacists surveyed planned to actually prescribe hormonal contraception when the legislation took effect. Shortage of pharmacy staff to provide services, concerns about liability, and a need for additional training were the three largest barriers to participation. Pharmacists practicing in urban locations (odds ratio 1.73, 95% CI 1.11-2.70) or currently offering emergency contraception (odds ratio 2.23, 95% CI 1.47-3.40) were significantly more likely to be planning to participate. Preliminary data indicate a need to support pharmacists with education on contraceptive provision and development of interventions to facilitate counseling in the pharmacy setting. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

A Snapshot of Urban Adolescent Women's Contraceptive Knowledge at the Onset of a Community Long-Acting Reversible Contraceptive Promotion Initiative.

PubMed

Greenberg, Katherine Blumoff; Jenks, Sara Catherine; Piazza, Nina; Malibiran, Beatriz Ramos; Aligne, C Andrew

2017-08-01

To contextualize young women's knowledge and attitudes regarding contraception at the outset of an intervention promoting long-acting reversible contraceptive (LARC) use for teen pregnancy prevention. Our intervention was on the basis of diffusion of innovation theory, and at the outset we were interested in likely early adopters' existing knowledge and attitudes toward contraception. This mixed methods study consisted of focus groups within positive youth development programs in Rochester, New York; we discussed young women's knowledge and sources of information for all US Food and Drug Administration-approved contraceptive methods. Seven focus groups and 24 female adolescent participants aged 15-19 years. Quantitative ranking of all contraceptive methods; qualitative themes from focus group discussions. Our findings showed a high level of knowledge about a select group of methods, which included LARC methods, and that participants received contraceptive information from peers and family. Participants had more concerns than positive impressions regarding the effectiveness, safety, practicality, and partner reception of the contraceptive methods, with the exception of the condom. Quantitatively, the condom received the highest average rating. The importance of personal anecdotes in our findings supports the use of outreach and information campaigns; providing medically accurate information and spreading positive personal anecdotes will be key to improving young women's impressions of the safety and acceptability of LARC use. This snapshot of contraceptive knowledge indicates that young women can be mature, informed consumers of sexual and reproductive health care, and through diffusion of innovation could be key players in promoting the most effective means of pregnancy prevention. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Increasing Contraceptive Access for Hard-to-Reach Populations With Vouchers and Social Franchising in Uganda.

PubMed

Bellows, Benjamin; Mackay, Anna; Dingle, Antonia; Tuyiragize, Richard; Nnyombi, William; Dasgupta, Aisha

2017-09-27

From 2001 to 2011, modern contraceptive prevalence in Uganda increased from 18% to 26%. However, modern method use, in particular use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs), remained low. In the 2011 Uganda Demographic and Health Survey, only 1 of 5 married women used a LARC or PM even though 34% indicated an unmet need for contraception. Between 2011 and 2014, a social franchise and family planning voucher program, supporting 400 private facilities to provide family planning counseling and broaden contraceptive choice by adding LARCs and PMs to the service mix, offered a voucher to enable poor women to access family planning services at franchised facilities. This study analyzes service trends and voucher client demographics and estimates the contribution of the program to increasing contraceptive prevalence in Uganda, using the Impact 2 model developed by Marie Stopes International. Between March 2011 and December 2014, 330,826 women received a family planning service using the voucher, of which 70% of voucher clients chose an implant and 25% chose an intrauterine device. The median age of voucher users was 28 years; 79% had no education or only a primary education; and 48% reported they were unemployed or a housewife. We estimated that by 2014, 280,000 of the approximately 8,600,000 women of reproductive age in Uganda were using a contraceptive method provided by the program and that 120,000 of the clients were "additional users" of contraception, contributing 1.4 percentage points to the national modern contraceptive prevalence rate. The combination of family planning vouchers and a franchise-based quality improvement initiative can leverage existing private health infrastructure to substantially expand family planning access and choice for disadvantaged populations and potentially improve contraceptive prevalence when scaled nationally. © Bellows et al.

Increasing Contraceptive Access for Hard-to-Reach Populations With Vouchers and Social Franchising in Uganda

PubMed Central

Bellows, Benjamin; Mackay, Anna; Dingle, Antonia; Tuyiragize, Richard; Nnyombi, William; Dasgupta, Aisha

2017-01-01

ABSTRACT From 2001 to 2011, modern contraceptive prevalence in Uganda increased from 18% to 26%. However, modern method use, in particular use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs), remained low. In the 2011 Uganda Demographic and Health Survey, only 1 of 5 married women used a LARC or PM even though 34% indicated an unmet need for contraception. Between 2011 and 2014, a social franchise and family planning voucher program, supporting 400 private facilities to provide family planning counseling and broaden contraceptive choice by adding LARCs and PMs to the service mix, offered a voucher to enable poor women to access family planning services at franchised facilities. This study analyzes service trends and voucher client demographics and estimates the contribution of the program to increasing contraceptive prevalence in Uganda, using the Impact 2 model developed by Marie Stopes International. Between March 2011 and December 2014, 330,826 women received a family planning service using the voucher, of which 70% of voucher clients chose an implant and 25% chose an intrauterine device. The median age of voucher users was 28 years; 79% had no education or only a primary education; and 48% reported they were unemployed or a housewife. We estimated that by 2014, 280,000 of the approximately 8,600,000 women of reproductive age in Uganda were using a contraceptive method provided by the program and that 120,000 of the clients were “additional users” of contraception, contributing 1.4 percentage points to the national modern contraceptive prevalence rate. The combination of family planning vouchers and a franchise-based quality improvement initiative can leverage existing private health infrastructure to substantially expand family planning access and choice for disadvantaged populations and potentially improve contraceptive prevalence when scaled nationally. PMID:28963175

Providing accessible medical abortion services in a Victorian rural community: A description and audit of service delivery and contraception follow up.

PubMed

Tomnay, Jane E; Coelli, Lauren; Davidson, Ange; Hulme-Chambers, Alana; Orr, Catherine; Hocking, Jane S

2018-06-01

To describe how a nurse led, MToP service is run in primary care in regional Victoria and investigate the characteristics and contraceptive choices of the women who have attended. Descriptive study of the development and implementation of a rural MToP service and a retrospective chart audit of patients attending between January 2015 and September 2016. Characteristics and clinical outcomes for women attending an MToP service in a primary care setting in rural Victoria. Contraceptive usage pre and post attending a rural service for MToP. There were 229 presentations, representing 223 women, of which 172 women (75.1%; 95%CI: 69.0%, 80.6%) had a successful MToP and for two further women, MToP failed, requiring a surgical termination (0.9%; 95%CI: 0.1%, 3.1%). At the time of presentation, the mean age of women was 25 years, the median length of gestation was 49 days and 171 (75%) had not had a previous termination. Data about contraceptive use was available for 195 women, 143 (73.3%) reported no contraception, 2 reported emergency contraceptive pill (1.0%), 10 used condoms (2.1%) and 39 (20.0%) reported hormonal contraception. Among the 156 women using no contraception, condoms or emergency contraception at the time of pregnancy, 113 (72.4%) initiated a reliable form of contraception post presentation to the MToP service. Provision of accessible, affordable MToP through an integrated primary health service is one strategy to address access inequity in regional areas. Copyright © 2018 Elsevier B.V. All rights reserved.

Oral contraceptives and benign breast disease.

PubMed

Hislop, T G; Threlfall, W J

1984-08-01

In 1980 a questionnaire was mailed to 726 nurses who had previously entered a study of breast disease in the late 1940s and 1950s; 665 responded. Between the ages of 30 to 49 years, 137 reported detecting their first signs of benign breast disease and 76 reported receiving their first biopsy for these signs. Long-term oral contraceptive usage reduced the risk of developing signs of benign breast disease and the risk of biopsy for these signs. The potential bias due to the effect of prior benign breast disease on the prescribing practices for oral contraceptives was minimized by considering oral contraceptive usage prior to detecting the first signs of benign breast disease.

Repeated use of the GnRH analogue deslorelin to down-regulate reproduction in male cheetahs (Acinonyx jubatus).

PubMed

Bertschinger, H J; Jago, M; Nöthling, J O; Human, A

2006-10-01

The GnRH analogue deslorelin, as a subcutaneous implant, was initially developed in Australia as an ovulation-inducing agent in mares. Its uses, for the suppression of reproduction in the domestic dog and cat and in other species, including humans, have been developed subsequently. Such implants have been used as a contraceptive modality in a variety of wild carnivores, both males and females. This paper describes the use of deslorelin implants as a contraceptive agent for cheetah males maintained in a semi-captive environment and housed in various camps together with females. Annually, male cheetahs were treated for 1 (n = 2), 2 (n = 7), 3 (n = 9), 4 (n = 3) or 5 (n = 1) consecutive years with an implant containing 4.7, 5.0 or 6.0 mg of deslorelin. On the first day of treatment and then on an annual basis, blood testosterone concentrations were analysed, testicular measurements were taken, appearance of penile spikes was determined, and semen was collected and evaluated. Pregnancy rates of mated or inseminated females were determined. A dose of 6 mg of deslorelin suppressed reproduction for at least 1 year, whereas with 4.7 and 5 mg of deslorelin, 3 of 17 males had a few non-motile spermatozoa in their ejaculates. All testosterone concentrations were basal at 1 year post-implant and no side effects were observed. We concluded that deslorelin implantation, at a dose of 6 mg, was a safe and reliable method of annual contraception in male cheetahs.

Interaction of oligomeric breast cancer resistant protein (BCRP) with adjudin: a male contraceptive with anti-cancer activity.

PubMed

Cheng, Yan Ho; Jenardhanan, Pranitha; Mathur, Premendu P; Qian, Xiaojing; Xia, Weiliang; Silvestrini, Bruno; Cheng, Chuen Yan

2014-01-01

Breast cancer resistant protein (BCRP, ABCG2) is an ATP-binding cassette (ABC) transporter, which together with two other ABC efflux drug pumps, namely P-glycoprotein (P-gp, ABCB1) and multidrug resistance-related protein 1 (MRP1, ABCC1) is the most important multidrug resistance protein foun d in eukaryotic cells including cells in the testis. However, unlike P-gp and MRP1, which are components of the Sertoli cell blood-testis barrier (BTB), BCRP is not expressed at the BTB in rodents and human testes. Instead, BCRP is expressed by peritubular myoid cells and endothelial cells of the lymphatic vessel in the tunica propria, residing outside the BTB. As such, the testis is equipped with two levels of defense against xenobiotics or drugs, preventing these harmful substances from entering the adluminal compartment to perturb meiosis and post-meiotic spermatid development: one at the level of the BTB conferred by P-gp and MRP1 and one at the tunica propria conferred by BCRP. The presence of drug transporters at the tunica propria as well as at the Sertoli cell BTB thus poses significant obstacles in developing non-hormonal contraceptives if these drugs (e.g., adjudin) exert their effects in germ cells behind the BTB, such as in the adluminal (apical) compartment of the seminiferous epithelium. Herein, we summarize recent findings pertinent to adjudin, a non-hormonal male contraceptive, and molecular interactions of adjudin with BCRP so that this information can be helpful to devise delivery strategies to evade BCRP in the tunica propria to improve its bioavailability in the testis.

A prospective, open-label, single arm, multicentre study to evaluate efficacy, safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg.

PubMed

Festin, Mario P R; Bahamondes, Luis; Nguyen, Thi My Huong; Habib, Ndema; Thamkhantho, Manopchai; Singh, Kuldip; Gosavi, Arundhati; Bartfai, Gyorgy; Bito, Tamas; Bahamondes, M Valeria; Kapp, Nathalie

2016-03-01

Will the use of levonorgestrel (LNG) 1.5 mg taken at each day of coitus by women who have relatively infrequent sex be an efficacious, safe and acceptable contraceptive method? Typical use of LNG 1.5 mg taken pericoitally, before or within 24 h of sexual intercourse, provides contraceptive efficacy of up to 11.0 pregnancies per 100 women-years (W-Y) in the primary evaluable population and 7.1 pregnancies per 100 W-Y in the evaluable population. LNG 1.5 mg is an effective emergency contraception following unprotected intercourse. Some users take it repeatedly, as their means of regular contraception. This was a prospective, open-label, single-arm, multicentre Phase III trial study with women who have infrequent coitus (on up to 6 days a month). Each woman had a follow-up visit at 2.5, 4.5 and 6.5 months after admission or until pregnancy occurs if sooner, or she decided to interrupt participation. The study was conducted between 10 January 2012 and 15 November 2014. A total of 330 healthy fertile women aged 18-45 years at risk of pregnancy who reported sexual intercourse on up to 6 days a month, were recruited from four university centres located in Bangkok, Thailand; Campinas, Brazil; Singapore and Szeged, Hungary to use LNG 1.5 mg pericoitally (24 h before or after coitus) as their primary method of contraception. The participants were instructed to take one tablet every day she had sex, without taking more than one tablet in any 24-h period, and to maintain a paper diary for recording date and time for every coital act and ingestion of the study tablet, use of other contraceptive methods and vaginal bleeding patterns. Anaemia was assessed by haemoglobin evaluation. Pregnancy tests were performed monthly and pregnancies occurring during product use were assessed by ultrasound. At the 2.5-month and final visit at 6.5 months, acceptability questions were administered. There were 321 women included in the evaluable population (which includes all eligible women enrolled), with 141.9 woman-years (W-Y) of observation and with a rate (95% confidence interval [CI]) of 7.1 (3.8; 13.1) pregnancies per 100 W-Y of typical use (which reflects use of the study drug as main contraceptive method, but also includes possible use of other contraceptives from admission to end of study) and 7.5 (4.0; 13.9) pregnancies per 100 W-Y of sole use. In the primary evaluable population (which includes only eligible enrolled women <35 years old), the rate was 10.3 (5.4; 19.9) pregnancies per 100 W-Y of typical use, and 11.0 (5.7; 13.1) pregnancies per 100 W-Y of sole use. There were three reported severe adverse events and 102 other mild adverse events (most common were headache, nausea, abdominal and pelvic pain), with high recovery rate. The vaginal bleeding patterns showed a slight decrease in volume of bleeding and the number of bleeding-free days increased over time. There was only one case of severe anaemia, found at the final visit (0.4%). The method was considered acceptable, as over 90% of participants would choose to use it in the future or would recommend it to others. This was a single-arm study with small sample size, without a control group, designed as a proof of concept study to explore the feasibility of this type of contraception. A larger clinical study evaluating pericoital contraception with LNG is feasible and our data show that this method would be acceptable to many women. This study received partial financial support from the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR) and the World Health Organization. Gynuity and the Bill and Melinda Gates Foundation (BMGF) provided financial support for project monitoring. HRA Pharma donated the LNG product. N.K. was the initial project manager when she was with WHO/HRP and was employed by HRA Pharma, which distributes LNG for emergency contraception. The other authors declare no conflicts of interest. This study was registered on ANZCTR, Trial ID ACTRN12611001037998. 4 October 2011. 10 January 2012. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

The political and social barriers for contraception in pest birds: a case study of Ovocontrol (nicarbazin).

PubMed

MacDonald, Alexander; Wolf, Erick

2013-12-01

In a joint program, Innolytics and the U.S. Department of Agriculture/Animal and Plant Health Inspection Service National Wildlife Research Center collaborated in the development of nicarbazin as an avian contraceptive, initially for resident Canada geese and subsequently for feral pigeons. Unfortunately, the introduction of the original goose product in 2005 was a commercial failure. Political and social barriers effectively thwarted attempts to establish the new technology with any meaningful market success. Although the market adoption of the pigeon contraceptive has been less difficult, the product still encounters significant social and political obstacles and opposition. Given the focus on instant results and gratification, the introduction of contraceptive technology for birds has been challenging and broad market acceptance remains elusive. Nevertheless, especially for short-lived and rapidly reproducing species, customers continue to replace outdated or ineffective techniques with the safer and more effective contraceptive tool.

Contraception in Japan: Current trends.

PubMed

Yoshida, Honami; Sakamoto, Haruka; Leslie, Asuka; Takahashi, Osamu; Tsuboi, Satoshi; Kitamura, Kunio

2016-06-01

High proportion of Japanese uses condoms; lower proportion uses oral contraceptive pills (OCPs). We examined the longitudinal patterns for contraceptive usage in Japan and evaluated differences before and after OCP government approval. We accessed nationally representative survey data for women aged 16-49years from 1950 to 2014. Usage of condoms and OCP was 83.4% and 3.0%, respectively in 2014. OCP use before (1.21%) and after (1.97%) government approval did not differ significantly (p=.58). The prevalence of OCP usage remains low in Japan. A wide gap in use between Japan and other developed countries exists. Through a wide gap in OCP use between Japan and other countries, we revealed how choices of contraceptive methods and their benefits could be openly available for women of reproductive age, and how health care professionals disseminate appropriate knowledge about contraception for women in need. Copyright © 2016 Elsevier Inc. All rights reserved.

Knowledge and Beliefs about Reproductive Anatomy and Physiology among Mexican-Origin Women in the U.S.A: Implications for Effective Oral Contraceptive Use

PubMed Central

Amastae, Jon; Potter, Joseph E.; Hopkins, Kristine; Grossman, Daniel

2013-01-01

Inherent in many reproductive health and family planning programmes is the problematic assumption that the body, its processes, and modifications to it are universally experienced in the same way. This paper addresses contraceptive knowledge and beliefs among Mexican-origin women, based upon data gathered by the qualitative component of the Border Contraceptive Access Study. Open-ended interviews explored the perceived mechanism of action of the pill, side effects, non-contraceptive benefits, and general knowledge of contraception. Findings revealed complex connections between traditional and scientific information. Use of medical terms (“hormone”) illustrated attempts to integrate new information with existing knowledge and belief systems. Conclusions address concerns that existing information and services may not be sufficient if population-specific knowledge and beliefs are not assessed and addressed. Findings can contribute to the development of effective education, screening, and reproductive health services. PMID:23464742

The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa.

PubMed

Bongaarts, John; Hardee, Karen

2017-06-01

Commonly used indicators of contraceptive behavior in a population-modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied-are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.

Spermicidal activity of Indian seaweeds: an in vitro study.

PubMed

Prakash, S; Ravikumar, S; Reddy, K V R; Kannapiran, E

2014-05-01

Contraceptive properties of seaweeds are still stands as lacuna; in this context, the screening of in vitro male contraceptive properties of crude ethanolic extract of Indian seaweeds against normal human sperm is carried out. In total, twelve seaweeds were screened for in vitro spermicidal activity. Among these twelve seaweeds, Halimeda gracilis showed 100% inhibition of human spermatozoa at 10 mg ml(-1) concentration in 20 s and its EC50 value was 2.05 mg ml(-1) in 20 s. Further, dose- and time-dependent spermicidal assay revealed that the sperm was completely immobilised for 20 s. Plasma membrane of sperm was damaged due to the exposure of H. gracilis extract. MTT assay with H. gracilis extract showed 88.5% of cytotoxic incidence. H. gracilis extract tested for cytotoxicity against Artemia salina recorded LC50 value of 34.8 μg ml(-1) . Phytochemical analysis of H. gracilis extract evidenced the presence of alkaloids, flavonoids, proteins and sugars. Results of this study clearly inferred that the synergistic effect of active principles reside within the H. gracilis extract had shown better contraceptive activity. © 2013 Blackwell Verlag GmbH.

Emergency contraception.

PubMed

Dunn, Sheila; Guilbert, Édith

2012-09-01

To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C).

Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries.

PubMed

McCarthy, Ona L; Wazwaz, Ola; Osorio Calderon, Veronica; Jado, Iman; Saibov, Salokhiddin; Stavridis, Amina; López Gallardo, Jhonny; Tokhirov, Ravshan; Adada, Samia; Huaynoca, Silvia; Makleff, Shelly; Vandewiele, Marieka; Standaert, Sarah; Free, Caroline

2018-05-02

Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.

Interest in nonsurgical female permanent contraception among men in Portland, Oregon and eastern Maharashtra, India.

PubMed

Harrington, Elizabeth K; Gordon, Diana; Bahulekar, Pramod; Garg, B S; Osgood-Roach, Isabel; Jensen, Jeffrey T; Aengst, Jennifer

2015-08-01

We examined the men's attitudes and perceptions toward the concept of female nonsurgical permanent contraception (NSPC) or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope. Cross-sectional survey of married/partnered men in Portland, OR, and rural eastern Maharashtra, India. Descriptive analysis was performed. In India (N=150), most men (80%) anticipated that their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective. Most men sampled in two diverse settings expressed interest in NSPC for women. Men's perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis

PubMed Central

Bird, Steven T.; Hartzema, Abraham G.; Brophy, James M.; Etminan, Mahyar; Delaney, Joseph A.C.

2013-01-01

Background: There is an increased risk of venous thromboembolism among women taking oral contraceptives. However, whether there is an additional risk among women with polycystic ovary syndrome (PCOS) is unknown. Methods: We developed a population-based cohort from the IMS LifeLink Health Plan Claims Database, which includes managed care organizations in the United States. Women aged 18–46 years taking combined oral contraceptives and who had a claim for PCOS (n = 43 506) were matched, based on a propensity score, to control women (n = 43 506) taking oral contraceptives. Venous thromboembolism was defined using administrative coding and use of anticoagulation. We used Cox proportional hazards models to assess the relative risk (RR) of venous thromboembolism among users of combined oral contraceptives with and without PCOS. Results: The incidence of venous thromboembolism among women with PCOS was 23.7/10 000 person-years, while that for matched controls was 10.9/10 000 person-years. Women with PCOS taking combined oral contraceptives had an RR for venous thromboembolism of 2.14 (95% confidence interval [CI] 1.41–3.24) compared with other contraceptive users. The incidence of venous thromboembolism was 6.3/10 000 person-years among women with PCOS not taking oral contraceptives; the incidence was 4.1/10 000 person-years among matched controls. The RR of venous thromboembolism among women with PCOS not taking oral contraceptives was 1.55 (95% CI 1.10–2.19). Interpretation: We found a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives. Physicians should consider the increased risk of venous thromboembolism when prescribing contraceptive therapy to women with PCOS. PMID:23209115

Moving towards the goals of FP2020 - classifying contraceptives.

PubMed

Festin, Mario Philip R; Kiarie, James; Solo, Julie; Spieler, Jeffrey; Malarcher, Shawn; Van Look, Paul F A; Temmerman, Marleen

2016-10-01

With the renewed focus on family planning, a clear and transparent understanding is needed for the consistent classification of contraceptives, especially in the commonly used modern/traditional system. The World Health Organization Department of Reproductive Health and Research and the United States Agency for International Development (USAID) therefore convened a technical consultation in January 2015 to address issues related to classifying contraceptives. The consultation defined modern contraceptive methods as having a sound basis in reproductive biology, a precise protocol for correct use and evidence of efficacy under various conditions based on appropriately designed studies. Methods in country programs like Fertility Awareness Based Methods [such as Standard Days Method (SDM) and TwoDay Method], Lactational Amenorrhea Method (LAM) and emergency contraception should be reported as modern. Herbs, charms and vaginal douching are not counted as contraceptive methods as they have no scientific basis in preventing pregnancy nor are in country programs. More research is needed on defining and measuring use of emergency contraceptive methods, to reflect their contribution to reducing unmet need. The ideal contraceptive classification system should be simple, easy to use, clear and consistent, with greater parsimony. Measurement challenges remain but should not be the driving force to determine what methods are counted or reported as modern or not. Family planning programs should consider multiple attributes of contraceptive methods (e.g., level of effectiveness, need for program support, duration of labeled use, hormonal or nonhormonal) to ensure they provide a variety of methods to meet the needs of women and men. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

University of Venda’s male students’ attitudes towards contraception and family planning

PubMed Central

Morwe, Keamogetse G.; Tshitangano, Takalani

2016-01-01

Background Many young men continue to disregard the importance of contraception and family planning in South Africa. The fact that even university students also do not take contraception and family planning seriously poses a serious threat to their own health and well-being. Aim This paper aims at investigating the attitudes of male students towards contraception and the promotion of female students’ sexual health rights and well-being at the University of Venda. Methods Quantitative research method is used to determine how attitudes of 60 male students towards contraception can jeopardise the health and well-being of both male and female students. Results This study reveals that the majority of 60 male students at the University of Venda have a negative attitude towards contraceptives. As a result, male students at the University of Venda are not keen on using contraceptives. Male students’ negative attitude and lack of interest in contraceptives and family planning also limit progress in achieving the Millennium Development Goals on primary health care, especially with regard to sexual and reproductive health and well-being of female students at the University of Venda. Conclusion The fact that more than half of the male students interviewed did not take contraception and family planning seriously poses a serious threat to health and well-being of students, including violation of female students’ sexual and reproductive health rights in South Africa. This calls for radical health promotion and sexual and reproductive rights programmes which should specifically target male students at the University of Venda. PMID:27542288

Dermaseptins and Magainins: Antimicrobial Peptides from Frogs' Skin—New Sources for a Promising Spermicides Microbicides—A Mini Review

PubMed Central

Zairi, Amira; Tangy, Frédéric; Bouassida, Khaireddine; Hani, Khaled

2009-01-01

Sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), the causative agents of acquired immunodeficiency syndrome (AIDS), are two great concerns in the reproductive health of women. Thus, the challenge is to find products with a double activity, on the one hand having antimicrobial/antiviral properties with a role in the reduction of STI, and on the other hand having spermicidal action to be used as a contraceptive. In the absence of an effective microbicide along with the disadvantages of the most commonly used spermicidal contraceptive worldwide, nonoxynol-9, new emphasis has been focused on the development of more potential intravaginal microbicidal agents. Topical microbicides spermicides would ideally provide a female-controlled method of self-protection against HIV as well as preventing pregnancies. Nonoxynol-9, the only recommended microbicide spermicide, damages cervicovaginal epithelium because of its membrane-disruptive properties. Clearly, there is an urgent need to identify new compounds with dual potential microbicidal properties; antimicrobial peptides should be candidates for such investigations. Dermaseptins and magainins are two classes of cationic, amphipathic α-helical peptides that have been identified in the skin extracts of frogs Phyllomedusa sauvagei and Xenopus laevis. Regarding their contraceptive activities and their effect against various STI-causing pathogens, we believe that these two peptides are appropriate candidates in the evaluation of newer and safer microbicides spermicides in the future. PMID:19893636

Flutamide-metformin plus an oral contraceptive (OC) for young women with polycystic ovary syndrome: switch from third- to fourth-generation OC reduces body adiposity.

PubMed

Ibáñez, Lourdes; De Zegher, Francis

2004-08-01

Low-dose flutamide-metformin has been developed as a background therapy for non-obese adolescents and young women with hyperinsulinaemic hyperandrogenism, a variant of polycystic ovary syndrome (PCOS). We verified whether the lipolytic efficacy of flutamide-metformin in women with PCOS is enhanced by giving an oral contraceptive (OC) co-therapy that contains drospirenone, instead of gestodene, as progestin. An open-labelled study was carried out in which non-obese women with PCOS (n = 29; age approximately 20 years), who had been on a combination of flutamide (62.5 mg/day), metformin (850 mg/day) and ethinylestradiol-gestodene for 8-15 months, were randomized for replacement of the gestodene OC by a drospirenone OC. Assessments of endocrine-metabolic state and body composition (by dual-energy X-ray absorptiometry) were performed at randomization and after 6 months. The switch to drospirenone OC was accompanied by a reduction of total and abdominal fat (mean -0.8 and -0.5 kg) and by an increment of lean body mass (+0.6 kg; all P < 0.01), so that body adiposity was strikingly reduced without changing body weight. In non-obese women with PCOS, low-dose flutamide-metformin reduces total and abdominal fat excess more effectively if contraceptive co-therapy contains drospirenone, instead of gestodene, as progestin. Copyright 2004 European Society of Human Reproduction and Embryology

Promoting contraceptive use among unmarried female migrants in one factory in Shanghai: a pilot workplace intervention.

PubMed

Qian, Xu; Smith, Helen; Huang, Wenyuan; Zhang, Jie; Huang, Ying; Garner, Paul

2007-05-31

In urban China, more single women are becoming pregnant and resorting to induced abortion, despite the wide availability of temporary methods of contraception. We developed and piloted a workplace-based intervention to promote contraceptive use in unmarried female migrants working in privately owned factories. Quasi-experimental design. In consultation with clients, we developed a workplace based intervention to promote contraception use in unmarried female migrants in a privately owned factory. We then implemented this in one factory, using a controlled before-and-after design. The intervention included lectures, bespoke information leaflets, and support to the factory doctors in providing a contraceptive service. 598 women participated: most were under 25, migrants to the city, with high school education. Twenty percent were lost when staff were made redundant, and implementation was logistically complicated. All women attended the initial lecture, and just over half the second lecture. Most reported reading the educational material provided (73%), but very few women reported using the free family planning services offered at the factory clinic (5%) or the Family Planning Institute (3%). At baseline, 90% (N = 539) stated that contraceptives were required if having sex before marriage; of those reporting sex in the last three months, the majority reporting using contraceptives (78%, 62/79) but condom use was low (44%, 35/79). Qualitative data showed that the reading material seemed to be popular and young women expressed a need for more specific reproductive health information, particularly on HIV/AIDS. Women wanted services with some privacy and anonymity, and views on the factory service were mixed. Implementing a complex intervention with a hard to reach population through a factory in China, using a quasi-experimental design, is not easy. Further research should focus on the specific needs and service preferences of this population and these should be considered in any policy reform so that contraceptive use may be encouraged among young urban migrant workers.

Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study.

PubMed

Ochako, Rhoune; Mbondo, Mwende; Aloo, Stephen; Kaimenyi, Susan; Thompson, Rachel; Temmerman, Marleen; Kays, Megan

2015-02-10

Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval. To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15-24, both users and non-users, that were drawn from randomly selected households. All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks. Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual's beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth.

Structural analyses to identify selective inhibitors of glyceraldehyde 3-phosphate dehydrogenase-S, a sperm-specific glycolytic enzyme

PubMed Central

Danshina, Polina V.; Qu, Weidong; Temple, Brenda R.; Rojas, Rafael J.; Miley, Michael J.; Machius, Mischa; Betts, Laurie; O'Brien, Deborah A.

2016-01-01

STUDY HYPOTHESIS Detailed structural comparisons of sperm-specific glyceraldehyde 3-phosphate dehydrogenase, spermatogenic (GAPDHS) and the somatic glyceraldehyde 3-phosphate dehydrogenase (GAPDH) isozyme should facilitate the identification of selective GAPDHS inhibitors for contraceptive development. STUDY FINDING This study identified a small-molecule GAPDHS inhibitor with micromolar potency and >10-fold selectivity that exerts the expected inhibitory effects on sperm glycolysis and motility. WHAT IS KNOWN ALREADY Glycolytic ATP production is required for sperm motility and male fertility in many mammalian species. Selective inhibition of GAPDHS, one of the glycolytic isozymes with restricted expression during spermatogenesis, is a potential strategy for the development of a non-hormonal contraceptive that directly blocks sperm function. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Homology modeling and x-ray crystallography were used to identify structural features that are conserved in GAPDHS orthologs in mouse and human sperm, but distinct from the GAPDH orthologs present in somatic tissues. We identified three binding pockets surrounding the substrate and cofactor in these isozymes and conducted a virtual screen to identify small-molecule compounds predicted to bind more tightly to GAPDHS than to GAPDH. Following the production of recombinant human and mouse GAPDHS, candidate compounds were tested in dose–response enzyme assays to identify inhibitors that blocked the activity of GAPDHS more effectively than GAPDH. The effects of a selective inhibitor on the motility of mouse and human sperm were monitored by computer-assisted sperm analysis, and sperm lactate production was measured to assess inhibition of glycolysis in the target cell. MAIN RESULTS AND THE ROLE OF CHANCE Our studies produced the first apoenzyme crystal structures for human and mouse GAPDHS and a 1.73 Å crystal structure for NAD+-bound human GAPDHS, facilitating the identification of unique structural features of this sperm isozyme. In dose–response assays T0501_7749 inhibited human GAPDHS with an IC50 of 1.2 μM compared with an IC50 of 38.5 μM for the somatic isozyme. This compound caused significant reductions in mouse sperm lactate production (P= 0.017 for 100 μM T0501_7749 versus control) and in the percentage of motile mouse and human sperm (P values from <0.05 to <0.0001, depending on incubation conditions). LIMITATIONS, REASONS FOR CAUTION The chemical properties of T0501_7749, including limited solubility and nonspecific protein binding, are not optimal for drug development. WIDER IMPLICATIONS OF THE FINDINGS This study provides proof-of-principle evidence that GAPDHS can be selectively inhibited, causing significant reductions in sperm glycolysis and motility. These results highlight the utility of structure-based drug design and support further exploration of GAPDHS, and perhaps other sperm-specific isozymes in the glycolytic pathway, as contraceptive targets. LARGE SCALE DATA None. Coordinates and data files for three GAPDHS crystal structures were deposited in the RCSB Protein Data Bank (http://www.rcsb.org). STUDY FUNDING AND COMPETING INTEREST(S) This work was supported by grants from the National Institutes of Health (NIH), USA, including U01 HD060481 and cooperative agreement U54 HD35041 as part of the Specialized Cooperative Centers Program in Reproduction and Infertility Research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and TW/HD00627 from the NIH Fogarty International Center. Additional support was provided by subproject CIG-05-109 from CICCR, a program of CONRAD, Eastern Virginia Medical School, USA. There are no conflicts of interest. PMID:26921398

The Combined Influence of Oral Contraceptives and Human Papillomavirus Virus on Cutaneous Squamous Cell Carcinoma

PubMed Central

Efird, Jimmy T.; Toland, Amanda E.; Lea, C. Suzanne; Phillips, Christopher J.

2011-01-01

The vast majority of cutaneous squamous cell carcinoma (CSCC) will occur in those with fair complexion, tendency to burn, and high ultraviolet radiation (UVR) exposure. Organ transplant recipients also are an important population at great risk for CSCC. An association has been reported between oral contraceptive (OC) use, human papillomavirus virus (HPV) and cervical cancer, and there could be a similar association for CSCC. The cutaneous HPV β-E6 protein, a close cousin of the transformative E6 protein underlying anogenital cancers, has been shown to inhibit apoptosis in response to UVR damage and stimulate morphologic transformation in rodent fibroblast cell lines. Furthermore, OC use has been shown to enhance HPV transcription and may contribute to CSCC risk through this pathway. PMID:21499554

Purchasing Nonprescription Contraceptives: The Underlying Structure of a Multi-Item Scale.

ERIC Educational Resources Information Center

Manolis, Chris; Winsor, Robert D.; True, Sheb L.

1999-01-01

Developed a multi-item scale for measuring attitudes associated with purchasing nonprescription contraceptives using construct specification and item generation and confirmatory factor analysis. Demonstrated a high degree of invariance across samples of 81 female and 115 male adult consumers. (SLD)

Reaching the hard to reach.

PubMed

Bhiwandi, P; Campbell, M; Potts, M

1994-01-01

The 1994 International Conference on Population and Development proposed increasing contraceptive couple protection from 550 million in 1995 to 880 million in 2015. The task for family planning (FP) programs is to provide access to services for, sometimes, inaccessible rural populations. FP need based on desire for no more children has ranged from under 20% in Senegal to almost 80% in Peru. Socioeconomic development was found not to be a prerequisite for fertility change. Gender inequalities in education and social autonomy must be changed. FP access is very important among women with a disadvantaged background or among women unsure about FP. Bangladesh is a good example of a country with increased contraceptive prevalence despite low income. The rule of thumb is that contraception increases of 15% contribute to a drop in family size of about one child. Program effectiveness is related to a variety of factors: contraceptive availability at many locations, acceptable price of contraception, delivery of the oral contraceptives without prescriptions, and other strategies. FP is a service not a medical treatment. A range of methods must be promoted and available from a range of facilities. Contraceptive use is dependent on the woman's stage in her lifecycle and is dependent on informed choice. Community-based distribution systems are effective, whereas free distribution by poorly-trained field workers is not always very effective because patient payment of all or part of the cost assures quality and freedom of choice. Effective programs for underprivileged groups involve aggressive, easy to manage programs that can be replicated rapidly. FP serves a useful function in depressing maternal mortality among the poor in Africa, who have no access to quality health services. Social marketing is an effective strategy for reaching remote areas. Political will and robust management are necessary commodities.

The social context of adolescent women's use of modern contraceptives in Zimbabwe: a multilevel analysis.

PubMed

Ngome, Enock; Odimegwu, Clifford

2014-08-10

Efforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics. Data from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM). The odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces. Both individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors.

Community resources and reproductive behaviour in rural Bangladesh.

PubMed

Saha, T D

1994-03-01

Local community impact on contraceptive usage is illustrated in this logistic model of contraceptive behavior in 1986 in rural Bangladesh. Variables include an index of accessibility and availability of family planning (FP) at the "thana" level, age of respondent, respondent's educational level, desire to have a child, distance from the district, rural electrification, an index of agricultural wages and percentage of small farm households, and presence of a mosque. Community-level variables are found to be significant in separate equations and in equations with individual level variables. Contraceptive use is more likely to occur in a rural situation where there are commercial places such as market places and post offices. Contraceptive use is enhanced by "thana" closeness to district headquarters. Reduced contraceptive use is related to rural areas with many small farm households and a high agricultural wage rate. Access to FP provides a positive environment for improving motivation to use contraception and for improving use of modern methods. The degree of rural isolation negatively impacts on contraceptive use. Bangladesh is one of the few countries with a comprehensive development program at the sub-district level or "thana." Health centers and family welfare centers are established but are unevenly distributed spatially. Data for this study were obtained from the 1985 Bangladesh Contraceptive Prevalence Survey of 7681 rural women aged under 50 years, from the 1983 Agricultural Census on farm land, and from other statistical publications. Information was obtained on 120 "thanas." Contraceptive use status is measured as use, nonuse, modern use, traditional use, intention to use, and nonintention to use. The religious variable is negative, as expected, but not significant for contraceptive use and intention to use. The sign is positive for modern contraceptive use. Closer examination reveals that respondents with no education and with no household land are more frequent users of modern methods, including sterilization which incurs a religious moral and social stigma. Other data support the notion that religious beliefs are not an important factor in nonuse of contraceptives in Bangladesh. The FP index has a significant impact on use and intention to use but has a positive and insignificant effect on modern methods, which may indicate measurement error.

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

PubMed

Dehlendorf, Christine; Fitzpatrick, Judith; Steinauer, Jody; Swiader, Lawrence; Grumbach, Kevin; Hall, Cara; Kuppermann, Miriam

2017-07-01

We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Our decision support tool appears acceptable to women in the family planning setting. Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial. Copyright © 2017 Elsevier B.V. All rights reserved.

[Sexual risk behaviours and PAP testing in university women vaccinated against human papillomavirus].

PubMed

Fernández-Feito, Ana; Antón-Fernández, Raquel; Paz-Zulueta, María

2018-05-01

To estimate the association between the human papillomavirus (HPV) vaccine and sexual risk behaviour, as well as the participation in the Cervical Cancer Screening Program (CCSP). Cross-sectional study. School of Medicine and Health Sciences, School of Law, and School of Economics and Business (University of Oviedo). Female university students. Information was collected about contraceptive methods, sexual behaviours, HPV knowledge, and participation in the CCSP. Furthermore, proportions and odds ratio (OR) were estimated with their corresponding 95% confidence intervals (95%CI). Approximately two-thirds (67.7%) of the sample was vaccinated against HPV, and 216 women (65.3%) were sexually active. Barrier contraceptive methods were used by 67.6% during their current intimate relationships, being less frequent in non-vaccinated women (54.9% vs. 75.4% in vaccinated female students) (P=.002). The risk of having at least one sexual risk behaviour was higher in non-vaccinated women: OR2.29 (95%CI: 1.29-4.07). In addition, the probability of having a PAP test within the CCSP was higher in non-vaccinated women: OR2.18 (95%CI: 1.07-4.47). The prevalence of sexual risk behaviours in non-vaccinated women is elevated, and it is related to the lack of use of barrier contraceptive methods. The vaccination against HPV could affect sexual behaviours and the participation in the CCSP. Therefore, the information received by young people about contraceptive methods, sexually transmitted diseases, and cancer prevention should be reinforced. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Hormonal Approaches to Male contraception

PubMed Central

Wang, Christina; Swerdloff, Ronald S.

2010-01-01

Purpose of review Condoms and vasectomy are male controlled family planning methods but suffer from limitations in compliance (condoms) and limited reversibility (vasectomy); thus many couples desire other options. Hormonal male contraceptive methods have undergone extensive clinical trials in healthy men and shown to be efficacious, reversible and appear to be safe. Recent Findings The success rate of male hormonal contraception using injectable testosterone alone is high and comparable to methods for women. Addition of progestins to androgens improved the rate of suppression of spermatogenesis. Supported by government or non-government organizations, current studies aim to find the best combination of testosterone and progestins for effective spermatogenesis suppression and to explore other delivery methods for these hormones. Translation of these advances to widespread use in the developed world will need the manufacturing and marketing skills of the pharmaceutical industry. Availability of male contraceptives to the developing world may require commitments of governmental and non-governmental agencies. In a time when imbalance of basic resources and population needs are obvious, this may prove to be a very wise investment. Summary Male hormonal contraception is efficacious, reversible and safe for the target population of younger men in stable relationships. Suppression of spermatogenesis is achieved with a combination of an androgen and a progestin. Partnership with industry will accelerate the marketing of a male hormonal contraceptive. Research is ongoing on selective androgen and progesterone receptor modulators that suppress spermatogenesis, minimize potential adverse events while retaining the androgenic actions. PMID:20808223

Rights of life. Sexuality and reproduction.

PubMed

Shallat, L

1993-01-01

Despite the inclusion in international human rights statements of the right to "decide freely and responsibly" the number of children to have, women are rarely able to exercise their right to reproductive and sexual choices. Historically, discussions of human rights have ignored reproductive rights because women have been excluded from the spheres where rights have been articulated and because of male attempts to control female reproduction and sexuality. The fact that reproductive rights have found their way into international declarations reflects a desire to "make the world safe for contraception" rather than to meet women's needs. International statements usually include one phrase that crucially needs defining: the right to exercise reproductive autonomy "freely and responsibly." Can governments, for example, take steps (and if so, what steps can they take) to insure that their citizens exercise their right responsibly? Because the right has been formulated by the population movement and the women's movement, it lacks the clarity necessary to be effective in influencing policy. Most women's rights activists read "freely and responsibly" to be in opposition to the goals of population control in developing countries and are uneasy with the alliance of feminists with the population establishment. Reproductive rights issues include fecundity, fertility, and infertility; voluntary motherhood; sex education and access to contraceptive usage; recognition of sexual pleasure in its various forms as a human right; emphasizing equal male-female responsibility; and including women in policy-making. International human rights declarations are a powerful platform for the advancement and protection of reproductive rights, and various legal strategies can be used to reform domestic laws.

Contraceptive sales in the setting of the Zika virus epidemic.

PubMed

Bahamondes, Luis; Ali, Moazzam; Monteiro, Ilza; Fernandes, Arlete

2017-01-01

Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil? Contraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak. Transmission of ZIKV is primarily by Aedes aegypti mosquitoes; however, sexual transmission has also been described. The association of several birth defects and the ZIKV infection during pregnancy has been established, and it was estimated in Bahia, Brazil that the infection rate could range from 10% to 80%. The World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February 2016. The Brazilian government also made recommendations for women who were planning to become pregnant and who reside in ZIKV-affected areas to reconsider or postpone pregnancy. The objective of this study was to assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak. We obtained information from all pharmaceutical companies based in Brazil and from the manufacturers of long-acting reversible contraceptives (LARCs), including the copper-intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants, about contraceptives sales in the public and private sectors between September 2014 and August 2016. We analyzed the data for: (i) oral contraceptives, i.e. combined oral contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives, (ii) injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate, (iii) LARCs and (iv) emergency contraceptive (EC) pills. Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7-13.8 million cycles/units per month (90%). The second largest group of sales was injectables, representing 0.8-1.5 million ampoules per month (9.5%). Following this, are LARC methods with sales of 37 000-41 000 devices per month (0.5%). It is important to note that although the peak months of sales were different for each group of contraceptives, there were no significant differences overall between the months of observation. The EC pill sales were between 1.0 million and 1.3 million of pills per month. Although the use of contraceptive methods was already high and no change was noted, the ZIKV outbreak may have changed the pregnancy intentions of Brazilian women. Consequently, the number of women planning pregnancy may be lower than that recorded. The contraceptive sales figures did not include condoms. Since condoms might not only prevent pregnancies, but also sexual transmission of ZIKV, this lack of information is a limitation. The results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil. Furthermore, it is possible that access to LARC methods was limited. Although we did not investigate the reason for low LARC uptake, we suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women. Projections estimate millions of additional cases of ZIKV transmission. Thus, a coordinated response is needed to ensure access to a wide range of contraceptive methods for women during the ZIKV outbreak. In conclusion, this assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and represents an alternative source of data to help us understand the trends in demand for contraception in ZIKV-affected areas. This study received partial financial support from Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504-9 and from an anonymous donor. The funding sources did not play a role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The authors declare no conflict of interest associated with this study. N/A. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial protocol.

PubMed

Mazza, Danielle; Black, Kirsten; Taft, Angela; Lucke, Jayne; McGeechan, Kevin; Haas, Marion; McKay, Heather; Peipert, Jeffery F

2016-10-07

The increased use of long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, has the potential to reduce unintended pregnancy and abortion rates. However, use of LARCs in Australia is very low, despite clinical practice guidance and statements by national and international peak bodies advocating their increased use. This protocol paper describes the Australian Contraceptive ChOice pRojet (ACCORd), a cluster randomised control trial that aims to test whether an educational intervention targeting general practitioners (GPs) and establishing a rapid referral service are a cost-effective means of increasing LARC uptake. The ACCORd intervention is adapted from the successful US Contraceptive CHOICE study and involves training GPs to provide 'LARC First' structured contraceptive counselling to women seeking contraception, and implementing rapid referral pathways for LARC insertion. Letters of invitation will be sent to 600 GPs in South-Eastern Melbourne. Using randomisation stratified by whether the GP inserts LARCs or not, a total of 54 groups will be allocated to the intervention (online 'LARC First' training and rapid referral pathways) or control arm (usual care). We aim to recruit 729 women from each arm. The primary outcome will be the number of LARCs inserted; secondary outcomes include the women's choice of contraceptive method and quality of life (Short Form Health Survey, SF-36). The costs and outcomes of the intervention and control will be compared in a cost-effectiveness analysis. The ACCORd study has been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080. Any protocol modifications will be communicated to Ethics Committee and Trial Registration registry. The authors plan to disseminate trial outcomes through formal academic pathways comprising journal articles, nation and international conferences and reports, as well as using more 'popular' strategies including seminars, workshops and media engagements. ACTRN12615001346561. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Vatican at the United Nations. Cairo + 5.

PubMed

Kissling, F

1999-01-01

During the International Conference on Population and Development in Cairo, a remarkable consensus on population and development was forged and a Programme of Action was issued. With its permanent observer status among governments at the UN, the Vatican had attempted to block such a worldwide consensus on a new structure for population and development programs, based on women's empowerment, universal and voluntary access to contraception, and improved reproductive health for all. After 5 years of implementing the Cairo Programme of Action, the UN conducted a review and appraisal of its implementation, ending with a final preparatory meeting and a Special Session of the UN General Assembly. During the review process and the meeting, the Vatican remained active but fell short, on the whole, of thwarting progress. The Vatican delegation was made up of five individuals--two women and three men, including two priests. Almost all their interventions were focused on the goal of obstructing progressive understanding of what would be necessary if the Programme of Action were to be fully and fairly implemented. This included the provision of emergency contraception to refugees; the definition of human rights; addressing unsafe abortion as a major public health issue; the provision of condoms for protection against HIV/AIDS; adolescent rights to privacy and confidentiality; and the inclusion of sex education in school curricula.

Combined hormonal contraceptive (CHC) use among obese women and contraceptive effectiveness: a systematic review.

PubMed

Dragoman, Monica V; Simmons, Katharine B; Paulen, Melissa E; Curtis, Kathryn M

2017-02-01

To evaluate from the literature whether combined hormonal contraception (CHC), including combined oral contraception pills (COCs), transdermal patch, vaginal ring or combined injectables, have different effectiveness or failure rates by body weight or body mass index (BMI). We searched PubMed and the Cochrane Library databases for all articles in all languages published between inception and February 2016, for evidence relevant to body weight or BMI, CHC use and contraceptive effectiveness. The quality of each individual study was assessed using the system for evaluating evidence developed by the United States Preventive Services Task Force. From 2874 articles, we identified 15 reports for inclusion, all of fair to poor quality. Fourteen studies measured the association of obesity status and contraceptive failure among COC users. Three fair quality and one poor quality study reported increased COC failure among a heterogeneous population of overweight and obese women compared with normal weight women, while eight fair quality and two poor quality studies did not find an association. Two fair quality studies reported on contraceptive transdermal patches. One pooled analysis described a higher proportion of pregnancies among women using the patch who weighed ≥90 kg; another secondary analysis suggested BMI>30 was associated with increased failure. No studies directly compared contraceptive effectiveness using the combined vaginal ring or combined injectable. Current available evidence addressing the risk of CHC failure in obese compared to normal weight women is limited to fair and poor quality studies. Studies of COCs show mixed results, though absolute differences in COC failure by body weight and BMI are small. Based on limited evidence, it appears that increasing body weight and BMI may contribute to decreasing contraceptive patch effectiveness. Copyright © 2017. Published by Elsevier Inc.

Patient and provider perspectives on Bedsider.org, an online contraceptive information tool, in a low income, racially diverse clinic population.

PubMed

Gressel, Gregory M; Lundsberg, Lisbet S; Illuzzi, Jessica L; Danton, Cheryl M; Sheth, Sangini S; Xu, Xiao; Gariepy, Aileen

2014-12-01

To explore patient and provider perspectives regarding a new Web-based contraceptive support tool. We conducted a qualitative study at an urban Medicaid-based clinic among sexually active women interested in starting a new contraceptive method, clinic providers and staff. All participants were given the opportunity to explore Bedsider, an online contraceptive support tool developed for sexually active women ages 18-29 by the National Campaign to Prevent Teen and Unplanned Pregnancy and endorsed by the American Congress of Obstetricians and Gynecologists. Focus groups were conducted separately among patient participants and clinic providers/staff using open-ended structured interview guides to identify specific themes and key concepts related to use of this tool in an urban clinic setting. Patient participants were very receptive to this online contraceptive support tool, describing it as trustworthy, accessible and empowering. In contrast, clinic providers and staff had concerns regarding the Website's legitimacy, accessibility, ability to empower patients and applicability, which limited their willingness to recommend its use to patients. Contrasting opinions regarding Bedsider may point to a potential disconnect between how providers and patients view contraception information tools. Further qualitative and quantitative studies are needed to explore women's perspectives on contraceptive education and counseling and providers' understanding of these perspectives. This study identifies a contrast between how patients and providers in an urban clinic setting perceive a Web-based contraceptive tool. Given a potential patient-provider discrepancy in preferred methods and approaches to contraceptive counseling, additional research is needed to enhance this important arena of women's health care. Copyright © 2014 Elsevier Inc. All rights reserved.

Provision of emergency contraception in general practice and confidentiality for the under 16's: results of a postal survey by general practitioners in Avon.

PubMed

Graham, A; Moore, L; Sharp, D

2001-10-01

To describe the provision of emergency contraception and confidentiality for the under 16's by general practitioners (GPs) in Avon, in order to inform the development of a health promotion intervention in schools in Avon. Confidential postal questionnaire survey. All principals in general practice in Avon Health Authority, South West England. Five hundred and eighty general practice principals were sent the questionnaire. Four hundred and eighty-six (84%) principals in general practice responded to the questionnaire. Only three (0.6%) GPs did not provide hormonal emergency contraception. Nearly half (232, 47.7%) would fit the intrauterine device (IUD) as emergency contraception. Fitting an IUD was associated with female gender of the GP (OR = 2.34, 95% CI 1.53-3.71), and whether the GP had a family planning qualification (OR = 4.55, 95% CI 2.41-8.60). Three hundred and fifty-two (72%) respondents would provide emergency contraception on a Sunday if requested to do so by a 14-year-old who reported having had unprotected sex the night before. Practice nurses in 26 (5%) of the respondent's practices were available to provide advice and tablets for patients requesting hormonal emergency contraception. However, 74 (21%) respondents employed a family planning trained practice nurse who was not involved in any way in the provision of emergency contraception. Practice nurses remain an under used resource in this area. Our findings suggest that most GPs provide hormonal emergency contraception. Only eight (1.6%) of respondents would need to ask for parental consent prior to providing hormonal emergency contraception to a 14-year old-girl. Young people need to be informed of GPs widespread adherence to current confidentiality guidelines.

A Brief Bibliography for the Sex Educator.

ERIC Educational Resources Information Center

Johnson, Anne D., Comp.; Turner, John, Comp.

The authors have developed a bibliography related to key issues in adolescent sexuality. Included are the following topics: (1) biological basis of sexuality; (2) adolescent sexual behavior; (3) homosexuality; (4) contraception and contraceptive behavior; (5) venereal disease; (6) morals; (7) abortion; (8) historical or anthropological view; (9)…

Sex education and family planning messages in Greek school books.

PubMed

Frisiras, S; Lagiou, A; Sourtzi, P; Vidalaki, M

1991-05-01

The Greek Family Planning Association (GFPA) completed in march 1990 a 3-year effort to evaluate whether sex education was an integral part of the school curricula. It was reported by a representative of the Pedagogical Institute in the Ministry of Education and Religion that important efforts have been made. The findings were presented at the 2nd Sex Education and Health seminar in March, 1990. Greek primary schools have 1 teacher for all lessons; but specialists in various fields of the secondary school curricula. Primary school books have various references and pictures on human reproduction. Equality of the sexes socially and culturally is represented, as well as good health messages on nutrition and hygiene. Noticeably absent, however, is any reference to human sexuality, nude human body or sex organ pictures, or other non-traditional family models. Family planning and contraception are also missing; teacher training or special courses are needed. Secondary school books have clear but limited messages. For example, there is a whole page on the philosophy and aims of family planning, but parenthood is only presented in the context of traditional marriage without contraception. It is recommended that legislative support be engaged to insure that sex education programs are systematic, age-specific, and a continuous activity from the primary level. Another important role in the implementation and curriculum development of sex education is one played by teachers and health professionals, those in touch with young people. GFPA needs to compile basic guidelines for those teaching sex education.

The demographic impact and development benefits of meeting demand for family planning with modern contraceptive methods.

PubMed

Goodkind, Daniel; Lollock, Lisa; Choi, Yoonjoung; McDevitt, Thomas; West, Loraine

2018-01-01

Meeting demand for family planning can facilitate progress towards all major themes of the United Nations Sustainable Development Goals (SDGs): people, planet, prosperity, peace, and partnership. Many policymakers have embraced a benchmark goal that at least 75% of the demand for family planning in all countries be satisfied with modern contraceptive methods by the year 2030. This study examines the demographic impact (and development implications) of achieving the 75% benchmark in 13 developing countries that are expected to be the furthest from achieving that benchmark. Estimation of the demographic impact of achieving the 75% benchmark requires three steps in each country: 1) translate contraceptive prevalence assumptions (with and without intervention) into future fertility levels based on biometric models, 2) incorporate each pair of fertility assumptions into separate population projections, and 3) compare the demographic differences between the two population projections. Data are drawn from the United Nations, the US Census Bureau, and Demographic and Health Surveys. The demographic impact of meeting the 75% benchmark is examined via projected differences in fertility rates (average expected births per woman's reproductive lifetime), total population, growth rates, age structure, and youth dependency. On average, meeting the benchmark would imply a 16 percentage point increase in modern contraceptive prevalence by 2030 and a 20% decline in youth dependency, which portends a potential demographic dividend to spur economic growth. Improvements in meeting the demand for family planning with modern contraceptive methods can bring substantial benefits to developing countries. To our knowledge, this is the first study to show formally how such improvements can alter population size and age structure. Declines in youth dependency portend a demographic dividend, an added bonus to the already well-known benefits of meeting existing demands for family planning.

The acceptance of the collagen sponge diaphragm as an intravaginal contraceptive in human volunteers.

PubMed

Chvapil, M; Heine, M W; Horton, H

1976-12-01

Two types of highly resilient and liquid-absorbent collagen sponge contraceptives (CSC) in the shape of cylindrical cups (6 cm wide and 2.5 cm thick) were evaluated for acceptance as an intravaginal contraceptive method for a period of 3 months in 27 volunteers. Parameters such as retention, odor, irritation, itching, discharge, and convenience for the user and her sexual partner were tested. Average retention time was 7 to 9 days (range, 2 to 28 days); still, most sexually active volunteers preferred to remove the CSC every 3 to 4 days, rinse them in tap water, and reinsert them. Odor was noticed by users in 4% of the tested sponges and in 30% of all volunteers by medical personnel at the time of removal of the CSC from the vagina. No irritation, itching, or discharge was reported. The CSC alone did not cause any inconvenience to the user or partner, while the CSC with inserted rubber ring was felt by both partners and was found to be dislocated. This study indicates good acceptance of the CSC in intravaginal use. Studies to evaluate the efficacy of collagen sponges as mechanical contraceptive barriers are in progress.

Trends in the use of female sterilisation through minilaparotomy for contraception at a teaching hospital in north central Nigeria.

PubMed

Abiodun, O M; Esuga, S A; Balogun, O R; Fawole, A A; Jimoh, A G

2012-01-01

Female sterilisation is the most widely used method of contraception worldwide. However, only a small proportion of contraceptors are reported to rely on female sterilisation in Nigeria. Continuous reviews of trends in its use are necessary to develop policies that will improve uptake in the country. To determine the volume and trends in the use of female sterilisation through minilaparotomy as a method of contraception in a Nigerian university teaching hospital. The records of women who had sterilisation through minilaparotomy over a ten year period were reviewed for socialdemographic characteristics, reasons for undergoing sterilisation, timing of the procedure, surgical method used and complications recorded. This is too sketchy Female sterilisation through minilaparotomy accounted for 95 (0.8%) of the 12,035 total contraceptive use during the period. The rate decreased from 1.5% of total contraceptive use in 1995 to 0.22% in 2003. Eighty two (86.4%) of the female sterilisation acceptors were aged 35 years and above, 46 (48.4%) had no or only primary education and 42 (44.2%) were petty traders. Sixty six (69.5%) of the women were grandmultiparae and 70 (73.7%) had more children than they desired. Seventy three (76.8%) had used other contraceptive methods before sterilisation. The average cost of female sterilisation through minilaparotomy in our hospital was USD25 and this was significantly more than the cost of other contraceptives, and more than hospital charges for normal vaginal delivery. The proportion of contraceptive acceptors who rely on female sterilisation is low in our environment and has steadily declined over the years. The higher cost of the procedure as compared to other contraceptives appears to be the main barrier. Reduction or outright elimination of cost will probably act as incentive for women to choose female sterilisation as a method of contraception.

How close are we in achieving safe, affordable and reversible male contraceptives?

PubMed

Tulsiani, Daulat R P; Abou-Haila, Aïda

2010-06-01

The world population, currently estimated to be over six billions, is expected to double in the next forty years. The projected growth will cause severe over crowding that will have an adverse effect on the ecological health of the planet. A recent survey by the United Nations found that a majority of men in many countries are willing to participate in family planning by taking full control of their fertility. However, the available contraceptives for men have either higher failure rates or they are irreversible. Thus, the contraceptive needs of tens of millions of men go unmet every day resulting in millions of unwanted pregnancies, and hundreds of thousands of abortions. Since the introduction of oral contraceptive (pill) for women over five decades ago, there have been numerous collaborative efforts by scientists and pharmaceutical companies to improve the effectiveness and delivery of contraceptives to women who wish to safely regulate their reproductive physiology. However, the contraceptive options available to men have not changed in several decades and are still limited to the use of condoms and timely withdrawal (coitus interruptus) or under going a minor surgical procedure (vasectomy) that prevents the release of spermatozoa during ejaculation. The first two methods have relatively higher typical-use failure rates, whereas the last approach is largely irreversible and not suitable for younger men. Despite non-stop efforts worldwide, we may still be several years away from providing safe, effective and affordable male contraceptives which will allow both men and women to participate fully in family planning. In this article, we will discuss various contraceptives currently available to regulate male fertility. In addition, we will summarize potentially new contraceptives for men that are at various stages of research and development. Finally, our intention is to discuss details of two safe, reversible and affordable male contraceptive approaches that are inching closure to being approved for use by the masses in India and China, the world's two most populous nations.

Liability concerns in contraceptive research and development.

PubMed

Segal, S J

1999-12-01

The history of liability claims in the US against contraceptive products is among the issues that discourage manufacturers from investing in discovery and development in this field. Other factors are the high cost of new drug development, elevated insurance rates for contraceptives, and the desire to avoid controversy that can disturb corporate tranquility. General features of the American legal system influence the large number and cost of product liability claims in the US compared to Europe. These differences pertain to issues such as the role of judges, how lawyers receive their compensation, and the use of expert scientific testimony. The history of litigation in the US against pharmaceutical products and devices pertaining to women's health suggests that interventions that involve the reproductive system are held to different standards or elicit different emotional responses than other pharmaceutical products or devices.

[Health Council of the Netherlands' report on contraception in intellectually disabled people].

PubMed

Meijer, M M; Ewals, F V P M; Scholte, F A

2003-02-01

Recently the Health Council of the Netherlands published a comprehensive report which incorporates juridical, ethical, medical and social aspects directing the judgement and decision-making regarding contraception in people with an intellectual disability. Although professional responsibility is in the hands of medical practitioners, medical guidelines to manage consent issues and to indicate contraception in this population are missing. There are no ethical and legal grounds for enforcing contraception and it comes down to professional accountability in trying to prevent irresponsible parenthood by a convincing dialogue. People with intellectual disabilities are intellectually, physically, socially and economically prone to be vulnerable parents, who need assistance in making deliberate choices to have children and in raising them. There is an urgent need for advanced sexual education and a comprehensive social discussion on contraception for this population. Physicians for intellectually disabled people embrace the committee's recommendations to stimulate public debate, enhance research, develop guidelines and build professional networks to call on.

‘We view that as contraceptive failure’: Containing the ‘multiplicity’ of contraception and abortion within Scottish reproductive healthcare

PubMed Central

Beynon-Jones, Siân M.

2013-01-01

Within contemporary Scottish policy guidance, abortion is routinely configured as evidence of a resolvable problem with the healthcare provision of contraception. This article draws on 42 semi-structured interviews with Scottish health professionals conducted during 2007–2008, in order to explore how, and in what form, realities of contraception/abortion are sustained within abortion practice. In addition to providing empirical insights concerning this sociologically neglected aspect of reproductive healthcare, it demonstrates how a novel conceptual approach could be used to develop existing social scientific analyses of the provision of techniques of fertility prevention. Science and Technology Studies (STS) has highlighted the importance of studying the complex socio-material practices through which realities are enacted (or ‘performed’). Mobilising this insight, my analysis illustrates the complex socio-material work required to enact abortion as evidence of a ‘problem’ with contraception that is resolvable within the healthcare consultation. This work, I argue, renders visible the ontologically ‘multiple’ (Mol, 2002) nature of contraception/abortion, with important implications for both social science and policy approaches to these techniques of fertility prevention. PMID:23287458

Long acting injectable hormonal contraceptives.

PubMed

Fraser, I S

1982-03-01

Injectable hormonal preparations can be highly effective and satisfactory contraceptives. The two main preparations available today are depot medroxy progesterone acetate (DMPA) and norethisterone oenanthate (NET-OEN), but several other approaches are currently under clinical trial. Injectable contraceptives have some unique advantages which give them justifiably wide appeal amongst many groups of women. However, they do have a number of disadvantages including invariable menstrual disturbance and a delay in the return of fertility. One formulation of DMPA, Depo-Provera, is probably the most extensively investigated single hormonal contraceptive ever made. These studies indicate that it is remarkably safe and does not face any more unresolved issues than the combined pill, intrauterine device or tubal sterilization. However, for a number of disparate emotional and political reasons it has attracted the attention of several consumer and feminist groups, who have waged a prolonged and quite unjustified campaign against it. It is to be hoped that future debate will be conducted on a more informed, rational and less emotional basis. Injectable contraceptives should have an important place in the family planning armamentarium of all countries, and current developments should lead to a decrease in concerns about presently available agents. This should further increase the widespread acceptability of this approach to contraception.

Testing the Gräfenberg Ring in Interwar Britain: Norman Haire, Helena Wright, and the Debate over Statistical Evidence, Side Effects, and Intra-uterine Contraception.

PubMed

Rusterholz, Caroline

2017-10-01

This paper examines the introduction to Britain of the Gräfenberg ring, an early version of what later became known as an intrauterine device (IUD). The struggle during the interwar years to establish the value of the ring provides an opportunity for a case study of the evaluation and acceptance of a new medical device. With the professionalization of the birth control movement and the expansion of birth control clinics in interwar Britain, efforts to develop better scientific means for contraception grew rapidly. At the end of the nineteenth century, methods for controlling fertility ranged from coitus interruptus and abstinence, to diverse substances ingested or placed into the vagina, to barrier methods. The first decades of the twentieth century brought early work on chemical contraceptives as well as a number of new intrauterine devices, among them the Gräfenberg ring. Developing a cheap, reliable, and widely acceptable contraceptive became a pressing goal for activists in the voluntary birth control movement in Britain between the wars. Yet, tensions developed over the best form of contraception to prescribe. By situating the Gräfenberg ring within the context of the debates and competition among British medical and birth control professionals, this paper reveals broader issues of power relationships and expertise in the assessment of a new medical technology. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A qualitative analysis of women's explanations for changing contraception: the importance of non-contraceptive effects.

PubMed

Wigginton, Britta; Harris, Melissa L; Loxton, Deborah; Lucke, Jayne C

2016-10-01

Women commonly report changing contraceptive methods because of side-effects. However, there is a lack of literature that has thoroughly examined women's perspectives, including why they changed contraception. Using qualitative data from a contraceptive survey of young Australian women, we explored women's explanations for their recent changes in contraception. A thematic analysis of 1051 responses to a question about why women recently changed contraception was conducted. Themes reflected reasons for changing contraception which included: both contraceptive and non-contraceptive (4%); relationship/sexual (9%); medical (11%); contraceptive (18%); non-contraceptive (41%). A minority of responses were uncoded (17%). Non-contraceptive effects (effects unrelated to pregnancy prevention) featured most frequently in women's reasons for changing contraception. While cessation of various contraceptives due to unwanted side-effects is a well-known phenomenon, this analysis provides evidence of the changing of contraception for its non-contraceptive effects and reframes the notion of 'side-effects'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Family Planning for women unable to tolerate oral contraceptives.

PubMed

Spellacy, W N

1974-04-08

Should women with a family history of diabetes or myocardial infarcation, or women with abnormal blood glucose or cholesterol levels receive oral contraceptives? There is clear evidence that oral contraceptives can alter both carbohydrate and lipid metabolism in certain women. The lipid alteration is mainly an elevation of the circulating triglyceride levels, and only rarely is cholesterol content altered. It is also clear from extensive research during the past ten years that women who already have subclinical abnormalities, either in their triglyceride levels (family hyperlipoproteinemia) or glucose tolerance, are at great risk for the development of clinical disease while using oral contraceptives. Accordingly, all pharmaceutical firms are required by the Food and Drug Administration to instruct physicians about these problems through the package inserts and other means. Specifically, the physician should be alerted by the patient's history, and then he should use the laboratory to confirm any suspicion of abnormalities of carbohydrate or lipid metabolism. If there is any abnormal blood glucose or triglyceride value, the oral contraceptives should not be prescribed. There are other forms of contraception available for child spacing. Mechanical contraceptives will not aggravate a metabolic disorder. A useful substitute then would be an intrauterine device plus vaginal foam. When the woman has completed her family, she should be all means be offered surgical sterilization as a permanent family planning technique.

Straight Talk About Birth Control: A Contraceptive Education Protocol for Home Care.

PubMed

Schoenberg, Leslie

Home healthcare providers play a critical role in the prevention of unintended pregnancies by providing evidence-based contraception education during home visits. This article describes an innovative and comprehensive contraception protocol that was developed for Nurse-Family Partnership to improve contraception education for home healthcare patients. The protocol focused on increasing uptake of long-acting reversible contraception (LARC) for high-risk prenatal and postpartum home healthcare patients. The protocol was designed to reduce early subsequent pregnancies and thereby improve outcomes for mothers and their infants. An evidence-based translation project was designed and piloted in three California counties. The protocol consisted of a contraception education module for nurses and a patient education toolkit. The toolkit included an interactive patient education workbook emphasizing LARC methods for nurses to complete with their patients along with other teaching tools. The project was evaluated using pre- and posttest surveys that measured changes in nurses' knowledge, attitudes, and practice before, after, and 2 months after implementation. Outcomes revealed the following statistically significant results: (a) nurses' knowledge doubled at the first posttest and persisted at 2 months, (b) nurses' attitudes improved on two of the three measures, and (c) there was a 17.7% increase in the frequency of LARC birth control education 2 months after implementation. An evidence-based contraception protocol can promote acceptance of LARC methods and improve home healthcare clinician comfort with and frequency of birth control education.

The use of hormonal contraceptive agents and mood disorders in women.

PubMed

Svendal, Gjertrud; Berk, Michael; Pasco, Julie A; Jacka, Felice N; Lund, Anders; Williams, Lana J

2012-09-01

Mood disorders are a major cause of disability in developed countries, and contraceptive agents among the most widely used medications. The relationship between contraceptive agents and mood is unclear. The aim of this study was therefore to investigate the association between current contraception use and mood disorders in a random population-based sample of women. This study examined epidemiological data obtained from 498 women aged 20-50year participating in the Geelong Osteoporosis Study (GOS). Mood disorders were diagnosed using a clinical interview (SCID-I/NP) and information on medication use and other lifestyle factors were documented. After adjusting for age and socioeconomic status (SES), women taking progestin-only contraceptive agents had an increased likelihood of a current mood disorder (OR 3.0 95%CI: 1.1-7.8, p=0.03). In contrast, women taking combined contraceptive agents had a decreased likelihood of a current mood disorder, adjusting this for age and SES (OR 0.3 95%CI: 0.1, 0.9 p=0.03). These findings were not explained by weight, physical activity level, past depression, number of medical conditions or cigarette smoking. This study is cross-sectional, which precludes any determination regarding the direction of the relationships. These data suggest a protective effect of the combined contraceptive pill, and a deleterious effect of progestin only agents in regards to mood disorders. Copyright © 2012 Elsevier B.V. All rights reserved.

Women's autonomy, education and employment in Oman and their influence on contraceptive use.

PubMed

Al Riyami, Asya; Afifi, Mustafa; Mabry, Ruth M

2004-05-01

Since 1970 political and economic changes have brought about great improvements in health and education in Oman, and since 1994 the government has provided free contraceptives to all married couples in primary health care centres. Despite rapid socio-economic development, the fertility rate was 4.2 in 2001. The aim of this study was to define baseline data on ever-married women's empowerment in Oman from a national study in 2000, analyse the correlates of women's empowerment and the effect of empowerment on unmet need for contraception. Two indicators of empowerment were used: women's involvement in decision-making and freedom of movement. Bivariate analysis was used to link these measures and their proxies, education and employment status, with use of a family planning method. Education was a key indicator of women's status. Unmet contraceptive need for women exposed to pregnancy was nearly 25%, but decreased significantly with educational level and paid employment. While empowered women were more likely to use contraception, women's education was a better predictor of "met need" than autonomy, as traditional factors and community influence remain strong. For nearly half the 1,830 women in the study, the husband decided whether contraception was used. Fewer than 1% were using contraception before their first child as women are expected to have a child within the first year of marriage.

Access to contraception by minors in Jamaica: a public health concern

PubMed Central

Crawford, Tazhmoye V.; McGrowder, Donovan A.; Crawford, Alexay

2009-01-01

Background: Access to contraceptive by minors (pre-adolescents and adolescents) has spurred policy and legislative debates, part of which is that in an effort to successfully meet government's objective of a healthy sexual lifestyle among minors. Aims: This study examined factors affecting sexual reproductive health in minors, namely: access to contraceptive advice and treatment, pregnancy, number of sexual partners, sexually transmitted infections (STIs) and confidentiality. Materials and Methods: This research involved quantitative and qualitative data. Two hundred and thirty eight sexually active cases were investigated in Jamaica by the researchers, during the period 2006-2007. The age group population was 9-11, 12-14, and 15-17. Results: The study showed that access to contraceptive advice and treatment by minors was more favorable to males than females. The difference in access to contraceptive between male and female was statistically significant (x2 = 20.16, p<0.05). Of the 80 male respondents, who are contraceptive users, 11 encountered challenges in legitimately accessing contraceptive methods, while 38 of the 40 female users also encountered challenges. This resulted in unintended pregnancies and impregnation (33.2%), as well as the contracting of STIs (21%). Conclusion: The findings of this study will be important in informing the development of reproductive health services and family life education programs for pre-adolescents and adolescents in Jamaica and other Caribbean countries. PMID:22666704

Melatonin in humans: Possible involvement in SIDS, and use in contraceptives

NASA Technical Reports Server (NTRS)

Wurtman, Richard J.; Lynch, Harry J.; Sturner, William Q.

1991-01-01

Relatively few tools exist for assessing the possible involvement of melatonin in normal or abnormal physiologlcal and behavioral states. One cannot perform the classic ablation experiment of endocrinologists by cavalierly removing the human's pineal, nor derive the same effect pharmacologically by administering a drug which blocks the actions of the indole on its receptors (because no such drugs, demonstrated to work in humans, exist). About all that can be done is to administer the melatonin and see what happens, or measure its levels in a body fluid and determine whether its temporal patterns track those of the physiological or behavioral variable being examined. The clinical state of Sudden Infant Death Syndrome (SIDS) which apparently is associated with abnormalities in melatonin concentrations within body fluids obtained at autopsy is described. New data which suggest that exogenous melatonin has sufficient antigonadal potency to allow it to replace estrogen and, acting in combination with norethisterone, serve as a useful contraceptive agent is summarized.

Preparing Daughters: The Context of Rurality on Mothers' Role in Contraception

ERIC Educational Resources Information Center

Noone, Joanne; Young, Heather M.

2009-01-01

Context: The United States continues to have the highest rate of adolescent childbearing among developed countries. Lack of access and disadvantage contribute to this problem, which disproportionately impacts rural women. Given the increased difficulty rural young women face regarding contraceptive access, parental communication and support play…

Knowledge and Use of Contraception in Twenty Developing Countries. Reports on the World Fertility Survey 3.

ERIC Educational Resources Information Center

Mamlouk, Maria

This report, third in a series based on data resulting from the World Fertility Survey (WFS), examines the extent of knowledge and use of contraception in 20 developing countries. The data analyzed in this report indicate that in 19 of the 20 countries (the exception being Nepal), three-quarters or more of the women who are or have been married…

Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia.

PubMed

Silumbwe, Adam; Nkole, Theresa; Munakampe, Margarate Nzala; Milford, Cecilia; Cordero, Joanna Paula; Kriel, Yolandie; Zulu, Joseph Mumba; Steyn, Petrus S

2018-05-31

Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.

Quality of care and contraceptive use in urban Kenya

PubMed Central

Pence, Brian W.; Curtis, Siân L.; Marshall, Stephen W.; Speizer, Ilene S.

2015-01-01

CONTEXT Family planning is highly beneficial to women’s overall health, morbidity, and mortality, particularly in developing countries. Yet, in much of sub-Saharan Africa, contraceptive prevalence remains low while unmet need for family planning remains high. It has been frequently hypothesized that the poor quality of family planning service provision in many low-income settings acts as a barrier to optimal rates of contraceptive use but this association has not been rigorously tested. METHODS Using data collected from 3,990 women in 2010, this study investigates the association between family planning service quality and current modern contraceptive use in five cities in Kenya. In addition to individual-level data, audits of select facilities and service provider interviews were conducted in 260 facilities. Within 126 higher-volume clinics, exit interviews were conducted with family planning clients. Individual and facility-level data are linked based on the source of the woman’s current method or other health service. Adjusted prevalence ratios are estimated using binomial regression and we account for clustering of observations within facilities using robust standard errors. RESULTS Solicitation of client preferences, assistance with method selection, provision of information by providers on side effects, and provider treatment of clients were all associated with a significantly increased likelihood of current modern contraceptive use and effects were often stronger among younger and less educated women. CONCLUSION Efforts to strengthen contraceptive security and improve the content of contraceptive counseling and treatment of clients by providers have the potential to significantly increase contraceptive use in urban Kenya. PMID:26308259

Biology of male fertility control: an overview of various male contraceptive approaches.

PubMed

Tulsiani, D R; Abou-Haila, A

2015-04-01

The population of our planet continues to grow at an alarming rate. If the growth continues at the present rate, the estimated current world population of about seven billion is expected to double in the next forty years. Accumulated data from surveys by the United Nations Population Control Division suggest that a majority of today's young men in many countries are willing to have fewer children than their parents did. However, the contraceptive options available to them have not changed in several decades. In spite of the general agreement that men, like women, must take full responsibility of their fertility, the availability of safe, reversible and affordable contraceptives for men have lagged behind because of the complexity of the science of the male reproductive system. Thus, the contraceptive needs of millions of men/couples go unmet every single day and results in millions of unwanted pregnancies. In this article, we intend to discuss new hormonal and non-hormonal contraceptive approaches that are at various stages of research and development and may someday provide new contraceptives for men. In addition, we intend to discuss many details of three safe, effective, affordable and reversible vas-based approaches that are inching closer to being approved for use by millions of men in multiple countries. Finally, our intention is to discuss the male contraceptive pill that will soon be available to men only in Indonesia. The availability of these male contraceptives will allow both men and women to take full control of their fertility and participate in slowing down the growth of world population.

Adaptation of the contraceptive self-efficacy scale for heterosexual Mexican men and women of reproductive age.

PubMed

Arias, María Luisa Flores; Champion, Jane Dimmitt; Soto, Norma Elva Sáenz

2017-08-01

Development of a Spanish Version Contraceptive Self-efficacy Scale for use among heterosexual Mexican populations of reproductive age inclusive of 18-35years. Methods of family planning have decreased in Mexico which may lead to an increase in unintended pregnancies. Contraceptive self-efficacy is considered a predictor and precursor for use of family planning methods. Cross-sectional, descriptive study design was used to assess contraceptive self-efficacy among a heterosexual Mexican population (N=160) of reproductive age (18-35years). Adaptation of a Spanish Version Contraceptive Self-efficacy scale was conducted prior to instrument administration. Exploratory and confirmatory factorial analyses identified seven factors with a variance of 72.812%. The adapted scale had a Cronbach alpha of 0.771. A significant correlation between the Spanish Version Contraceptive Self-efficacy Scale and the use of family planning methods was identified. The Spanish Version Contraceptive Self-efficacy scale has an acceptable Cronbach alpha. Exploratory factor analysis identified 7 components. A positive correlation between self-reported contraceptive self-efficacy and family planning method use was identified. This scale may be used among heterosexual Mexican men and women of reproductive age. The factor analysis (7 factors versus 4 factors for the original scale) identified a discrepancy for interpretation of the Spanish versus English language versions. Interpretation of findings obtained via the Spanish versión among heterosexual Mexican men and women of reproductive age require interpretation based upon these differences identified in these analyses. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of modern contraceptives among married women in Vietnam: a multilevel analysis using the Multiple Indicator Cluster Survey (2011) and the Vietnam Population and Housing Census (2009).

PubMed

Vu, Lan Thi Hoang; Oh, Juhwan; Bui, Quyen Thi-Tu; Le, Anh Thi-Kim

2016-01-01

The prevalence of modern contraceptive use is an important indicator that reflects accessibility to reproductive health services. Satisfying unmet needs for family planning alone could reduce the number of maternal deaths by almost a third. This study uses multiple data sources to examine multilevel factors associated with the use of modern contraceptives among married women in Vietnam aged 15-49 years. Data from different national surveys (Vietnam Population and Housing Census, Vietnam Living Standard Survey, and Multiple Indicator Cluster Survey) were linked to create a dataset including individual and contextual (provincial) variables (N=8,341). Multilevel modeling was undertaken to examine the impact of both individual and provincial characteristics on modern contraceptive use. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Individual factors significantly associated with the use of modern contraceptives were age 30-34 years (reference 15-19 years) (OR=1.63); high socioeconomic status (SES) (OR=0.8); having two living children (OR=2.4); and having a son (OR=1.4). The provincial poverty rate mediated the association between the individual's SES and the likelihood of using modern contraceptives. The proportion of women in Vietnam using modern contraceptive methods has remained relatively high in recent years with significant variation across Vietnam's 63 provinces. Women of lower SES are more likely to use modern contraceptive methods, especially in the poorer provinces. Achieving access to universal reproductive health is one of the Millennium Development Goals. Vietnam must continue to make progress in this area.

Counseling during Maternal and Infant Health Visits and Postpartum Contraceptive use in Uttar Pradesh, India

PubMed Central

Rajan, Sowmya; Speizer, Ilene S.; Calhoun, Lisa M.; Nanda, Priya

2017-01-01

Context Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest level of unmet need for contraception in the year following a birth. A cost-effective way to inform women about their risk of becoming pregnant after the birth of a child is to integrate family planning counseling and services with maternal and infant health services. Methods We use recently collected survey data from 2733 women from six cities in Uttar Pradesh, India who had a recent birth (since 2011) to examine the role of exposure to family planning information at maternal and infant health visits on (1) any contraceptive use in the postpartum period, and (2) choice of modern method in the postpartum period. We use discrete-time event history multinomial logit models to examine the duration to contraceptive use, and choice of modern method, in the 12 months following the last birth since 2011. Results We find that receiving counseling in an institution at the time of delivery has the strongest influence on women’s subsequent uptake of modern contraception (female sterilization and IUD). Being visited by a CHW in the extended postpartum period was also strongly associated with subsequent uptake of modern contraception (IUD, condom and hormonal contraception). Conclusion Providing postpartum family planning counseling at key junctures during maternal health visits has the potential to increase uptake of modern contraceptive method in urban Uttar Pradesh. PMID:28649295

Interaction of Oligomeric Breast Cancer Resistant Protein (BCRP) with Adjudin: A Male Contraceptive with Anti-Cancer Activity

PubMed Central

Cheng, Yan Ho; Jenardhanan, Pranitha; Mathur, Premendu P.; Qian, Xiaojing; Xia, Weiliang; Silvestrini, Bruno; Cheng, Chuen Yan

2016-01-01

Breast cancer resistant protein (BCRP, ABCG2) is an ATP-binding cassette (ABC) transporter, which together with two other ABC efflux drug pumps, namely P-glycoprotein (P-gp, ABCB1) and multidrug resistance-related protein 1 (MRP1, ABCC1) is the most important multidrug resistance protein found in eukaryotic cells including cells in the testis. However, unlike P-gp and MRP1, which are components of the Sertoli cell blood-testis barrier (BTB), BCRP is not expressed at the BTB in rodents and human testes. Instead, BCRP is expressed by peritubular myoid cells and endothelial cells of the lymphatic vessel in the tunica propria, residing outside the BTB. As such, the testis is equipped with two levels of defense against xenobiotics or drugs, preventing these harmful substances from entering the adluminal compartment to perturb meiosis and post-meiotic spermatid development: one at the level of the BTB conferred by P-gp and MRP1 and one at the tunica propria conferred by BCRP. The presence of drug transporters at the tunica propria as well as at the Sertoli cell BTB thus poses significant obstacles in developing non-hormonal contraceptives if these drugs (e.g., adjudin) exert their effects in germ cells behind the BTB, such as in the adluminal (apical) compartment of the seminiferous epithelium. Herein, we summarize recent findings pertinent to adjudin, a non-hormonal male contraceptive, and molecular interactions of adjudin with BCRP so that this information can be helpful to devise delivery strategies to evade BCRP in the tunica propria to improve its bioavailability in the testis. PMID:25620224

Vasectomy project launched in Turkey. Turkey's first VSC clinic.

PubMed

1992-03-01

One third of young married couples are currently using modern methods of contraception. Recent studies indicate that more than 30% of Turkey's married couples use withdrawal as their means of fertility control and only slightly more than 1% of Turkish families have opted for female sterilization. There is certainly an higher proportion of reproductive age married couples in Turkey which have completed their family size and could enjoy the advantages of permanent contraceptive methods. There has been little effort, however, on the part of the Turkish government to provide men with information and education on male voluntary surgical contraception (VSC), and the appropriate counseling and surgical services. As in many Asian, Islamic societies, the idea of males learning about and practicing family planning has long been culturally unacceptable. The Human Resource Development Foundation, with the assistance of Pathfinder International, opened the first VSC clinic for men in May 1989 in Ankara. This initiative makes Pathfinder the first private voluntary organization to establish a project offering VSC methods to Turkey's male population through hospital clinics. The urology department of the Ankara Social Security Hospital serves as the site for the project's counseling and training network. From that department, the project director and supervisor coordinate the development and establishment of male family planning clinics in surrounding hospitals. In just over two years, 19 urologists have been trained in VSC procedures and counseling, and more than 700 men have had vasectomies using the no-scalpel technique. An additional 6000 clients, both men and women, have received counseling on VSC procedures and the project's popularity continues to grow. The project expanded in 1991 into Istanbul and Izmir in response to growing demand for services. It is possible that even more expansion of VSC services is on the horizon in Turkey.

Pharmacokinetics and tolerability of voriconazole and a combination oral contraceptive co-administered in healthy female subjects

PubMed Central

Andrews, Emma; Damle, Bharat D; Fang, Annie; Foster, Grover; Crownover, Penelope; LaBadie, Robert; Glue, Paul

2008-01-01

AIM To assess the two-way pharmacokinetic interaction between voriconazole and Ortho-Novum® 1/35, an oral contraceptive containing norethindrone 1 mg and ethinyl oestradiol 35 μg. METHODS In this open-label, three-period, fixed-sequence study, 16 healthy females received voriconazole (400 mg q12 h, day 1; 200 mg q12 h, days 2–4) (period 1), oral contraceptive (q24 h, days 12–32) (period 2), and combination voriconazole (400 mg q12 h, day 57; 200 mg q12 h, days 58–60) and oral contraceptive (q24 h, days 40–60) (period 3). RESULTS Voriconazole geometric mean AUCτ and Cmax increased 46% (12 682–18 495 ng h ml−1; 90% confidence interval [CI] 32, 61) and 14% (2485–2840 ng ml−1; 90% CI 3, 27), respectively, when co-administered with oral contraceptive vs. voriconazole alone. Ethinyl oestradiol geometric mean AUCτ and Cmax increased 61% (1031–1657 ng h ml−1; 90% CI 50, 72) and 36% (119–161 ng ml−1; 90% CI 28, 45), respectively, and norethindrone geometric mean AUCτ and Cmax increased 53% (116–177 ng h ml−1; 90% CI 44, 64) and 15% (18–20 ng ml−1; 90% CI 3, 28), respectively, during voriconazole co-administration vs. oral contraceptive alone. Neither ethinyl oestradiol nor norethindrone levels were reduced in subjects following voriconazole co-administration. Adverse events (AEs) were generally mild, occurring less in subjects receiving voriconazole alone (36 events) vs. oral contraceptive alone (88 events) or combination treatment (68 events); four subjects experienced a severe AE. CONCLUSIONS Co-administration of voriconazole and oral contraceptive increased systemic exposures of all analytes relative to respective monotherapy. Although generally safe and well tolerated, it is recommended that patients receiving co-administered voriconazole and oral contraceptive be monitored for development of AEs commonly associated with these medications. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Voriconazole, a broad-spectrum antifungal drug, is a substrate and inhibitor of CYP2C19 and CYP3A4 isozymes.Ethinyl oestradiol and norethindrone, components of the combination oral contraceptive drug Ortho-Novum® 1/35, also are substrates of cytochrome P450 CYP2C19 and CYP3A4 isozymes.Because co-administration of voriconazole and Ortho-Novum® 1/35 could potentially result in pharmacokinetic interactions that increase systemic exposure of one or both drugs to unsafe levels, clinical studies are needed to define better the two-way pharmacokinetic interaction between these drugs. WHAT THIS STUDY ADDS Although co-administered voriconazole and oral contraceptive did result in increased systemic exposures of all three drugs relative to respective monotherapy, co-administered treatment was generally safe and well tolerated.It is recommended, however, that patients receiving co-administered voriconazole and oral contraceptives be monitored for the development of adverse events commonly associated with these medications. PMID:18294327

Students’ Perceptions of Contraceptives in University of Ghana

PubMed Central

Kayi, Esinam Afi

2013-01-01

Objective This study sought to explore University of Ghana Business School diploma student's knowledge of contraceptives, types of contraceptives, attitudes towards contraceptive users, preference for contraceptives, benefits, and side-effects of contraceptives. Materials and methods Data was conducted with three sets of focus group discussions. Participants were systematically sampled from accounting and public administration departments. Results Findings showed that students had little knowledge of contraceptives. The male and female condoms were the main contraceptive types reported out of the many modern and traditional methods of contraceptives. The main benefits of contraceptives were; ability to protect against STIs, abortions, unwanted pregnancy and psychological trauma. Whilst most respondents preferred future use of pills, side-effects of contraceptives were mostly reported for condoms than other contraceptive methods. Results showed that participants had bad attitudes towards unmarried contraceptive users. Conclusion Generally, our findings show that detailed knowledge about contraceptives is low. There is a little gap of information on contraception knowledge, timing, and contraceptive types among university diploma students. Reproductive and maternal services should be available and accessible for tertiary students. PMID:24971101

The social context of adolescent women’s use of modern contraceptives in Zimbabwe: a multilevel analysis

PubMed Central

2014-01-01

Background Efforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics. Methods Data from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM). Results The odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces. Conclusions Both individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors. PMID:25108444

The profile of women who seek emergency contraception from the family planning service.

PubMed

Lo, Sue S T; Ho, P C

2012-08-01

OBJECTIVES. To review the profile of emergency contraceptive users, their reasons for using emergency contraception, and whether they use it correctly. DESIGN. Retrospective analysis of medical records. SETTING. Six Birth Control Clinics and three Youth Health Care Centres of the Family Planning Association of Hong Kong. PARTICIPANTS. Women requesting emergency contraception between 2006 and 2008. MAIN OUTCOME MEASURES. Demographics of emergency contraception users, reasons for requesting emergency contraception, number of times the subject had unprotected intercourse before emergency contraception use, type of emergency contraception provided, coitus-treatment intervals, and outcomes. RESULTS. A total of 11 014 courses of emergency contraception were provided, which included 10 845 courses of levonorgestrel-only pills, 168 intrauterine contraceptive devices, and one course of pills plus an intrauterine contraceptive device. The mean age of the users was 30 years. Two thirds (65.6%) were nulliparous and 64.9% had not had a previous abortion. Their major reasons for requesting emergency contraception were: omission of contraceptive at the index intercourse (38.9%), condom accidents (38.0%), and non-use of any regular contraceptives (20.6%). Non-users of contraceptives were more likely to have had a previous abortion. In all, 97.9% of women took emergency contraception within 72 hours of their unprotected intercourse; 98% had had a single act of unprotected intercourse. None of the intrauterine contraceptive device users became pregnant. The failure rate for emergency contraceptive pills was 1.8%. CONCLUSIONS. Women requested emergency contraception because contraceptives were omitted or condom accidents. Health care providers should focus on motivating women with a history of abortion to use contraceptives, and ensure that condom users know how to use them correctly. Most women followed instructions on the use for emergency contraception and their outcomes were satisfactory.

Political constraints on contraceptive development in the United States.

PubMed

Smith, J B; Potts, D M; Fortney, J A

1991-10-01

In the US there is a great need for new contraceptives because the current available choices are too limited. Many groups of women, teenagers, women over 40 and lactating mothers have even greater need because of their special requirement. There are 6 million annual pregnancies in the US, 50% of them are unintended. This is the highest percentage of unintended pregnancies in the developed world with Canada having only 39%, the UK 32%, and the Netherlands 17%. 46% of women can expect to have at least 1 unintended pregnancy in their lifetime. Almost half of these unintended pregnancies end in abortion. Of those seeking abortion, 26% are under 20 and 81% are under 30. 69% are white and 82% are single. 49% of these women reported not using contraception when they conceived. Even when a woman uses contraceptives she is still exposed to the risk of contraceptive failure. These failure rates vary from 5-30% for the pill to spermicides. Over a 10-year period the rate climbs to 25-50% for the pill or the IUD. In the US, contraceptives are the most expensive with the pill selling for 60 times what is costs for similar formulations in other countries. Norplant and IUDs, the most reliable reversible methods cost hundreds of dollars and thus make them unavailable for teenagers and poor women who need them most. The primary benefit of increased contraceptive prevalence (CP) is a reduction in the number of unwanted pregnancies and thus abortions. The CP rate for married women of reproductive age in the us is 66%, compared to 73% in Canada, 83% in the UK, 78% in Sweden, and 72% in the Netherlands. The reason new methods are not being developed are multiple: fear of product liability litigation; fear of poor product sales due to public fear; regulation and market pressures that simply do not make them profitable. It can take 12 years and $200 million to develop a new drug and US patents only last 17 years. Thus in order to make a profit the company must have a high rate of sales. Changes in the approval process and financial incentives similar to those for orphan drugs could bring new methods to market.

An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial

PubMed Central

Osorio Calderon, Veronica; Makleff, Shelly; Huaynoca, Silvia; Leurent, Baptiste; Edwards, Phil; Lopez Gallardo, Jhonny; Free, Caroline

2017-01-01

Background Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months. Objective The objective of this study is to evaluate the effect of the intervention on young women’s use of and attitudes toward the most effective contraceptive methods. Methods We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months. Results Recruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018. Conclusions This trial will evaluate the effect of the intervention on young women’s use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. Trial Registration ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN) PMID:29254910

Thrombin impairs human endometrial endothelial angiogenesis; implications for progestin-only contraceptive-induced abnormal uterine bleeding.

PubMed

Shapiro, John P; Guzeloglu-Kayisli, Ozlem; Kayisli, Umit A; Semerci, Nihan; Huang, S Joseph; Arlier, Sefa; Larsen, Kellie; Fadda, Paolo; Schatz, Frederick; Lockwood, Charles J

2017-06-01

Progestin-only contraceptives induce abnormal uterine bleeding, accompanied by prothrombin leakage from dilated endometrial microvessels and increased thrombin generation by human endometrial stromal cell (HESC)-expressed tissue factor. Initial studies of the thrombin-treated HESC secretome identified elevated levels of cleaved chondroitin sulfate proteoglycan 4 (CSPG4), impairing pericyte-endothelial interactions. Thus, we investigated direct and CSPG4-mediated effects of thrombin in eliciting abnormal uterine bleeding by disrupting endometrial angiogenesis. Liquid chromatography/tandem mass spectrometry, enzyme-linked immunosorbent assay (ELISA) and quantitative real-time-polymerase chain reaction (PCR) evaluated conditioned medium supernatant and cell lysates from control versus thrombin-treated HESCs. Pre- and post-Depo medroxyprogesterone acetate (DMPA)-administered endometria were immunostained for CSPG4. Proliferation, apoptosis and tube formation were assessed in human endometrial endothelial cells (HEECs) incubated with recombinant human (rh)-CSPG4 or thrombin or both. Thrombin induced CSPG4 protein expression in cultured HESCs as detected by mass spectrometry and ELISA (p<.02, n=3). Compared to pre-DMPA endometria (n=5), stromal cells in post-DMPA endometria (n=5) displayed stronger CSPG4 immunostaining. In HEEC cultures (n=3), total tube-formed mesh area was significantly higher in rh-CSPG4 versus control (p<.05). However, thrombin disrupted HEEC tube formation by a concentration- and time-dependent reduction of angiogenic parameters (p<.05), whereas CSPG4 co-treatment did not reverse these thrombin-mediated effects. These results suggest that disruption of HEEC tube formation by thrombin induces aberrant angiogenesis and abnormal uterine bleeding in DMPA users. Mass spectrometry analysis identified several HESC-secreted proteins regulated by thrombin. Therapeutic agents blocking angiogenic effects of thrombin in HESCs can prevent or minimize progestin-only contraceptive-induced abnormal uterine bleeding. Copyright © 2017. Published by Elsevier Inc.

Effective Delivery of Male Contraceptives Behind the Blood-Testis Barrier (BTB) – Lesson from Adjudin

PubMed Central

Chen, Haiqi; Mruk, Dolores D.; Xia, Weiliang; Bonanomi, Michele; Silvestrini, Bruno; Cheng, Chuen-Yan

2016-01-01

The blood-testis barrier (BTB) is one of the tightest blood-tissue barriers in the mammalian body. It divides the seminiferous epithelium of the seminiferous tubule, the functional unit of the testis, where spermatogenesis takes place, into the basal and the adluminal (apical) compartments. Functionally, the BTB provides a unique microenvironment for meiosis I/II and post-meiotic spermatid development which take place exclusively in the apical compartment, away from the host immune system, and it contributes to the immune privilege status of testis. However, the BTB also poses major obstacles in developing male contraceptives (e.g., adjudin) that exert their effects on germ cells in the apical compartment, such as by disrupting spermatid adhesion to the Sertoli cell, causing germ cell exfoliation from the testis. Besides the tight junction (TJ) between adjacent Sertoli cells at the BTB that restricts the entry of contraceptives from the microvessels in the interstitium to the adluminal compartment, drug transporters, such as P-glycoprotein and multidrug resistance-associated protein 1 (MRP1), are also present that actively pump drugs out of the testis, limiting drug bioavailability. Recent advances in drug formulations, such as drug particle micronization (<50 μm) and co-grinding of drug particles with ß-cyclodextrin have improved bioavailability of contraceptives via considerable increase in solubility. Herein, we discuss development in drug formulations using adjudin as an example. We also put emphasis on the possible use of nanotechnology to deliver adjudin to the apical compartment with multidrug magnetic mesoporous silica nanoparticles. These advances in technology will significantly enhance our ability to develop effective non-hormonal male contraceptives for men. PMID:26758796

Effective Delivery of Male Contraceptives Behind the Blood-Testis Barrier (BTB) - Lesson from Adjudin.

PubMed

Chen, Haiqi; Mruk, Dolores D; Xia, Weiliang; Bonanomi, Michele; Silvestrini, Bruno; Cheng, Chuen-Yan

2016-01-01

The blood-testis barrier (BTB) is one of the tightest blood-tissue barriers in the mammalian body. It divides the seminiferous epithelium of the seminiferous tubule, the functional unit of the testis, where spermatogenesis takes place, into the basal and the adluminal (apical) compartments. Functionally, the BTB provides a unique microenvironment for meiosis I/II and post-meiotic spermatid development which take place exclusively in the apical compartment, away from the host immune system, and it contributes to the immune privilege status of testis. However, the BTB also poses major obstacles in developing male contraceptives (e.g., adjudin) that exert their effects on germ cells in the apical compartment, such as by disrupting spermatid adhesion to the Sertoli cell, causing germ cell exfoliation from the testis. Besides the tight junction (TJ) between adjacent Sertoli cells at the BTB that restricts the entry of contraceptives from the microvessels in the interstitium to the adluminal compartment, drug transporters, such as P-glycoprotein and multidrug resistance-associated protein 1 (MRP1), are also present that actively pump drugs out of the testis, limiting drug bioavailability. Recent advances in drug formulations, such as drug particle micronization (<50 μm) and co-grinding of drug particles with ß-cyclodextrin have improved bioavailability of contraceptives via considerable increase in solubility. Herein, we discuss development in drug formulations using adjudin as an example. We also put emphasis on the possible use of nanotechnology to deliver adjudin to the apical compartment with multidrug magnetic mesoporous silica nanoparticles. These advances in technology will significantly enhance our ability to develop effective non-hormonal male contraceptives for men.

Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease.

PubMed

Sharmila, Vijayan; Babu, Thirunavukkarasu Arun

2015-01-01

Chorea is a neurological adverse effect of oral contraceptive pills (OCPs). The onset of chorea following OCPs usage varies widely from few weeks to several years. We report a rare case of chorea which developed within a week of starting OCPs in an adolescent girl with polycystic ovarian disease.

Contraceptives of the future in the light of HIV infection.

PubMed

Short, R V

1994-06-01

The AIDS and sexually transmissible disease pandemics have helped to focus the world's attention on the need for good protection against transmission of infections during sexual intercourse. Most of the highly effective modern contraceptives provide only limited protection against STD transmission, although recent progress with the development of loose-fitting plastic male condoms and new spermicides gives some hope. Urgent attention must continue to be given to contraceptives with STD protective qualities which are under the woman's control. Refinements of the female condom and vaginal sponges with new spermicides and microbicides may be a step in this direction.

Emergency contraception.

PubMed

Conard, Lee Ann E; Gold, Melanie A

2005-10-01

Emergency contraception is increasing in use and has become a universal standard of care in the United States. This article reviews available forms of emergency contraception, their indications, contraindications, adverse effects and efficacy at preventing pregnancy. This article describes the mechanism of action of different forms of emergency contraception and provides recommendations on when to start or restart an ongoing method of contraceptive after emergency contraception use. Literature on the impact of the advance provision of emergency contraception on contracepting behaviors is reviewed, and behavior change counseling related to emergency contraception is described.

Male contraception: past, present and future.

PubMed

Payne, Christopher; Goldberg, Erwin

2014-01-01

Current contraceptive options available to men include withdrawal, condoms, and vasectomy, each of which has its own drawbacks. In this chapter we will describe the pros and cons for each, as well as methodological and product updates. Statistics from the U.S. Centers for Disease Control on acceptance and satisfaction will be included. Advances in vasectomy and reversal will be presented. Methods to develop new contraceptive technologies fall into two categories: hormonal and non-hormonal. Many targets and strategies have been proposed for non-hormonal male contraception within the testis. Targets include structural components in the testis, as well as enzymes, ion channels and other proteins specific to spermatozoa. Here we provide an overview of the spermatogenic mechanisms and proteins that have received research interest to date. We also discuss potential novel targets, such as ubiquitin specific proteases, that warrant greater research emphasis.

[Demographic transition or revolution? The weaknesses and implications of the demographic transition theory. Part 1: the origins].

PubMed

Bourcier De Carbon, P

1998-01-01

The work of Adolphe Landry is reviewed in relation to development of demographic transition theory. Landry was appointed administrator in 1912 of the National Alliance Against Depopulation and remained active in it his whole life. He also helped create family allowance programs in France. As early as 1909, Landry described three different population regimes. In the "primitive" regime, which characterized all nonhuman life and human life during most of history, the population was adjusted to available subsistence by mortality. In the "intermediate" phase, restrictions on marriage and control of reproduction outside marriage maintained the population at a level below the maximum supportable. In the "contemporary" regime, the universal practice of contraception and abortion could lead to very low levels of fertility. The spread of contraception and low fertility appeared to Landry a true demographic revolution. He attributed the acceptance of contraception to a change in the common aspirations of human beings regarding their conditions, a desire for improved material well-being and social advancement, and an increased spirit of rationality and even calculation in their behavior. Landry believed that the contemporary regime, unlike the preceding two, had no mechanism implying equilibrium. The demographic revolution freed fertility from social determinants and linked it more closely to individual interests. Landry expected the contemporary regime to spread throughout the entire world, with many areas still in the primitive phase passing directly to the contemporary. He was concerned with the effects of demographic aging, and he deplored birth control propaganda that claimed it as a cure for unemployment and for overpopulation in the poor Asian countries. The birth control movements in England and the US were successful in bringing the two countries into the contemporary regime. A number of organizations such as the Population Association of America and the Office of Population Research at Princeton were favorable toward the spread of birth control through the rest of the world.

[Contextualization of sexual initiation and individual barriers to the use of contraceptives by adolescents of Lima, Huamanga, and Iquitos].

PubMed

Carmona, Gloria; Beltran, Jessica; Calderón, María; Piazza, Marina; Chávez, Susana

2017-01-01

To contextualize sexual initiation and barriers to the use of contraceptives by adolescents as well as the acquisition of adequate knowledge regarding contraception and sexually transmitted diseases. This quantitative and qualitative study evaluated adolescents living in three cities with high pregnancy rates in Peru: Iquitos, Huamanga, and Lima. Subjects were invited to participate in the study via Facebook. Questionnaires were then used to select adolescents who met the inclusion criteria, and interviews were conducted to obtain detailed data regarding the study topic. A total of 33 women and 23 men aged 18 to 19 years participated in the study. The age of onset of sexual activity ranged from 14 to 16 years; the main reasons for sexual initiation were sexual desire among men and pressure from the partner among women; in most cases, the sexual partner was an occasional companion for men and a boyfriend for women. The barriers related to the use of contraceptives were the financial stability of the partner, responsibility of the female partner when using contraceptives, limited capacity to negotiate choices, fear of abandonment by the male partner for demanding the use of contraceptives, and the reduction of sexual sensitivity with the use of condoms. The barriers identified in this study limit the use of contraceptives and indicate the need to develop specific strategies to strengthen the interpersonal skills of adolescents and provide accurate information about the risks of unprotected sex.

Physical access to health facilities and contraceptive use in Kenya: evidence from the 2008-2009 Kenya Demographic and Health Survey.

PubMed

Ettarh, Remare R; Kyobutungi, Catherine

2012-09-01

The objective of the study was to determine the spatial variation in modern contraceptive use and unmet need for family planning across the counties of Kenya and to examine whether the spatial patterns were associated with inequalities in physical access to health facilities. Data were obtained from the 2008-2009 Kenya Demographic and Health Survey and linked to the location of health facilities in the country. Multivariate logistic regression was used to examine the influence of distance to the nearest health facility and health facility density, in addition to other covariates, on modern contraceptive use and unmet need. Overall, the prevalence of modern contraceptive use and unmet need among women aged 15-49 in Kenya was 42.1% and 19.7% respectively. Among the respondents who lived more than 5 km from the nearest health facility modern contraceptive use was significantly less likely compared to women resident 5 km or less from the nearest health facility. Women from counties with higher health facility density were 53% more likely to use modern contraceptives compared to women in counties with low health facility density. Distance and health facility density in the county were not significantly associated with unmet need. Physical access to health facilities is an important determinant of modern contraceptive use and unmet need in Kenya. Strategies should be developed in underserved counties to mitigate the challenge of distance to health facilities, such as delivering services by outreach and mobile facilities.

Analysing the relationship between family planning workers' contact and contraceptive switching in rural Bangladesh using multilevel modelling.

PubMed

Hossain, Mian B

2005-09-01

With a population of over 131 million and a fertility rate of 29.9 per 1000, population growth constitutes a primary threat to continued economic growth and development in Bangladesh. One strategy that has been used to cease further increases in fertility in Bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. This study uses a longitudinal database to assess the impact of family planning outreach workers' contact upon contraceptive switching and upon the risk of an unintended pregnancy. Using longitudinal data on contraceptive use from the Operations Research Project (ORP) of the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. After controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers' contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. This contact also reduces the risk of an unintended pregnancy. Family planning workers' contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. The study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural Bangladesh.

Emergency contraception.

PubMed

2012-12-01

Despite significant declines over the past 2 decades, the United States continues to have teen birth rates that are significantly higher than other industrialized nations. Use of emergency contraception can reduce the risk of pregnancy if used up to 120 hours after unprotected intercourse or contraceptive failure and is most effective if used in the first 24 hours. Indications for the use of emergency contraception include sexual assault, unprotected intercourse, condom breakage or slippage, and missed or late doses of hormonal contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring (ie, improper placement or loss/expulsion), and injectable contraception. Adolescents younger than 17 years must obtain a prescription from a physician to access emergency contraception in most states. In all states, both males and females 17 years or older can obtain emergency contraception without a prescription. Adolescents are more likely to use emergency contraception if it has been prescribed in advance of need. The aim of this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on safety, efficacy, and use of emergency contraception in teenagers; and (3) encourage routine counseling and advance emergency-contraception prescription as 1 part of a public health strategy to reduce teen pregnancy. This policy focuses on pharmacologic methods of emergency contraception used within 120 hours of unprotected or underprotected coitus for the prevention of unintended pregnancy. Emergency contraceptive medications include products labeled and dedicated for use as emergency contraception by the US Food and Drug Administration (levonorgestrel and ulipristal) and the "off-label" use of combination oral contraceptives.

Sperm calcineurin inhibition prevents mouse fertility with implications for male contraceptive.

PubMed

Miyata, Haruhiko; Satouh, Yuhkoh; Mashiko, Daisuke; Muto, Masanaga; Nozawa, Kaori; Shiba, Kogiku; Fujihara, Yoshitaka; Isotani, Ayako; Inaba, Kazuo; Ikawa, Masahito

2015-10-23

Calcineurin inhibitors, such as cyclosporine A and FK506, are used as immunosuppressant drugs, but their adverse effects on male reproductive function remain unclear. The testis expresses somatic calcineurin and a sperm-specific isoform that contains a catalytic subunit (PPP3CC) and a regulatory subunit (PPP3R2). We demonstrate herein that male mice lacking Ppp3cc or Ppp3r2 genes (knockout mice) are infertile, with reduced sperm motility owing to an inflexible midpiece. Treatment of mice with cyclosporine A or FK506 creates phenocopies of the sperm motility and morphological defects. These defects appear within 4 to 5 days of treatment, which indicates that sperm-specific calcineurin confers midpiece flexibility during epididymal transit. Male mouse fertility recovered a week after we discontinued treatment. Because human spermatozoa contain PPP3CC and PPP3R2 as a form of calcineurin, inhibition of this sperm-specific calcineurin may lead to the development of a reversible male contraceptive that would target spermatozoa in the epididymis. Copyright © 2015, American Association for the Advancement of Science.

Missed pills: frequency, reasons, consequences and solutions.

PubMed

Chabbert-Buffet, Nathalie; Jamin, Christian; Lete, Iñaki; Lobo, Paloma; Nappi, Rossella E; Pintiaux, Axelle; Häusler, Günther; Fiala, Christian

2017-06-01

Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions. The article comprises a narrative review of the literature. Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression. For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

Impact of a theory-based video on initiation of long-acting reversible contraception after abortion.

PubMed

Davidson, AuTumn S; Whitaker, Amy K; Martins, Summer L; Hill, Brandon; Kuhn, Caroline; Hagbom-Ma, Catherine; Gilliam, Melissa

2015-03-01

Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

Absorption and metabolization of sex hormones and their transformation into contraceptive technologies: the paths taken by medical thought in Brazil.

PubMed

Bonan, Claudia; Teixeira, Luiz Antonio; Nakano, Andreza Rodrigues

2017-01-01

The article analyses knowledge assimilation and the development of clinical and research practices relating to sex hormones among Brazilian gynaecologists. It discusses the paths taken by medical thought from the reception of the hormones to their transformation into contraceptives. Our objective is to comprehend styles of introducing and disseminating medical technologies in the area of reproductive health in Brazil. It uses methods of historical analysis and takes as its source the Anais Brasileiros de Ginecologia, a journal published between 1936 and 1970. From the outset, the accompaniment of scientific breakthroughs in relation to sex hormones and their use to treat diverse female illnesses played a key role in the rapid medical acceptance of hormonal contraception. Scientific and technical questions (side effects, dosages) and the demographic issue formed part of the majority of the debates. Objections from the Catholic Church were considered but did not set the agenda of medical thought on contraceptives. The quest to consolidate gynaecology as a scientific, modern and cosmopolitan area of expertise, along with sanitary and demographic motives that allowed contraceptives to be classed as ethical drugs, are identified as processes underlying the assimilation and metabolization of sex hormones as hormonal contraceptives.

Reproductive Life Plan Counseling and Effective Contraceptive Use among Urban Women Utilizing Title X Services.

PubMed

Bommaraju, Aalap; Malat, Jennifer; Mooney, Jennifer L

2015-01-01

Although the Centers for Disease Control and Prevention and the U.S. Office of Population Affairs recommend inclusion of reproductive life plan counseling (RLPC) in all well-woman health care visits, no studies have examined the effect of RLPC sessions on the decision to use effective contraception at publicly funded family planning sites. RLPC could be a particularly impactful intervention for disadvantaged social groups who are less likely to use the most effective contraceptive methods. Using data from 771 nonpregnant, non-pregnancy-seeking women receiving gynecological services in the Cincinnati-Hamilton County Reproductive Health and Wellness Program, multinomial logistic regression models compared users of nonmedical/no method with users of 1) the pill, patch, or ring, 2) depot medroxyprogesterone acetate, and 3) long-acting reversible contraception (LARC). The effect of RLPC on the use of each form of contraception, and whether it mediated the effect of race/ethnicity and education on contraceptive use, was examined while controlling for age, insurance status, and birth history. The interaction between RLPC and race/ethnicity and the interaction between RLPC and educational attainment was also assessed. RLPC was not associated with contraceptive use. The data suggested that RLPC may increase LARC use over nonmedical/no method use. RLPC did not mediate or moderate the effect of race/ethnicity or educational attainment on contraceptive use in any comparison. In this system of publicly funded family planning clinics, RLPC seems not to encourage effective method use, providing no support for the efficacy of the RLPC intervention. The results suggest that this intervention requires further development and evaluation. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Use of modern contraceptives among married women in Vietnam: a multilevel analysis using the Multiple Indicator Cluster Survey (2011) and the Vietnam Population and Housing Census (2009)

PubMed Central

Vu, Lan Thi Hoang; Oh, Juhwan; Bui, Quyen Thi-Tu; Le, Anh Thi-Kim

2016-01-01

Background The prevalence of modern contraceptive use is an important indicator that reflects accessibility to reproductive health services. Satisfying unmet needs for family planning alone could reduce the number of maternal deaths by almost a third. This study uses multiple data sources to examine multilevel factors associated with the use of modern contraceptives among married women in Vietnam aged 15–49 years. Design Data from different national surveys (Vietnam Population and Housing Census, Vietnam Living Standard Survey, and Multiple Indicator Cluster Survey) were linked to create a dataset including individual and contextual (provincial) variables (N=8,341). Multilevel modeling was undertaken to examine the impact of both individual and provincial characteristics on modern contraceptive use. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results Individual factors significantly associated with the use of modern contraceptives were age 30–34 years (reference 15–19 years) (OR=1.63); high socioeconomic status (SES) (OR=0.8); having two living children (OR=2.4); and having a son (OR=1.4). The provincial poverty rate mediated the association between the individual's SES and the likelihood of using modern contraceptives. Conclusions The proportion of women in Vietnam using modern contraceptive methods has remained relatively high in recent years with significant variation across Vietnam's 63 provinces. Women of lower SES are more likely to use modern contraceptive methods, especially in the poorer provinces. Achieving access to universal reproductive health is one of the Millennium Development Goals. Vietnam must continue to make progress in this area. PMID:26950565

Global contraceptive use improves health.

PubMed

Ross, J A

1988-01-01

Over 40% of all cohabiting women, in Asia and Latin America, are using contraceptives, most of them modern methods. In many countries, upper order births are disappearing, and rural birth rates in some regions have fallen nearly as much as urban ones. The average family size is diminishing sharply. It is close to 2 children in Thailand, and below 2 throughout urban China. 4/5 of the developing world's population live in only 17 countries, in which contraceptive use has risen from 41% to 52% of couples in 10 years. Moreover, family planning programs affect the overall health of the population: fewer births have meant fewer maternal deaths, and fewer orphans, fewer infant and child deaths, fewer high-risk births (especially at short intervals and upper parities), fewer children left unimmunized, and fewer unserved by the health services. The extent of this quiet social revolution has its limits. Mainly in the 50 struggling countries of sub-Saharan Africa, most of them with weak health ministries, as well as, among the largest 8 countries, Nigeria and Pakistan, which have changed little. But both are reactivating their family planning programs, and the concentration of 2/3 of the developing world's population in 8 large countries means that only 8 administrations can control the course of vital rates. The consequence of the great transformation induced by contraceptive use has begun to give developing world's women control over their own child bearing, adding freedom to their lives. Nevertheless, if the contraceptive revolution has enormously advanced the cause of international health, it still has a long way to go.

The ring plus project: safety and acceptability of vaginal rings that protect women from unintended pregnancy.

PubMed

Schurmans, Céline; De Baetselier, Irith; Kestelyn, Evelyne; Jespers, Vicky; Delvaux, Thérèse; Agaba, Stephen K; van Loen, Harry; Menten, Joris; van de Wijgert, Janneke; Crucitti, Tania

2015-04-10

Research is ongoing to develop multipurpose vaginal rings to be used continuously for contraception and to prevent Human Immunodeficiency Virus (HIV) infection. Contraceptive vaginal rings (CVRs) are available in a number of countries and are most of the time used intermittently i.e. three weeks out of a 4-week cycle. Efficacy trials with a dapivirine-containing vaginal ring for HIV prevention are ongoing and plans to develop multi-purpose vaginal rings for prevention of both HIV and pregnancy have been elaborated. In contrast with the CVRs, multi-purpose vaginal rings will have to be used continuously. Women who continuously use a CVR will no longer have menses. Furthermore, some safety aspects of CVR use have never been studied in-depth in the past, such as the impact of the vaginal ring on the vaginal microbiota, biofilm formation and induction of inflammation. We studied acceptability and these novel aspects of safety in Rwandan women. Although significant progress has been made over the past decade, Rwanda still has a high unmet need for contraception (with 47% unplanned births) and a generalized HIV epidemic, and CVRs are not yet available. We will conduct an open label, single centre, randomized controlled trial. A total of 120 HIV-negative women will be randomized to intermittent CVR use (to allow menstruation) or continuous CVR use. Women will be followed for a maximum of 14 weeks. In parallel, we will conduct a qualitative study using in-depth interview and focus group discussion methodology. In addition to evaluating the safety and acceptability of intermittent and continuous CVR use in Rwandan women, we hope that our findings will inform the development of future multipurpose vaginal rings, will prepare Rwandan study populations for future clinical trials of multipurpose vaginal rings, and will pave the way for introduction of CVRs on African markets. Clinicaltrials.gov NCT01796613 . Registered 14 February 2013.

Leveraging long acting reversible contraceptives to achieve FP2020 commitments in sub-Saharan Africa: The potential of implants

PubMed Central

Garfinkel, Danielle; Riley, Christina; Esch, Keith; Girma, Woldemariam; Kebede, Tadele; Kasongo, Gaby; Afolabi, Kayode; Kalamar, Amanda; Thurston, Sarah; Longfield, Kim; Bertrand, Jane; Shaw, Bryan

2018-01-01

Background In developing regions, an estimated 214 million women have an unmet need for family planning. Reaching Family Planning 2020 (FP2020) commitments will require a shift in modern contraceptive promotion, including improved access to long-acting reversible contraceptives (LARCs). Until now, a lack of market data limited understanding of the potential of LARCs to increase contraceptive access and choice. Methods From 2015, the FPwatch Project conducted representative surveys in Ethiopia, Nigeria, and Democratic Republic of Congo (DRC) using a full census approach in selected administrative areas. In these areas, every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, market share, availability, price, and outlet readiness to perform services. Results Fifty-four percent of outlets in Ethiopia had LARC commodities or services available at the time of the survey, versus 7% and 8% of outlets in Nigeria and DRC, respectively. When present, LARCs were usually available with at least two other methods (99%, 39%, and 84% of public health facilities in Ethiopia, Nigeria and DRC, respectively). Many public facilities had both implants and IUDs in stock (76%, 47%, and 53%, respectively). Lack of readiness to provide LARCs was mostly due to a lack of equipment, private room, or the commodity itself. Market share for implants in the public sector was 60%, 53%, and 37% of Couple Years of Protection (CYP) in Ethiopia, Nigeria, and DRC. Discussion Limited availability of LARCs in Nigeria and DRC restricts contraceptive choice and makes it difficult for women to adopt and use modern contraception consistently. Brand-specific subsidies, task shifting, and promotion of methods that require less equipment and training are promising strategies for increasing uptake. Substantial government investment is required to improve availability and affordability. Investment in implants should be prioritized to make progress towards FP2020 commitments. PMID:29630607

Male contraceptive efficacy of poly herbal formulation, contracept-TM, composed of aqueous extracts of Terminalia chebula fruit and Musa balbisiana seed in rat.

PubMed

Ghosh, Abhinandan; Pakhira, Bhabani Prasad; Tripathy, Adrija; Ghosh, Debidas

2017-12-01

Terminalia chebula Retz (Combretaceae) and Musa balbisiana Colla (Musaceae) have a traditional reputation as a male contraceptive. To determine the hypo-testicular activity of aqueous extracts of Terminalia chebula (fruit) and Musa balbisiana (seed) separately, and in composite manner at the ratio of 1:1 named as 'Contracept-TM' compared to cyproterone acetate (CPA), for developing a polyherbal contraceptive. The separate extract of above said plants or 'Contracept-TM' at the dose of 40 mg/100 g body weight of rat/day or CPA at 2 mg/100 g body weight of rat/day was administered for 28 days. Spermiological, androgenic and oxidative stress sensors, LD 50 and ED 50 /100 g body weight values were measured. Treatment of individual, 'Contracept-TM' or CPA resulted significant decrease in the count of spermatogonia A (36.36-49.09%), pre-leptotene spermatocyte (19.11-55.30%), mid-pachytene spermatocyte (28.65-47.28%) and step 7 spermatid (29.65-51.59%). Activities of testicular Δ 5 , 3β (21.25-48.02%),17β-hydroxysteroid dehydrogenases (29.75-55.08%), catalase (19.06-43.29%) and peroxidase (30.76-62.82%), levels of testosterone (28.15-63.44%), testicular cholesterol (19.61-49.33%), conjugated diene (29.69-84.99%) and thiobarbituric acid reactive substances (41.25-86.73%) were elevated compare to the control. The ED 50 and LD 50 values were 40 mg and 5.8 g (T. chebula), 48 mg and 6.3 g (M. bulbisiana), 40 mg and 6.0 g ('Contracept-TM'), respectively. The said spermiological and androgenic sensors' levels were decreased significantly by 'Contracept-TM' than its constitutional individual plant extract and it may be comparable to standard anti-testicular drug like CPA. So, it may be concluded that above polyherbal formulation is potent for inducing hypo-testicular activity.

What matters most? The content and concordance of patients' and providers' information priorities for contraceptive decision making.

PubMed

Donnelly, Kyla Z; Foster, Tina C; Thompson, Rachel

2014-09-01

The objective of this study was to identify women's and health care providers' information priorities for contraceptive decision making and counseling, respectively. Cross-sectional surveys were administered online to convenience samples of 417 women and 188 contraceptive care providers residing in the United States. Participants were provided with a list of 34 questions related to the features of contraceptive options and rated the importance of each. Participants also ranked the questions in descending order of importance. For both women and providers, we calculated the mean importance rating for each question and the proportion that ranked each question in their three most important questions. The average importance ratings given by women and providers were similar for 18 questions, but dissimilar for the remaining 16 questions. The question rated most important for women was "How does it work to prevent pregnancy?" whereas, for providers, "How often does a patient need to remember to use it?" and "How is it used?" were rated equally. The eight questions most frequently selected in the top three by women and/or providers were related to the safety of the method, mechanism of action, mode of use, side effects, typical- and perfect-use effectiveness, frequency of administration and when it begins to prevent pregnancy. Although we found considerable concordance between women's and provider's information priorities, the presence of some inconsistencies highlights the importance of patient-centered contraceptive counseling and, in particular, shared contraceptive decision making. This study provides insights into the information priorities of women for their contraceptive decision making and health care providers for contraceptive counseling. These insights are critical both to inform the development of decision support tools for implementation in contraceptive care and to guide the delivery of patient-centered care. Copyright © 2014 Elsevier Inc. All rights reserved.

Efficacy and safety of an oral contraceptive containing ethinylestradiol 20 µg/drospirenone 3 mg (24/4 regimen) in three indications in the People’s Republic of China: a comparison with international studies

PubMed Central

Marr, Joachim; Huang, Zirong; Wang, Baoxi; Zhang, Hongyan; Roth, Katrin

2015-01-01

While combined oral contraceptives are a popular choice in developed Western countries, they are used by only 1% of women who are married or in a relationship in the People’s Republic of China. The purpose of this review is to describe the efficacy and safety of the combined oral contraceptive containing ethinylestradiol (EE) 20 µg/drospirenone 3 mg taken in a 24/4 regimen (YAZ®; Bayer HealthCare Pharmaceuticals, Berlin, Germany) by Chinese women and to compare these results with those in women assessed in the international studies. Studies of EE 20 µg/drospirenone 3 mg in three different indications (contraception, acne, and premenstrual dysphoric disorder [PMDD]) have been conducted in Chinese women. The results of these three studies indicate that the EE 20 µg/drospirenone 3 mg combined oral contraceptive is a good long-term contraceptive option in Chinese women, providing 99% contraceptive protection over the observed 1-year treatment period, and additionally had a favorable effect on moderate acne vulgaris and relieved the symptoms of PMDD. The contraceptive efficacy, improvement in acne, and relief from PMDD symptoms observed in these studies did not differ from the effects observed in other international studies of EE 20 µg/drospirenone 3 mg, indicating that EE 20 µg/drospirenone 3 mg is as effective in Chinese women as in other ethnicities. Further, EE 20 µg/drospirenone 3 mg demonstrated a similar safety and tolerability profile in women enrolled in the Chinese and international trials, with no unexpected adverse events reported in any of the three Chinese trials. Overall, the efficacy, tolerability, and degree of non-contraceptive benefits with EE 20 µg/drospirenone 3 mg appear similar in Chinese women when compared with those reported in larger studies done at other international centers. PMID:29386927

[The year 2000: one billion couples of child-bearing age].

PubMed

Lintong, L J

1988-04-01

Out of 1 billion couples there are only 124 million who use modern and effective contraceptives. World abortions number 33 million/year. 250 million sexually active women of child-bearing age in developing countries outside China do not use modern and effective contraceptives. Fertility control costs on the average US$2.5 billion a year in each developing country, 20% of which is assistance from developed countries. Expanding the family planning service to the 250 million sexually active child-bearing aged women costs an additional U.S. $5 billion yearly. A family planning accessibility survey was conducted by the Population Crisis Committee. PCC divided the countries into 2 categories: Developed and developing countries. The 110 countries (15 developed and 95 developing) covered 96% of the world population. The survey placed the countries in 5 classes according to accessibility levels: Excellent, good, fair, poor, very poor. The developed countries were analyzed according to effective contraceptive methods, service to the poor and minorities, sex education in the schools, and family planning information and advertisement. The developing countries were analyzed according to effective contraceptive methods, performance of service and distribution, public information and education, private sector participation, government finance and policies. Of the 15 developed countries, 43% were excellent, 22% good, 24% fair, and 2% poor. Of the 95 developing countries, 5 were excellent, 10 good, 16 fair, and 64 either poor or very poor countries in respect to family planning accessibility. In the face of a population explosion in the year 2000, many countries lack of government support for family planning programs. After 30 years of world effort in population control, half of the world population still has no effective family planning services.

Impact of male partner's awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria.

PubMed

Ezeanolue, Echezona E; Iwelunmor, Juliet; Asaolu, Ibitola; Obiefune, Michael C; Ezeanolue, Chinenye O; Osuji, Alice; Ogidi, Amaka G; Hunt, Aaron T; Patel, Dina; Yang, Wei; Ehiri, John E

2015-09-10

Despite the growing body of evidence on use of modern contraceptives among women in sub-Saharan African countries, little is known about the broader context in which female decision-making concerning contraceptive use occurs, particularly the role of their male partners' awareness and support of modern contraceptives. We conducted a cross-sectional survey of 2468 pregnant women and their male partners enrolled in the Healthy Beginning Initiative (HBI), an intervention to increase HIV testing among pregnant women in Enugu, southeast Nigeria. The aims of this study were to determine: 1) male partners' awareness of, and support for, female contraceptive methods, and 2) influence of male partners' contraceptive awareness and support on pregnant women's expressed desire to use contraception. We used logistic regression models to examine the association between male partners' awareness and support of modern contraceptives on their spouses' desire to use contraceptives. Men's awareness of, and support for, use of modern contraceptives were significantly associated with their female partners' desire to use contraception. A majority of the men who were aware of modern contraceptives (66.5 %) and those who supported their spouses' use of contraception (72.5 %) had partners who expressed a desire to use contraception. Men who were aware of female contraception were 3 times more likely to have spouses who desired to use contraception (AOR = 3.17, 95 % C.I: 2.70-3.75). In addition, men who showed support for their spouses' use of contraception were over 5 times more likely to have spouses who indicated a desire to use contraception (AOR = 5.76, 95 % C.I: 4.82-6.88). Living in a household of 5 or more people (AOR = 1.45, 95 % C.I: 1.23-1.72) and residing in an urban area (AOR = 0.81, 95 % C.I: 0.67-0.97) were also significantly associated with women's expressed desire to use modern contraception. Men's awareness of, and support for, use of modern contraceptives were markedly associated with their spouses' desire to use contraception. This underscores the need for men's involvement in programs that seek to address women's uptake of contraception in low and middle income countries.

Does proximity of women to facilities with better choice of contraceptives affect their contraceptive utilization in rural Ethiopia?

PubMed Central

Spigt, Mark; Seme, Assefa; Amogne, Ayanaw; Skrøvseth, Stein; Desta, Selamawit; Radloff, Scott; GeertJan, Dinant

2017-01-01

Background There is limited evidence of the linkage between contraceptive use, the range of methods available and level of contraceptive stocks at health facilities and distance to facility in developing countries. The present analysis aims at examining the influence of contraceptive method availability and distance to the nearby facilities on modern contraceptive utilization among married women in rural areas in Ethiopia using geo-referenced data. Methods We used data from the first round of surveys of the Performance Monitoring & Accountability 2020 project in Ethiopia (PMA2020/Ethiopia-2014). The survey was conducted in a sample of 200 enumeration areas (EAs) where for each EA, 35 households and up to 3 public or private health service delivery points (SDPs) were selected. The main outcome variable was individual use of a contraceptive method for married women in rural Ethiopia. Correlates of interest include distance to nearby health facilities, range of contraceptives available in facilities, household wealth index, and the woman’s educational status, age, and parity and whether she recently visited a health facility. This analysis primarily focuses on stock provision at public SDPs. Results Overall complete information was collected from 1763 married rural women ages 15–49 years and 198 SDPs in rural areas (97.1% public). Most rural women (93.9%) live within 5 kilometers of their nearest health post while a much lower proportion (52.2%) live within the same distance to the nearest health centers and hospital (0.8%), respectively. The main sources of modern contraceptive methods for married rural women were health posts (48.8%) and health centers (39.0%). The mean number of the types of contraceptive methods offered by hospitals, health centers and health posts was 6.2, 5.4 and 3.7 respectively. Modern contraceptive use (mCPR) among rural married women was 27.3% (95% CI: 25.3, 29.5). The percentage of rural married women who use modern contraceptives decreased as distance from the nearest SDP increased; 41.2%, 27.5%, 22.0%, and 22.6% of women living less than 2 kilometers, 2 to 3.9kilometers, 4 to 5.9 kilometers and 6 or more kilometers, respectively (p-value<0.01). Additionally, women who live close to facilities that offer a wider range of contraceptive methods were significantly more likely to use modern contraceptives. The mCPR ranged from 42.3% among women who live within 2 kilometers of facilities offering 3 or more methods to 22.5% among women living more than 6 kilometers away from the nearest facility with the same number (3 or more methods) available after adjusting for observed covariates. Conclusions Although the majority of the Ethiopian population lives within a relatively close distance to lower level facilities (health posts), the number and range of methods available (method choice) and proximity are independently associated with contraceptive utilization. By demonstrating the extent to which objective measures of distance (of relatively small magnitude) explain variation in contraceptive use among rural women, the study fills an important planning gap for family planning programs operating in resource limited settings. PMID:29131860

Does proximity of women to facilities with better choice of contraceptives affect their contraceptive utilization in rural Ethiopia?

PubMed

Shiferaw, Solomon; Spigt, Mark; Seme, Assefa; Amogne, Ayanaw; Skrøvseth, Stein; Desta, Selamawit; Radloff, Scott; Tsui, Amy; GeertJan, Dinant

2017-01-01

There is limited evidence of the linkage between contraceptive use, the range of methods available and level of contraceptive stocks at health facilities and distance to facility in developing countries. The present analysis aims at examining the influence of contraceptive method availability and distance to the nearby facilities on modern contraceptive utilization among married women in rural areas in Ethiopia using geo-referenced data. We used data from the first round of surveys of the Performance Monitoring & Accountability 2020 project in Ethiopia (PMA2020/Ethiopia-2014). The survey was conducted in a sample of 200 enumeration areas (EAs) where for each EA, 35 households and up to 3 public or private health service delivery points (SDPs) were selected. The main outcome variable was individual use of a contraceptive method for married women in rural Ethiopia. Correlates of interest include distance to nearby health facilities, range of contraceptives available in facilities, household wealth index, and the woman's educational status, age, and parity and whether she recently visited a health facility. This analysis primarily focuses on stock provision at public SDPs. Overall complete information was collected from 1763 married rural women ages 15-49 years and 198 SDPs in rural areas (97.1% public). Most rural women (93.9%) live within 5 kilometers of their nearest health post while a much lower proportion (52.2%) live within the same distance to the nearest health centers and hospital (0.8%), respectively. The main sources of modern contraceptive methods for married rural women were health posts (48.8%) and health centers (39.0%). The mean number of the types of contraceptive methods offered by hospitals, health centers and health posts was 6.2, 5.4 and 3.7 respectively. Modern contraceptive use (mCPR) among rural married women was 27.3% (95% CI: 25.3, 29.5). The percentage of rural married women who use modern contraceptives decreased as distance from the nearest SDP increased; 41.2%, 27.5%, 22.0%, and 22.6% of women living less than 2 kilometers, 2 to 3.9kilometers, 4 to 5.9 kilometers and 6 or more kilometers, respectively (p-value<0.01). Additionally, women who live close to facilities that offer a wider range of contraceptive methods were significantly more likely to use modern contraceptives. The mCPR ranged from 42.3% among women who live within 2 kilometers of facilities offering 3 or more methods to 22.5% among women living more than 6 kilometers away from the nearest facility with the same number (3 or more methods) available after adjusting for observed covariates. Although the majority of the Ethiopian population lives within a relatively close distance to lower level facilities (health posts), the number and range of methods available (method choice) and proximity are independently associated with contraceptive utilization. By demonstrating the extent to which objective measures of distance (of relatively small magnitude) explain variation in contraceptive use among rural women, the study fills an important planning gap for family planning programs operating in resource limited settings.

Impact on hepatic estrogen-sensitive proteins by a 1-year contraceptive vaginal ring delivering Nestorone® and ethinyl estradiol.

PubMed

Archer, D F; Thomas, M A; Conard, J; Merkatz, R B; Creasy, G W; Roberts, K; Plagianos, M; Blithe, D; Sitruk-Ware, R

2016-01-01

Estrogen-sensitive hepatic proteins were assessed in women using a contraceptive vaginal ring (CVR) delivering 150mcg Nestorone® (NES) and 15mcg ethinyl estradiol (EE). A substudy of the Contraceptive Clinical Trials Network of the National Institute of Child Health and Human Development enrolled 129 participants, with assessments of factor VIII, fibrinogen, protein S (PS) and sex hormone binding globulin (SHBG). Thirty-six participants had used combined hormonal contraceptives (CHCs) in the cycle preceding first CVR use (recent users) and 70 had no history of recent use (nonusers). Mean values at baseline were within the normal range for all four proteins but were higher for factor VIII, fibrinogen and SHBG and significantly lower for PS in recent compared to nonusers. During NES/EE CVR use, factor VIII, fibrinogen and PS were within the normal range; however, SHBG levels were increased by nearly 100% at Cycle 13. The change from baseline to final evaluation was statistically significant for all proteins in nonusers. The change in recent users was significant for factor VIII at Cycle 6 and for SHBG at Cycles 6 and 13, but not for PS or fibrinogen. NES/EE CVR for up to 13cycles was associated with changes from baseline in plasma levels of factor VIII, fibrinogen and PS that were within the normal range, with SHBG levels above the normal range by Cycle 6. Nonusers of CHC before CVR showed wider changes in values versus recent users whose baseline values were increased by previous EE exposure. Recent use of CHCs demonstrated significant changes in all four measured hepatic proteins at baseline compared to nonusers. Use of the NES/EE CVR further changed these hepatic protein markers, but values remained within the normal range. Prebaseline exposure to estrogen can obscure interpretation of hepatic proteins changes associated with a second CHC. Copyright © 2016 Elsevier Inc. All rights reserved.

Inhibition of sperm motility in male macaques with EP055, a potential non-hormonal male contraceptive.

PubMed

O'Rand, Michael G; Hamil, Katherine G; Adevai, Tiffany; Zelinski, Mary

2018-01-01

Men have two practical choices for contraception; the condom which has a high typical use failure rate or vasectomy. New male hormonal and non-hormonal contraceptives are under development that target either the production of sperm (spermatogenesis) or the delivery of sperm. One particular target is the sperm protein EPPIN, which is present on the surface of human spermatozoa. EP055 is a small organic compound that targets EPPIN on the surface of sperm and inhibits motility. EP055 was tested in cynomolgus (Macaca fascicularis) males to determine its plasma half-life after intravenous (i.v.) infusion of a single dose and for binding to its target tissues. Our initial study demonstrated a plasma half-life for EP055 of 10.6 minutes. In a second study examination of macaque testis, epididymis, and plasma after i.v. infusion of a single dose of compound EP055 (63.25 mg/kg) demonstrated that EP055 was detected in testis and epididymis two hours and six hours post-infusion. We initiated a trial in rhesus (Macaca mulatta) males to assess the availability of EP055 in semen and its effect on sperm motility as a measure of the drug's efficacy. Four macaques were infused with a low dose (75-80 mg/kg) followed by a recovery period and a subsequent high dose (125-130 mg/kg) of EP055. After high dose administration, sperm motility fell to approximately 20% of pretreatment levels within 6 hours post-infusion; no normal motility was observed at 30 hours post-infusion. Recovery of sperm motility was obvious by 78 hours post-infusion; with full recovery in all animals by 18 days post-infusion. EP055 has the potential to be a male contraceptive that would provide a reversible, short-lived pharmacological alternative.

Pharmacologic management of types 1 and 2 diabetes mellitus and their complications in women of childbearing age.

PubMed

Mukherjee, Mimi S; Coppenrath, Valerie A; Dallinga, Bree A

2015-02-01

The numbers of women of childbearing age with pregestational diabetes mellitus (diabetes existing before pregnancy) are increasing, primarily because more patients are developing type 2 diabetes at younger ages. The teratogenicity associated with hyperglycemia in early pregnancy is well documented, and tight glucose control minimizes the risk of congenital malformation. Preconception planning is essential; thus contraception that does not worsen complications of diabetes is desirable. In addition, because contraceptives are not 100% effective, the treatment of elevated blood glucose levels, hypertension, and dyslipidemia in these women requires consideration of unplanned pregnancy. We summarized the literature to aid clinicians in choosing individualized treatment that minimizes risk in case pregnancy occurs and maximizes benefit in preventing the complications of diabetes. In women with well-controlled diabetes without vascular disease, all contraceptive methods are safe. Intrauterine devices are recommended due to their minimal effects on risk factors for diabetic complications and their lack of reliance on patient adherence for efficacy. Among insulins, the insulin analogs-insulin lispro, insulin aspart, and insulin detemir-offer patients greater convenience than regular insulin and NPH insulin, and they are safe in case of unplanned pregnancy. Of the noninsulin agents, glyburide and metformin are the safest during pregnancy, but many of the other agents pose minimal risk as long as they are withdrawn during early pregnancy. The risks and benefits of angiotensin-converting enzyme inhibitors in women with compelling indications must be weighed individually. In hypertensive patients at a high risk for unplanned pregnancy, nifedipine should be considered due to literature supporting its safety during early pregnancy. Pravastatin is recommended for women with dyslipidemia who are using effective contraception because there have been no reports of birth defects with this statin when used during early pregnancy in humans and animals. © 2015 Pharmacotherapy Publications, Inc.

Characteristics associated with suppression of spermatogenesis in a male hormonal contraceptive trial using testosterone and Nestorone(®) gels.

PubMed

Roth, M Y; Ilani, N; Wang, C; Page, S T; Bremner, W J; Swerdloff, R S; Dart, C; Sitruk-Ware, R; Kumar, N; Blithe, D; Amory, J K

2013-11-01

Development of a male hormonal contraceptive has been challenging ascribable to the failure to adequately suppress spermatogenesis in 5-10% of men. Methods to identify incomplete suppressors early in treatment might identify men most responsive to male hormonal contraceptives. We hypothesized that serum hormone and gonadotropin concentrations after 4 weeks of transdermal treatment with testosterone and Nestorone in a contraceptive trial would be associated with suppression of sperm concentrations to <1 million/mL after 24 weeks. Indeed, luteinizing hormone or follicle-stimulating hormone concentrations greater than 1 IU/L after 4 weeks of transdermal testosterone/nestorone treatment were 97% sensitive for predicting failure to suppress spermatogenesis after 24 weeks of treatment. Serum nestorone concentrations were significantly associated with suppression, but serum testosterone concentrations were not. Early suppression of gonadotropins is associated with, but does not ensure, adequate suppression of spermatogenesis. This information may allow for rapid identification of non-responders in male hormonal contraceptive trials. © 2013 American Society of Andrology and European Academy of Andrology.

Impact of the 2013 French Pill Crisis on Women's Behaviour Regarding Contraception.

PubMed

Lemaitre, Magali; Lastennet, Glenn; Syr, David; Emmerich, Joseph; Zureik, Mahmoud

2015-03-01

In the last decade, several epidemiological studies have shown the increased risk of venous thromboembolism associated with third- and fourth-generation oral contraceptives (C3Gs and C4Gs) versus older combined first- and second-generation oral contraceptives (C1Gs and C2Gs). In France, in December 2012, a lawsuit filed against the National Agency for the Safety of Medicines and Health Products (ANSM) by a patient who had experienced a stroke, possibly due to the use of a C3G, triggered a national 'pill crisis'. Consequently, a 'crisis cell' was set up and pre-existing health recommendations were reinforced. The main aim of this study was to evaluate, in real time, the impact of the French health authorities' recommendations and communications on French women's behaviour regarding contraception. Real-time monthly sales data reported during 2013 were compared with monthly sales data reported in 2012. Analyses were stratified according to the type of contraceptive and age. An index corresponding to the number of months of contraception sold was developed to facilitate comparison of the different contraceptives despite their distinct features and to assess the overall trend of contraception. After a 2-year analysis (2013 versus 2012), a significant 45 % decrease (p < 0.0001) in C3G-4G sales was observed, compared with a significant increase of 30 % (p < 0.0001) in C1G-2G sales. The sharp increase in C1G-2G sales focused specifically on C2Gs with an oestrogen concentration below 20 µg. Moreover, a large (47 %) increase was reported in sales of intrauterine devices (p < 0.0001). Finally, taking all types of contraceptive sales into account, a slight decrease (1 %) in overall sales was identified. Thanks to an effective national communication plan, real-time monitoring of drug sales and favourable reactions from physicians and patients, French women changed their behaviour regarding contraception. However, this study was conducted over a short period following the crisis. A longitudinal analysis is required in order to assess any real long-term changes.

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

PubMed Central

Williamson, Lisa M; Parkes, Alison; Wight, Daniel; Petticrew, Mark; Hart, Graham J

2009-01-01

Background Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses. Methods Literature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data. Results Of the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health. Conclusion Increasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved. PMID:19228420

A combined oral contraceptive affects mucosal SHIV susceptibility factors in a pigtail macaque model

PubMed Central

Ostergaard, Sharon Dietz; Butler, Katherine; Ritter, Jana M.; Johnson, Ryan; Sanders, Jeanine; Powell, Nathaniel; Lathrop, George; Zaki, Sherif R.; McNicholl, Janet M.; Kersh, Ellen N.

2015-01-01

Background Injectable hormonal contraception may increase women’s risk of HIV acquisition, and can affect biological risk factors in animal models of HIV. We established, for the first time, a model to investigate whether combined oral contraceptives (COC) alter SHIV susceptibility in macaques. Methods Seven pigtail macaques were administered a monophasic levonorgestrel (LNG)/ethinyl estradiol (EE) COC at 33% or 66% of the human dose for 60 days. Menstrual cycling, vaginal epithelial thickness and other SHIV susceptibility factors were monitored for a mean of 18 weeks. Results Mean vaginal epithelial thicknesses was 290.8 μm at baseline and 186.2 μm during COC (p=0.0141, Mann Whitney test). Vaginal pH decreased from 8.5 during to 6.5 post- treatment (0.0176 two-tailed t-test). Measured microflora was unchanged. Conclusions COC caused thinning of the vaginal epithelium and vaginal pH changes, which may increase SHIV susceptibility. 0.033 mg LNG + 0.0066 mg EE appeared effective in suppressing ovulation. PMID:25536296

[Dynamic model of seasonal breeding rodent pest population controlled with short-acting sterilant].

PubMed

Liu, Han-wu; Jin, Zhen; Zhang, Feng-qin; Li, Qiu-ying

2013-04-01

Rodent pests bring great damage to human beings, while rodenticide and sterilant can be used to control the pests. After ingesting sterilant, rodent pests lose their fertility, but in some cases, the sterile individuals may gain their fertility again, produce offspring, and enlarge population size. In this paper, the dynamic models of rodent pest population under lethal control and shortacting contraception control were formulated, and, with the prerequisite of the seasonal breeding of rodent pest population, the models were used to regularly analyze their behaviors and the effects of the contraception rate, lethal rate, control interval, and sterilant valid period on the dynamics of the pest population. The results showed that larger contraception rate and lethal rate and shorter control interval could have better control effect, making the controlled population become smaller and even died out. Short-acting sterilant limited the control effect. At the later period of breeding season, the rodent pest population controlled with short-acting sterilant would have a weak recovery.

Contraceptive use and pregnancies in adolescents' romantic relationships: role of relationship activities and parental attitudes and communication.

PubMed

Amialchuk, Aliaksandr; Gerhardinger, Laura

2015-01-01

In a unified framework, the authors estimate whether romantic relationship activities and parental attitudes predict contraception use and consistency, and whether contraception use and consistency predict pregnancy risk among male and females adolescents in the United States. Data on 3717 participants of the first 2 waves of the National Longitudinal Study of Adolescent Health (Add Health) who were sexually experienced in their recent romantic relationship were analyzed to examine how presex activities in the romantic relationship and parental attitudes and communication are associated with contraception choices and how contraception choices are associated with pregnancies. In multivariate logistic regression analysis, only some relationship activities and parental communication about contraception were significant predictors of contraception, and their influence differed by gender. Going out with the partner increased contraception consistency among males (odds ratio, 2.04). Discussing contraception with the partner before having first sex increased the odds of ever using contraception for both genders (2.61 for females and 1.59 for males) and increased the odds of consistent contraception for females (1.505). Discussing contraception with parent increased the odds of consistent contraception among females (1.383). Merely, using contraception was not a significant predictor of the risk of pregnancy, whereas using contraception consistently significantly reduced the odds of getting partner pregnant for males (0.413) and the odds of pregnancy of females (0.343). Contraception and pregnancy education programs should take into account qualities of romantic relationship and emphasize consistent use of contraception and communication about contraception between partners and with parents.

What College Students Want To Learn about Contraception/STD: Marketing Your Services.

ERIC Educational Resources Information Center

Griffith, Jeanne A.; Kile, Marilyn J.

This paper describes a health education program developed by Planned Parenthood of Wisconsin for students at a university health center. Three goals of the program, which was targeted at 2,000 incoming first-year students, are listed: (1) to increase student awareness of existing services related to contraception and prevention/treatment of…

Impact of Counseling on Repeated Unplanned Pregnancy and Contraceptive Behavior in Low SES Abortion Population.

ERIC Educational Resources Information Center

Burnhill, Michael S.; And Others

High numbers of repeat abortions at a medical school clinic prompted clinic personnel to develop an experimental fertility control counseling program. Counseling objectives included the following: (1) to engender rapport and trust; (2) to assess the patient's past contraceptive use and psychosocial history; (3) to improve patient's knowledge of…

The influence of nurse home visits, including provision of 3 months of contraceptives and contraceptive counseling, on perceived barriers to contraceptive use and contraceptive use self-efficacy.

PubMed

Melnick, Alan L; Rdesinski, Rebecca E; Creach, E Dawn; Choi, Dongseok; Harvey, S Marie

2008-01-01

To identify the influence of a community health nurse (CHN) home visit on perceived barriers to contraceptive access and contraceptive use self-efficacy. We enrolled 103 women into two groups in a randomized trial evaluating the influence of contraceptive dispensing and family planning counseling during home visits on perceived barriers to accessing contraceptives and contraceptive use self-efficacy. Both groups received counseling by a CHN about sexually transmitted disease and pregnancy prevention, and a resource card listing phone numbers of family planning clinics. After randomization, the CHN dispensed three months of hormonal contraception to the intensive intervention group and advised the minimal intervention group to schedule an appointment at a family planning clinic. Data collection at baseline and 12 months included demographic, reproductive and other health-related information as well as quantitative assessments of information on perceived barriers to contraceptive access and contraceptive use self-efficacy. The mean age of participants was 24.7 years. Three-fourths had household incomes under $25,000. We found significant reductions in three perceived barriers to contraceptive access for both groups, as well as significant increases in two measures of contraceptive use self-efficacy at twelve months compared to baseline. Nurse home visits involving family planning counseling might be effective in reducing perceived barriers to contraceptive access and increasing contraceptive use self-efficacy.

The role of previous contraception education and moral judgment in contraceptive use.

PubMed

Bader, Valerie; Kelly, Patricia J; Cheng, An-Lin; Witt, Jackie

2014-01-01

The knowledge and attitudes that lead to nonuse of contraception are not well understood. The goal of this study was to determine whether an association exists between contraceptive use and specific knowledge and attitudinal factors. We conducted a secondary analysis of data from a nationally representative telephone survey of 897 unmarried women aged 18 to 29 years to examine the relationship between contraceptive use and comprehensive sex education, attitude toward pregnancy prevention, perceived infertility, distrust toward the health care system or contraception, and moral attitude toward contraception. Both ever having made a visit to a physician or clinic for women's health care and ever having used any method of contraception to prevent pregnancy were significantly impacted by more comprehensive sex education and less likelihood to view contraception as morally wrong. Consistent with other research, we found no association between the desire to avoid pregnancy and contraceptive use. We found an association between health system distrust and contraceptive use, but health system distrust did not predict contraceptive use. Our findings show that contraceptive use among a sample of young women is influenced by previous contraceptive education and moral attitudes toward contraception. Clinicians should be cognizant of these realities, which may need to be addressed in both clinical and nonclinical venues. © 2014 by the American College of Nurse-Midwives.

Sex, age, pubertal development and use of oral contraceptives in relation to serum concentrations of DHEA, DHEAS, 17α-hydroxyprogesterone, Δ4-androstenedione, testosterone and their ratios in children, adolescents and young adults.

PubMed

Søeborg, Tue; Frederiksen, Hanne; Mouritsen, Annette; Johannsen, Trine Holm; Main, Katharina Maria; Jørgensen, Niels; Petersen, Jørgen Holm; Andersson, Anna-Maria; Juul, Anders

2014-11-01

The influence of sex, age, pubertal development and oral contraceptives on dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), 17α-hydroxyprogesterone (17-OHP), Δ4-androstenedione (Adione), testosterone (T), calculated free testosterone (fT), free androgen index (FAI) and selected ratios in 1798 serum samples from healthy children, adolescents and young adults was evaluated. Samples were analyzed by Turboflow-LC-MS/MS. Sex hormone-binding globulin was analyzed by immunoassay. All steroid metabolite concentrations were positively associated with age and pubertal development in both sexes and generally higher in males than in females except for Adione. The pubertal rise in T in males was more pronounced compared to females, reflecting contribution from the testes. Ratios between steroid metabolites varied and depended on sex and age. All ratios were lower during infancy compared to later in life. Use of oral contraceptives significantly lowered serum concentrations of all steroid metabolites, fT, FAI, the 17-OHP/Adione, the Adione/T and the DHEA/Adione ratios, but not the DHEA/DHEAS ratio. We provide reference ranges for DHEA, DHEAS, 17-OHP, Adione, T, fT, FAI and selected ratios in relation to sex, age and pubertal development. Use of oral contraceptives strongly influences adrenal steroidogenesis and should be considered when diagnosing and monitoring treatment of patients with disorders of sex development. Copyright © 2014 Elsevier B.V. All rights reserved.

Contraceptive knowledge and attitudes among 14-24-year-olds in New South Wales, Australia.

PubMed

Ritter, Todd; Dore, Anne; McGeechan, Kevin

2015-06-01

To investigate correlates of contraceptive knowledge and attitudes and describe differences in contraceptive knowledge by contraceptive category among young people in New South Wales. A total of 119 young people aged 14 to 24, recruited from youth centres, completed a contraceptive knowledge and attitude survey. Overall contraceptive knowledge was low. Females had significantly better knowledge than males. There was high knowledge about condoms and withdrawal and low knowledge about shorter-term hormonal methods (oral contraceptive pill and vaginal ring) and long-acting reversible contraceptive (LARC) methods. Nearly half of respondents agreed that 'contraceptives make sex seem less romantic', while 58% agreed that 'contraceptives are difficult to use'. Despite this, both genders had positive attitudes to contraception, with females' attitudes significantly more positive than males. While young people, particularly young women, expressed attitudes conducive to contraceptive use, many are unaware of basic facts about methods, including highly effective LARC. Our findings reflect the modest reproductive and sexual health education received by Australian young people and cultural norms of condoms and oral contraceptives as default methods and highlight the need to improve knowledge, among young men, in particular, about the most effective contraceptive methods. © 2015 Public Health Association of Australia.

Understanding Population.

ERIC Educational Resources Information Center

Mothner, Ira

Activities and concerns of Ford Foundation supported population research and training centers are described in this report. The centers are concerned with population growth, consequences of growth for human welfare, forces that determine family planning, interrelations among population variables, economics of contraceptive distribution, and…

Committee Opinion No 707: Access to Emergency Contraception.

PubMed

2017-07-01

Emergency contraception refers to contraceptive methods used to prevent pregnancy in the first few days after unprotected intercourse, sexual assault, or contraceptive failure. Although the U.S. Food and Drug Administration approved the first dedicated product for emergency contraception in 1998, numerous barriers to emergency contraception remain. The purpose of this Committee Opinion is to examine barriers to the use of emergency contraception, emphasize the importance of increasing access, and review new methods of emergency contraception and limitations in efficacy in special populations.

Committee Opinion No. 707 Summary: Access to Emergency Contraception.

PubMed

2017-07-01

Emergency contraception refers to contraceptive methods used to prevent pregnancy in the first few days after unprotected intercourse, sexual assault, or contraceptive failure. Although the U.S. Food and Drug Administration approved the first dedicated product for emergency contraception in 1998, numerous barriers to emergency contraception remain. The purpose of this Committee Opinion is to examine barriers to the use of emergency contraception, emphasize the importance of increasing access, and review new methods of emergency contraception and limitations in efficacy in special populations.

Factors associated with ex-nuptial birth.

PubMed

Fergusson, D M; Horwood, L J; Shannon, F T

1979-04-11

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.

Comparison of family planning in Cuba and Ireland.

PubMed

Smyth, Suzie; Stronge, Shirley

2015-08-26

Family planning gives individuals and couples control and choice over the number of children they have and the timing of their births. Developments in reproductive health have resulted in major changes in the options for family planning, providing more choice and control over fertility. This article explores reproductive health in the Republic of Cuba and the Republic of Ireland, with a focus on contraceptive use and termination of pregnancy as methods of family planning. The predominant religion in both countries is Catholicism, which promotes the right to life of the unborn child. The two countries have adopted different approaches to the availability of both contraception and termination of pregnancy. Cuba has offered free access to contraception and termination of pregnancy since the 1960s to reduce maternal mortality. In Ireland, contraception was not widely available until 1995 and termination of pregnancy is available only in extremely limited circumstances.

Practice Bulletin No. 152: Emergency Contraception.

PubMed

2015-09-01

Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception (). Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen-progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises (). The purpose of this Practice Bulletin is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase awareness of these methods among obstetrician-gynecologists and other gynecologic providers.

[Post-abortion contraception: effects of contraception services and reproductive intention].

PubMed

Borges, Ana Luiza Vilela

2016-02-01

Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Studies showing such evidence have been conducted predominantly in countries with no legal restrictions on abortion and with adequate care for women that terminate a pregnancy. However, little is known about contraceptive practices in contexts where abortion is illegal, as in Brazil, in which post-abortion contraceptive care is inadequate. The objective of this study was to analyze the effect of contraceptive care on male condom use and oral and injectable contraceptives in the six months post-abortion, considering reproductive intention. The results showed that contraceptive care only has a positive effect on the use of oral contraceptives in the first six months post-abortion, as long as the woman had a medical consultation in the same month in which she received information on contraception. One or the other intervention alone had no significant impact.

Mobile Technology for Improved Family Planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia.

PubMed

Smith, Chris; Vannak, Uk; Sokhey, Ly; Ngo, Thoai D; Gold, Judy; Free, Caroline

2016-01-05

The objective of this paper is to outline the formative research process used to develop the MOTIF mobile phone-based (mHealth) intervention to support post-abortion family planning in Cambodia. The formative research process involved literature reviews, interviews and focus group discussions with clients, and consultation with clinicians and organisations implementing mHealth activities in Cambodia. This process led to the development of a conceptual framework and the intervention. Key findings from the formative research included identification of the main reasons for non-use of contraception and patterns of mobile phone use in Cambodia. We drew on components of existing interventions and behaviour change theory to develop a conceptual framework. A multi-faceted voice-based intervention was designed to address health concerns and other key determinants of contraception use. Formative research was essential in order to develop an appropriate mHealth intervention to support post-abortion contraception in Cambodia. Each component of the formative research contributed to the final intervention design.

A hugh marketing research task: birth control.

PubMed

Simon, J L

1968-02-01

Research in underdeveloped countries to sell family planning is discussed. The article also aims at pinpointing other possible research areas. Census reports were actually the earliest work relevant to birth control. Later came the research on psychosocial factors affecting family size in developed countries. After World War I, client oriented research into family planning began. The history of this type of research is discussed with more emphasis on the surveys of the knowledge, attitude and contraception practices (KAP) in various countries. The author claims the KAP surveys to be the largest worldwide market research job ever done. Propagands campaigns, contraceptive costs, bonuses for contraceptive practices, and effectiveness of persuasion techniques are discussed.

Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women--A Nationwide Survey.

PubMed

Kopp Kallner, Helena; Thunell, Louise; Brynhildsen, Jan; Lindeberg, Mia; Gemzell Danielsson, Kristina

2015-01-01

To describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies. Telephone survey. National survey of women living in Sweden. Women between 16 and 49 years. The survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy. Distribution of use of contraceptive methods and non-use of contraception among Swedish women. Prevalence and outcome of unintended pregnancies. A total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness. Sweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.

[Contraceptive practices among university students: the use of emergency contraception].

PubMed

Borges, Ana Luiza Vilela; Fujimori, Elizabeth; Hoga, Luiza Akiko Komura; Contin, Marcelo Vieira

2010-04-01

This study investigated contraceptive practices and especially the use of emergency contraception by 487 young students at a public university in São Paulo State. A structured questionnaire was sent by e-mail and completed online in December 2007. Contraceptive methods and use of emergency contraception were investigated. Female and male students reported a high proportion of contraceptive use, mainly condoms and the pill. Half of the students had already used emergency contraception, often when already using some other highly effective method. Among female students, multiple regression analysis showed that current age, age at sexual initiation, not having used condoms in sexual relations, condom failure, and knowing someone that has used emergency contraception were associated with use of the latter. The option for emergency contraception proved to be more closely related to inconsistencies in the use of regular methods than to lack of their use, and can thus be considered a marker for discontinuity in regular contraception.

Contraceptive counseling among pediatric primary care providers in Western Pennsylvania: A survey-based study.

PubMed

Papas, Beth Ann; Shaikh, Nader; Watson, Katherine; Sucato, Gina S

2017-01-01

Data suggest that adolescents in the United States receive inadequate contraceptive counseling. This study sought to determine factors affecting pediatricians' discussion of contraception with adolescent patients, with a specific focus on long-acting reversible contraception-implantable contraception and intrauterine devices. A cross-sectional survey was sent via email to a convenience sample of pediatric residents and pediatric primary care providers in Western Pennsylvania. Self-reported contraceptive counseling and prescribing practices in response to clinical vignettes were assessed. Of potential participants (287), 88 (31%) responded. Younger providers and providers who had received contraceptive training were significantly more likely to discuss long-acting reversible contraception methods. Discussion of contraceptive methods also varied by both the age and the sexual history of the patient. Variation in contraceptive counseling potentially results in missed opportunities to counsel about and provide the most effective contraceptive methods. More uniform, universal provider training might alleviate some of these inconsistencies.

Adolescent contraception: review and guidance for pediatric clinicians.

PubMed

Potter, J; Santelli, J S

2015-02-01

The majority of adolescents initiate sexual activity during their teenage years, making contraception an important aspect of routine adolescent health care. Despite common misperceptions, all available methods of reversible contraception are appropriate for adolescent use. Contraceptive side effects profiles and barriers to use of certain methods should be considered when providing contraceptives to adolescents. In particular, ease of use, confidentiality, and menstrual effects are main concerns of adolescents. Contraceptive counseling with adolescents should describe method efficacy, discuss user preferences, explore barriers to use, counsel regarding sexually transmitted infection prevention, and consider what to do if contraception fails. Emergency contraception should be widely discussed with adolescents, as it is appropriate for use during gaps in other contraceptive use, method failure, and adolescents who are not using another form of contraception. Dual method use (condom plus a highly effective method of contraception) is the gold standard for prevention of both pregnancy and sexually transmitted infections.

Influence of multiple antenatal counselling sessions on modern contraceptive uptake in Nigeria.

PubMed

Adanikin, Abiodun I; Onwudiegwu, Uche; Loto, Olabisi M

2013-10-01

To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception. A total of 216 eligible pregnant women were randomised into antenatal and postnatal counselling groups. The 'Antenatal group' received one-to-one antenatal contraceptive counselling on several occasions while the 'Postnatal group' received a single one-to-one contraceptive counselling session at the sixth week postnatal check, as is routinely practised. All participants were contacted six months postpartum by telephone or personal visit, and questioned about their contraceptive use, if any. More women who had multiple antenatal contraceptive counselling sessions used modern contraceptive methods than those who had a single postnatal counselling session (57% vs. 35%; p = 0.002). There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group (p = 0.014). Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception.

Reproductive and Contraceptive Knowledge, Contraceptive Self-Efficacy, and Contraceptive Behavior among Teenage Women.

ERIC Educational Resources Information Center

Levinson, Ruth Andrea

1995-01-01

Investigates the relationships among teenage women's Contraceptive Self-Efficacy (CSE), reproductive and contraceptive knowledge (RCK), and contraceptive behavior. No significant relationships existed between RCK and behavior. However, CSE explained variance in RCK, while other measures uncovered common areas of misinformation that influence…

Partner approval and intention to use contraception among Zanzibari women presenting for post-abortion care.

PubMed

Esber, Allahna; Foraker, Randi E; Hemed, Maryam; Norris, Alison

2014-07-01

We examined the effect of partner approval of contraception on intention to use contraception among women obtaining post-abortion care in Zanzibar. Our data source was a 2010 survey of 193 women obtaining post-abortion care at a large public hospital in Zanzibar. We used multivariable logistic regression analysis to assess associations between partner approval and intention to use contraception. Overall, 23% of participants had used a contraceptive method in the past, and 66% reported intending to use contraception in the future. We found that partner approval of contraception and ever having used contraception in the past were each associated with intending to use contraception in the future. In the multivariable model, adjusting for past contraception use, partner approval of contraception was associated with 20 times the odds of intending to use contraception (odds ratio, 20.25; 95% confidence interval, 8.45-48.56). We found a strong association between partner approval and intention to use contraception. Efforts to support contraceptive use must include both male and female partners. Public health and educational efforts to increase contraceptive use must include men and be targeted to both male and female partners. Given that male partners are often not present when women obtain health care, creative efforts will be required to meet men in community settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Does Contraceptive Use in the United States Meet Global Goals?

PubMed

Frederiksen, Brittni N; Ahrens, Katherine A; Moskosky, Susan; Gavin, Loretta

2017-12-01

The United Nations Sustainable Development Goals (SDGs) seek to achieve health equity, and they apply to all countries. SDG contraceptive use estimates for the United States are needed to contextualize U.S. performance in relation to that of other countries. Data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were used to calculate three SDG indicators of contraceptive use for U.S. women aged 15-44: contraceptive prevalence, unmet need for family planning and demand for family planning satisfied by modern methods. These measures were calculated separately for married or cohabiting women and for unmarried, sexually active women; differences by sociodemographic characteristics were assessed using t tests from logistic regression analysis. Estimates for married women were compared with 2010-2015 estimates from 94 other countries, most of which were low- or middle-income. For married or cohabiting women, U.S. estimates for contraceptive prevalence, unmet need and demand satisfied by modern methods were 74%, 9% and 80%, respectively; for unmarried, sexually active women, they were 85%, 11% and 82%, respectively. Estimates varied by sociodemographic characteristics, particularly among married or cohabiting women. Five countries performed better than the United States on contraceptive prevalence, 12 on unmet need and four on both measures; seven performed better on demand satisfied by modern methods. There is a need to continue efforts to expand access to contraceptive care in the United States, and to monitor the SDG indicators so that improvement can be tracked over time. Copyright © 2017 by the Guttmacher Institute.

Inequality in fertility rate and modern contraceptive use among Ghanaian women from 1988–2008

PubMed Central

2013-01-01

Background In most resource poor countries, particularly sub-Saharan Africa, modern contraceptive use and prevalence is unusually low and fertility is very high resulting in rapid population growth and high maternal mortality and morbidity. Current evidence shows slow progress in expanding the use of contraceptives by women of low socioeconomic status and insufficient financial commitment to family planning programs. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008. Methods We constructed a database using the Women’s Questionnaire from the Ghana Demographic and Health Survey (GDHS) 1988, 1993, 1998, 2003 and 2008. We applied regression-based Total Attributable Fraction (TAF); we also calculated the Relative and Slope Indices of Inequality (RII and SII) to complement the TAF in our investigation. Results Equality in use of modern contraceptives increased from 1988 to 2008. In contrast, inequality in fertility rate increased from 1988 to 2008. It was also found that rural–urban residence gap in the use of modern contraceptive methods had almost disappeared in 2008, while education and income related inequalities remained. Conclusions One obvious observation is that the discrepancy between equality in use of contraceptives and equality in fertility must be addressed in a future revision of policies related to family planning. Otherwise this could be a major obstacle for attaining further progress in achieving the Millennium Development Goal (MDG) 5. More research into the causes of the unfortunate discrepancy is urgently needed. There still exist significant education and income related inequalities in both parameters that need appropriate action. PMID:23718745

Inequality in fertility rate and modern contraceptive use among Ghanaian women from 1988-2008.

PubMed

Asamoah, Benedict O; Agardh, Anette; Ostergren, Per-Östergren

2013-05-29

In most resource poor countries, particularly sub-Saharan Africa, modern contraceptive use and prevalence is unusually low and fertility is very high resulting in rapid population growth and high maternal mortality and morbidity. Current evidence shows slow progress in expanding the use of contraceptives by women of low socioeconomic status and insufficient financial commitment to family planning programs. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008. We constructed a database using the Women's Questionnaire from the Ghana Demographic and Health Survey (GDHS) 1988, 1993, 1998, 2003 and 2008. We applied regression-based Total Attributable Fraction (TAF); we also calculated the Relative and Slope Indices of Inequality (RII and SII) to complement the TAF in our investigation. Equality in use of modern contraceptives increased from 1988 to 2008. In contrast, inequality in fertility rate increased from 1988 to 2008. It was also found that rural-urban residence gap in the use of modern contraceptive methods had almost disappeared in 2008, while education and income related inequalities remained. One obvious observation is that the discrepancy between equality in use of contraceptives and equality in fertility must be addressed in a future revision of policies related to family planning. Otherwise this could be a major obstacle for attaining further progress in achieving the Millennium Development Goal (MDG) 5. More research into the causes of the unfortunate discrepancy is urgently needed. There still exist significant education and income related inequalities in both parameters that need appropriate action.

Contraceptive social marketing in the Philippines. A new initiative.

PubMed

Migallos, G; Araneta, A

1994-01-01

By offering contraceptives at subsidized prices through pharmacies, drugstores, grocery shops, and other conveniently-located retail outlets, and promoting them with modern marketing techniques, social marketing programs can do much to reduce the unmet need for family planning. Users obviously benefit, while the family planning program benefits from advertising and marketing skills and some cost recovery. The Philippine Contraceptive Social Marketing Project (PCSMP) was formally launched in the Philippines in 1993 in response to the large unmet need in the country, and initial results are promising. The project was started with funding from the US Agency for International Development to provide affordable, quality contraceptives through the private sector to Filipino couples who choose to practice family planning. A 1988 survey found that only 22.4% of women aged 15-44 years were using modern methods of contraception and 13.8% were using traditional methods; approximately three million women therefore had unmet need for family planning. The PCSMP established an AIDS prevention component and a birth spacing component, enlisting the participation of oral contraceptive manufacturers Wyeth, Organon, and Schering, along with one condom distributor, Philusa. These companies lowered their product prices by 20% for the program. Despite objections from the Catholic church, sales of both oral pills and condoms increased in the first year. In its second year, the program will advertise Sensation condoms and the Couple's Choice Pills via television, through intensive distribution drives, consumer and trade promotions, and the continuous training of health professionals. The contraceptive injectable DMPA will be added to the Couple's Choice product line in April 1994. This method, too, will be heavily promoted.

Comparative Study of the Effects of Combined Oral Contraceptives in Hemostatic Variables

PubMed Central

Stocco, Bianca; Fumagalli, Helen F.; Franceschini, Silvio A.; Martinez, Edson Z.; Marzocchi-Machado, Cleni M.; de Sá, Marcos Felipe S.; Toloi, Maria Regina T.

2015-01-01

Abstract Thrombotic risk is associated with the estrogen dose and type of progestin in combined oral contraceptives. Studies published since 1990 showed that third-generation progestins have larger risk to contribute to thrombosis development than the second-generation. However, there are conflicts in the literature regarding the thrombotic risk associated to the drospirenone progestin. So, this study aimed to evaluate the effects of 3 formulations of contraceptives containing ethinylestradiol (EE) (20 and 30 μg) combined with drospirenone versus levonorgestrel combined with EE (30 μg) in hemostatic parameters. This cross-sectional study included 70 healthy women between 18 and 30 years, BMI 19 to 30 kg/m2, not pregnant, non-smokers, and users or non-users (control) of contraceptives for a minimum period of 6 months. The following parameters were assessed: prothrombin time (PT), Factor VII, activated partial thromboplastin time (aPTT), Factor XII, fibrinogen, Factor 1 + 2, Protein C, Protein S, antithrombin, D-dimers, and plasminogen activator inhibitor-1. Significant alterations were found in PT, aPTT, fibrinogen, D-dimers, and protein S, all favoring a state of hypercoagulation for contraceptive containing DRSP/20EE. Both contraceptives containing DRSP/30EE and LNG/30EE promoted changes that favor the hypercoagulability in the coagulant variable PT and in the anticoagulant variables Protein S and Protein C, respectively. We suggest that the progestin drospirenone can contribute to an inadequate balance among procoagulant, anticoagulant, and fibrinolytic factors, since that the contraceptive containing the lowest dose of estrogen and drospirenone (DRSP/20EE) caused a higher number of hemostatic changes. PMID:25634167

Nicotine and estrogen synergistically exacerbate cerebral ischemic injury.

PubMed

Raval, A P; Hirsch, N; Dave, K R; Yavagal, D R; Bramlett, H; Saul, I

2011-05-05

The greater incidence of myocardial infarction, cardiac arrest, and ischemic stroke among women who smoke and use oral contraception (OC) compared to women who do not smoke and who do or do not use OC may be due in part to how nicotine influences endocrine function in women. For example, we recently demonstrated that chronic exposure to nicotine, the addictive agent in tobacco smoke responsible for the elevated risk of cardiac arrest, abolishes the endogenous or exogenous 17β-estradiol-conferred protection of the hippocampus against global cerebral ischemia (a potential outcome of cardiac arrest) in naive or ovariectomized female rats. In the current study we examined the hypotheses that (1) a synergistic deleterious effect of nicotine plus oral contraceptives exacerbates post-ischemic hippocampal damage in female rats, and (2) nicotine directly inhibits estrogen-mediated intracellular signaling in the hippocampus. To test first hypothesis and to simulate smoking behavior-induced nicotine levels in the human body, we implanted osmotic pumps containing nicotine in the female rats for 16 days. Furthermore, we mimicked the use of oral contraceptives in females by administering oral contraceptives orally to the rat. Rats exposed to either nicotine alone or in combination with oral contraceptives were subjected to an episode of cerebral ischemia and the resultant brain damage was quantified. These results showed for the first time that nicotine with oral contraceptives did indeed exacerbate post-ischemic CA1 damage as compared to nicotine alone in naive female rats. In ex vivo hippocampal slice cultures, we found that nicotine alone or with 17β-estradiol directly hinders estrogen receptors-mediated phosphorylation of cyclic-AMP element binding protein, a process required for neuronal survival and also exacerbates ischemic damage. Thus, nicotine can affect the outcome of cerebral ischemia by influencing brain endocrine function directly rather than through indirect systemic effects. Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.

Hormonal contraception and HIV acquisition risk: implications for individual users and public policies.

PubMed

Jain, Anrudh K

2012-12-01

A recent observational study among HIV-1 serodiscordant couples (uninfected women living with an infected partner) raised concerns about the safety of injectable contraceptives, especially depot medroxyprogesterone acetate (DMPA). The purpose of this paper is to assess the implications of potentially elevated risk of Human Immunodeficiency Virus (HIV) acquisition with the use of hormonal contraceptives for individual users and public policies. Two indicators expressing costs (additional unwanted births and additional maternal deaths) in terms of the same unit of benefit (per 100 HIV infections averted) are estimated by using data on competing risks of unwanted birth and HIV acquisition associated with the use of various contraceptive methods. Elevated HIV acquisition risks associated with hormonal contraception observed in the observational studies of family planning users, sex workers and HIV-1 serodiscordant couples are used. Other relevant data for Kenya, South Africa and Zimbabwe are used to illustrate the potential effect of withdrawal of DMPA at the population level. Both the risks of unwanted birth and HIV acquisition with sterilization, intrauterine devices (IUDs) and implants at the individual level are lower than those with DMPA. A shift from DMPA to an oral contraceptive (OC) or male condom by an individual could result in about 600 and a shift to no method in about 5400 additional unwanted births per 100 HIV infections averted. At the population level, the withdrawal of DMPA from Kenya, for example, could result in 7600 annual additional unwanted births and 40 annual additional maternal deaths per 100 HIV infections averted. Individual DMPA users may be advised to shift to sterilization, IUD or implant depending upon their reproductive needs and circumstances, but not to no method, OC or even condom alone. At the macro level, the decision to withdraw DMPA from family planning programs in sub-Saharan Africa is not warranted. Copyright © 2012 Elsevier Inc. All rights reserved.

Effects of Contraceptive Education on Adolescent Male Contraceptive Behavior and Attitudes.

ERIC Educational Resources Information Center

Taylor, Mary E.; And Others

1989-01-01

The relationship between contraceptive education and teenage male contraceptive behavior was investigated. Findings indicated that brief or moderately in-depth contraceptive education had little effect on contraceptive behavior. The teenage pregnancy and other sex-related problems may make parents and schools more amenable to comprehensive…

An Intervention Delivered by App Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Protocol of a Randomized Controlled Trial.

PubMed

McCarthy, Ona L; Osorio Calderon, Veronica; Makleff, Shelly; Huaynoca, Silvia; Leurent, Baptiste; Edwards, Phil; Lopez Gallardo, Jhonny; Free, Caroline

2017-12-18

Unintended pregnancy is associated with numerous poorer health outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low- and middle-income countries continue to face obstacles in realizing their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15 to 19 years is estimated to be 38%, with the adolescent fertility rate at 70 per 1000 women. Mobile phones are an established and popular mode in which to deliver health behavior support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioral intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioral science and consists of short instant messages sent through an app over 4 months. The objective of this study is to evaluate the effect of the intervention on young women's use of and attitudes toward the most effective contraceptive methods. We will allocate 1310 women aged 16 to 24 years with an unmet need for contraception in a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the Tú decides app, which contains standard family planning information. Coprimary outcomes are use and acceptability of at least one effective contraceptive method, both measured at 4 months. Recruitment commenced on March 1, 2017 and was completed on July 29, 2017. We estimate that the follow-up period will end in January 2018. This trial will evaluate the effect of the intervention on young women's use of and attitudes toward the (nonpermanent) effective contraception methods available in Bolivia. ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526 (Archived by WebCite at http://www.webcitation.org/6vT0yIFfN). ©Ona L McCarthy, Veronica Osorio Calderon, Shelly Makleff, Silvia Huaynoca, Baptiste Leurent, Phil Edwards, Jhonny Lopez Gallardo, Caroline Free. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.12.2017.

What makes a contraceptive acceptable?

PubMed

Berer, M

1995-01-01

The women's health movement is developing an increasing number of negative campaigns against various contraceptive methods based on three assumptions: 1) user-controlled methods are better for women than provider-controlled methods, 2) long-acting methods are undesirable because of their susceptibility to abuse, and 3) systemic methods carry unacceptable health risks to women. While these objections have sparked helpful debate, criticizing an overreliance on such methods is one thing and calling for bans on the provision of injectables and implants and on the development of vaccine contraceptives is another. Examination of the terms "provider-controlled," "user-controlled," and "long-acting" reveals that their definitions are not as clear-cut as opponents would have us believe. Some women's health advocates find the methods that are long-acting and provider-controlled to be the most problematic. They also criticize the near 100% contraceptive effectiveness of the long-acting methods despite the fact that the goal of contraception is to prevent pregnancy. It is wrong to condemn these methods because of their link to population control policies of the 1960s, and it is important to understand that long-acting, effective methods are often beneficial to women who require contraception for 20-22 years of their lives. Arguments against systemic methods (including RU-486 for early abortion and contraceptive vaccines) rebound around issues of safety. Feminists have gone so far as to create an intolerable situation by publishing books that criticize these methods based on erroneous conclusions and faulty scientific analysis. While women's health advocates have always rightly called for bans on abuse of various methods, they have not extended this ban to the methods themselves. In settings where other methods are not available, bans can lead to harm or maternal deaths. Another perspective can be used to consider methods in terms of their relationship with the user (repeated application). While feminists have called for more barrier and natural methods, most people in the world today refuse to use condoms even though they are the best protection from infection. Instead science should pursue promising new methods as well as continue to improve existing methods and to fill important gaps. Feminists should be advocates for women and their diverse needs rather than advocates against specific contraceptive methods.

Aqueous exposure to the progestin, levonorgestrel, alters anal fin development and reproductive behavior in the eastern mosquitofish (Gambusia holbrooki)

USGS Publications Warehouse

Frankel, Tyler E.; Meyer, Michael T.; Orlando, Edward F.

2016-01-01

Endogenous progestogens are important regulators of vertebrate reproduction. Synthetic progestins are components of human contraceptive and hormone replacement pharmaceuticals. Both progestogens and progestins enter the environment through a number of sources, and have been shown to cause profound effects on reproductive health in various aquatic vertebrates. Progestins are designed to bind human progesterone receptors, but they also have been shown to strongly activate androgen receptors in fish. Levonorgestrel (LNG) activates fish androgen receptors and induces development of male secondary sex characteristics in females of other species. Although behavior has been postulated to be a sensitive early indicator of exposure to certain environmental contaminants, no such research on the reproductive behavior of gestagen-exposed fish has been conducted to date. The goal of our study was to examine the exposure effects of a human contraceptive progestin, LNG, on the reproductive development and behavior of the viviparous eastern mosquitofish (Gambusia holbrooki). Internal fertilization is a requisite characteristic of viviparous species, and is enabled by an androgen driven elongation of the anal fin into the male gonopodium (i.e., phallus). In this study, we exposed adult mosquitofish to ethanol (EtOH control), 10 ng/L, and 100 ng/L LNG for 8 d using a static replacement exposure design. After 8 d, a subset of males and females from each treatment were examined for differences in the 4:6 anal fin ratio. In addition, paired social interaction trials were performed using individual control males and control females or females treated 10 ng/L or 100 ng/L LNG. Female mosquitofish exposed to LNG were masculinized as evidenced by the elongation of the anal fin rays, a feature normal to males and abnormal to females. LNG caused significant increases in the 4:6 anal fin ratios of female mosquitofish in both the 10 ng/L and 100 ng/L treatments, although these differences were not significant between the two treatments. LNG caused significant increases in the 4:6 anal fin ratio of males exposed to 100 ng/L, with no effects observed in the 10 ng/L treatment. In addition, the reproductive behavior of control males paired with female mosquitofish exposed to 100 ng/L LNG was also altered, for these males spent more time exhibiting no reproductive behavior, had decreased attending behavior, and a lower number of gonopodial thrusts compared to control males paired to control female mosquitofish. Given the rapid effects on both anal fin morphology and behavior observed in this study, the mosquitofish is an excellent sentinel species for the detection of exposure to LNG and likely other 19-nortestosterone derived contraceptive progestins in the environment.

Family planning and protection of human rights.

PubMed

1991-12-01

The discussion of human rights in China is based on the White Paper issued by the Information Office under the State Council on November 1, 1991. China is the most populous country in the world at 1.14 billion in 1990. Annual increases of 17 million are expected even with family planning (FP). The area of cultivated land/capita has dropped to 1.3 mu (16.5% of an acre)/capita, or 25% of the world average. Fresh water resources have also dropped similarly. The amount of grain.person is 22% of that in the US. 25% of additional income to the national income is consumed by newborns annually. Savings have been cut and reinvestment in economic development has been slowed. There are pressures on all social and economic systems. There is acknowledged success in FP. The birth rate has dropped to 21.06.1000 in 1990, the rate of natural increase to 14.39%/1000, and the fertility rate to 2.31. These figures are lower than the averages for other developing countries. The FP policy is to promote deferred marriage and childbearing, fewer but healthier births, and 1 child/couple. Rural families who are having difficulties may after an interval of several years have a 2nd child. Minority nationalities are being encouraged to adopt FP voluntarily. Han requirements are different. The policy has been understood and supported by the masses and has contributed to the drop in 3rd and higher parity births to 19.32% in 1989 from 62.21% in 1970. The government role is one of guidance and persuasion within the law, and cannot be accomplished by administrative decrees alone. The government has given priority to enlightening the masses through publicity and education that birth control has a direct impact on the nation's prosperity and people's happy family life. The China FP Association has set up 600,000 grass roots branches with 32 million members to assist in aiding the masses in self-education, self-management, and self-service. Ideological education has been combined with helping the masses solve practical problems. FP identifies contraception as protection of maternal and child health. 75% of couples of childbearing age practice contraception. Coercive abortions are resolutely opposed. Induced abortion in cases of contraceptive failure are voluntary and safe. The abortion ratio is comparable to world rates, but lower rates are targeted. Policy objectives are to control population growth and improve the quality of human resources. Maternal and child health care is provided. Law forbids infanticide. Policy conforms to item 9 of the UN Mexico City Declaration on Population and Development, 1984, and the UN World Population Plan of Action.

Young women's accounts of factors influencing their use and non-use of emergency contraception: in-depth interview study

PubMed Central

Free, Caroline; Lee, Raymond M; Ogden, Jane

2002-01-01

Objectives To explore young women's accounts of their use and non-use of emergency contraception. Design Qualitative study using in-depth interviews. Participants 30 women aged 16-25; participants from socially deprived inner city areas were specifically included. Setting Community, service, and educational settings in England. Results Young women's accounts of their non-use of emergency contraception principally concerned evaluations of the risk conferred by different contraceptive behaviours, their evaluations of themselves in needing emergency contraception, and personal difficulties in asking for emergency contraception. Conclusions The attitudes and concerns of young women, especially those from disadvantaged backgrounds, may make them less able or willing than others to take advantage of recent increases in access to emergency contraception. Interventions that aim to increase the use of emergency contraception need to address the factors that influence young women's non-use of emergency contraception. What is already known on this topicLimited knowledge of, or poor access to, emergency contraception, and concerns about side effects and moral issues may reduce the use of emergency contraception in women at riskYoung people can be embarrassed about using contraception servicesInterventions to increase knowledge of and access to emergency contraception have had limited success among teenagersWhat this study addsPerceptions of low vulnerability to pregnancy, negative self evaluations about the need for such contraception, and concerns about what others think deter young women from using emergency contraceptionThese women find it difficult to ask for emergency contraceptionThe attitudes and concerns of young women, especially those from deprived inner city areas, may render them least willing and able to obtain emergency contraception PMID:12480855

IPPF firm reconciles money with mission.

PubMed

1991-01-01

Despite its seemingly conflicting goals, the Family Health Management Service (FHMS) has become an important middleman agency for contraceptives. A for-profit subsidiary of the International Planned Parenthood Federation (IPPF), FHMS has established itself by helping fill the funding gap left by large international donor agencies. FHMS acts as consulting and procurement firm of contraceptives for smaller family planning programs around the world. These organizations, whether government or private, are generally too small to qualify extensive assistance from major donor groups. Although FHMS is a for-profit organization, its leadership stresses that its main goal is to make family planning knowledge and skills available to everyone. FHMS makes a determination whether the organization seeking contraceptives is a charitable or commercial enterprise. If the organization is charitable, FHMS charges only a handling fee. If the organization is commercial, FHMS adds a percentage to make the cost of the contraceptive reflect the market value. Since it begun operating in 1988, FHMS has assisted hundreds of customers. When Action Aid needed 6000 contraceptive products (a figure too small to attract funding from large donor organizations but too large to buy in the open market) for its rural development program in sierra Leone, FHMS procured them at an affordable cost. Last year, the organization spent about $1 million in procuring, shipping, and managing contraceptive sales, and netted a profit of about $45,000. All profits are channeled back to IPPF's altruistic programs.

Evaluation of effects of an oral contraceptive containing ethinylestradiol combined with drospirenone on adrenal steroidogenesis in hyperandrogenic women with polycystic ovary syndrome.

PubMed

De Leo, Vincenzo; Morgante, Giuseppe; Piomboni, Paola; Musacchio, Maria Concetta; Petraglia, Felice; Cianci, Antonio

2007-07-01

To investigate whether the administration of an oral contraceptive containing the new antiandrogenic drospirenone is associated with reduced adrenal androgen synthesis in hyperandrogenic women with diagnosis of polycystic ovary syndrome. Drospirenone, an analogue of spironolactone and aldosterone antagonist, is a novel progestin under clinical development that is similar to the natural hormone progesterone, combining potent progestogenic with antimineralocorticoid and antiandrogenic activities. Prospective study. Healthy volunteers in University Department of Obstetrics and Gynecology. Fifteen women ages 18 to 28 years with the diagnosis of polycystic ovary syndrome. Three months of contraceptive use (30 mcg ethinylestradiol, 3 mg drospirenone). An adrenocorticotropic hormone test was performed before and after the study. Adrenal production of cortisol was unchanged after therapy with oral contraceptives. An interesting observation was reduced basal concentrations of androgens such as androstenedione, dehydroepiandrosterone sulfate, testosterone, and free testosterone during therapy. The ratios of the areas of substrates to products before and after oral contraceptive administration were compared for differences in 17alpha-hydroxylase (17-hydroxyprogesterone/progesterone) and 17,20-lyase (androstenedione/17-hydroxyprogesterone); activities were significantly reduced, indicating a reduction in the activities of these enzymes. The present results show for the first time that oral contraceptives containing drospirenone affect adrenal steroidogenesis by reducing synthesis and release of androgens in response to adrenocorticotropic hormone, leaving adrenal production of cortisol unchanged.

Bangladesh's SMP earns top marks.

PubMed

1984-01-01

A recent evaluation funded by the US Agency for International Development (AID) confirms that Bangladesh's contraceptive social marketing program has exceeded its planner's goals and demonstrated the ability of such a system to widely distribute contraceptive products at a low cost. The project, which began contraceptive sales in 1975, distributes condoms, oral contraceptives, and foaming vaginal tablets. Almost 25% of contraceptive users in Bangladesh are serviced by the social marketing program. By the end of 1983, the program was providing 1,022,000 couple years of protection; this included 84 million condoms, 1.7 million pill cycles, and 5.1 million spermicidal tablets each year. The program's cost for 1 couple year of protection is US$1.66. Social marketing sales have accounted for all increases in couple years of protection experienced by the country's national population program since 1975. Sales have been boosted by recent efforts to draw rural medical practitioners into family planning activities. Mobile film units have further increased sales. The USAID report identifies 3 elements that have spearheaded the social marketing program's achievements: 1) the existence of a committed core management team, 2) the granting of autonomy to make daily decisions to this management team, and 3) central control fo the product distribution system by management rather than by subcontractors. Overall, the social marketing program is credited with legitimizing discussion of contraception in a country formerly considered too conservative to tolerate open product promotion.

Create positive contraceptive images for strongest impact in single lesson.

PubMed

1987-05-01

Health educators attempting to deliver contraceptive information to adolescents in the classroom must seek ways to make a major impact in a very short period of time. A Planned Parenthood professional from New Jersey has developed a single-shot birth control lesson that, rather than presenting the pros and cons of various contraceptive methods, has teenagers identify themselves as at high, low, or no risk of pregnancy. Students estimate the number of classmates who are in each category and then assess whether they personally are at risk of an unintended pregnancy. In general, teens overestimate the number of classmates who are sexually active. This approach seems to make the ensuing discussion of contraceptive methods more meaningful. This discussion presents the condom and foam, the sponge, and visiting a family planning clinic. After this 40 minute presentation, fewer adolescents report being afraid of contraceptive side effects; they also have more knowledge about the efficacy and availability of different methods. A lesson in preparation is centered around a videotape entitled "Swept Away is Not Okay." It shows a teen couple going to a family planning clinic before they ever have intercourse. This strategy of encouraging adolescents to seek contraception before sexual involvement begins is considered more realistic than pressuring teens to abstain from sex. School officials and teachers have been receptive to this educational approach, viewing it as presenting important public health information.

Beyond the Effects of Comprehensive Sexuality Education: The Significant Prospective Effects of Youth Assets on Contraceptive Behaviors.

PubMed

Green, Jennifer; Oman, Roy F; Vesely, Sara K; Cheney, Marshall; Carroll, Leslie

2017-12-01

The purpose of the study was to prospectively determine if youth assets were significantly associated with contraception use after accounting for the effects of youths' exposure to comprehensive sexuality education programming. Prospective associations between youth asset scores, comprehensive sexuality education topics received, type of contraceptive used, and consistent contraceptive use were analyzed using multinomial and binomial logistic regression in a sample of 757 sexually active youth. Higher youth asset scores were associated with condom use (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.01-2.28), hormonal birth control use (AOR = 2.71, 95% CI = 1.69-4.35), dual method use (AOR = 2.35, 95% CI = 1.44-3.82), and consistent contraceptive use (AOR = 1.97, 95% CI = 1.38-2.82). After controlling for youths' experience with comprehensive sexuality education, higher youth asset scores remained a significant predictor of hormonal birth control use (AOR = 2.09, 95% CI = 1.28-3.42), dual method use (AOR = 2.58, 95% CI = 1.61-4.15), and consistent contraceptive use (AOR = 1.95, 95% CI = 1.36-2.80). Youth serving organizations that are interested in preventing teen pregnancy should consider widespread implementation of evidence-based youth development programs that focus on building and strengthening specific youth assets. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Testicular cell junction: a novel target for male contraception.

PubMed

Lee, Nikki P Y; Wong, Elissa W P; Mruk, Dolores D; Cheng, C Yan

2009-01-01

Even though various contraceptive methods are widely available, the number of unwanted pregnancies is still on the rise in developing countries, pressurizing the already resource limited nations. One of the major underlying reasons is the lack of effective, low cost, and safe contraceptives for couples. During the past decade, some studies were performed using animal models to decipher if the Sertoli-germ cell junction in the testis is a target for male fertility regulation. Some of these study models were based on the use of hormones and/or chemicals to disrupt the hypothalamic-pituitary-testicular axis (e.g., androgen-based implants or pills) and others utilized a panel of chemical entities or synthetic peptides to perturb spermatogenesis either reversibly or non-reversibly. Among them, adjudin, a potential male contraceptive, is one of the compounds exerting its action on the unique adherens junctions, known as ectoplasmic specializations, in the testis. Since the testis is equipped with inter-connected cell junctions, an initial targeting of one junction type may affect the others and these accumulative effects could lead to spermatogenic arrest. This review attempts to cover an innovative theme on how male infertility can be achieved by inducing junction instability and defects in the testis, opening a new window of research for male contraceptive development. While it will still take much time and effort of intensive investigation before a product can reach the consumable market, these findings have provided hope for better family planning involving men.

Family Planning Programs: The Clients' Perspective. World Bank Staff Working Papers No. 676 and Population and Development Series No. 1.

ERIC Educational Resources Information Center

Ainsworth, Martha

Lowering fertility will require both a reduction in desired family size and provision of family planning services that respond to clients' needs. The World Fertility Survey and the Contraceptive Prevalence Survey found sizable groups of women with an "unmet need" for contraception. Investigators have also found evidence of unanswered…

Ethinyl estradiol and levonorgestrel in a transdermal contraceptive delivery system.

PubMed

Sriprasert, Intira; Stanczyk, Frank Z; Archer, David F

2015-01-01

The new transdermal contraceptive delivery system (TCDS) developed by Agile Therapeutics containing ethinyl estradiol and levonorgestrel (EE/LNG) is a reversible contraceptive method that maintains stable serum levels of both estrogen and progestin, and has efficacy similar to that of combination oral contraceptives (COC). We provided information of this new TCDS compared with the only TCDS available on the market that contains EE and norelgestromin, and has a higher EE exposure than a COC with 35 µg of EE potentially increasing the risk of venous thromboembolism. The article will summarize finding from clinical studies Phase I, II and III of EE/LNG TCDS. The development of the lower dose EE/LNG TCDS has demonstrated less EE exposure. The serum levels of EE and LNG were stable and comparable between various application sites and daily life conditions. Moreover, the EE/LNG TCDS showed comparable efficacy among obese and non-obese users. However, the Pearl index of this EE/LNG TCDS is questionable and the problem of compliance is a potential confounder of the results. The current Phase III efficacy study will contribute to a further evaluation of compliance and efficacy and will be completed in 2016.

Effect of low zinc intake and oral contraceptive agents on nitrogen utilization and clinical findings in young women.

PubMed

Hess, F M; King, J C; Margen, S

1977-12-01

In a previous paper we reported that serum, urine and fecal zinc levels fell markedly in women taking a combination oral contraceptive agent (+OCA) and in women with normal menstrual cycles (-OCA) when they consumed a low-zinc diet (less than 0.2 mg/day) for 35 days. We evaluated other biochemical and clinical data in order to determine if depletion of accessible body zinc and/or physiologic adjustment to conserve body zinc stores had occurred. Neither low zinc intake nor oral contraceptive use appeared to influence nitrogen balance or body weight. Use of contraceptive drugs appeared to influence the response of blood parameters to zinc depletion. Serum transferrin and cholesterol declined significantly in the -OCA group, whereas alkaline phosphatase and gamma-globulin changed significantly in both groups. Clinical problems developed in all the subjects with serum zinc levels below 50 microgram/dl during the study; three of the six with serum zinc levels above 50 microgram/dl also complained of clinical symptoms. The results suggest that zinc deficiency through depletion of accessible body zinc stores developed during the 35-day study.

Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey

PubMed Central

Kopp Kallner, Helena; Thunell, Louise; Brynhildsen, Jan; Lindeberg, Mia; Gemzell Danielsson, Kristina

2015-01-01

Objective To describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies. Design Telephone survey. Setting National survey of women living in Sweden. Population Women between 16 and 49 years. Methods The survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy. Main Outcome Measures Distribution of use of contraceptive methods and non-use of contraception among Swedish women. Prevalence and outcome of unintended pregnancies. Results A total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness. Conclusions Sweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies. PMID:25992901

A mixed-methods exploration of the contraceptive experiences of female teens with epilepsy.

PubMed

Manski, Ruth; Dennis, Amanda

2014-09-01

We explored the contraceptive experiences of female teens with epilepsy, including their knowledge and perceptions of interactions between antiepileptic drugs and hormonal contraception and contraceptive decision-making processes. From November 2012 to May 2013, we conducted one online survey (n=114) and 12 online focus group discussions (n=26) with female teens with epilepsy about their contraceptive experiences and unmet needs. Survey data were analyzed using descriptive statistics and focus group transcripts were analyzed thematically using modified grounded theory methods. Both survey and focus group participants reported believing that interactions between epilepsy medications and hormonal contraceptives could lead to reductions in contraceptive efficacy and seizure control. However, their knowledge about these types of medication interactions was often incomplete. Many study participants viewed contraceptive decision making as a difficult process, and some participants reported avoiding hormonal contraceptives because of potential interactions with antiepileptic drugs. Study participants reported relying on health care providers and parents for contraceptive decision-making support. Focus group participants also reported they wanted health care providers to provide more in-depth and comprehensive counseling about contraception, and that they desired peer support with contraceptive decisions. The ability to make informed contraceptive decisions is important for teens with epilepsy as interactions between anti-epileptic drugs and hormonal contraceptives can impact seizure occurrence and lead to an increased risk of unplanned pregnancy. Guidance for providers offering contraceptive care to this population is needed, as well as a contraceptive support tool that empowers teens with epilepsy to advocate for desired health care. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Practice Bulletin Summary No. 152: Emergency Contraception.

PubMed

2015-09-01

Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception (1-3). Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen-progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises (4-6). The purpose of this Practice Bulletin is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase awareness of these methods among obstetrician-gynecologists and other gynecologic providers.

ACOG Committee Opinion Number 542: Access to emergency contraception.

PubMed

2012-11-01

Emergency contraception includes contraceptive methods used to prevent pregnancy in the first few days after unprotected intercourse, sexual assault, or contraceptive failure. Although the U.S. Food and Drug Administration approved the first dedicated product for emergency contraception in 1998, numerous barriers to access to emergency contraception remain. The purpose of this Committee Opinion is to examine the barriers to the use of oral emergency contraception methods and to highlight the importance of increasing access.

Investigational hormone receptor agonists as ongoing female contraception: a focus on selective progesterone receptor modulators in early clinical development.

PubMed

Nelson, Anita L

2015-01-01

As efforts are made to continue to increase the safety of contraceptive methods, those without estrogen have attracted new attention. Progestin-only options are available in many delivery systems, but most cause disturbed bleeding patterns. For gynecologic patients, selective progesterone receptor modulators (SPRMs) have been approved for medical abortion, for ovulation suppression in emergency contraception, and for the treatment of heavy menstrual bleeding due to leiomyoma. This article discusses the role of SPRMs in controlling fertility on an ongoing basis with particular emphasis on mifepristone and ulipristal acetate (UPA), since none of the other compounds has progressed out of early Phase I - II testing. It also discusses important information about the mechanisms of action and safety of these two SPRMs. Of all the investigational hormone agonist/antagonists, SPRMs have demonstrated the greatest potential as ongoing female contraceptives. They have the ability to suppress ovulation after initiation of the luteinizing hormone (LH) surge without affecting ovarian production of estrogen or inducing any significant metabolic changes. SPRMs may well be able to provide longer term contraception as oral agents, vaginal rings, and perhaps even intrauterine devices. UPA has the greatest promise. Current research needs to be expanded.